Active cooling of pulse compression diffraction gratings for high energy, high average power ultrafast lasers

DOE PAGES

Alessi, David A.; Rosso, Paul A.; Nguyen, Hoang T.; ...

2016-12-26

Laser energy absorption and subsequent heat removal from diffraction gratings in chirped pulse compressors poses a significant challenge in high repetition rate, high peak power laser development. In order to understand the average power limitations, we have modeled the time-resolved thermo-mechanical properties of current and advanced diffraction gratings. We have also developed and demonstrated a technique of actively cooling Petawatt scale, gold compressor gratings to operate at 600W of average power - a 15x increase over the highest average power petawatt laser currently in operation. As a result, combining this technique with low absorption multilayer dielectric gratings developed in ourmore » group would enable pulse compressors for petawatt peak power lasers operating at average powers well above 40kW.« less

[Locked plating with minimally invasive percutaneous plate osteosynthesis versus intramedullary nailing of distal extra-articular tibial fracture: a retrospective study].

PubMed

Yao, Qi; Ni, Jie; Peng, Li-bin; Yu, Da-xin; Yuan, Xiao-ming

2013-12-17

To compare the efficacies of minimally invasive plate osteosynthesis (MIPPO) and interlocking intramedullary nailing (IMN) in the treatment of extra-articular fractures of distal tibia. Retrospective reviews were conducted for 126 patients with extra-articular distal tibia fractures. Treatment was either MIPPO (n = 61) or IMN (n = 65). The outcomes were assessed by comparing operating duration, time to union, the last follow-up American Orthopedic Foot and Ankle Society (AOFAS) score and complication rate. The average follow-up period was 23.7 (12-53) months. In the minimally invasive plate osteosynthesis group, there were deep infections (n = 2), superficial infections (n = 5), delayed union (n = 2), malunion (n = 2) and knee joint pain (n = 10) were observed. In addition, the average operating duration (85.9 ± 18.9 min), average time to union (17.3 ± 3.8 weeks) and average AOFAS (83.2 ± 11.9) were analyzed. In the interlocking intramedullary nailing group, there were delayed union (n = 3), malunion (n = 12) and knee joint pain (n = 22). And the average operating duration (83.3 ± 15.7 min), average time to union (16.5 ± 3.1 weeks) and average AOFAS (84.9 ± 12.0) were analyzed. No statistical significance existed in operating duration, time to union and the last follow-up AOFAS between two groups (P > 0.05). However, the rates of malformation and knee joint pain were higher in the intramedullary nail group than those in the plate group. And the difference was statistically significant (P = 0.015, P = 0.025). Both MIPPO and IMN are effective for extra-articular fractures of distal tibia. However, the former has the advantage of lowers rate of malformation and knee joint pain. Therefore a surgeon should consider the degree of injury while managing extra-articular fracture of distal tibia.

The effect of early operative stabilization on late displacement of zone I and II sacral fractures.

PubMed

Emohare, Osa; Slinkard, Nathaniel; Lafferty, Paul; Vang, Sandy; Morgan, Robert

2013-02-01

This study was designed to evaluate the effect on displacement of early operative stabilization on unstable fractures when compared to stable fractures of the sacrum. Patient consisted of those sustaining traumatic pelvic fractures that also included sacral fractures of Denis type I and type II classification, who were over 18 at the time of the study. Patients were managed emergently, as judged appropriate at the time and then subsequently divided into two cohorts, comprising those who were either treated operatively or non-operatively. The operative group comprised those treated with either internal fixation or external fixation. Twenty-eight patients had zone II fractures, and 20 had zone I fractures. Zone II fractures showed average displacements of 6.5mm and 6.9mm in the rostral-caudal and anteroposterior directions, respectively, at final follow up. Zone I fractures had average displacements of 6.6mm and 6.1mm in both directions. There were no significant differences between zone I and II sacral fractures (rostral-caudal P=0.74, anteroposterior P=0.24). Average changes in fracture displacement in patients with zone I fractures were 0.6-1.0mm in both directions. Average changes in zone II fractures were 1.8-1.5mm in both directions. There were no significant differences between the average changes in zone I and II fractures in any direction (rostral-caudal P=0.64, anteroposterior P=0.68) or in average displacements at final follow up in any of zone or the entire cohort. Statistically significant differences were noted in average changes in displacement in zone II fractures in the anteroposterior plane (P=0.03) and the overall cohort in the anteroposterior plane (P=0.02). Operative fixation for unstable sacral fractures ensures displacement at follow up is comparable with stable fractures treated non operatively. Copyright © 2012 Elsevier Ltd. All rights reserved.

[Comparison of double titanium plate and clavicular hook plate for the treatment of Neer II distal clavicular fracture].

PubMed

Xu, Qian; Wang, Qiang-Mao; He, Jian-Fei; Sun, Wei-Guo; Chen, Xian-Wei

2016-12-25

To compare clinical efficacy of double titanium plate and clavicular hook plate for the treatment of Neer II distal clavicular fracture. From April 2013 to June 2015, 42 patients with Neer II distal clavicle fractures were non-randomly selected, including 25 males and 17 females. All patients were fresh closed fractures. Twenty patients were treated with double titanium plate with tight rope(group A), including 11 males and 9 females aged from 16 to 49 years old with an average age of(33.8±10.7) years;the time from injury to operation ranged from 2 to 5 days with an average of (3.5±1.8) days. Twenty-two patients were treated with clavicle hook plate(group B), including 14 males and 8 females aged from 27 to 53 years old with an average age of (37.7±9.9) years;the time from injury to operation ranged from 2 to 5 days with an average of (3.1±2.0) days. Operative time, blood loss, hospital stays and postoperative complications were observed and compared; fracture healing were compared among preoperative, postoperative at 1, 3 and 6 months; VAS and ASES scoring were used to evaluate shoulder function. All patients were followed up from 6 to 12 months with an average of 7.2 months. All incisions were healed at stage I. Blood loss in group A were less than that of group B( P <0.05); while there were no significant difference in hospital stays and operative time between two groups. No shoulder pain occurred in group A, 4 cases occurred shoulder pain in group B, and had significant difference. Fracture healing time ranged from 3 to 6 months with an average of 4.3 months. VAS score and ASES score in group A were higher than that of group B in pain, function and total score. Compared with clavicle hook plate, double titanium plate has advantages of shorter incision wound, less bleeding and simply operation, less complications, and could avoid pain for removing internal fixation. Over reduction of acromioclavicular joint during operation does not affect its superior curative effect. It is better choice for the treatment of Neer II distal clavicle fracture.

Constrained Optimization of Average Arrival Time via a Probabilistic Approach to Transport Reliability

PubMed Central

Namazi-Rad, Mohammad-Reza; Dunbar, Michelle; Ghaderi, Hadi; Mokhtarian, Payam

2015-01-01

To achieve greater transit-time reduction and improvement in reliability of transport services, there is an increasing need to assist transport planners in understanding the value of punctuality; i.e. the potential improvements, not only to service quality and the consumer but also to the actual profitability of the service. In order for this to be achieved, it is important to understand the network-specific aspects that affect both the ability to decrease transit-time, and the associated cost-benefit of doing so. In this paper, we outline a framework for evaluating the effectiveness of proposed changes to average transit-time, so as to determine the optimal choice of average arrival time subject to desired punctuality levels whilst simultaneously minimizing operational costs. We model the service transit-time variability using a truncated probability density function, and simultaneously compare the trade-off between potential gains and increased service costs, for several commonly employed cost-benefit functions of general form. We formulate this problem as a constrained optimization problem to determine the optimal choice of average transit time, so as to increase the level of service punctuality, whilst simultaneously ensuring a minimum level of cost-benefit to the service operator. PMID:25992902

[Curative effect analysis on closed reduction and external fixator under local anesthesia for the treatment of intertrochanteric fracture in elderly patients with high-risk].

PubMed

Wang, Zeng-ping; Liu, Lin; Xue, Wen; Zhou, Hui-ru; Song, Yu-xin; Cai, Li-yang; Cheng, Xian-tang; Qian, Yao-wen

2016-06-01

To explore clinical efficacy of closed reduction and external fixation under local anesthesia for the treatment of high-risk elderly patients with intertrochanteric fracture. From March 2013 to March 2015, 10 patients with intertrochanteric fractures treated with closing reduction and external fixator under local anesthesia were analyszed, including 4 males and 6 females, aged from 69 to 88 years old with an average of 75.2 years old. All fractures were caused by injury and classified to type I (5 cases), II (3 cases), and V (2 cases) according to Evans classification. According to American Society of Anesthesiologists (ASA), 6 cases were type III and 4 cases were type IV. Blood loss,operative time,hospital stays, postoperative complications, ambulation time and fracture healing time were observed, and Harris scoring were used to evaluate hip joint function. All patients were followed up from 3 to 23 months with an average of 13.1 months. One patient with chronic obstructive pulmonary disease died for non-operation reason at 4 months after operation, the other fractures were healed at stage I, the mean fracture healing time was 5.6 months. There were no coxa vara, lower limb venous thrombosis, loosen and remove of needle passage. The average operative time was 46 min, blood loss was (35.00 ± 8.46) ml without blood transfusion. One patient was occurred pulmonary infection and stent-tract infection on the 2 nd and 3 rd day after operation, and improved with active anti-infection and dressing change; the other patients gone to ground activity at 4.2 d after operation. The patients stayed hospital for 10.6 d on average. According to Harris scoring at final following-up, the total score was 83.42 ± 3.27, 3 cases obtained excellent results, 5 cases good and 1 case poor. Closed reduction and external fixation under local anesthesia in treating high-risk elderly patients with intertrochanteric fracture,which has advantages of shorter operative time, less blood loss, good recovery of postoperative function, is a safe, stable and economic method.

Operative Outcomes of Grade 3 Turf Toe Injuries in Competitive Football Players.

PubMed

Smith, Kenneth; Waldrop, Norman

2018-06-01

Turf toe is a term used to describe a hyperextension injury to the first metatarsophalangeal joint. Although the vast majority of turf toe injuries can be treated successfully without operative intervention, there are instances where surgery is required to allow the athlete to return to play. Although there is a plethora of literature on turf toe injuries and nonoperative management, there are currently few reports on operative outcomes in athletes. We obtained all cases of turf toe repair according to the ICD-10 procedural code. The inclusion criteria included: age greater than 16, turf toe injury requiring operative management and at least a varsity level high school football player. The charts were reviewed for age, BMI, level of competition, injury mechanism, football position, setting of injury and playing surface. In addition, we recorded the specifics of the operative procedure, a listing of all injured structures, the implants used and the great toe range of motion at final follow-up visit. The AOFAS Hallux score and VAS was used postoperatively as our outcome measures. Our patient population included 15 patients. The average follow-up time was 27.5 months. The average patient was 19.3 years old with a body mass index of 32.3. The average playing time missed was 16.5 weeks. The average dorsiflexion range of motion at the final follow-up was 42.3 degrees. At final follow-up, the average AOFAS Hallux score was 91.3. The average VAS pain score was 0.7 at rest and 0.8 with physical activity. Complete turf toe injuries are often debilitating and may require operative management to restore a pain-free, stable, and functional forefoot. This study represents the largest cohort of operatively treated grade 3 turf toe injuries in the literature and demonstrates that good clinical outcomes were achieved with operative repair. Level IV, case series.

Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis.

PubMed

Park, Yoonah; Yong, Yuen Geng; Yun, Seong Hyeon; Jung, Kyung Uk; Huh, Jung Wook; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

2015-05-01

This study aimed to compare the learning curves and early postoperative outcomes for conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC). This retrospective study included the initial 35 cases in each group. Learning curves were evaluated by the moving average of operative time, mean operative time of every five consecutive cases, and cumulative sum (CUSUM) analysis. The learning phase was considered overcome when the moving average of operative times reached a plateau, and when the mean operative time of every five consecutive cases reached a low point and subsequently did not vary by more than 30 minutes. Six patients with missing data in the CL RHC group were excluded from the analyses. According to the mean operative time of every five consecutive cases, learning phase of SIL and CL RHC was completed between 26 and 30 cases, and 16 and 20 cases, respectively. Moving average analysis revealed that approximately 31 (SIL) and 25 (CL) cases were needed to complete the learning phase, respectively. CUSUM analysis demonstrated that 10 (SIL) and two (CL) cases were required to reach a steady state of complication-free performance, respectively. Postoperative complications rate was higher in SIL than in CL group, but the difference was not statistically significant (17.1% vs. 3.4%). The learning phase of SIL RHC is longer than that of CL RHC. Early oncological outcomes of both techniques were comparable. However, SIL RHC had a statistically insignificant higher complication rate than CL RHC during the learning phase.

[Case-control study on measurement of coracoclavicular and acromioclavicular ligament injuries during internal fixation operation for the treatment of fresh acromioclavicular joint dislocation of Tossy type III].

PubMed

Guan, Ting-Jin; Sun, Peng; Zheng, Liang-Guo; Qi, Xiang-Yang

2014-01-01

To study measurement methods of acromioclavicular and coracoclavicular ligament injuries,its therapeutic effects and complications during internal fixation operation for the treatment of fresh acromioclavicular joint dislocations of Tossy type III. From July 2003 to May 2012,127 patients with acromioclavicular joint dislocations of Tossy type III were treated with wire fixation from coracoid process to clavicle or hook-plate fixation. The patients were divided into group A (63 cases) and group B (64 cases) according to whether acromioclavicular ligament and coracoclavicular ligament were repaired or not. In group A (ligaments repaired), there were 39 males and 24 females with an average age of (33.25 +/- 8.46) years old (ranged from 17 to 59 years). And in group B (no ligaments repaired), there were 41 males and 23 females with an average age of (34.10 +/- 7.19) years (ranged from 19 to 57 years). The operation times, intraoperative blood loss, postoperative infections, internal fixation failure, recurrence and other complications, together with therapeutic effects were compared between two groups. The outcome was analyzed according to Karlsson standard. In group A, 54 patients got an excellent result and 9 good according to Karlsson standard;the average operative time was (55.90 +/- 26.56) min; the average intraoperative bleeding amount was (99.80 +/- 50.30) ml; 1 patient had wire broken without re-dislocation at 16 weeks after operation, 3 patients got wound fat liquefaction and recovered after treatment, 1 patient had pain after shoulder joint motion and pain disappeared after implants were taken out. In group B, 52 patients got an excellent result and 12 good according to Karlsson standard; the average operative time was (49.50 +/- 23.14) min; the average intraoperative bleeding amount was (87.30 +/- 46.41) ml; 2 patients got wound fat liquefaction, and 2 patients had pain after shoulder joint motion. All the patients were followed up, and the duration ranged from 9 to 16 months. All internal steel-wire or hook plate were taken out during 4 to 9 months without acromioclavicular joint re dislocation. There were no significant difference in the average operative time, the average intraoperative blood less, complication recurrence rates of fixation failure, wound fat liquefaction, postoperative infection, acromioclavicular joint re-dislocation, and therapeutic effects between two groups. Both wire and clavicular hook plate fixation, performed for fresh acromioclavicular joint dislocation with Tossy type III, are simple, effective, less invasive method with less blood loss. In addition, the treatment without ligaments repaired could not increase incidence of complications.

Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: A single-center 7-year experience

PubMed Central

Chen, Ke; Pan, Yu; Cai, Jia-Qin; Xu, Xiao-Wu; Wu, Di; Yan, Jia-Fei; Chen, Rong-Gao; He, Yang; Mou, Yi-Ping

2016-01-01

AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy (LTG) for gastric cancer. METHODS: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records. RESULTS: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 mL. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%. However, there were no cases of postoperative death. CONCLUSION: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness. PMID:27022225

Intracorporeal esophagojejunostomy after totally laparoscopic total gastrectomy: A single-center 7-year experience.

PubMed

Chen, Ke; Pan, Yu; Cai, Jia-Qin; Xu, Xiao-Wu; Wu, Di; Yan, Jia-Fei; Chen, Rong-Gao; He, Yang; Mou, Yi-Ping

2016-03-28

To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy (LTG) for gastric cancer. A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records. The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 mL. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%. However, there were no cases of postoperative death. LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.

Results of a randomized trial of HERMES-assisted versus non-HERMES-assisted laparoscopic antireflux surgery.

PubMed

Luketich, J D; Fernando, H C; Buenaventura, P O; Christie, N A; Grondin, S C; Schauer, P R

2002-09-01

Speech recognition technology is a recent development in minimally invasive surgery. This study was designed to assess the impact of HERMES on operating room efficiency and user satisfaction. Patients undergoing laparoscopic antireflux operations by surgeons experienced in minimally invasive surgery were randomized to HERMES-assisted or standard laparoscopic operations. The variables of interest were circulating nurse's time spent adjusting devices that are voice-controlled by HERMES, number of adjustments to devices requested, and surgeon and nurse satisfaction measured on a scale from 1 (dissatisfied) to 10 (satisfied). A total of 30 cases were studied. In the non-HERMES cases, nurses were interrupted to make device adjustments an average of 15.3 times per case versus 0.33 times per case in the with-HERMES cases (p < 0.01). The interruptions during the non-HERMES cases averaged 4.35 min per case versus 0.16 min per case in the with-HERMES cases (p = 0.03). Average satisfaction scores for HERMES operations as opposed to non-HERMES operations were 9.2 versus 5.3 for nurses (p < 0.01) and 9.0 versus 5.1 for surgeons (p < 0.01). Physician and nurse acceptance of HERMES was very high because of the smoother interruption-free environment.

Comparison of Clinical Efficacy of Lateral and Lateral and Medial Double-plating Fixation of Distal Femoral Fractures.

PubMed

Bai, Zhibiao; Gao, Shichang; Hu, Zhenming; Liang, Anlin

2018-03-20

The present study was performed to compare the clinical efficacy of lateral plate and lateral and medial double-plating fixation of distal femoral fractures and explore the indication of lateral and medial double-plating fixation of the distal femoral fractures. From March 2006 to April 2014, 48 and 12 cases of distal femoral fractures were treated with lateral plate (single plate) and lateral and medial plates (double plates), respectively. During the surgery, after setting the lateral plate for the distal femoral fractures, if the varus stress test of the knee was positive and the lateral collateral ligament rupture was excluded, lateral and medial double-plating fixation was used for the stability of the fragments. All the patients were followed up at an average period of 15.9 months. The average operation time, the intraoperative hemorrhage and the fracture union time of the two groups were compared. One year after operation, knee function was evaluated by the Kolmert's standard. There was no significant difference in the average operation time, intraoperative hemorrhage, fracture healing time and excellent and good rates of postoperative knee function between two groups. Positive Varus stress test during operation can be an indication for lateral and medial double-plating fixation of distal femoral fractures.

Navy Operational Planner: Anti-Submarine Warfare with Time-Dependent Performance

DTIC Science & Technology

2017-09-01

PLANNER: ANTI-SUBMARINE WARFARE WITH TIME -DEPENDENT PERFORMANCE by Anthony M. Baldessari September 2017 Thesis Advisor: W. Matthew...reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instruction, searching...REPORT TYPE AND DATES COVERED Master’s thesis 4. TITLE AND SUBTITLE NAVY OPERATIONAL PLANNER: ANTI-SUBMARINE WARFARE WITH TIME -DEPENDENT

A Real-Time Phase Vector Display for EEG Monitoring

NASA Technical Reports Server (NTRS)

Finger, Herbert J.; Anliker, James E.; Rimmer, Tamara

1973-01-01

A real-time, computer-based, phase vector display system has been developed which will output a vector whose phase is equal to the delay between a trigger and the peak of a function which is quasi-coherent with respect to the trigger. The system also contains a sliding averager which enables the operator to average successive trials before calculating the phase vector. Data collection, averaging and display generation are performed on a LINC-8 computer. Output displays appear on several X-Y CRT display units and on a kymograph camera/oscilloscope unit which is used to generate photographs of time-varying phase vectors or contourograms of time-varying averages of input functions.

Operating room efficiency improvement after implementation of a postoperative team assessment.

PubMed

Porta, Christopher R; Foster, Andrew; Causey, Marlin W; Cordier, Patricia; Ozbirn, Roger; Bolt, Stephen; Allison, Dennis; Rush, Robert

2013-03-01

Operating room time is highly resource intensive, and delays can be a source of lost revenue and surgeon frustration. Methods to decrease these delays are important not only for patient care, but to maximize operating room resource utilization. The purpose of this study was to determine the root cause of operating room delays in a standardized manner to help improve overall operating room efficiency. We performed a single-center prospective observational study analyzing operating room utilization and efficiency after implementing an executive-driven standardized postoperative team debriefing system from January 2010 to December 2010. A total of 11,342 procedures were performed over the 1-y study period (elective 86%, urgent 11%, and emergent 3%), with 1.3 million min of operating room time, 865,864 min of surgeon operative time (62.5%), and 162,958 min of anesthesia time (11.8%). Overall, the average operating room delay was 18 min and varied greatly based on the surgical specialty. The longest delays were due to need for radiology (40 min); other significant delays were due to supply issues (22.7 min), surgeon issues (18 min), nursing issues (14 min), and room turnover (14 min). Over the 1-y period, there was a decrease in mean delay duration, averaging a decrease in delay of 0.147 min/mo with an overall 9% decrease in the mean delay times. With regard to overall operating room utilization, there was a 39% decrease in overall un-utilized available OR time that was due to delays, improving efficiency by 2334 min (212 min/mo). During this study interval no sentinel events occurred in the operating room. A standardized postoperative debrief tracking system is highly beneficial in identifying and reducing overall operative delays and improving operating room utilization. Published by Elsevier Inc.

An order insertion scheduling model of logistics service supply chain considering capacity and time factors.

PubMed

Liu, Weihua; Yang, Yi; Wang, Shuqing; Liu, Yang

2014-01-01

Order insertion often occurs in the scheduling process of logistics service supply chain (LSSC), which disturbs normal time scheduling especially in the environment of mass customization logistics service. This study analyses order similarity coefficient and order insertion operation process and then establishes an order insertion scheduling model of LSSC with service capacity and time factors considered. This model aims to minimize the average unit volume operation cost of logistics service integrator and maximize the average satisfaction degree of functional logistics service providers. In order to verify the viability and effectiveness of our model, a specific example is numerically analyzed. Some interesting conclusions are obtained. First, along with the increase of completion time delay coefficient permitted by customers, the possible inserting order volume first increases and then trends to be stable. Second, supply chain performance reaches the best when the volume of inserting order is equal to the surplus volume of the normal operation capacity in mass service process. Third, the larger the normal operation capacity in mass service process is, the bigger the possible inserting order's volume will be. Moreover, compared to increasing the completion time delay coefficient, improving the normal operation capacity of mass service process is more useful.

Bi-Pedicle Fixation of Affected Vertebra in Thoracolumbar Burst Fracture.

PubMed

Padalkar, Pravin; Mehta, Varshil

2017-04-01

Burst fractures of the spine account for 14% of all spinal injuries and more than 50% of all thoracolumbar trauma. However, there is ambiguity while choosing the right treatment plan. Short Segment Pedicle screw Fixation (SSPF) has become an increasingly popular method of treatment of thoracolumbar burst fractures, providing the advantage of incorporating fewer motion segments in the fixation. Various biomechanical studies showed that the use of pedicle screws could achieve stable construct within short-segment fixation. To evaluate the efficacy of SSPF using longest possible screws in both pedicles of fractured vertebra. A retrospective chart review of 25 single burst thoracolumbar fracture patients, operated between May 2009 to 2015 in a tertiary care trauma center, was conducted. Preoperative and post-operative plain radiographs were evaluated for kyphotic angulations using the traditional Cobb method. Anterior Vertebral Height (AVH), Posteriors Vertebral Height (PVH) were measured preoperatively and immediate postoperatively. Average percentage loss of AVH and mid-sagittal height were calculated on preoperative and postoperative X-rays on follow up. Fourteen men and 11 women with an average age of 42.92 years comprised the study population. Mean age at the time of operation was 34.5±14.2 years. Mean operation time was 168±72 (minutes). Average hospitalization time was 9±7 (days). Mean blood loss was 515±485 (ml). There were two cases of postoperative infection and implant failure each. A mean of 15.2° of kyphosis correction was attained from pre-operation to post-operation (p<0.0001). Although, there was a 15° average improvement of kyphosis post-fixation, loss of correction over time was nearly 8°, resulting in a 7° mean correction of kyphosis. A mean loss of AVH on postoperative radiograph was 6.12% and maintained 12.4% at the time of review (p<0.001). Similarly, there was 32.8% mid-sagittal height loss at time of injury, which was improved to only 12.6% as compare to initial height loss (p<0.0001). In this study, we propose SSPF using longest possible screws in both pedicle of fractured vertebra. Bi-pedicular fixation gives significant radiological corrections.

Space Domain Awareness

DTIC Science & Technology

2012-09-01

the Space Surveillance Network has been tracking orbital objects and maintaining a catalog that allows space operators to safely operate satellites ...collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources...Distribution Unlimited) backward) in time , but the accuracy degrades as the amount of propagation time increases. Thus, the need to maintain a

Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection.

PubMed

Basques, Bryce A; Golinvaux, Nicholas S; Bohl, Daniel D; Yacob, Alem; Toy, Jason O; Varthi, Arya G; Grauer, Jonathan N

2014-10-15

Retrospective database review. To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. The American College of Surgeons National Surgical Quality Improvement Program database, which includes data from more than 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without the use of an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. A total of 23,670 elective spine procedures were identified, of which 2226 (9.4%) used an operating microscope. The average patient age was 55.1±14.4 years. The average operative time (incision to closure) was 125.7±82.0 minutes.Microscope use was associated with minor increases in preoperative room time (+2.9 min, P=0.013), operative time (+13.2 min, P<0.001), and total room time (+18.6 min, P<0.001) on multivariate analysis.A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and nonmicroscope groups for occurrence of any infection, superficial surgical site infection, deep surgical site infection, organ space infection, or sepsis/septic shock, regardless of surgery type. We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. 3.

Use of an operating microscope during spine surgery is associated with minor increases in operating room times and no increased risk of infection

PubMed Central

Basques, Bryce A.; Golinvaux, Nicholas S.; Bohl, Daniel D.; Yacob, Alem; Toy, Jason O.; Varthi, Arya G.; Grauer, Jonathan N.

2014-01-01

Study Design Retrospective database review. Objective To evaluate whether microscope use during spine procedures is associated with increased operating room times or increased risk of infection. Summary of Background Data Operating microscopes are commonly used in spine procedures. It is debated whether the use of an operating microscope increases operating room time or confers increased risk of infection. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database, which includes data from over 370 participating hospitals, was used to identify patients undergoing elective spinal procedures with and without an operating microscope for the years 2011 and 2012. Bivariate and multivariate linear regressions were used to test the association between microscope use and operating room times. Bivariate and multivariate logistic regressions were similarly conducted to test the association between microscope use and infection occurrence within 30 days of surgery. Results A total of 23,670 elective spine procedures were identified, of which 2,226 (9.4%) used an operating microscope. The average patient age was 55.1 ± 14.4 years. The average operative time (incision to closure) was 125.7 ± 82.0 minutes. Microscope use was associated with minor increases in preoperative room time (+2.9 minutes, p=0.013), operative time (+13.2 minutes, p<0.001), and total room time (+18.6 minutes, p<0.001) on multivariate analysis. A total of 328 (1.4%) patients had an infection within 30 days of surgery. Multivariate analysis revealed no significant difference between the microscope and non-microscope groups for occurrence of any infection, superficial surgical site infection (SSI), deep SSI, organ space infection, or sepsis/septic shock, regardless of surgery type. Conclusions We did not find operating room times or infection risk to be significant deterrents for use of an operating microscope during spine surgery. PMID:25188600

Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis

PubMed Central

Park, Yoonah; Yong, Yuen Geng; Jung, Kyung Uk; Huh, Jung Wook; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

2015-01-01

Purpose This study aimed to compare the learning curves and early postoperative outcomes for conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC). Methods This retrospective study included the initial 35 cases in each group. Learning curves were evaluated by the moving average of operative time, mean operative time of every five consecutive cases, and cumulative sum (CUSUM) analysis. The learning phase was considered overcome when the moving average of operative times reached a plateau, and when the mean operative time of every five consecutive cases reached a low point and subsequently did not vary by more than 30 minutes. Results Six patients with missing data in the CL RHC group were excluded from the analyses. According to the mean operative time of every five consecutive cases, learning phase of SIL and CL RHC was completed between 26 and 30 cases, and 16 and 20 cases, respectively. Moving average analysis revealed that approximately 31 (SIL) and 25 (CL) cases were needed to complete the learning phase, respectively. CUSUM analysis demonstrated that 10 (SIL) and two (CL) cases were required to reach a steady state of complication-free performance, respectively. Postoperative complications rate was higher in SIL than in CL group, but the difference was not statistically significant (17.1% vs. 3.4%). Conclusion The learning phase of SIL RHC is longer than that of CL RHC. Early oncological outcomes of both techniques were comparable. However, SIL RHC had a statistically insignificant higher complication rate than CL RHC during the learning phase. PMID:25960990

Integrating robotic partial nephrectomy to an existing robotic surgery program.

PubMed

Yuh, Bertram; Muldrew, Shantel; Menchaca, Anita; Yip, Wesley; Lau, Clayton; Wilson, Timothy; Josephson, David

2012-04-01

As more centers develop robotic proficiency, progressing to a successful robot-assisted partial nephrectomy (RAPN) program depends on a number of factors. We describe our technique, results, and analysis of program setup for RAPN. Between 2005 and 2011, 92 RAPNs were performed following maturation of a robotic prostatectomy program. Operating rooms and supply rooms were outfitted for efficient robotic throughput. Tilepro and intraoperative ultrasound were used for all cases. Training and experiential learning for surgeons, anesthesia and nursing staff was a high priority. An onsite robotic technician helped troubleshoot, prepare the room and staff prior to starting surgery, and provide assistance with different robotic models. Average operative time decreased over time from 235 min to 199 min (p = .03). Warm ischemia time decreased from 26 minutes to 23 minutes (p = .02) despite an increased complexity of tumors and operations on multiple tumors. Median estimated blood loss was 150 mL. Average length of hospital stay was 3 days (range 1-9). Average size of lesions was 2.7 cm (range 0.7-8.6). Final pathology demonstrated 71 (77%) malignant lesions and 21 (23%) benign lesions. The addition of a robot-assisted partial nephrectomy program to an institutional robotic program can be coordinated with several key steps. Outcomes from an operational, oncologic, and renal functional standpoint are acceptable. Despite increased complexity of tumors and treatment of multiple lesions, operative and warm ischemia times showed a decrease over time. An organizational model that involves the surgeons, anesthesia, nursing staff, and possibly a robotic technical specialist helps to overcome the learning curve.

The Accuracy of Two-Way Satellite Time Transfer Calibrations

DTIC Science & Technology

2005-01-01

20392, USA Abstract Results from successive calibrations of Two-Way Satellite Time and Frequency Transfer ( TWSTFT ) operational equipment at...USNO and five remote stations using portable TWSTFT equipment are analyzed for internal and external errors, finding an average random error of ±0.35...most accurate means of operational long-distance time transfer are Two-Way Satellite Time and Frequency Transfer ( TWSTFT ) and carrier-phase GPS

A monitoring tool for performance improvement in plastic surgery at the individual level.

PubMed

Maruthappu, Mahiben; Duclos, Antoine; Orgill, Dennis; Carty, Matthew J

2013-05-01

The assessment of performance in surgery is expanding significantly. Application of relevant frameworks to plastic surgery, however, has been limited. In this article, the authors present two robust graphic tools commonly used in other industries that may serve to monitor individual surgeon operative time while factoring in patient- and surgeon-specific elements. The authors reviewed performance data from all bilateral reduction mammaplasties performed at their institution by eight surgeons between 1995 and 2010. Operative time was used as a proxy for performance. Cumulative sum charts and exponentially weighted moving average charts were generated using a train-test analytic approach, and used to monitor surgical performance. Charts mapped crude, patient case-mix-adjusted, and case-mix and surgical-experience-adjusted performance. Operative time was found to decline from 182 minutes to 118 minutes with surgical experience (p < 0.001). Cumulative sum and exponentially weighted moving average charts were generated using 1995 to 2007 data (1053 procedures) and tested on 2008 to 2010 data (246 procedures). The sensitivity and accuracy of these charts were significantly improved by adjustment for case mix and surgeon experience. The consideration of patient- and surgeon-specific factors is essential for correct interpretation of performance in plastic surgery at the individual surgeon level. Cumulative sum and exponentially weighted moving average charts represent accurate methods of monitoring operative time to control and potentially improve surgeon performance over the course of a career.

Complexity and the Fractional Calculus

DTIC Science & Technology

2013-01-01

these trajectories over the entire Lotka - Volterra cycle thereby generating the mistaken impression that the resulting average trajectory reaches...interpreted as a form of phase decor- relation process rather than one with friction. The fractional version of the popular Lotka - Volterra ecological...trajectory is an ordinary Lotka - Volterra cycle in the operational time . Transitioning from the operational time to the chronological time spreads

Overview of aerothermodynamic loads definition study

NASA Technical Reports Server (NTRS)

Gaugler, Raymond E.

1991-01-01

The objective of the Aerothermodynamic Loads Definition Study is to develop methods of accurately predicting the operating environment in advanced Earth-to-Orbit (ETO) propulsion systems, such as the Space Shuttle Main Engine (SSME) powerhead. Development of time averaged and time dependent three dimensional viscous computer codes as well as experimental verification and engine diagnostic testing are considered to be essential in achieving that objective. Time-averaged, nonsteady, and transient operating loads must all be well defined in order to accurately predict powerhead life. Described here is work in unsteady heat flow analysis, improved modeling of preburner flow, turbulence modeling for turbomachinery, computation of three dimensional flow with heat transfer, and unsteady viscous multi-blade row turbine analysis.

Analysis of DFW Perimeter Taxiway Operations

NASA Technical Reports Server (NTRS)

Engelland, Shawn A.; Ruszkowski, Louise Morgan

2010-01-01

This study examines operations of the perimeter taxiway system at Dallas/Fort Worth International Airport (DFW) to characterize and understand the impact of the perimeter taxiway system and to provide operational decision makers with guidance on use of this new airport resource. DFW s perimeter taxiway entered service in December 2008 and is representative of perimeter or end-around taxiways currently in use at several other airports worldwide. This perimeter taxiway analysis is a collaborative effort between NASA and various DFW stakeholders including the FAA, air carriers and the airport operator. The initial investigation has focused on quantifying perimeter taxiway usage and assessing effects on taxi times at both the local and global levels. Local-level results show taxi times via the perimeter taxiway to be about forty-five seconds longer on average, but with significantly less variability. Global-level results show average perimeter taxiway times to be a little more than one minute longer with variability that is comparable to that for other taxi paths.

A comparison of two methods of infiltration in breast reduction surgery.

PubMed

Armour, A D; Rotenberg, B W; Brown, M H

2001-08-01

The superwet technique has been shown in previous studies to dramatically reduce blood loss in breast reduction surgery, compared with standard infiltration. A retrospective chart review of 303 consecutive patients undergoing bilateral breast reduction surgery was undertaken to demonstrate additional differences in complication rate, operative time, or sponge use in the operating room. In this series, 132 consecutive patients received standard infiltration along incision lines (25 cc per breast of 1:100,000 epinephrine), and 171 patients received superwet infiltration with 240 cc per breast of 1:1,000,000 epinephrine. The average operative time was significantly reduced in the superwet group, from 78.5 minutes to 70.7 minutes (p < 0.01 level). The average number of sponges used intraoperatively was also decreased significantly (p < 0.01), from 26 to 20 sponges. Complication rates were equally low in both groups, demonstrating the safety of the superwet technique. In addition to limiting blood loss, the superwet infiltration effectively reduces operative time and sponge use without increasing complications in breast reduction surgery.

A method of percutaneous vertebroplasty under the guidance of two C-arm fluoroscopes

PubMed Central

Xu, Ren-Jie; Yan, Yong-Qing; Chen, Guang-Xiang; Zou, Tian-Ming; Cai, Xiao-Qiang; Wang, Dong-Lai

2014-01-01

Objective: To compare the clinical application in the percutaneous vertebroplasty under the guidance of one or two C-arm fluoroscopes. Methods: One hundred forty three elderly patients with Osteoporotic vertebral compression fractures (OVCFs) underwent percutaneous vertebroplasty under the guidance of one or two C-arm fluoroscopes. The number of pulsed imagings, the time of operation and the incidence of cement leakage were recorded. Results: The average number of pulsed imagings was 16.00±1.58 vs 13.07±2.00 per patient under the guidance of one vs two C-arm fluoroscopes. The average time of operation was 48.42±5.00 minutes vs 39.70±7.42 minutes per patient under the guidance of one vs two C-arm fluoroscopes. The incidence of cement leakage was 20% vs 15.7% of the patients under the guidance of one vs two C-arm fluoroscopes. The differences in the number of pulsed imagings and the time of operation were statistically significant. The difference in incidence of cement leakage was not statistically significant. Conclusion: The two-fluoroscopic technique reduce the labor cost, the radiation, the time of operation and the operation risk. PMID:24772138

Atmospheric Radiation Measurement program climate research facilities quarterly report April 1 - June 30, 2009.

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

Sisterson, D. L.

2009-07-14

Individual raw data streams from instrumentation at the Atmospheric Radiation Measurement (ARM) Program Climate Research Facility (ACRF) fixed and mobile sites are collected and sent to the Data Management Facility (DMF) at Pacific Northwest National Laboratory (PNNL) for processing in near-real time. Raw and processed data are then sent approximately daily to the ACRF Archive, where they are made available to users. For each instrument, we calculate the ratio of the actual number of data records received daily at the archive to the expected number of data records. The results are tabulated by (1) individual data stream, site, and monthmore » for the current year and (2) site and fiscal year (FY) dating back to 1998. The U.S. Department of Energy (DOE) requires national user facilities to report time-based operating data. The requirements concern the actual hours of operation (ACTUAL); the estimated maximum operation or uptime goal (OPSMAX), which accounts for planned downtime; and the VARIANCE [1 - (ACTUAL/OPSMAX)], which accounts for unplanned downtime. The OPSMAX time for the third quarter of FY 2009 for the Southern Great Plains (SGP) site is 2,074.80 hours (0.95 x 2,184 hours this quarter); for the North Slope Alaska (NSA) locale it is 1,965.60 hours (0.90 x 2,184); and for the Tropical Western Pacific (TWP) locale it is 1,856.40 hours (0.85 x 2,184). The ARM Mobile Facility (AMF) was officially operational May 1 in Graciosa Island, the Azores, Portugal, so the OPSMAX time this quarter is 1390.80 hours (0.95 x 1464). The differences in OPSMAX performance reflect the complexity of local logistics and the frequency of extreme weather events. It is impractical to measure OPSMAX for each instrument or data stream. Data availability reported here refers to the average of the individual, continuous data streams that have been received by the Archive. Data not at the Archive are caused by downtime (scheduled or unplanned) of the individual instruments. Therefore, data availability is directly related to individual instrument uptime. Thus, the average percentage of data in the Archive represents the average percentage of the time (24 hours per day, 91 days for this quarter) the instruments were operating this quarter. Table 1 shows the accumulated maximum operation time (planned uptime), actual hours of operation, and variance (unplanned downtime) for April 1 - June 30, 2009, for the fixed sites. Because the AMF operates episodically, the AMF statistics are reported separately and are not included in the aggregate average with the fixed sites. The AMF statistics for this reporting period were not available at the time of this report. The third quarter comprises a total of 2,184 hours for the fixed sites. The average well exceeded our goal this quarter.« less

Atmospheric Radiation Measurement program climate research facility operations quarterly report.

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

Sisterson, D. L.; Decision and Information Sciences

2006-09-06

Individual raw data streams from instrumentation at the Atmospheric Radiation Measurement (ARM) Program Climate Research Facility (ACRF) fixed and mobile sites are collected and sent to the Data Management Facility (DMF) at Pacific Northwest National Laboratory (PNNL) for processing in near real time. Raw and processed data are then sent daily to the ACRF Archive, where they are made available to users. For each instrument, we calculate the ratio of the actual number of data records received daily at the Archive to the expected number of data records. The results are tabulated by (1) individual data stream, site, and monthmore » for the current year and (2) site and fiscal year dating back to 1998. The U.S. Department of Energy requires national user facilities to report time-based operating data. The requirements concern the actual hours of operation (ACTUAL); the estimated maximum operation or uptime goal (OPSMAX), which accounts for planned downtime; and the VARIANCE [1-(ACTUAL/OPSMAX)], which accounts for unplanned downtime. The OPSMAX time for the third quarter for the Southern Great Plains (SGP) site is 2,074.80 hours (0.95 x 2,184 hours this quarter). The OPSMAX for the North Slope Alaska (NSA) locale is 1,965.60 hours (0.90 x 2,184), and that for the Tropical Western Pacific (TWP) locale is 1,856.40 hours (0.85 x 2,184). The OPSMAX time for the ARM Mobile Facility (AMF) is 2,074.80 hours (0.95 x 2,184). The differences in OPSMAX performance reflect the complexity of local logistics and the frequency of extreme weather events. It is impractical to measure OPSMAX for each instrument or data stream. Data availability reported here refers to the average of the individual, continuous data streams that have been received by the Archive. Data not at the Archive are caused by downtime (scheduled or unplanned) of the individual instruments. Therefore, data availability is directly related to individual instrument uptime. Thus, the average percent of data in the Archive represents the average percent of the time (24 hours per day, 91 days for this quarter) the instruments were operating this quarter. Table 1 shows the accumulated maximum operation time (planned uptime), the actual hours of operation, and the variance (unplanned downtime) for the period April 1 through June 30, 2006, for the fixed and mobile sites. Although the AMF is currently up and running in Niamey, Niger, Africa, the AMF statistics are reported separately and not included in the aggregate average with the fixed sites. The third quarter comprises a total of 2,184 hours. For all fixed sites (especially the TWP locale) and the AMF, the actual data availability (and therefore actual hours of operation) exceeded the individual (and well as aggregate average of the fixed sites) operational goal for the third quarter of fiscal year (FY) 2006.« less

Advanced laparoscopic bariatric surgery Is safe in general surgery training.

PubMed

Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

2017-05-01

Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

Radical Islam

DTIC Science & Technology

2002-07-01

0704-0188 Public reporting burder for this collection of information is estibated to average 1 hour per response, including the time for reviewing...information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and...information operations and reports, 1215 Jefferson davis highway, suite 1204, Arlington, VA 22202-4302, and to the office of management and budget, paperwork

An Order Insertion Scheduling Model of Logistics Service Supply Chain Considering Capacity and Time Factors

PubMed Central

Yang, Yi; Wang, Shuqing; Liu, Yang

2014-01-01

Order insertion often occurs in the scheduling process of logistics service supply chain (LSSC), which disturbs normal time scheduling especially in the environment of mass customization logistics service. This study analyses order similarity coefficient and order insertion operation process and then establishes an order insertion scheduling model of LSSC with service capacity and time factors considered. This model aims to minimize the average unit volume operation cost of logistics service integrator and maximize the average satisfaction degree of functional logistics service providers. In order to verify the viability and effectiveness of our model, a specific example is numerically analyzed. Some interesting conclusions are obtained. First, along with the increase of completion time delay coefficient permitted by customers, the possible inserting order volume first increases and then trends to be stable. Second, supply chain performance reaches the best when the volume of inserting order is equal to the surplus volume of the normal operation capacity in mass service process. Third, the larger the normal operation capacity in mass service process is, the bigger the possible inserting order's volume will be. Moreover, compared to increasing the completion time delay coefficient, improving the normal operation capacity of mass service process is more useful. PMID:25276851

Segmental Mirroring: Does It Eliminate the Need for Intraoperative Readjustment of the Virtually Pre-Bent Reconstruction Plates and Is It Economically Valuable?

PubMed

Khalifa, Ghada Amin; Abd El Moniem, Nahed Adly; Elsayed, Shadia Abd-ElHameed; Qadry, Yara

2016-03-01

The aim of this study was to compare segmental mirroring with mirroring of the entire unaffected side to determine which method obviates intraoperative readjustment of virtually planned pre-bent plates and to evaluate the effect on costs. Patients eligible for inclusion in this prospective study had unilateral mandibular discontinuity defects. Patients were randomly divided into 2 groups. In group I, models were constructed by mirroring the entire unaffected side of the mandible at the midsagittal plane. In group II, only the resected segments were cut and replaced by the corresponding mirrored healthy segments. The lesions were resected, and their sites were reconstructed using pre-bent reconstruction plates. The need for intraoperative plate readjustment, plate placement time, operation time, and operation costs were reviewed. Fifty patients were enrolled in this study. All but 5 plates in group I required readjustment. In group II, plates were placed without intraoperative handling. Average operating times were 4.20 ± 0.56 hours in group I and 3.186 ± 0.28 hours in group II (P = .00002). Mean times for plate placement were 33.36 ± 8.20 and 21.88 ± 5.73 minutes in groups I and II, respectively. The difference resulted in an average time gain of 11.48 minutes. Average personal costs per minute were US$740.77 for group I and US$560.87 for group II. The difference resulted in an average saving of approximately US$179.90. Segmental mirroring is superior in reflecting the bone anatomy in 3-dimensional models, thus eliminating intraoperative plate readjustment and providing better plate adaptation with better contour. It decreases operating time and costs and thus can be recommended for lesions that do not cross the midline. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

An averaging battery model for a lead-acid battery operating in an electric car

NASA Technical Reports Server (NTRS)

Bozek, J. M.

1979-01-01

A battery model is developed based on time averaging the current or power, and is shown to be an effective means of predicting the performance of a lead acid battery. The effectiveness of this battery model was tested on battery discharge profiles expected during the operation of an electric vehicle following the various SAE J227a driving schedules. The averaging model predicts the performance of a battery that is periodically charged (regenerated) if the regeneration energy is assumed to be converted to retrievable electrochemical energy on a one-to-one basis.

40 CFR 52.1923 - Best Available Retrofit Requirements (BART) for SO2 and Interstate pollutant transport provisions...

Code of Federal Regulations, 2014 CFR

2014-07-01

... combusted at any time at the steam generating unit. Daily average means the arithmetic average of the hourly... which may include, but is not limited to, monitoring results, review of operating and maintenance...

Limb lengthening in short stature patients.

PubMed

Aldegheri, R; Dall'Oca, C

2001-07-01

A series of 140 patients with short stature operated on for limb lengthening (80 had achondroplasia, 20 had hypochondroplasia, 20 had Turner syndrome, 10 had idiopathic short stature due to an undemonstrated cause, 5 regarded their stature as too short, and 5 had a psychopathic personality due to dysmorphophobia that had developed because of their short stature) was reviewed. All patients underwent symmetric lengthening of both femora and tibiae; 10 of these achondroplastic patients underwent lengthening of the humeri. We carried out the 580 lengthening procedures by means of three different surgical techniques: 440 callotasis, 120 chondrodiatasis and 20 mid-shaft osteotomy. In the 130 patients with a disproportionate short stature, the average gain in length was 18.2 +/- 3.93 cm: 43.8% had complications and 3.8% had sequelae; the average treatment time was 31 months. In the 10 patients with proportionate short stature, the average gain in length was 10.8 +/- 1.00 cm: 4 experienced complications and none had sequelae; the average treatment time was 21 months. Patients who underwent lengthening of the upper limbs experienced an average gain in length of 10.2 +/- 1.25 cm: the average treatment time was 9 months and none of them experienced any complications or sequelae. The authors discuss how difficult it is to achieve the benefits of this surgery: they underline the strong commitment on the part of the patients and their families, the time in the hospital, the number of operations and, above all, the severity of those permanent sequelae that occurred.

On a distinctive feature of problems of calculating time-average characteristics of nuclear reactor optimal control sets

NASA Astrophysics Data System (ADS)

Trifonenkov, A. V.; Trifonenkov, V. P.

2017-01-01

This article deals with a feature of problems of calculating time-average characteristics of nuclear reactor optimal control sets. The operation of a nuclear reactor during threatened period is considered. The optimal control search problem is analysed. The xenon poisoning causes limitations on the variety of statements of the problem of calculating time-average characteristics of a set of optimal reactor power off controls. The level of xenon poisoning is limited. There is a problem of choosing an appropriate segment of the time axis to ensure that optimal control problem is consistent. Two procedures of estimation of the duration of this segment are considered. Two estimations as functions of the xenon limitation were plot. Boundaries of the interval of averaging are defined more precisely.

Use of operating room information system data to predict the impact of reducing turnover times on staffing costs.

PubMed

Dexter, Franklin; Abouleish, Amr E; Epstein, Richard H; Whitten, Charles W; Lubarsky, David A

2003-10-01

Potential benefits to reducing turnover times are both quantitative (e.g., complete more cases and reduce staffing costs) and qualitative (e.g., improve professional satisfaction). Analyses have shown the quantitative arguments to be unsound except for reducing staffing costs. We describe a methodology by which each surgical suite can use its own numbers to calculate its individual potential reduction in staffing costs from reducing its turnover times. Calculations estimate optimal allocated operating room (OR) time (based on maximizing OR efficiency) before and after reducing the maximum and average turnover times. At four academic tertiary hospitals, reductions in average turnover times of 3 to 9 min would result in 0.8% to 1.8% reductions in staffing cost. Reductions in average turnover times of 10 to 19 min would result in 2.5% to 4.0% reductions in staffing costs. These reductions in staffing cost are achieved predominantly by reducing allocated OR time, not by reducing the hours that staff work late. Heads of anesthesiology groups often serve on OR committees that are fixated on turnover times. Rather than having to argue based on scientific studies, this methodology provides the ability to show the specific quantitative effects (small decreases in staffing costs and allocated OR time) of reducing turnover time using a surgical suite's own data. Many anesthesiologists work at hospitals where surgeons and/or operating room (OR) committees focus repeatedly on turnover time reduction. We developed a methodology by which the reductions in staffing cost as a result of turnover time reduction can be calculated for each facility using its own data. Staffing cost reductions are generally very small and would be achieved predominantly by reducing allocated OR time to the surgeons.

Lengthening Temporalis Myoplasty for Single-Stage Smile Reconstruction in Children with Facial Paralysis.

PubMed

Panossian, Andre

2016-04-01

Free muscle transfer for dynamic smile reanimation in facial paralysis is not always predictable with regard to cosmesis. Hospital stays range from 5 to 7 days. Prolonged operative times, longer hospital stays, and excessive cheek bulk are associated with free flap options. Lengthening temporalis myoplasty offers single-stage smile reanimation with theoretical advantages over free tissue transfer. From 2012 to 2014, 18 lengthening temporalis myoplasties were performed in 14 children for smile reconstruction. A retrospective chart review was completed for demographics, operative times, length of hospital stay, and perioperative complications. Fourteen consecutive patients with complete facial paralysis were included. Four patients underwent single-stage bilateral reconstruction, and 10 underwent unilateral procedures. Diagnoses included Möbius syndrome (n = 5), posterior cranial fossa tumors (n = 4), posttraumatic (n = 2), hemifacial microsomia (n = 1), and idiopathic (n = 2). Average patient age was 10.1 years. Average operative time was 410 minutes (499 minutes for bilateral lengthening temporalis myoplasty and 373 for unilateral lengthening temporalis myoplasty). Average length of stay was 3.3 days (4.75 days for bilateral lengthening temporalis myoplasty and 2.8 for unilateral lengthening temporalis myoplasty). Nine patients required minor revisions. Lengthening temporalis myoplasty is a safe alternative to free tissue transfer for dynamic smile reconstruction in children with facial paralysis. Limited donor-site morbidity, shorter operative times, and shorter hospital stays are some benefits over free flap options. However, revisions are required frequently secondary to tendon avulsions and adhesions. Therapeutic, IV.

Cycle-time equation for the Koller K300 cable yarder operating on steep slopes in the Northeast

Treesearch

Neil K. Huyler; Chris B. LeDoux

1997-01-01

Describes a delay-free-cycle time equation for the Koller K300 skyline yarder operating on steep slopes in the Northeast. Using the equation, the average delay-free-cycle time was 5.72 minutes. This means that about 420 cubic feet of material per hour can be produced. The important variables used in the equation were slope yarding distance, lateral yarding distance,...

3D printing-assisted osteotomy treatment for the malunion of lateral tibial plateau fracture.

PubMed

Yang, Peng; Du, Di; Zhou, Zhibin; Lu, Nan; Fu, Qiang; Ma, Jun; Zhao, Liangyu; Chen, Aimin

2016-12-01

Osteotomy and internal fixation are usually the most effective way to treat the malunion of lateral tibial plateau fractures, and the accuracy of the osteotomy is still a challenge for surgeons. This is a report of a series of prospectively study of osteotomy treatment for the malunion of lateral plateau fractures with the aid of 3D printing technology. A total of 7 patients with malunion of lateral tibial plateau fractures were enrolled in the study between September 2012 to September 2014 and completed follow up. CT image data were used for 3D reconstruction, and individually 3D printed models were used for accurate measurements and detail osteotomy procedures planning. Under the premeditated operation plan, the osteotomy operations were performed. Patients were invited for follow-up examinations at 2 and 6 weeks and then at intervals of 6 to 8 weeks until 12 months or more. Mean age of the patients was 44 years (range 30-52 years), 3 cases were result of fall injuries, 2 were traffic accidents and 2 were sports injuries. Among the cases, one accompanied with craniocerebra trauma, one with pelvic fracture, one accompanied with both. According to the Schatzker Tibial Plateau classification, the original fracture type were 3 type I, 1 type II and 3 type III. The lateral tibial plateau collapse ranges from 4 mm-12mm, with an average of 9.4mm. All the operations were successfully completed, the average operation time was 77.1min (range 70-90 min), the average intraoperative blood loss was 121.4ml (range 90-180ml), the mean follow-up time was 14.4 months (range 12-18 months), and the average healing time of the osteotomy fragments was 12 weeks (range 11-13 weeks). The difference between preoperative and postoperative Rasmussen scores were statistically significant (P<0.05). All the patients were obtained functional recovery, with no complications. 3D printing technology is helpful to accurately design osteotomy operation, reduce the risk of postoperative deformity, decrease intraoperative blood loss, shorten the operation time, and can effectively improve the treatment effect. Copyright © 2016. Published by Elsevier Ltd.

[Advanced bone graft combined with locking compression plate for the treatment of middle and distal tibia nonunion].

PubMed

Zhao, Xue; Wang, Pan-feng; Zhang, Yun-tong; Zhang, Chun-cai; Xu, Shuo-gui; Zhang, Xin

2014-12-01

To explore methods of treating middle and distal tibia nonunion with the treatment of advanced bone graft combined with locking compression plate. From January 2011 to December 2012, 12 patients with middle and distal tibia nonunion were treated with advanced bone graft combined with locking compression plate. Among patients, there were 8 males and 4 females aged from 20 to 69 with an average of 47 years old. The time from first injuries to bone nonunion was from 9 months to 5 years, avergaed 19 months. Four cases were treated with external fixation, 6 cases were treated with plate fixation, 2 cases of 12 patients occurred broken of plate and nail. Eleven patients were non-infective bone nonunion and 1 patient was infective bone nonunion. Preoperative X-ray and CT showed all patients had sequestration and formation of ossified bone with different degrees. Operative time, blood loss, wound healing were observed, fracture healing time was evaluated by postoperative X-ray. Johner-Wruhs scoring standards was used to evaluate ankle joint function after operation at 10 months. Operative time ranged from 90 to 185 min with an average of (125.00±20.15) min; blood loss ranged from 225 to 750 ml with an average of (415.00±120.00) ml. All patients were followed up from 10 months to 2.5 years with an average of 1.5 years. Postoperative X-ray showed bone union was formed around fracture after operation at 4 months in all patients, 3 cases obtained bone healing within 6 months after operation, 9 cases obtained from 8 to 12 months. No infection, injury of nerve and vessles, and broken of plate and nail were ocurred. According to Johner-Wruhs scoring at 10 months after operation, 10 cases obtained excellent results, 1 good and 1 moderate. Advanced bone graft combined with locking compression plate, which can build fracture multi-point supporting based on full compression of bone nonunion to get effective fixation, is an effective method in treating middle and distal tibia nonunion.

Medium-Range Forecast Skill for Extraordinary Arctic Cyclones in Summer of 2008-2016

NASA Astrophysics Data System (ADS)

Yamagami, Akio; Matsueda, Mio; Tanaka, Hiroshi L.

2018-05-01

Arctic cyclones (ACs) are a severe atmospheric phenomenon that affects the Arctic environment. This study assesses the forecast skill of five leading operational medium-range ensemble forecasts for 10 extraordinary ACs that occurred in summer during 2008-2016. Average existence probability of the predicted ACs was >0.9 at lead times of ≤3.5 days. Average central position error of the predicted ACs was less than half of the mean radius of the 10 ACs (469.1 km) at lead times of 2.5-4.5 days. Average central pressure error of the predicted ACs was 5.5-10.7 hPa at such lead times. Therefore, the operational ensemble prediction systems generally predict the position of ACs within 469.1 km 2.5-4.5 days before they mature. The forecast skill for the extraordinary ACs is lower than that for midlatitude cyclones in the Northern Hemisphere but similar to that in the Southern Hemisphere.

Laparosopic hand-assisted living donor nephrectomy: the Niguarda experience.

PubMed

Maione, G; Sansalone, C V; Aseni, P; De Roberto, A; Soldano, S; Mangoni, I; Perrino, L; Minetti, E; Civati, G

2005-01-01

Perioperative donor morbidity, a barrier to living organ donation, may be mitigated by the laparoscopic approach. From September 2002 to September 2004, 15 living donors, of ages ranging from 36 to 59 years, underwent laparoscopic nephrectomy. We used a hand-assisted device to increase the safety of the procedure. The average operating time was 200 minutes. The average blood loss was about 100 mL. The patients resumed oral intake and started walking within 1 day. The average postoperative hospital stay was 6 days. Although laparoscopic operating times were longer than those for traditional surgery, we showed benefits to the laparoscopic donor to be less postoperative pain, better cosmesis, shorter recovery time, and faster return to normal activities. We therefore consider laparoscopic nephrectomy a good alternative to traditional surgery for selected patients. Despite a lack of strong evidence, such as large prospective randomized studies, laparoscopic donor nephrectomy is likely to become the gold standard for donor nephrectomy in the near future.

Dioxins from medical waste incineration: Normal operation and transient conditions.

PubMed

Chen, Tong; Zhan, Ming-xiu; Yan, Mi; Fu, Jian-ying; Lu, Sheng-yong; Li, Xiao-dong; Yan, Jian-hua; Buekens, Alfons

2015-07-01

Polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) are key pollutants in waste incineration. At present, incinerator managers and official supervisors focus only on emissions evolving during steady-state operation. Yet, these emissions may considerably be raised during periods of poor combustion, plant shutdown, and especially when starting-up from cold. Until now there were no data on transient emissions from medical (or hospital) waste incineration (MWI). However, MWI is reputed to engender higher emissions than those from municipal solid waste incineration (MSWI). The emission levels in this study recorded for shutdown and start-up, however, were significantly higher: 483 ± 184 ng Nm(-3) (1.47 ± 0.17 ng I-TEQ Nm(-3)) for shutdown and 735 ng Nm(-3) (7.73 ng I-TEQ Nm(-3)) for start-up conditions, respectively. Thus, the average (I-TEQ) concentration during shutdown is 2.6 (3.8) times higher than the average concentration during normal operation, and the average (I-TEQ) concentration during start-up is 4.0 (almost 20) times higher. So monitoring should cover the entire incineration cycle, including start-up, operation and shutdown, rather than optimised operation only. This suggestion is important for medical waste incinerators, as these facilities frequently start up and shut down, because of their small size, or of lacking waste supply. Forthcoming operation should shift towards much longer operating cycles, i.e., a single weekly start-up and shutdown. © The Author(s) 2015.

Comparison of ultrasonic energy expenditures and corneal endothelial cell density reductions during modulated and non-modulated phacoemulsification.

PubMed

Davison, James A

2007-01-01

To compare the Legacy 20000 Advantec continuous and Infiniti hyperpulse modes (Alcon Laboratories, Fort Worth, TX) with respect to average power, machine-measured phacoemulsification time, total stopwatch real time spent within the phacoemulsification process, balanced salt solution (BSS) volume, and corneal endothelial cell density losses. A background study was done of consecutive patients operated on with the Legacy (n = 60) and Infiniti (n = 40) machines programmed with identical parameters and using the continuous mode only. A primary study of another set of consecutive cases was operated on using the Legacy (n = 87) and Infiniti (n = 94) with the same parameters, but using the hyperpulse mode during quadrant removal with the Infiniti. Measurements for each set included average power and phacoemulsification time with corneal endothelial cell densities, BSS volume, and time spent in the phacoemulsification process. Similarities were found in the background study for average power percent and average minutes of phacoemulsification time. In the primary study, similarities were found for total minutes in the phacoemulsification process, BSS usage, and ECD losses, and differences were found for average power percent (P< .001) and machine-measured phacoemulsification minutes (P< .001). The Legacy and Infiniti performed similarly in continuous mode. With the Infiniti hyperpulse mode, a total ultrasonic energy reduction of 66% was noted. The machines required the same amount of total stopwatch measured time to accomplish phacoemulsification and produced the same 5% corneal endothelial cell loss. Therefore, clinically, these two machines behave in a comparable manner relative to safety and effectiveness.

Return-to-play outcomes after microscopic lumbar diskectomy in professional athletes.

PubMed

Watkins, Robert G; Hanna, Robert; Chang, David; Watkins, Robert G

2012-11-01

It has been shown a microscopic lumbar diskectomy (MLD) is effective in getting professional athletes back to their sport after a herniated nucleus pulposus (HNP). There is a need for more information on the time it takes professional athletes to return after surgery. To determine average time for return to play and success in returning to play for professional athletes undergoing MLD. Case series; Level of evidence, 4. Between 1996 and 2010, the senior authors treated 171 professional athletes for lumbar HNP. A retrospective review was performed using patient charts, operative reports, team medical records, and internet search. Eighty-five patients were treated with MLD, and 86 patients were treated nonoperatively. This study focused on the return to play of the operatively treated patients. Primary outcome measures were return rate and average return time, considering only patients whose sport is in season at specific postoperative time points. Of surgically treated patients, 89.3% returned to sport. The average time it took operative patients to return to their sport (return time) was 5.8 months. Progressive return data for surgically treated patients showed the percentage of athletes who returned increased from 50% at 3 months to 72% at 6 months to 77% at 9 months and 84% at 12 months. The chance a player returns to play after MLD is 50% at 3 months, 72% at 6 months, 77% at 9 months, and 84% at 12 months. The overall chance of returning to play at any point is 89%.

Atmospheric Radiation Measurement program climate research facility operations quarterly report July 1 - Sep. 30, 2009.

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

Sisterson, D. L.

2009-10-15

Individual raw data streams from instrumentation at the Atmospheric Radiation Measurement (ARM) Program Climate Research Facility (ACRF) fixed and mobile sites are collected and sent to the Data Management Facility (DMF) at Pacific Northwest National Laboratory (PNNL) for processing in near-real time. Raw and processed data are then sent approximately daily to the ACRF Archive, where they are made available to users. For each instrument, we calculate the ratio of the actual number of data records received daily at the Archive to the expected number of data records. The results are tabulated by (1) individual data stream, site, and monthmore » for the current year and (2) site and fiscal year (FY) dating back to 1998. The U.S. Department of Energy (DOE) requires national user facilities to report time-based operating data. The requirements concern the actual hours of operation (ACTUAL); the estimated maximum operation or uptime goal (OPSMAX), which accounts for planned downtime; and the VARIANCE [1 - (ACTUAL/OPSMAX)], which accounts for unplanned downtime. The OPSMAX time for the fourth quarter of FY 2009 for the Southern Great Plains (SGP) site is 2,097.60 hours (0.95 ? 2,208 hours this quarter). The OPSMAX for the North Slope Alaska (NSA) locale is 1,987.20 hours (0.90 ? 2,208) and for the Tropical Western Pacific (TWP) locale is 1,876.8 hours (0.85 ? 2,208). The ARM Mobile Facility (AMF) was officially operational May 1 in Graciosa Island, the Azores, Portugal, so the OPSMAX time this quarter is 2,097.60 hours (0.95 x 2,208). The differences in OPSMAX performance reflect the complexity of local logistics and the frequency of extreme weather events. It is impractical to measure OPSMAX for each instrument or data stream. Data availability reported here refers to the average of the individual, continuous data streams that have been received by the Archive. Data not at the Archive result from downtime (scheduled or unplanned) of the individual instruments. Therefore, data availability is directly related to individual instrument uptime. Thus, the average percentage of data in the Archive represents the average percentage of the time (24 hours per day, 92 days for this quarter) the instruments were operating this quarter. Table 1 shows the accumulated maximum operation time (planned uptime), actual hours of operation, and variance (unplanned downtime) for the period July 1 - September 30, 2009, for the fixed sites. Because the AMF operates episodically, the AMF statistics are reported separately and not included in the aggregate average with the fixed sites. The fourth quarter comprises a total of 2,208 hours for the fixed and mobile sites. The average of the fixed sites well exceeded our goal this quarter. The AMF data statistic requires explanation. Since the AMF radar data ingest software is being modified, the data are being stored in the DMF for data processing. Hence, the data are not at the Archive; they are anticipated to become available by the next report.« less

[Coronary artery bypass grafting without use of cardiopulmonary bypass].

PubMed

Mujanović, Emir; Bergsland, Jacob; Hadziselimović, Mehdin; Softić, Muniba; Azabagic, Azur; Stanimirović-Mujanović, Sanja; Kabil, Emir

2002-01-01

Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit and total length of hospitalisation in two groups of patients operated with these methods. One hundred and four patients with coronary artery disease operated in Cardiovascular Clinic Tuzla, from September, 1998 to September 2002 divided in two groups, were included in this study. There were 52 patients in the first group operated with CPB and 52 patients in the second group operated without CPB. The groups were matched for gender, age, ejection fraction and preoperative risk factors. The incidence of postoperative complications was lower in patients operated without CPB (5.77% vs. 21.15%). The mortality rate was reduced in patients operated without CPB (0.00% vs. 5.76%). There were reduced need for transfusion in patients operated without CPB (0.28 vs. 1.11 units of blood). The average time spent on respirators was shorter in patients operated without CPB (1.50 vs. 4.76 hours). The average time of total hospitalisation was also shorter in patients operated withouth CPB (6.53 vs. 8.13 days). In conclusion CABG without CPB has many advantages compared to the conventional method. Mortality and morbidity are reduced and there is less need for transfusion. The time spent on mechanical ventilation is reduced and less time is spent in intensive care and the total hospitalisation time is also less.

[Uterine autologous transplantation in cynomolgus monkeys: a preliminary report of 6 case].

PubMed

Wang, Yifeng; Zhu, Ying; Yu, Ping; Chen, Gaowen; Cai, Baota; Zhang, Zhengguang; Liu, Na; Lü, Xiaogang; Xiong, Juxiang; Zhong, Lijuan; Rao, Junhua

2014-12-23

To evaluate the surgical feasibility of uterine autologous transplantation in female cynomolgus monkeys and explore the effect of microsurgical technique. From May 2011 to March 2014, 6 female cynomolgus monkeys, aged 7 to 12 years, were randomly divided into 2 surgical groups. In group A, gross surgeries were performed with naked eyes. In group B, uterine re-transplantation was performed under 10-time-magnifying microscopy. Anatomical data and operative durations were recorded and analyzed. Viable uterine tissue and vascular patency were observed on trans-abdominal ultrasonography and second-look laparotomy after 3 months. The average uterus retrieval time, average vascular anastomotic time, average perfusion time and average total operative time of group B were 88.7, 147.3 and 320.0 min versus 123.7, 180.7 and 393.7 min in group A. The average perfusion durations were 35.0 and 27.3 min. And there was no inter-group difference. A total of 12 successful vascular procedures (including 6 internal iliac arteries and 6 uterine-ovary veins) of vascular anastomosis were recorded in group B versus 4 cases (including 1 artery and 3 veins) in group A (vein, P > 0.05; artery, P < 0.05). In group A, there was only 1 successful operation but uterus turned necrotic after 4 weeks. In group B, the surgical success rate was 100%. However one animal died due to intestinal obstruction. And in another 2 animals, viable uterine tissue and vascular patency were observed on trans-abdominal ultrasonography and second-look laparotomy. Two survivors resumed cyclicity at days 17 and 50 respectively as a sign of re-established uterine function. This study has demonstrated the feasibility of uterus transplantation by vascular anastomosis in cynomolgus monkeys. And assistance of microsurgical technique can significantly improve the success rate of arterial anastomosis during uterus transplantation.

Stability improvement of an operational two-way satellite time and frequency transfer system

NASA Astrophysics Data System (ADS)

Huang, Yi-Jiun; Fujieda, Miho; Takiguchi, Hiroshi; Tseng, Wen-Hung; Tsao, Hen-Wai

2016-04-01

To keep national time accurately coherent with coordinated universal time, many national metrology institutes (NMIs) use two-way satellite time and frequency transfer (TWSTFT) to continuously measure the time difference with other NMIs over an international baseline. Some NMIs have ultra-stable clocks with stability better than 10-16. However, current operational TWSTFT can only provide frequency uncertainty of 10-15 and time uncertainty of 1 ns, which is inadequate. The uncertainty is dominated by the short-term stability and the diurnals, i.e. the measurement variation with a period of one day. The aim of this work is to improve the stability of operational TWSTFT systems without additional transmission, bandwidth or increase in signal power. A software-defined receiver (SDR) comprising a high-resolution correlator and successive interference cancellation associated with open-loop configuration as the TWSTFT receiver reduces the time deviation from 140 ps to 73 ps at averaging time of 1 h, and occasionally suppresses diurnals. To study the source of the diurnals, TWSTFT is performed using a 2  ×  2 earth station (ES) array. Consequently, some ESs sensitive to temperature variation are identified, and the diurnals are significantly reduced by employing insensitive ESs. Hence, the operational TWSTFT using the proposed SDR with insensitive ESs achieves time deviation to 41 ps at 1 h, and 80 ps for averaging times from 1 h to 20 h.

[MINIMALLY INVASIVE PROCEDURE FOR CORRECTION OF PECTUS CARINATUM].

PubMed

Xu, Bing; Liu, Wenying

2015-04-01

To explore the method and experience in correction of pectus carinatum with minimally invasive procedure. Between June 2010 and January 2014, 30 patients with pectus carinatum were corrected by minimally invasive procedure. There were 21 boys and 9 girls whose average age was 13 years and 2 months (range, from 8 years and 10 months to 18 years and 9 months), including 24 cases of first operation, 2 recurrence after traditional pectus carinatum correction, and 4 cases secondary to median thoracotomy. Thirty patients had symmetric and asymmetric mild pectus carinatum. The operation was performed successfully in all patients, and no severe complication occurred. The operation time was 42-95 minutes (mean, 70 minutes). The bleeding volume during operation was 4-30 mL (mean, 10 mL). The time from operation to discharge was 6-10 days (mean, 7 days). The average time of follow-up was 25 months (range, 9-54 months). All surgical wound healed primarily with no infection. The X-ray films showed slight pneumothorax in 7 cases, and it was absorbed after 1 month without treatment. Loosening of internal fixation was found in 1 patient because of trauma at 6 months, and operation was performed again. The bar was removed at 2 years in 21 patients. The patients had good thoracic contour and normal activity. Minimally invasive procedure for correction of pectus carinatum is safe and will get satisfactory effect in maintaining thoracic contour. It has also less trauma and shorter operation time.

Nitrogen dioxide exposures inside ice skating rinks.

PubMed Central

Brauer, M; Spengler, J D

1994-01-01

OBJECTIVES. The common operation of fuel-powered resurfacing equipment in enclosed ice skating rinks has the potential for producing high concentrations of carbon monoxide and nitrogen dioxide. Exposures to these gaseous combustion products may adversely affect the health of those inside the rink. Little information is available on pollutant concentrations under normal operating conditions. METHODS. One-week average nitrogen dioxide concentrations in 70 northeastern US rinks were measured with passive samplers during normal winter season conditions. RESULTS. The median nitrogen dioxide level inside rinks was 180 ppb, more than 10 times higher than the median outdoor concentration. One-week average nitrogen dioxide concentrations above 1000 ppb were measured in 10% of the rinks. CONCLUSIONS. Considering that short-term peak concentrations were likely to have reached two to five times the measured 1-week averages, our results suggest that nitrogen dioxide levels were well above short-term air quality guidelines and constitute a public health concern of considerable magnitude. PMID:8129060

Atmospheric Radiation Measurement program climate research facility operations quarterly report April 1 - June 30, 2007.

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

Sisterson, D. L.

2007-07-26

Individual raw data streams from instrumentation at the Atmospheric Radiation Measurement (ARM) Program Climate Research Facility (ACRF) fixed and mobile sites are collected and sent to the Data Management Facility (DMF) at Pacific Northwest National Laboratory (PNNL) for processing in near real time. Raw and processed data are then sent daily to the ACRF Archive, where they are made available to users. For each instrument, we calculate the ratio of the actual number of data records received daily at the Archive to the expected number of data records. The results are tabulated by (1) individual data stream, site, and monthmore » for the current year and (2) site and fiscal year (FY) dating back to 1998. The U.S. Department of Energy requires national user facilities to report time-based operating data. The requirements concern the actual hours of operation (ACTUAL); the estimated maximum operation or uptime goal (OPSMAX), which accounts for planned downtime; and the VARIANCE [1 - (ACTUAL/OPSMAX)], which accounts for unplanned downtime. The OPSMAX time for the third quarter of FY 2007 for the Southern Great Plains (SGP) site is 2,074.8 hours (0.95 x 2,184 hours this quarter). The OPSMAX for the North Slope Alaska (NSA) locale is 1,965.6 hours (0.90 x 2,184), and that for the Tropical Western Pacific (TWP) locale is 1,856.4 hours (0.85 x 2,184). The OPSMAX time for the ARM Mobile Facility (AMF) is 2,074.8 hours (0.95 x 2,184). The differences in OPSMAX performance reflect the complexity of local logistics and the frequency of extreme weather events. It is impractical to measure OPSMAX for each instrument or data stream. Data availability reported here refers to the average of the individual, continuous data streams that have been received by the Archive. Data not at the Archive are caused by downtime (scheduled or unplanned) of the individual instruments. Therefore, data availability is directly related to individual instrument uptime. Thus, the average percent of data in the Archive represents the average percent of the time (24 hours per day, 91 days for this quarter) the instruments were operating this quarter. Table 1 shows the accumulated maximum operation time (planned uptime), the actual hours of operation, and the variance (unplanned downtime) for the period April 1 through June 30, 2007, for the fixed sites only. The AMF has been deployed to Germany and is operational this quarter. The third quarter comprises a total of 2,184 hours. Although the average exceeded our goal this quarter, there were cash flow issues resulting from Continuing Resolution early in the period that did not allow for timely instrument repairs that kept our statistics lower than past quarters at all sites. The low NSA numbers resulted from missing MFRSR data this spring that appears to be recoverable but not available at the Archive at the time of this report.« less

Turbulent transport measurements with a laser Doppler velocimeter.

NASA Technical Reports Server (NTRS)

Edwards, R. V.; Angus, J. C.; Dunning, J. W., Jr.

1972-01-01

The power spectrum of phototube current from a laser Doppler velocimeter operating in the heterodyne mode has been computed. The spectral width and shape predicted by the theory are in agreement with experiment. For normal operating parameters the time-average spectrum contains information only for times shorter than the Lagrangian-integral time scale of the turbulence. To examine the long-time behavior, one must use either extremely small scattering angles, much-longer-wavelength radiation, or a different mode of signal analysis, e.g., FM detection.

Investigation of Non-Linear Optical Behavior of Semiconductors for Optical Switching. Volume 1.

DTIC Science & Technology

1987-09-30

a ’ 0.001 0.0014 0.0018 0.00 2 0.0026 0.003 0.0034. Figure 36 Plot of average grain size versus heat treatment temperature . i .1...linearity. This NLO behavior. switches on and off in sub-picosecond times. However, the switching time, the NLO coefficient and the operating temperature are...in sub-picosecond times. However, the switching time, the . 9NLO coefficient and the operating temperature are affected by the microstruc- ture of the

Operational frequency stability of rubidium and cesium frequency standards

NASA Technical Reports Server (NTRS)

Lavery, J. E.

1973-01-01

The frequency stabilities under operational conditions of several commercially available rubidium and cesium frequency standards were determined from experimental data for frequency averaging times from 10 to the 7th power s and are presented in table and graph form. For frequency averaging times between 10 to the 5th power and 10 to the 7th power s, the rubidium standards tested have a stability of between 10 to the minus 12th power and 5 x 10 to the minus 12th power, while the cesium standards have a stability of between 2 x 10 to the minus 13th power and 5 x 10 to the minus 13th power.

Atmospheric Radiation Measurement program climate research facility operations quarterly report January 1 - March 31, 2009.

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

Sisterson, D. L.

2009-04-23

Individual raw data streams from instrumentation at the Atmospheric Radiation Measurement (ARM) Program Climate Research Facility (ACRF) fixed and mobile sites are collected and sent to the Data Management Facility (DMF) at Pacific Northwest National Laboratory (PNNL) for processing in near real-time. Raw and processed data are then sent daily to the ACRF Archive, where they are made available to users. For each instrument, we calculate the ratio of the actual number of data records received daily at the Archive to the expected number of data records. The results are tabulated by (1) individual data stream, site, and month formore » the current year and (2) site and fiscal year (FY) dating back to 1998. The U.S. Department of Energy (DOE) requires national user facilities to report time-based operating data. The requirements concern the actual hours of operation (ACTUAL); the estimated maximum operation or uptime goal (OPSMAX), which accounts for planned downtime; and the VARIANCE [1 - (ACTUAL/OPSMAX)], which accounts for unplanned downtime. The OPSMAX time for the second quarter of FY 2009 for the Southern Great Plains (SGP) site is 2,052.00 hours (0.95 x 2,160 hours this quarter). The OPSMAX for the North Slope Alaska (NSA) locale is 1,944.00 hours (0.90 x 2,160), and for the Tropical Western Pacific (TWP) locale is 1,836.00 hours (0.85 x 2,160). The OPSMAX time for the ARM Mobile Facility (AMF) is not reported this quarter because not all of the metadata have been acquired that are used to generate this metric. The differences in OPSMAX performance reflect the complexity of local logistics and the frequency of extreme weather events. It is impractical to measure OPSMAX for each instrument or data stream. Data availability reported here refers to the average of the individual, continuous data streams that have been received by the Archive. Data not at the Archive are caused by downtime (scheduled or unplanned) of the individual instruments. Therefore, data availability is directly related to individual instrument uptime. Thus, the average percentage of data in the Archive represents the average percentage of the time (24 hours per day, 90 days for this quarter) the instruments were operating this quarter. Summary. Table 1 shows the accumulated maximum operation time (planned uptime), actual hours of operation, and variance (unplanned downtime) for the period January 1 - March 31, 2009, for the fixed sites. The AMF has completed its mission in China but not all of the data can be released to the public at the time of this report. The second quarter comprises a total of 2,160 hours. The average exceeded our goal this quarter.« less

[Endoscopic realignment with drainage via a peel-away sheath for the treatment of urethral rupture: A report of 21 cases].

PubMed

Han, Cong-Xiang; Xu, Wei-Jie; Li, Wei; Yu, Zhong-Ying; Li, Jin-Yu; Lin, Xia-Cong; Zhao, Li

2016-07-01

To study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture. We treated 21 urethral rupture patients by endoscopic realignment with drainage via a peel-away sheath using normal saline for irrigation under the normal nephroscope or Li Xun nephroscope, followed by analysis of the clinical results. The operation was successfully accomplished in 20 cases but failed in 1 and none experienced urinary extravasation. In the 14 cases of bulbar urethral rupture, the mean operation time was (5.1±1.6) min and the mean Foley catheter indwelling time was (26.0±5.1) d. Urethral stricture developed in 57.1% (8/14) of the cases after catheter removal, of which 1 was cured by internal urethrotomy and the other 7 by urethral sound dilation, with an average maximum urinary flow rate of (18.8±1.8) ml/s at 12 months after operation. In the 6 cases of posterior urethral rupture, the mean operation time was (15.8±7.5) min and the mean Foley catheter indwelling time was 8 weeks. Urethral stricture developed in all the 6 cases after catheter removal, of which 3 cases were cured by urethral dilation, 1 by internal urethrotomy, and 2 by open urethroplasty. The average maxium urinary flow rate of the 4 cases exempt from open surgery was (17.9±1.9) ml/s at 12 months after operation. Endoscopic realignment with drainage via a peel-away sheath can keep the operative field clear, avoid intraoperative rinse extravasation, shorten the operation time, improve the operation success rate, and achieve satisfactory early clinical outcomes in the treatment of either bulbar or posterior urethral rupture.

[Septic arthrodesis of the talocrural joint].

PubMed

Laky, R; Gazsó, I

1991-01-01

Authors report on 20 arthrodeses of the talocrural joint performed in infected surrounding. The accident anamnesis was the following: Talar fracture (3 cases), malleolar fracture (10 cases), "pylon tibial" fracture (7 cases). The operative method was a simple transversal resection and fixation with fixateur externe. The average time of bony fusion was 9.9 months. The patients were controlled in average 3.8 years after the operation. 17 patients could be controlled, all of them could walk. 6 have their original jobs, 4 have an easier work, 7 are invalids. 12 patients have no pains, 5 have major or minor complaints. All patients judge their state as being better than before the operation.

[Surgical Correction of Scoliosis: Does Intraoperative CT Navigation Prolong Operative Time?

PubMed

Skála-Rosenbaum, J; Ježek, M; Džupa, V; Kadeřábek, R; Douša, P; Rusnák, R; Krbec, M

2016-01-01

PURPOSE OF THE STUDY The aim of the study was to compare the duration of corrective surgery for scoliosis in relation to the intra-operative use of either fluoroscopic or CT navigation. MATERIAL AND METHODS The indication for surgery was adolescent idiopathic scoliosis in younger patients and degenerative scoliosis in middleage or elderly patients. In a retrospective study, treatment outcomes in 43 consecutive patients operated on between April 2011 and April 2014 were compared. Only patients undergoing surgical correction of five or more spinal segments (fixation of six and more vertebrae) were included. RESULTS Transpedicular screw fixation of six to 13 vertebrae was performed under C-arm fluoroscopy guidance in 22 patients, and transpedicular screws were inserted in six to 14 vertebrae using the O-arm imaging system in 21 patients. A total of 246 screws were placed using the C-arm system and 340 screws were inserted using the O-arm system (p < 0.001). The procedures with use of the O-arm system were more complicated and required an average operative time longer by 48% (measured from the first skin incision to the completion of skin suture). However, the mean time needed for one screw placement (the sum of all surgical procedures with the use of a navigation technique divided by the number of screws placed using this technique) was the same in both techniques (19 min). DISCUSSION With good teamwork (surgeons, anaesthesiologists and a radiologist attending to the O-arm system), the time required to obtain one intra-operative CT scan is 3 to 5 minutes. The study showed that the mean time for placement of one screw was identical in both techniques although the average operative time was longer in surgery with O-arm navigation. The 19- minute interval was not the real placement time per screw. It was the sum of all operative times of surgical procedures (from first incision to suture completion including the whole approach within the range of planned stabilization) which used the same navigation technique divided by the number of all screws inserted during the procedures. The longer average operative time in procedures using O-arm navigation was not related to taking intra-operative O-arm scans. The authors consider surgery with an O-arm imaging system to be a safer procedure and use it currently in surgical correction of scoliosis. CONCLUSIONS The study focused on the length of surgery to correct scoliosis performed using either conventional fluoroscopy (C-arm) or intra-operative CT scanning (O-arm) showed that the mean placement time for one screw was identical in both imaging techniques when six or more vertebrae were stabilised. The use of intra-operative CT navigation did not make the surgery longer, and the higher number of inserted screws provides evidence that this technique is safer and allows us to achieve good stability of the correction procedure. Key words: virtual CT guidance, O-arm, scoliosis, transpedicular screw.

Computations of unsteady multistage compressor flows in a workstation environment

NASA Technical Reports Server (NTRS)

Gundy-Burlet, Karen L.

1992-01-01

High-end graphics workstations are becoming a necessary tool in the computational fluid dynamics environment. In addition to their graphic capabilities, workstations of the latest generation have powerful floating-point-operation capabilities. As workstations become common, they could provide valuable computing time for such applications as turbomachinery flow calculations. This report discusses the issues involved in implementing an unsteady, viscous multistage-turbomachinery code (STAGE-2) on workstations. It then describes work in which the workstation version of STAGE-2 was used to study the effects of axial-gap spacing on the time-averaged and unsteady flow within a 2 1/2-stage compressor. The results included time-averaged surface pressures, time-averaged pressure contours, standard deviation of pressure contours, pressure amplitudes, and force polar plots.

Video-Assisted Thoracic Surgical Lobectomy for Lung Cancer: Description of a Learning Curve.

PubMed

Yao, Fei; Wang, Jian; Yao, Ju; Hang, Fangrong; Cao, Shiqi; Cao, Yongke

2017-07-01

Video-assisted thoracic surgical (VATS) lobectomy is gaining popularity in the treatment of lung cancer. The aim of this study is to investigate the learning curve of VATS lobectomy by using multidimensional methods and to compare the learning curve groups with respect to perioperative clinical outcomes. We retrospectively reviewed a prospective database to identify 67 consecutive patients who underwent VATS lobectomy for lung cancer by a single surgeon. The learning curve was analyzed by using moving average and the cumulative sum (CUSUM) method. With the moving average and CUSUM analyses for the operation time, patients were stratified into two groups, with chronological order defining early and late experiences. Perioperative clinical outcomes were compared between the two learning curve groups. According to the moving average method, the peak point for operation time occurred at the 26th case. The CUSUM method also showed the operation time peak point at the 26th case. When results were compared between early- and late-experience periods, the operation time, duration of chest drainage, and postoperative hospital stay were significantly longer in the early-experience group (cases 1 to 26). The intraoperative estimated blood loss was significantly less in the late-experience group (cases 27 to 67). CUSUM charts showed a decreasing duration of chest drainage after the 36th case and shortening postoperative hospital stay after the 37th case. Multidimensional statistical analyses suggested that the learning curve for VATS lobectomy for lung cancer required ∼26 cases. Favorable intraoperative and postoperative care parameters for VATS lobectomy were observed in the late-experience group.

Traffic in the operating room during joint replacement is a multidisciplinary problem

PubMed Central

Bédard, Martin; Pelletier-Roy, Rémi; Angers-Goulet, Mathieu; Leblanc, Pierre-Alexandre; Pelet, Stéphane

2015-01-01

Background Door openings disrupt the laminar air flow and increase the bacterial count in the operating room (OR). We aimed to define the incidence of door openings in the OR during primary total joint arthroplasty (TJA) surgeries and determine whether measures were needed and/or possible to reduce OR staff traffic. Methods We recorded the number of door openings during 100 primary elective TJA surgeries; the OR personnel were unaware of the observer’s intention. Operating time was divided into the preincision period, defined as the time from the opening of surgical trays to skin incision, and the postincision period, defined as time from incision to dressing application. Results The mean number of door openings during primary TJA was 71.1 (range 35–176) with a mean operative time of 111.9 (range 53–220) minutes, for an average of 0.64 (range 0.36–1.05) door openings/min. Nursing staff were responsible for 52.2% of total door openings, followed by anesthesia staff at 23.9% and orthopedic staff at 12.7%. In the preincision period, we observed an average of 0.84 door openings/min, with nursing and orthopedic personnel responsible for most of the door openings. The postincision period yielded an average of 0.54 door openings/min, with nursing and anesthesia personnel being responsible for most of the door openings. Conclusion There is a high incidence of door openings during TJA. Because we observed a range in the number of door openings per surgery, we believe it is possible to reduce this number during TJA. PMID:26022153

Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy.

PubMed

Wu, Cheng; Hua, Li-Xin; Zhang, Jian-Zhong; Zhou, Xun-Rong; Zhong, Wei; Ni, Hao-Dong

2017-01-01

This study was proposed to compare the clinical effectiveness of mini-tract percutaneous nephrolithotomy (MPCNL) with standard-tract percutaneous nephrolithotomy (SPCNL) and verify whether MPCNL is associated with both higher renal pelvic pressure (RPP) and incidence of postoperative fever. A total of 228 patients with kidney stone were randomly allocated to the MPCNL group (n=114) and SPCNL group (n=114). Both intraoperative and postoperative indexes along with the incidence of complications were compared between the two treatment groups. RPP was measured using a baroreceptor which was connected to an open-ended ureteric catheter during the operation of percutaneous nephrolithotomy. The MPCNL group exhibited significantly longer average operation time, more average amount of flush water, and lesser average amount of bleeding during the operation than the SPCNL group (p<0.05). Moreover, significantly lesser average amount of postoperative serum creatinine, shorter average hospital stay, and more average amount of postoperative hemoglobin were observed in the MPCNL group than in the SPCNL group (p<0.05). MPCNL were more applicable to clear caliceal stones (p<0.05), whereas SPCNL were more effective for the removal of simple pelvic stones. The difference in the incidence of postoperative fever between the two treatment groups also appeared to be significant (p<0.05). Logistic regression provided solid evidence that both RPP and its accumulation time at which RPP≥30 mmHg significantly affected the incidence of postoperative fever. MPCNL was correlated with both higher RPP and increased likelihood of postoperative fever compared with SPCNL. Copyright © 2016 The Authors. Published by Elsevier Taiwan.. All rights reserved.

[Midterm follow-up results on Asian femoral intramedullary nail for the treatment of segmental and comminuted femoral fractures].

PubMed

Li, Lang; Gao, Feng; Huang, Qi; Li, Qiang; Xie, Lin; Zhang, Bin

2016-06-01

To investigate midterm follow-up results on Asian femoral intramedullary nail in treating segmental and comminuted femoral fractures. Between June 2011 and October 2012,16 patients with segmental and comminuted femoral fractures were treated with minimally invasive reset and Asian femoral intramedullary nail under extension table. Among them, there were 10 males and 6 females aged from 21 to 49 years old with an average of 34.5 years old; the time from injury to operation ranged from 3 to 24 d with an average of 9.1 d. There were 6 cases were type C1,2 cases were type C2 and 8 cases were type C3 according to AO classification. X-ray of femoral segment at 3,6 and 12 months after operation were applied for evaluating fracture healing. Harris score of hip joint and HSS score of knee joint were used to evaluate postoperative function. All patients were followed up from 24 to 36 months with an average of 28.4 months. Operative time was from 88 to 112 min with an average of 90.7 min; blood loss ranged from 150 to 200 ml with an average of 188.75 ml; the time of fracture healing was from 5 to 9 months with an average of 5.4 months. All incision were healed at stage I. No loosening, breakage of internal fixation and displacement of fracture were occurred. There were no significant differences in Harris score of hip joint at 3, 6 and 12 months after operation (F = 0.07, P = 0.893 > 0.05), 10 cases obtained excellent results, 5 good and 1 moderate. There was no obvious meaning in HSS score of knee joint (F = 0.08,P = 0.876 > 0.05), 9 cases obtained excellent results, 6 good and 1 poor. Asian femoral intramedullary nail could treat segmental and comminuted femoral fractures by using variety of less invasive ways,which has advantages of less trauma, quick recovery of function and satisfied midterm following-up results. But long term following-up effects remains to be seen.

Effects of Repeated Sublethal VX Exposure on Operant Time Estimation in Rats

DTIC Science & Technology

2007-08-01

1 week of food restriction, preliminary behavioral training ( autoshaping ) began. Apparatus Eight commercially available operant chambers for... Autoshaping was used to produce acquisition of lever pressing. Every 50 seconds (range = 10-90 s) on average, the cue light was illuminated and

Rolling element bearing defect diagnosis under variable speed operation through angle synchronous averaging of wavelet de-noised estimate

NASA Astrophysics Data System (ADS)

Mishra, C.; Samantaray, A. K.; Chakraborty, G.

2016-05-01

Rolling element bearings are widely used in rotating machines and their faults can lead to excessive vibration levels and/or complete seizure of the machine. Under special operating conditions such as non-uniform or low speed shaft rotation, the available fault diagnosis methods cannot be applied for bearing fault diagnosis with full confidence. Fault symptoms in such operating conditions cannot be easily extracted through usual measurement and signal processing techniques. A typical example is a bearing in heavy rolling mill with variable load and disturbance from other sources. In extremely slow speed operation, variation in speed due to speed controller transients or external disturbances (e.g., varying load) can be relatively high. To account for speed variation, instantaneous angular position instead of time is used as the base variable of signals for signal processing purposes. Even with time synchronous averaging (TSA) and well-established methods like envelope order analysis, rolling element faults in rolling element bearings cannot be easily identified during such operating conditions. In this article we propose to use order tracking on the envelope of the wavelet de-noised estimate of the short-duration angle synchronous averaged signal to diagnose faults in rolling element bearing operating under the stated special conditions. The proposed four-stage sequential signal processing method eliminates uncorrelated content, avoids signal smearing and exposes only the fault frequencies and its harmonics in the spectrum. We use experimental data1

Effect of preoperative suggestion on postoperative gastrointestinal motility.

PubMed Central

Disbrow, E A; Bennett, H L; Owings, J T

1993-01-01

Autonomic behavior is subject to direct suggestion. We found that patients undergoing major operations benefit more from instruction than from information and reassurance. We compared the return of intestinal function after intra-abdominal operations in 2 groups of patients: the suggestion group received specific instructions for the early return of gastrointestinal motility, and the control group received an equal-length interview offering reassurance and nonspecific instructions. The suggestion group had a significantly shorter average time to the return of intestinal motility, 2.6 versus 4.1 days. Time to discharge was 6.5 versus 8.1 days. Covariates including duration of operation, amount of intraoperative bowel manipulation, and amount of postoperative narcotics were also examined using the statistical model analysis of covariance. An average savings of $1,200 per patient resulted from this simple 5-minute intervention. In summary, the use of specific physiologically active suggestions given preoperatively in a beleivable manner can reduce the morbidity associated with an intra-abdominal operation by reducing the duration of ileus. PMID:8342264

Electron cyclotron resonance plasma production by using pulse mode microwaves and dependences of ion beam current and plasma parameters on the pulse condition

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

Kiriyama, Ryutaro; Takenaka, Tomoya; Kurisu, Yousuke

2012-02-15

We measure the ion beam current and the plasma parameters by using the pulse mode microwave operation in the first stage of a tandem type ECRIS. The time averaged extracted ion beam current in the pulse mode operation is larger than that of the cw mode operation with the same averaged microwave power. The electron density n{sub e} in the pulse mode is higher and the electron temperature T{sub e} is lower than those of the cw mode operation. These plasma parameters are considered to cause in the increase of the ion beam current and are suitable to produce molecularmore » or cluster ions.« less

Depth-averaged instantaneous currents in a tidally dominated shelf sea from glider observations

NASA Astrophysics Data System (ADS)

Merckelbach, Lucas

2016-12-01

Ocean gliders have become ubiquitous observation platforms in the ocean in recent years. They are also increasingly used in coastal environments. The coastal observatory system COSYNA has pioneered the use of gliders in the North Sea, a shallow tidally energetic shelf sea. For operational reasons, the gliders operated in the North Sea are programmed to resurface every 3-5 h. The glider's dead-reckoning algorithm yields depth-averaged currents, averaged in time over each subsurface interval. Under operational conditions these averaged currents are a poor approximation of the instantaneous tidal current. In this work an algorithm is developed that estimates the instantaneous current (tidal and residual) from glider observations only. The algorithm uses a first-order Butterworth low pass filter to estimate the residual current component, and a Kalman filter based on the linear shallow water equations for the tidal component. A comparison of data from a glider experiment with current data from an acoustic Doppler current profilers deployed nearby shows that the standard deviations for the east and north current components are better than 7 cm s-1 in near-real-time mode and improve to better than 6 cm s-1 in delayed mode, where the filters can be run forward and backward. In the near-real-time mode the algorithm provides estimates of the currents that the glider is expected to encounter during its next few dives. Combined with a behavioural and dynamic model of the glider, this yields predicted trajectories, the information of which is incorporated in warning messages issued to ships by the (German) authorities. In delayed mode the algorithm produces useful estimates of the depth-averaged currents, which can be used in (process-based) analyses in case no other source of measured current information is available.

Improved estimation of commuter waiting times using headway and commuter boarding information

NASA Astrophysics Data System (ADS)

Ramli, Muhamad Azfar; Jayaraman, Vasundhara; Kwek, Hyen Chee; Tan, Kian Heong; Lee Kee Khoon, Gary; Monterola, Christopher

2018-07-01

The average amount of waiting time spent by commuters is one of the key indicators of service quality for public bus operations. While actual measurements of actual waiting time is difficult to be done en masse, models of waiting time can be derived from bus headways and these models have been adopted by transport planners in monitoring and regulating service reliability of operators. However, these models are founded on several assumptions on the patterns of commuter arrival which may not be applicable for bus services that experience high demand and heavily fluctuating commuter patterns. Given the availability of granular data on commuter boarding from automated fare collection systems, we propose a new methodology to better estimate the average waiting time of commuters. The formulation is anchored and validated using a three-month dataset from ten selected bus routes in Singapore. Finally, we discuss how our new measure allows for minimization of commuter waiting time through schedule optimization.

[Effect of actoprotectors on the work capacity of operators during modeling of various factors of space flight].

PubMed

Bobkov, Iu G; Epishkin, A K

1988-01-01

This paper presents experimental findings indicating that bemithyl, an actoprotective agent, has a beneficial effect on the health status and work capacity of operators during simulated space flight and 56-hour continuous work. The drug enhanced psychophysiological tolerance of the operators and improved the quality of their work: the quality of their compensatory tracking was on the average 10% higher, the number of errors of their porsuit tracking was 1.8 times lower, and the time of visual signal detection was 2.4 times shorter as compared to the placebo controls.

Lower Extremity Limb Salvage with Cross Leg Pedicle Flap, Cross Leg Free Flap, and Cross Leg Vascular Cable Bridge Flap.

PubMed

Manrique, Oscar J; Bishop, Sarah N; Ciudad, Pedro; Adabi, Kian; Martinez-Jorge, Jorys; Moran, Steven L; Huang, Tony; Vijayasekaran, Aparna; Chen, Shih-Heng; Chen, Hung-Chi

2018-05-16

 Lower extremity salvage following significant soft tissue loss can be complicated by lack of recipient vessel for free tissue transfer. We describe our experience in lower limb salvage for patients with no recipient vessels with the use of pedicle, free and cable bridge flaps.  A retrospective review from 1985 to 2017 of patients undergoing lower limb salvage using a contralateral pedicle cross leg (PCL) flaps, free cross leg (FCL) flaps, or free cable bridge (FCB) flaps was conducted. Demographics, etiology of the reconstruction, type of flap used, donor-site vessels, defect size, operating time, time of pedicle division, length of hospital stay, time to ambulation, and complications were analyzed.  A total of 53 patients (48 males and 5 females) with an average age of 35 years (range, 29-38 years) were identified. The etiology for the reconstruction was trauma in 52 patients and oncological resection in 1 patient. There were 18 PCL, 25 FCL, and 10 FCB completed. The recipient vessels for all flaps were the posterior tibial artery and vein. The average operating room times for PCL, FCL, and FCB flaps were 4, 9, and 10 hours, respectively. The average length of hospital stay was 5 weeks and average time to ambulation was 4 weeks. The average follow-up time was 7.5 years (range, 3-12 years). Complications encountered were hematoma (six), prolonged pain (six), total flap loss (two), reoperation (five), and infection (four). Limb salvage rates were 96.2%.  When ipsilateral limb vessels are not available, and other reconstructive options have been exhausted, cross leg flaps can be a viable option for limb salvage in the setting of extensive defects. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Cost analysis of home care with activity-based costing (ABC)].

PubMed

Lee, Su-Jeong

2004-10-01

This study was carried out to substantiate the application process of activity-based costing on the current cost of hospital home care (HHC) service. The study materials were documents, 120 client charts, health insurance demand bills, salary of 215 HHC nurses, operating expense, 6 HHC agencies, and 31 HHC nurses. The research was carried out by analyzing the HHC activities and then collecting labor and operating expenses. For resource drivers, HHC activity performance time and workload were studied. For activity drivers, the number of HHC activity performances and the activity number of visits were studied. The HHC activities were classified into 70 activities. In resource, the labor cost was 245 won per minute, operating cost was 9,570 won per visit and traffic expense was an average of 12,750 won. In resource drivers, education and training had the longest time of 67 minutes. Average length of performance for activities was 13.7 minutes. The workload was applied as a relative value. The average cost of HHC was 62,741 won and the cost ranged from 55,560 won to 74,016 won. The fixed base rate for a visit in the current HHC medical fee should be increased. Exclusion from the current fee structure or flexible operation of traveling expenses should be reviewed.

An excellent navigation system and experience in craniomaxillofacial navigation surgery: a double-center study

PubMed Central

Dai, Jiewen; Wu, Jinyang; Wang, Xudong; Yang, Xudong; Wu, Yunong; Xu, Bing; Shi, Jun; Yu, Hongbo; Cai, Min; Zhang, Wenbin; Zhang, Lei; Sun, Hao; Shen, Guofang; Zhang, Shilei

2016-01-01

Numerous problems regarding craniomaxillofacial navigation surgery are not well understood. In this study, we performed a double-center clinical study to quantitatively evaluate the characteristics of our navigation system and experience in craniomaxillofacial navigation surgery. Fifty-six patients with craniomaxillofacial disease were included and randomly divided into experimental (using our AccuNavi-A system) and control (using Strker system) groups to compare the surgical effects. The results revealed that the average pre-operative planning time was 32.32 mins vs 29.74 mins between the experimental and control group, respectively (p > 0.05). The average operative time was 295.61 mins vs 233.56 mins (p > 0.05). The point registration orientation accuracy was 0.83 mm vs 0.92 mm. The maximal average preoperative navigation orientation accuracy was 1.03 mm vs 1.17 mm. The maximal average persistent navigation orientation accuracy was 1.15 mm vs 0.09 mm. The maximal average navigation orientation accuracy after registration recovery was 1.15 mm vs 1.39 mm between the experimental and control group. All patients healed, and their function and profile improved. These findings demonstrate that although surgeons should consider the patients’ time and monetary costs, our qualified navigation surgery system and experience could offer an accurate guide during a variety of craniomaxillofacial surgeries. PMID:27305855

A Model for the Stop Planning and Timetables of Customized Buses

PubMed Central

Yang, Yang

2017-01-01

Customized buses (CBs) are a new mode of public transportation and an important part of diversified public transportation, providing advanced, attractive and user-led service. The operational activity of a CB is planned by aggregating space–time demand and similar passenger travel demands. Based on an analysis of domestic and international research and the current development of CBs in China and considering passenger travel data, this paper studies the problems associated with the operation of CBs, such as stop selection, line planning and timetables, and establishes a model for the stop planning and timetables of CBs. The improved immune genetic algorithm (IIGA) is used to solve the model with regard to the following: 1) multiple population design and transport operator design, 2) memory library design, 3) mutation probability design and crossover probability design, and 4) the fitness calculation of the gene segment. Finally, a real-world example in Beijing is calculated, and the model and solution results are verified and analyzed. The results illustrate that the IIGA solves the model and is superior to the basic genetic algorithm in terms of the number of passengers, travel time, average passenger travel time, average passenger arrival time ahead of schedule and total line revenue. This study covers the key issues involving operational systems of CBs, combines theoretical research and empirical analysis, and provides a theoretical foundation for the planning and operation of CBs. PMID:28056041

A Model for the Stop Planning and Timetables of Customized Buses.

PubMed

Ma, Jihui; Zhao, Yanqing; Yang, Yang; Liu, Tao; Guan, Wei; Wang, Jiao; Song, Cuiying

2017-01-01

Customized buses (CBs) are a new mode of public transportation and an important part of diversified public transportation, providing advanced, attractive and user-led service. The operational activity of a CB is planned by aggregating space-time demand and similar passenger travel demands. Based on an analysis of domestic and international research and the current development of CBs in China and considering passenger travel data, this paper studies the problems associated with the operation of CBs, such as stop selection, line planning and timetables, and establishes a model for the stop planning and timetables of CBs. The improved immune genetic algorithm (IIGA) is used to solve the model with regard to the following: 1) multiple population design and transport operator design, 2) memory library design, 3) mutation probability design and crossover probability design, and 4) the fitness calculation of the gene segment. Finally, a real-world example in Beijing is calculated, and the model and solution results are verified and analyzed. The results illustrate that the IIGA solves the model and is superior to the basic genetic algorithm in terms of the number of passengers, travel time, average passenger travel time, average passenger arrival time ahead of schedule and total line revenue. This study covers the key issues involving operational systems of CBs, combines theoretical research and empirical analysis, and provides a theoretical foundation for the planning and operation of CBs.

Crew Factors in Flight Operations. 8; A Survey of Fatigue Factors in Corporate/Executive A Viation Operations

NASA Technical Reports Server (NTRS)

Rosekind, Mark R.; Co, Elizabeth L.; Gregory, Kevin B.; Miller, Donna L.

2000-01-01

Corporate flight crews face unique challenges including unscheduled flights, quickly changing schedules, extended duty days, long waits, time zone changes, and peripheral tasks. Most corporate operations are regulated by Part 91 FARs which set no flight or duty time limits. The objective of this study was to identify operationally significant factors that may influence fatigue, alertness, and performance in corporate operations. In collaboration with the National Business Aircraft Association and the Flight Safety Foundation, NASA developed and distributed a retrospective survey comprising 107 questions addressing demographics, home sleep habits, flight experience, duty schedules, fatigue during operations, and work environment. Corporate crewmembers returned 1,488 surveys. Respondents averaged 45.2 years of age, had 14.9 years of corporate flying experience, and 9,750 total flight hours. The majority (89%) rated themselves as 'good' or 'very good' sleepers at home. Most (82%) indicated they are subject to call for duty and described an average duty day of 9.9 h. About two-thirds reported having a daily duty time limit and over half (57%) reported a daily flight time limit. Nearly three-quarters (71%) acknowledged having 'nodded off' during a flight. Only 21% reported that their flight departments offer training on fatigue issues. Almost three-quarters (74%) described fatigue as a 'moderate' or 'serious' concern, and a majority (61%) characterized it as a common occurrence. Most (85%) identified fatigue as a 'moderate' or 'serious' safety issue.

Atmospheric Radiation Measurement program climate research facility operations quarterly report October 1 - December 31, 2008.

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

Sisterson, D. L.

2009-01-15

Individual raw data streams from instrumentation at the Atmospheric Radiation Measurement (ARM) Program Climate Research Facility (ACRF) fixed and mobile sites are collected and sent to the Data Management Facility (DMF) at Pacific Northwest National Laboratory (PNNL) for processing in near real-time. Raw and processed data are then sent daily to the ACRF Archive, where they are made available to users. For each instrument, they calculate the ratio of the actual number of data records received daily at the Archive to the expected number of data records. The results are tabulated by (1) individual data stream, site, and month formore » the current year and (2) site and fiscal year (FY) dating back to 1998. The US Department of Energy (DOE) requires national user facilities to report time-based operating data. The requirements concern the actual hours of operation (ACTUAL); the estimated maximum operation or uptime goal (OPSMAX), which accounts for planned downtime; and the VARIANCE [1-(ACTUAL/OPSMAX)], which accounts for unplanned downtime. The OPSMAX time for the first quarter of FY 2009 for the Southern Great Plains (SGP) site is 2,097.60 hours (0.95 x 2,208 hours this quarter). The OPSMAX for the North Slope Alaska (NSA) locale is 1,987.20 hours (0.90 x 2,208), and for the Tropical Western Pacific (TWP) locale is 1,876.80 hours (0.85 x 2,208). The OPSMAX time for the ARM Mobile Facility (AMF) is not reported this quarter because the data have not yet been released from China to the DMF for processing. The differences in OPSMAX performance reflect the complexity of local logistics and the frequency of extreme weather events. It is impractical to measure OPSMAX for each instrument or data stream. Data availability reported here refers to the average of the individual, continuous data streams that have been received by the Archive. Data not at the Archive are caused by downtime (scheduled or unplanned) of the individual instruments. Therefore, data availability is directly related to individual instrument uptime. Thus, the average percentage of data in the Archive represents the average percentage of the time (24 hours per day, 92 days for this quarter) the instruments were operating this quarter. Table 1 shows the accumulated maximum operation time (planned uptime), actual hours of operation, and variance (unplanned downtime) for the period October 1-December 31, 2008, for the fixed sites. The AMF has been deployed to China, but the data have not yet been released. The first quarter comprises a total of 2,208 hours. The average exceeded their goal this quarter.« less

[Antero-medial incision of knee joint for the treatment of intercondylar fracture of femur].

PubMed

Yin, Zi-Fei; Sun, Bin-Feng; Yang, Xiao-Hai; Wang, Qing; Qian, Ping-Kang; Wu, Xiao-Feng; Xu, Feng

2017-12-25

To explore the clinical effect of antero-medial incision of knee joint in treating intercondylar fracture of femur. From September 2012 to March 2015, 24 patients with intercondylar fracture of femur were selected, including 17 males and 7 females, aged from 20 to 65 years old with an average of(38.3±9.5) years old. Among them, 12 cases were caused by traffic accident, 8 cases were caused by falling injury and 4 cases were caused by falling down. All patients were closed fractures. The time from injury to hospital was from 30 min to 8 h with an average of(2.2±0.3) h. According to AO classification, 4 cases were type B1, 3 type B2, 2 type B3, 5 type C1, 6 type C2 and 4 type C3. All patients were treated with antero-medial incision of knee joint. Operative time, blood loss and postoperative complications were observed and recovery of keen function was evaluated by Kolmert scoring. All patients were followed-up from 6 to 12 months with average of (9.0±1.7) months. Operative time ranged from 50 to 90 min with an average of (70.0±8.2) min; blood loss ranged from 90 to 400 ml with an average of (180±36) ml; negative pressure flow was from 30 to 90 ml, with an average of (50.0±7.1) ml. All fracture were healed at stage I without loosening of internal fixator, fracture nonunion, and deep vein thrombosis. According to Kolmert scoring, 16 patients got excellent result, 5 patients good and 3 fair. Antero-medial incision of knee joint in treating intercondylar fracture of femur, which has advantages of good fracture reduction, less injury of soft tissue and simple operation, could obtain good clinical results.

Age, circadian rhythms, and sleep loss in flight crews

NASA Technical Reports Server (NTRS)

Gander, Philippa H.; Nguyen, DE; Rosekind, Mark R.; Connell, Linda J.

1993-01-01

Age-related changes in trip-induced sleep loss, personality, and the preduty temperature rhythm were analyzed in crews from various flight operations. Eveningness decreased with age. The minimum of the baseline temperature rhythm occurred earlier with age. The amplitude of the baseline temperature rhythm declined with age. Average daily percentage sleep loss during trips increased with age. Among crewmembers flying longhaul flight operations, subjects aged 50-60 averaged 3.5 times more sleep loss per day than subjects aged 20-30. These studies support previous findings that evening types and subjects with later peaking temperature rhythms adapt better to shift work and time zone changes. Age and circadian type may be important considerations for duty schedules and fatigue countermeasures.

[Analysis and evaluation of the visual effort in remote-control public traffic operators working with computer-based equipments].

PubMed

Gullà, F; Zambelli, P; Bergamaschi, A; Piccoli, B

2007-01-01

The aim of this study is the objective evaluation of the visual effort in 6 public traffic controllers (4 male, 2 female, mean age 29,6), by means of electronic equipment. The electronic equipment quantify the observation distance and the observation time for each controller's occupational visual field. The quantification of these parameters is obtained by the emission of ultrasound at 40 KHz from an emission sensor (placed by the VDT screen) and the ultrasound reception by means of a receiving sensor (placed on the operator's head). The travelling time of the ultrasound (US), as the air speed is known and costant (about 340 m/s), it is used to calculate the distance between the emitting and the receiving sensor. The results show that the visual acuity required is of average level, while accommodation's and convergence's effort vary from average to intense (depending on the visual characteristics of the operator considered), ranging from 26,41 and 43,92% of accommodation and convergence available in each operator. The time actually spent in "near observation within the c.v.p." (Tscr) was maintained in a range from 2h 54' and 4h 05'.

40 CFR 63.2270 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2011 CFR

2011-07-01

... appropriate, monitor malfunctions, associated repairs, and required quality assurance or control activities... monitoring in continuous operation at all times that the process unit is operating. For purposes of calculating data averages, you must not use data recorded during monitoring malfunctions, associated repairs...

40 CFR 63.2270 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2014 CFR

2014-07-01

... control activities (including, as applicable, calibration checks and required zero and span adjustments), you must conduct all monitoring in continuous operation at all times that the process unit is operating. For purposes of calculating data averages, you must not use data recorded during monitoring...

40 CFR 63.2270 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2010 CFR

2010-07-01

... appropriate, monitor malfunctions, associated repairs, and required quality assurance or control activities... monitoring in continuous operation at all times that the process unit is operating. For purposes of calculating data averages, you must not use data recorded during monitoring malfunctions, associated repairs...

40 CFR 63.2270 - How do I monitor and collect data to demonstrate continuous compliance?

Code of Federal Regulations, 2013 CFR

2013-07-01

... control activities (including, as applicable, calibration checks and required zero and span adjustments), you must conduct all monitoring in continuous operation at all times that the process unit is operating. For purposes of calculating data averages, you must not use data recorded during monitoring...

[Treatment of multi-segment fracture of complex femoral shaft with instrument-assisted reduction combined with intramedullary interlocking nail fixation].

PubMed

Fan, Ke-Jie; Chen, Ke; Ma, Wen-Long; Tian, Ke-Wei; Ye, Ye; Chen, Hong-Gan; Tang, Yan-Feng; Cai, Hong-Min

2018-05-25

To investigate the effect of minimally invasive mini-incision and instrumented reduction combined with interlocking intramedullary nailing in the treatment of patients with multi-segment fracture of complex femoral shaft. From January 2013 to January 2016, 32 patients with multiple fractures segments of femoral shaft were treated with instrumentation-assisted reduction combined with interlocking intramedullary nailing, including 22 males and 10 females with an average age of 45 years old ranging 17 to 68 years old. The time from injured to operation was 5 to 10 days with an average of 7 days. After admission, routine tibial tubercle or supracondylar bone traction was performed. The patient's general condition was evaluated, the operation time and intraoperative blood loss were recorded. According to Thorsen femoral fracture morphology evaluation criteria and Hohl knee function evaluation of postoperative efficacy, postoperative fracture healing, complications and postoperative recovery of limb function were observed. All patients were followed up for 6 to 24 months with an average of 12 months. The operative time ranged from 48 to 76 minutes with an average of 67 min. The intraoperative blood loss was 150 to 400 ml with an average of 220 ml. The surgical incisions all achieved grade A healing. The fractures reached the clinical standard of healing. The fracture healing time ranged from 4.2 to 10.8 months with an average of 5.7 months. There were no nonunion, incision infection and internal fixation fracture, failure and other complications. According to Thorsen femoral fracture morphology evaluation criteria, the result was excellent in 28 cases, good in 3 cases, fair in 1 case. According to Hohl knee function evaluation criteria, the result was excellent in 30 cases, good in 2 cases. Instrument-assisted reduction combined with interlocking intramedullary nail fixation is a safe and effective method for the treatment of complex femoral shaft fractures. It has advantages of small trauma, fixed fixation, quick recovery, early postoperative functional exercise. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

A Review of Statistical Failure Time Models with Application of a Discrete Hazard Based Model to 1Cr1Mo-0.25V Steel for Turbine Rotors and Shafts

PubMed Central

2017-01-01

Producing predictions of the probabilistic risks of operating materials for given lengths of time at stated operating conditions requires the assimilation of existing deterministic creep life prediction models (that only predict the average failure time) with statistical models that capture the random component of creep. To date, these approaches have rarely been combined to achieve this objective. The first half of this paper therefore provides a summary review of some statistical models to help bridge the gap between these two approaches. The second half of the paper illustrates one possible assimilation using 1Cr1Mo-0.25V steel. The Wilshire equation for creep life prediction is integrated into a discrete hazard based statistical model—the former being chosen because of its novelty and proven capability in accurately predicting average failure times and the latter being chosen because of its flexibility in modelling the failure time distribution. Using this model it was found that, for example, if this material had been in operation for around 15 years at 823 K and 130 MPa, the chances of failure in the next year is around 35%. However, if this material had been in operation for around 25 years, the chance of failure in the next year rises dramatically to around 80%. PMID:29039773

40 CFR 57.402 - Elements of the supplementary control system.

Code of Federal Regulations, 2013 CFR

2013-07-01

... capable of routine real time measurement of maximum expected SO2 concentrations for the averaging times of... emission curtailment decisions based on the use of real time information from the air quality monitoring... meteorological information necessary to operate the system; (iv) The ambient concentrations and meteorological...

40 CFR 57.402 - Elements of the supplementary control system.

Code of Federal Regulations, 2011 CFR

2011-07-01

... capable of routine real time measurement of maximum expected SO2 concentrations for the averaging times of... emission curtailment decisions based on the use of real time information from the air quality monitoring... meteorological information necessary to operate the system; (iv) The ambient concentrations and meteorological...

40 CFR 57.402 - Elements of the supplementary control system.

Code of Federal Regulations, 2012 CFR

2012-07-01

... capable of routine real time measurement of maximum expected SO2 concentrations for the averaging times of... emission curtailment decisions based on the use of real time information from the air quality monitoring... meteorological information necessary to operate the system; (iv) The ambient concentrations and meteorological...

40 CFR 57.402 - Elements of the supplementary control system.

Code of Federal Regulations, 2014 CFR

2014-07-01

... capable of routine real time measurement of maximum expected SO2 concentrations for the averaging times of... emission curtailment decisions based on the use of real time information from the air quality monitoring... meteorological information necessary to operate the system; (iv) The ambient concentrations and meteorological...

40 CFR 57.402 - Elements of the supplementary control system.

Code of Federal Regulations, 2010 CFR

2010-07-01

... capable of routine real time measurement of maximum expected SO2 concentrations for the averaging times of... emission curtailment decisions based on the use of real time information from the air quality monitoring... meteorological information necessary to operate the system; (iv) The ambient concentrations and meteorological...

Prolonged Operative Duration Increases Risk of Surgical Site Infections: A Systematic Review

PubMed Central

Chen, Brian Po-Han; Soleas, Ireena M.; Ferko, Nicole C.; Cameron, Chris G.; Hinoul, Piet

2017-01-01

Abstract Background: The incidence of surgical site infection (SSI) across surgical procedures, specialties, and conditions is reported to vary from 0.1% to 50%. Operative duration is often cited as an independent and potentially modifiable risk factor for SSI. The objective of this systematic review was to provide an in-depth understanding of the relation between operating time and SSI. Patients and Methods: This review included 81 prospective and retrospective studies. Along with study design, likelihood of SSI, mean operative times, time thresholds, effect measures, confidence intervals, and p values were extracted. Three meta-analyses were conducted, whereby odds ratios were pooled by hourly operative time thresholds, increments of increasing operative time, and surgical specialty. Results: Pooled analyses demonstrated that the association between extended operative time and SSI typically remained statistically significant, with close to twice the likelihood of SSI observed across various time thresholds. The likelihood of SSI increased with increasing time increments; for example, a 13%, 17%, and 37% increased likelihood for every 15 min, 30 min, and 60 min of surgery, respectively. On average, across various procedures, the mean operative time was approximately 30 min longer in patients with SSIs compared with those patients without. Conclusions: Prolonged operative time can increase the risk of SSI. Given the importance of SSIs on patient outcomes and health care economics, hospitals should focus efforts to reduce operative time. PMID:28832271

A novel weight determination method for time series data aggregation

NASA Astrophysics Data System (ADS)

Xu, Paiheng; Zhang, Rong; Deng, Yong

2017-09-01

Aggregation in time series is of great importance in time series smoothing, predicting and other time series analysis process, which makes it crucial to address the weights in times series correctly and reasonably. In this paper, a novel method to obtain the weights in time series is proposed, in which we adopt induced ordered weighted aggregation (IOWA) operator and visibility graph averaging (VGA) operator and linearly combine the weights separately generated by the two operator. The IOWA operator is introduced to the weight determination of time series, through which the time decay factor is taken into consideration. The VGA operator is able to generate weights with respect to the degree distribution in the visibility graph constructed from the corresponding time series, which reflects the relative importance of vertices in time series. The proposed method is applied to two practical datasets to illustrate its merits. The aggregation of Construction Cost Index (CCI) demonstrates the ability of proposed method to smooth time series, while the aggregation of The Taiwan Stock Exchange Capitalization Weighted Stock Index (TAIEX) illustrate how proposed method maintain the variation tendency of original data.

Crew Factors in Flight Operations 7: Psychophysiological Responses to Overnight Cargo Operations

NASA Technical Reports Server (NTRS)

Gander, Philippa H.; Gregory, Kevin B.; Connell, Linda J.; Miller, Donna L.; Graeber, R. Curtis; Rosekind, Mark R.

1996-01-01

To document the psychophysiological effects of flying overnight cargo operations, 41 B-727 crew members (average age 38 yr) were monitored before, during, and after one of two typical 8-day trip patterns. During daytime layovers, the average sleep episode was 3 hr (41%) shorter than nighttime sleeps and was rated as lighter, less restorative, and poorer overall. Sleep was frequently split into several episodes and totaled 1.2 hr less per 24 hr than on pretrip days. Each trip pattern included a night off, which was an effective countermeasure against the accumulating sleep debt. The organization of sleep during daytime layovers reflected the interaction of duty timing with circadian physiology. The circadian temperature rhythm did not adapt completely to the inverted wake-rest schedule on duty days, being delayed by about 3 hr. Highest subjective fatigue and lowest activation occurred around the time of the temperature minimum. On duty days, reports of headaches increased by 400%, of congested nose by 200%, and of burning eyes by 900%. Crew members also reported eating more snacks. Compared with daytime short-haul air-transport operations, the overnight cargo trips included fewer duty and flight hours, and had longer layovers. Overnight cargo crews also averaged 5.4 yr younger than their daytime short-haul counterparts. On trips, both groups lost a comparable amount of sleep per 24 hr, but the overnight cargo crews had shorter individual sleep episodes and more broken sleep. These data clearly demonstrate that overnight cargo operations, like other night work, involve physiological disruption not found in comparable daytime operations.

Turbulent transport measurements with a laser Doppler velocimeter

NASA Technical Reports Server (NTRS)

Edwards, R. V.; Angus, J. C.; Dunning, J. W., Jr.

1972-01-01

The power spectrum of phototube current from a laser Doppler velocimeter operating in the heterodyne mode has been computed. The spectrum is obtained in terms of the space time correlation function of the fluid. The spectral width and shape predicted by the theory are in agreement with experiment. For normal operating parameters the time average spectrum contains information only for times shorter than the Lagrangian integral time scale of the turbulence. To examine the long time behavior, one must use either extremely small scattering angles, much longer wavelength radiation or a different mode of signal analysis, e.g., FM detection.

Autonomous cryogenic sapphire oscillators employing low vibration pulse-tube cryocoolers at NMIJ

NASA Astrophysics Data System (ADS)

Ikegami, Takeshi; Watabe, Ken-ichi; Yanagimachi, Shinya; Takamizawa, Akifumi; Hartnett, John G.

2016-06-01

Two liquid-helium-cooled cryogenic sapphire-resonator oscillators (CSOs), have been modified to operate using cryo-refrigerators and low-vibration cryostats. The Allan deviation of the first CSO was evaluated to be better than 2 x 10-15 for averaging times of 1 s to 30 000 s, which is better than that of the original liquid helium cooled CSO. The Allan deviation of the second CSO is better than 4 x 10-15 from 1 s to 6 000 s averaging time.

Magnetically operated beam dump for dumping high power beams in a neutral beamline

DOEpatents

Dagenhart, W.K.

1984-01-27

It is an object of this invention to provide a beam dump system for a neutral beam generator which lowers the time-averaged power density of the beam dump impingement surface. Another object of this invention is to provide a beam dump system for a neutral particle beam based on reionization and subsequent magnetic beam position modulation of the beam onto a beam dump surface to lower the time-averaged power density of the beam dump ion impingement surface.

Budgeting Facilities Operation Costs Using the Facilities Operation Model

DTIC Science & Technology

2011-06-01

practices that today’s modern buildings have built into them. Several factors can change from the time the requirement is generated to when actual...information is estimated to average 1 hour per response, including the time for reviewing instruction, searching existing data sources, gathering and...BOS required $4.2 billion.2 In FY2012, it is estimated it will reach $4.6 billion.3 Unlike sustainment and modernization , failure to fund facility

Operational summary of an electric propulsion long term test facility

NASA Technical Reports Server (NTRS)

Trump, G. E.; James, E. L.; Bechtel, R. T.

1982-01-01

An automated test facility capable of simultaneously operating three 2.5 kW, 30-cm mercury ion thrusters and their power processors is described, along with a test program conducted for the documentation of thruster characteristics as a function of time. Facility controls are analog, with full redundancy, so that in the event of malfunction the facility automaticcally activates a backup mode and notifies an operator. Test data are recorded by a central data collection system and processed as daily averages. The facility has operated continuously for a period of 37 months, over which nine mercury ion thrusters and four power processor units accumulated a total of over 14,500 hours of thruster operating time.

Developments In Electronic Speckle Pattern Interferometry For Automotive Vibration Analysis.

NASA Astrophysics Data System (ADS)

Davies, Jeremy C.; Buckberry, Clive H.; Jones, Julian D. C.; Pannell, Chris N.

1989-01-01

The incorporation of monomode fibre optics into an argon ion powered Electronic Speckle Pattern Interferometer (ESPI) is reported. The system, consisting of an optics assembly linked to the laser and a CCD camera transceiver, flexibly connected by 40m of monomode fibre optic cable to the optics, has been used to analyse the modal behaviour of structures up to 5m X 3m X 2m in size. Phase modulation of the reference beam in order to operate in a heterodyne mode has been implemented using a piezo-electric crystal operating on the monomode fibre. A new mode of operation - sequential time-average subtraction - and the results of a new processing algorithm are also reported. Their implementation enables speckle free, time-average vibration maps to be generated in real-time on large, unstable structures. Example results for a four cylinder power unit, a vehicle body shell component and an engine oil pan are included. In all cases the analysis was conducted in a general workshop environment without the need for vibration isolation facilities.

Robot-assisted vasovasostomy using a single layer anastomosis.

PubMed

Marshall, Michael T; Doudt, Alexander D; Berger, Jonathan H; Auge, Brian K; Christman, Matthew S; Choe, Chong H

2017-09-01

Of all patients who have vasectomies performed in the United States, upwards of 6% will pursue a vasectomy reversal. Currently, the gold-standard reversal procedure is a microscopic vasovasostomy utilizing either a one or two-layer vasal anastomosis. Unfortunately, most urologists do not perform these procedures as they require extensive training and experience in microsurgery. The objective of our study was to evaluate the feasibility and success rate of robot-assisted vasovasostomy performed at our institution. We completed a retrospective review of our experience with vasectomy reversal utilizing the da Vinci ® Surgical System and a single layer vasal anastomosis. A successful reversal was defined as a return of sperm on semen analysis or light microscopy. Since 2009 we have completed 79 robotic vasectomy reversals, 60 of which utilized a single-layer vasal anastomosis. The average obstructive interval was 5.7 ± 2.2 years. Average operative time was 192 min. 42 patients returned for a post-operative semen evaluation at an average time of 4.3 months post-procedure revealing a success rate of 88% (37 out of 42). Post-operative semen parameters were significant for an average sperm density of 31.0 million/mL with an average motility of 29.1%. Robot-assisted vasovasostomy with a single layer anastomosis has overall success rates that are similar to that of reported microscopic vasovasostomy rates. Although more study is warranted with regard to cost, we feel as though our study demonstrates an alternative approach to vasectomy reversal that can be performed successfully by urologists trained in robotic surgery.

Clinical evaluation of complete solo surgery with the "ViKY®" robotic laparoscope manipulator.

PubMed

Takahashi, Masahiro; Takahashi, Masanori; Nishinari, Naoto; Matsuya, Hideki; Tosha, Tsutomu; Minagawa, Yukihiro; Shimooki, Osamu; Abe, Tadashi

2017-02-01

Advancement in both surgical technique and medical equipment has enabled solo surgery. ViKY ® Endoscope Positioning System (ViKY ® ) is a robotic system that remotely controls an endoscope and provides direct vision control to the surgeon. Here, we report our experience with ViKY ® -assisted solo surgery. We retrospectively examined 25 cases of solo surgery TAPP with ViKY ® . ViKY ® was setup by the surgeon alone, and the setup duration was determined as the time at which the side rail was positioned and that when the endoscope was installed. For assessing the control unit, the number of false movements was counted. We compared the operative results between ViKY ® -assisted solo surgery TAPP and the conventional method with an assistant. The average time to set up ViKY ® was 7.9 min. The average number of commands for ViKY ® during surgery was 98.3, and the average number of errors and no response of control unit was 7.9. The mean duration of surgery was 136 min for the ViKY ® group, including the setup time, and 117 min for the conventional method. No case required an assistant during the operation. There was also no difference between the two groups with regard to postoperative complications and the rate of recurrence. ViKY ® proved reliable in recognizing orders with very few failures, and the operations were performed safely and were comparable to the conventional operations with assistants. Solo surgery with ViKY ® was beneficial in this clinical evaluation.

[Coronary bypass in treatment of high-risk patients].

PubMed

Avdagić, Harun; Mujanović, Emir; Mesanović, Nihad; Sijereić-Avdagić, Selma; Pirić, Melika

2009-01-01

Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit, total length of hospitalisation and number of complication in two groups of patients operated with these methods. Patients with EuroScore > or =5 with CABG operated in Cardiovascular Clinic Tuzla, from May 2000 to May 2005 divided in two groups, were included in this study. There were 100 patients in the first group operated with CPB and 100 patients in the second group operated without CPB. The average time spent on respirators was shorter in patients operated without CPB (3.7 vs.9.74 hours, p = 0.023) and the time spent in Intensive care shorter too (19 vs. 23 days, p = 0.008). Volume of postoperative bleeding was less in patients operated without CPB (574.9 vs. 988.9 ml, p = 0.038), as volume after blood transfusion (168.8 vs. 350.3 mi, p = 0.001). Intraoperative inotrope support was less in patients operated without CPB (8.0 vs. 19.0%, p = 0.038) as postoperative inotrope support (6.0 vs. 17.0%, p = 0.027). The most usual postoperative complication was atrial fibrillation and there was no difference between patients operated with CPB and without CPB (24% vs. 17%, p = 0.293). Mortality was not different in patients operated with or without CPB (2.0% vs. 6.0%, p = 0.140). The average time of total hospitalisation was also shorter in patients operated without CPB (8.0 vs. 9.5 days, p = 0.039. In conclusion CABG without CPB has many advantages compared to the conventional method. Mortality and morbidity are reduced and there is less need for transfusion. The time spent on mechanical ventilation is reduced and less time is spent in intensive care. The total hospitalisation time is also reduced.

Development of a Sonar Oil Tanker Cargo Measurement System.

DTIC Science & Technology

1980-08-01

used at any one time is dependent upon the capacity of the stripping system. The operation is conducted to strip at least as fast , if not faster, than...operational mode, measure the average value and variance of the thickness of an oil layer on an intermit - tent sampling basis. Laboratory testing

40 CFR 61.67 - Emission tests.

Code of Federal Regulations, 2010 CFR

2010-07-01

... being tested is operating at the maximum production rate at which the equipment will be operated and... cross section. The sample is to be extracted at a rate proportional to the gas velocity at the sampling... apply. The average is to be computed on a time weighted basis. (iii) For gas streams containing more...

40 CFR 60.2220 - What must I include in the deviation report?

Code of Federal Regulations, 2010 CFR

2010-07-01

... § 60.2215, for any pollutant or parameter that deviated from the emission limitations or operating... section. (a) The calendar dates and times your unit deviated from the emission limitations or operating limit requirements. (b) The averaged and recorded data for those dates. (c) Durations and causes of each...

Time and frequency domain characteristics of detrending-operation-based scaling analysis: Exact DFA and DMA frequency responses

NASA Astrophysics Data System (ADS)

Kiyono, Ken; Tsujimoto, Yutaka

2016-07-01

We develop a general framework to study the time and frequency domain characteristics of detrending-operation-based scaling analysis methods, such as detrended fluctuation analysis (DFA) and detrending moving average (DMA) analysis. In this framework, using either the time or frequency domain approach, the frequency responses of detrending operations are calculated analytically. Although the frequency domain approach based on conventional linear analysis techniques is only applicable to linear detrending operations, the time domain approach presented here is applicable to both linear and nonlinear detrending operations. Furthermore, using the relationship between the time and frequency domain representations of the frequency responses, the frequency domain characteristics of nonlinear detrending operations can be obtained. Based on the calculated frequency responses, it is possible to establish a direct connection between the root-mean-square deviation of the detrending-operation-based scaling analysis and the power spectrum for linear stochastic processes. Here, by applying our methods to DFA and DMA, including higher-order cases, exact frequency responses are calculated. In addition, we analytically investigate the cutoff frequencies of DFA and DMA detrending operations and show that these frequencies are not optimally adjusted to coincide with the corresponding time scale.

Time and frequency domain characteristics of detrending-operation-based scaling analysis: Exact DFA and DMA frequency responses.

PubMed

Kiyono, Ken; Tsujimoto, Yutaka

2016-07-01

We develop a general framework to study the time and frequency domain characteristics of detrending-operation-based scaling analysis methods, such as detrended fluctuation analysis (DFA) and detrending moving average (DMA) analysis. In this framework, using either the time or frequency domain approach, the frequency responses of detrending operations are calculated analytically. Although the frequency domain approach based on conventional linear analysis techniques is only applicable to linear detrending operations, the time domain approach presented here is applicable to both linear and nonlinear detrending operations. Furthermore, using the relationship between the time and frequency domain representations of the frequency responses, the frequency domain characteristics of nonlinear detrending operations can be obtained. Based on the calculated frequency responses, it is possible to establish a direct connection between the root-mean-square deviation of the detrending-operation-based scaling analysis and the power spectrum for linear stochastic processes. Here, by applying our methods to DFA and DMA, including higher-order cases, exact frequency responses are calculated. In addition, we analytically investigate the cutoff frequencies of DFA and DMA detrending operations and show that these frequencies are not optimally adjusted to coincide with the corresponding time scale.

PubMed Central

SARTINI, M.; PANATTO, D.; PERDELLI, F.; CRISTINA, M.L.

2013-01-01

Summary An experimental study was conducted in a hospital in Liguria (northern Italy) on two groups of patients with the same disease severity who were undergoing the same type of surgery (primary hemiarthroplasty). Our aim was to assessing the results of a quality- improvement scheme implemented in the operating room. The quality-improvement protocol involved analyzing a set of parameters concerning the operating team's behavior and environmental conditions that could be attributed to the operating team itself. A program of training and sanitary education was carried to rectify any improper behavior of the operating staff. Two hundred and six hip-joint replacement operations (primary hip hemiarthroplasty - ICD9-CM 81.51) all conducted in the same operating room were studied: 103 patients, i.e. operations performed before the quality-improvement scheme and 103 patients, i.e. operations performed after the quality improvement scheme; all were comparable in terms of type of surgery and severity. The scheme resulted in an improvement in both behavioral and environmental parameters and an 80% reduction in the level of microbial air contamination (p < 0.001). Patient outcomes improved in terms of average postoperative hospitalization time, the occurrence and duration of fever (>37.5°C) and microbiological contamination of surgical wounds. From an economic point of view, facility efficiency increased by 28.57%, average hospitalization time decreased (p<0.001) and a theoretical increase of € 1,441,373.58 a year in revenues was achieved. PMID:24396985

Configuring Airspace Sectors with Approximate Dynamic Programming

NASA Technical Reports Server (NTRS)

Bloem, Michael; Gupta, Pramod

2010-01-01

In response to changing traffic and staffing conditions, supervisors dynamically configure airspace sectors by assigning them to control positions. A finite horizon airspace sector configuration problem models this supervisor decision. The problem is to select an airspace configuration at each time step while considering a workload cost, a reconfiguration cost, and a constraint on the number of control positions at each time step. Three algorithms for this problem are proposed and evaluated: a myopic heuristic, an exact dynamic programming algorithm, and a rollouts approximate dynamic programming algorithm. On problem instances from current operations with only dozens of possible configurations, an exact dynamic programming solution gives the optimal cost value. The rollouts algorithm achieves costs within 2% of optimal for these instances, on average. For larger problem instances that are representative of future operations and have thousands of possible configurations, excessive computation time prohibits the use of exact dynamic programming. On such problem instances, the rollouts algorithm reduces the cost achieved by the heuristic by more than 15% on average with an acceptable computation time.

Some series of intuitionistic fuzzy interactive averaging aggregation operators.

PubMed

Garg, Harish

2016-01-01

In this paper, some series of new intuitionistic fuzzy averaging aggregation operators has been presented under the intuitionistic fuzzy sets environment. For this, some shortcoming of the existing operators are firstly highlighted and then new operational law, by considering the hesitation degree between the membership functions, has been proposed to overcome these. Based on these new operation laws, some new averaging aggregation operators namely, intuitionistic fuzzy Hamacher interactive weighted averaging, ordered weighted averaging and hybrid weighted averaging operators, labeled as IFHIWA, IFHIOWA and IFHIHWA respectively has been proposed. Furthermore, some desirable properties such as idempotency, boundedness, homogeneity etc. are studied. Finally, a multi-criteria decision making method has been presented based on proposed operators for selecting the best alternative. A comparative concelebration between the proposed operators and the existing operators are investigated in detail.

Alternate charging and discharging of capacitor to enhance the electron production of bioelectrochemical systems.

PubMed

Liang, Peng; Wu, Wenlong; Wei, Jincheng; Yuan, Lulu; Xia, Xue; Huang, Xia

2011-08-01

A bioelectrochemical system (BES) can be operated in both "microbial fuel cell" (MFC) and "microbial electrolysis cell" (MEC) modes, in which power is delivered and invested respectively. To enhance the electric current production, a BES was operated in MFC mode first and a capacitor was used to collect power from the system. Then the charged capacitor discharged electrons to the system itself, switching into MEC mode. This alternate charging and discharging (ACD) mode helped the system produce 22-32% higher average current compared to an intermittent charging (IC) mode, in which the capacitor was first charged from an MFC and then discharged to a resistor, at 21.6 Ω external resistance, 3.3 F capacitance and 300 mV charging voltage. The effects of external resistance, capacitance and charging voltage on average current were studied. The average current reduced as the external resistance and charging voltage increased and was slightly affected by the capacitance. Acquisition of higher average current in the ACD mode was attributed to the shorter discharging time compared to the charging time, as well as a higher anode potential caused by discharging the capacitor. Results from circuit analysis and quantitatively calculation were consistent with the experimental observations.

The Experimental Study about the Effect of Operating Conditions on Multi-tube Pulse Detonation Engine Performance

NASA Astrophysics Data System (ADS)

Kim, Jung-Min; Han, Hyung-Seok; Choi, Jeong-Yeol

2018-04-01

This study examines a multi-tube pulse detonation engine (PDE) which has a type of constant volume combustion. We designed and made the multi-tube PDE and then conducted an experiment in various operating frequencies and equivalence ratios. First, experiments with operating frequencies of 40, 80, 120, 160, and 200 Hz resulted in an average thrust and specific impulse 23.14 N and 42.34 s. The next experiment resulted in the equivalence ratio varying from 0.81 to 1.38, which resulted in an average thrust and specific impulse 22.36 N and 40.11 s. The average detonation velocity was 8% lower than that calculated according to C-J theory. The incidence ratios of the detonation wave were stable with the exception of the operating frequency of 200 Hz. However, at 200 Hz, the incidence ratio was less than 50%. We assumed that a low fill fraction occurred for this problem. The thrust of the PDE increased with the operating frequency. However, the thrust increase was at a lower rate than in previous studies, because of a lost thrust output result from the slow response time of the load cell amplifier.

A Tropospheric Emission Spectrometer HDO/H2O Retrieval Simulator for Climate Models

NASA Technical Reports Server (NTRS)

Field, R. D.; Risi, C.; Schmidt, G. A.; Worden, J.; Voulgarakis, A.; LeGrande, A. N.; Sobel, A. H.; Healy, R. J.

2012-01-01

Retrievals of the isotopic composition of water vapor from the Aura Tropospheric Emission Spectrometer (TES) have unique value in constraining moist processes in climate models. Accurate comparison between simulated and retrieved values requires that model profiles that would be poorly retrieved are excluded, and that an instrument operator be applied to the remaining profiles. Typically, this is done by sampling model output at satellite measurement points and using the quality flags and averaging kernels from individual retrievals at specific places and times. This approach is not reliable when the model meteorological conditions influencing retrieval sensitivity are different from those observed by the instrument at short time scales, which will be the case for free-running climate simulations. In this study, we describe an alternative, categorical approach to applying the instrument operator, implemented within the NASA GISS ModelE general circulation model. Retrieval quality and averaging kernel structure are predicted empirically from model conditions, rather than obtained from collocated satellite observations. This approach can be used for arbitrary model configurations, and requires no agreement between satellite-retrieved and model meteorology at short time scales. To test this approach, nudged simUlations were conducted using both the retrieval-based and categorical operators. Cloud cover, surface temperature and free-tropospheric moisture content were the most important predictors of retrieval quality and averaging kernel structure. There was good agreement between the D fields after applying the retrieval-based and more detailed categorical operators, with increases of up to 30 over the ocean and decreases of up to 40 over land relative to the raw model fields. The categorical operator performed better over the ocean than over land, and requires further refinement for use outside of the tropics. After applying the TES operator, ModelE had D biases of 8 over ocean and 34 over land compared to TES D, which were less than the biases using raw model D fields.

[Early total care pattern for intertrochanteric fracture of femur in the elderly].

PubMed

Gu, Jie; Kang, Xin-yong; Xu, Hong-wei; Li, Yong-fu; Zahng, Bin; Guo, Jian; He, Zhen-nian

2016-06-01

To evaluate clinical results of early total care (ETC) treatment for elderly patients with intertrochanteric femur fractures. Clinical data of 106 elderly patients with intertrochanteric fracture treated from January 2012 and February 2015 were retrospectively studied. According to whether receiving the early total care mode, the patients were divided into 2 groups, 34 cases were diagnosed and treated with early total care pattern (ETC group), including 14 males and 20 females with an average age of (74.88 ± 4.38) years old ranging from 70 to 86. According to Evans types, 4 cases were type I, 5 cases were type II, 13 cases were type III, 11 cases were type IV, 1 case was type V. Seventy-two patients were treated with conventional trauma method (conventional group), including 35 males and 37 females with an average age of (74.46 ± 3.63) years old ranging from 70 to 85. According to Evans type, 8 cases were type I ,13 cases were type II, 25 cases were type III, 25 cases were type IV, and 1 case was type V. All fractures were treated with proximal femoral nails anti-rotation (PFNA). Operative time, hospital stays, leaving bed time, complications, cases of death at 1 year after operation, postoperative Harris score at 12 months were observed and compared. All patients were followed up, the time of ETC group ranged from 9 to 18 months with an average of 13.29 ± 1.51, and the time in conventional group ranged from 12 to 16 months with an average 12.93 ± 1.15, while there was no significant difference between two groups in time of following-up (t = 1.368, P = 0.174). There was no significant meaning in cases of death between ETC group (2 cases) and conventional group (8 cases). Three cases occurred complications in ETC group, and 20 cases in conventional group,there was obvious meaning between two groups (χ² = 0.739, P = 0.318). Operative time,hospital stays,leaving bed time in ETC group respectively was (2.03 ± 0.67) d, (15.41 ± 2.87) d and (3.62 ± 0.74) d; while in conventional group respectively was (4.17 ± 1.59) d, (20.11 ± 4.24) d and (5.35 ± 1.22) d; there were significant differences between two groups in operative time, hospital stays, leaving bed time. Postoperative Harris scores at 12 months in ETC group was (82.32 ± 4.56), and (79.24 ± 5.52) in conventional group, there was obvious meaning between two groups (t = 2.833, P = 0.006). ETC pattern is a novel method for diagnosis and treatment of intertrochanteric femur fractures in elderly, it could shorten operative time, hospital stays, leaving bed time, decrease complications and promote recovery of function.

[Estimation of surgical treatment capacity for managing mass casualty incidents based on time needed for life-saving emergency operations].

PubMed

Kanz, K-G; Huber-Wagner, S; Lefering, R; Kay, M; Qvick, M; Biberthaler, P; Mutschler, W

2006-04-01

The surgical treatment capacity of a hospital constitutes a significant restriction in the capability to deal with critically injured patients from multiple or mass casualty incidents (MCI). With regard to the time needed for life-saving operative interventions there are no basic reference values available in the literature, which can aid in detailed planning for management of mass casualty incidents. The data of 20,815 trauma patients, recorded in the trauma registry hosted by the German Association for Trauma Surgery DGU, were analyzed to extract the median duration of life-saving surgical interventions carried out in an operating theatre. Inclusion criteria were an ISS > or = 16 and the performance of relevant ICPM coded procedures within 6 h after trauma room admission. Orthopedic procedures as well as the placement of ICP catheters and chest tubes or performance of laparoscopies were not included. Complete data sets with the required variables were available from 9,988 trauma patients with an ISS > or = 16, and included 7,907 interventions that took place within 6 h after hospital admission. From among 1,228 patients 1,793 operations could be identified as relevant life-saving emergency operations. Acute injury to the abdomen was the major cause accounting for 54.1% of all emergency surgical procedures with a median intervention duration of 137 min followed by head injuries accounting for 26.3% with a median duration of 110 min. Interventions in the pelvis amounted to 11.5% taking an average of 136 min, 5.0% were in the thorax requiring 91 min and 3.1% major amputations with 142 min. The average cut to suture time for all emergency surgical interventions was 130 min. A prerequisite for estimating the surgical operation capacity for critically injured patients of an MCI is the number of OR teams available during and outside of the normal working hours of the hospital. The average operation time of 130 min calculated from investigation of 1,793 emergency life-saving surgical procedures provides a realistic guideline. Used in combination with the number of available OR teams the prospective treatment capacity can be estimated and projected into an actual incident admission capacity. The identification and numerical value of such significant variables are the basis for operations research and realistic planning in emergency and disaster medicine.

The role of laparoscopic Heller myotomy in the treatment of achalasia.

PubMed

Zonca, P; Cambal, M; Labas, P; Hrbaty, B; Jacobi, C A

2014-01-01

To evaluate the results of laparoscopic Heller myotomy in our group of patients. A retrospective clinical trial was carried out to evaluate the indication, technique and controversies of laparoscopic Heller myotomy in the achalasia treatment. The following symptoms were evaluated prior and after Heller myotomy: dysphagia, heartburn, nausea/vomiting after meal and asthma/coughing. The patients were evaluated by the use of Likert score. Statistical analysis was performed by using Student t test. The intra-operative (operation time, intraoperative complications, blood loss, conversion rate), and peri-operative parameters (morbidity, mortality, hospital stay) were evaluated as well. The patients who underwent laparoscopic Heller myotomy were included in the trial. All patients were perioperatively managed by a multidisciplinary team. The evaluation of fourteen patients was performed (average age: 53.2 yrs., eleven men, two women, BMI 23.6 kg/m(2)). The patients were indicated for surgery in all of the stages (I-III). Previous semiconservative therapeutic modalities were performed in thirteen patients. The standard laparoscopic technique for Heller myotomy with semifundoplication was applied. All the observed symptoms were statistically improved after the surgery (p=0.05). The average operating time was 89 minutes. Intraoperative blood loss was below 20 ml. There was no conversion to open surgery. An average hospital stay was 4.3 days. Morbidity was 14.3 % and mortality 0 %. In one patient esophageal mucosa perforation was intra-operatively identified and sutured. Post-operative course in this patient was without any complications. The laparoscopic Heller myotomy has become the "gold standard" procedure for achalasia. It is an excellent method allowing precise operation technique with good visualization of the esophagogastric junction. The operation with this approach is safe, efficient, and with excellent reproducible operative results. The correct and early indication for surgery is crucial. The delayed diagnosis with a late indication for surgery is not an exemption (Tab. 2, Fig. 2, Ref. 36).

Atmospheric Radiation Measurement Program Climate Research Facility Operations Quarterly Report. October 1 - December 31, 2010.

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

Sisterson, D. L.

2011-02-01

Individual raw datastreams from instrumentation at the Atmospheric Radiation Measurement (ARM) Climate Research Facility fixed and mobile sites are collected and sent to the Data Management Facility (DMF) at Pacific Northwest National Laboratory (PNNL) for processing in near-real time. Raw and processed data are then sent approximately daily to the ARM Archive, where they are made available to users. For each instrument, we calculate the ratio of the actual number of processed data records received daily at the Archive to the expected number of data records. The results are tabulated by (1) individual datastream, site, and month for the currentmore » year and (2) site and fiscal year (FY) dating back to 1998. The U.S. Department of Energy (DOE) requires national user facilities to report time-based operating data. The requirements concern the actual hours of operation (ACTUAL); the estimated maximum operation or uptime goal (OPSMAX), which accounts for planned downtime; and the VARIANCE [1 - (ACTUAL/OPSMAX)], which accounts for unplanned downtime. The OPSMAX time for the first quarter of FY2010 for the Southern Great Plains (SGP) site is 2097.60 hours (0.95 x 2208 hours this quarter). The OPSMAX for the North Slope Alaska (NSA) locale is 1987.20 hours (0.90 x 2208) and for the Tropical Western Pacific (TWP) locale is 1876.80 hours (0.85 x 2208). The first ARM Mobile Facility (AMF1) deployment in Graciosa Island, the Azores, Portugal, continued through this quarter, so the OPSMAX time this quarter is 2097.60 hours (0.95 x 2208). The second ARM Mobile Facility (AMF2) began deployment this quarter to Steamboat Springs, Colorado. The experiment officially began November 15, but most of the instruments were up and running by November 1. Therefore, the OPSMAX time for the AMF2 was 1390.80 hours (.95 x 1464 hours) for November and December (61 days). The differences in OPSMAX performance reflect the complexity of local logistics and the frequency of extreme weather events. It is impractical to measure OPSMAX for each instrument or datastream. Data availability reported here refers to the average of the individual, continuous datastreams that have been received by the Archive. Data not at the Archive are caused by downtime (scheduled or unplanned) of the individual instruments. Therefore, data availability is directly related to individual instrument uptime. Thus, the average percentage of data in the Archive represents the average percentage of the time (24 hours per day, 92 days for this quarter) the instruments were operating this quarter. Summary. Table 1 shows the accumulated maximum operation time (planned uptime), actual hours of operation, and variance (unplanned downtime) for the period October 1-December 31, 2010, for the fixed sites. Because the AMFs operate episodically, the AMF statistics are reported separately and not included in the aggregate average with the fixed sites. This first quarter comprises a total of 2,208 possible hours for the fixed sites and the AMF1 and 1,464 possible hours for the AMF2. The average of the fixed sites exceeded our goal this quarter. The AMF1 has essentially completed its mission and is shutting down to pack up for its next deployment to India. Although all the raw data from the operational instruments are in the Archive for the AMF2, only the processed data are tabulated. Approximately half of the AMF2 instruments have data that was fully processed, resulting in the 46% of all possible data made available to users through the Archive for this first quarter. Typically, raw data is not made available to users unless specifically requested.« less

Time and motion studies of National Health Service cataract theatre lists to determine strategies to improve efficiency.

PubMed

Roberts, Harry W; Myerscough, James; Borsci, Simone; Ni, Melody; O'Brart, David P S

2017-11-24

To provide a quantitative assessment of cataract theatre lists focusing on productivity and staffing levels/tasks using time and motion studies. National Health Service (NHS) cataract theatre lists were prospectively observed in five different institutions (four NHS hospitals and one private hospital). Individual tasks and their timings of every member of staff were recorded. Multiple linear regression analyses were performed to investigate possible associations between individual timings and tasks. 140 operations were studied over 18 theatre sessions. The median number of scheduled cataract operations was 7 (range: 5-14). The average duration of an operation was 10.3 min±(SD 4.11 min). The average time to complete one case including patient turnaround was 19.97 min (SD 8.77 min). The proportion of the surgeons' time occupied on total duties or operating ranged from 65.2% to 76.1% and from 42.4% to 56.7%, respectively. The correlations of the surgical time to patient time in theatre was R 2 =0.95. A multiple linear regression model found a significant association (F(3,111)=32.86, P<0.001) with R 2 =0.47 between the duration of one operation and the number of allied healthcare professionals (AHPs), the number of AHP key tasks and the time taken to perform these key tasks by the AHPs. Significant variability in the number of cases performed and the efficiency of patient flow were found between different institutions. Time and motion studies identified requirements for high-volume models and factors relating to performance. Supporting the surgeon with sufficient AHPs and tasks performed by AHPs could improve surgical efficiency up to approximately double productivity over conventional theatre models. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The value of time-averaged serum high-sensitivity C-reactive protein in prediction of mortality and dropout in peritoneal dialysis patients.

PubMed

Liu, Shou-Hsuan; Chen, Chao-Yu; Li, Yi-Jung; Wu, Hsin-Hsu; Lin, Chan-Yu; Chen, Yung-Chang; Chang, Ming-Yang; Hsu, Hsiang-Hao; Ku, Cheng-Lung; Tian, Ya-Chung

2017-01-01

C-reactive protein (CRP) is a useful biomarker for prediction of long-term outcomes in patients undergoing chronic dialysis. This observational cohort study evaluated whether the time-averaged serum high-sensitivity CRP (HS-CRP) level was a better predictor of clinical outcomes than a single HS-CRP level in patients undergoing peritoneal dialysis (PD). We classified 335 patients into three tertiles according to the time-averaged serum HS-CRP level and followed up regularly from January 2010 to December 2014. Clinical outcomes such as cardiovascular events, infection episodes, newly developed malignancy, encapsulating peritoneal sclerosis (EPS), dropout (death plus conversion to hemodialysis), and mortality were assessed. During a 5-year follow-up, 164 patients (49.0%) ceased PD; this included 52 patient deaths (15.5%), 100 patients (29.9%) who converted to hemodialysis, and 12 patients (3.6%) who received a kidney transplantation. The Kaplan-Meier survival analysis and log-rank test revealed a significantly worse survival accumulation in patients with high time-average HS-CRP levels. A multivariate Cox regression analysis revealed that a higher time-averaged serum HS-CRP level, older age, and the occurrence of cardiovascular events were independent mortality predictors. A higher time-averaged serum HS-CRP level, the occurrence of cardiovascular events, infection episodes, and EPS were important predictors of dropout. The receiver operating characteristic analysis verified that the value of the time-average HS-CRP level in predicting the 5-year mortality and dropout was superior to a single serum baseline HS-CRP level. This study shows that the time-averaged serum HS-CRP level is a better marker than a single baseline measurement in predicting the 5-year mortality and dropout in PD patients.

Redefining the Surgical Council of Resident Education (SCORE) Curriculum: A Comparison with the Operative Experiences of Graduated General Surgical Residents.

PubMed

Strosberg, David S; Quinn, Kristen M; Abdel-Misih, Sherif R; Harzman, Alan E

2018-04-01

Our objective was to investigate the number and classify surgical operations performed by general surgery residents and compare these with the updated Surgical Council on Resident Education (SCORE) curriculum. We performed a retrospective review of logged surgical cases from general surgical residents who completed training at a single center from 2011 to 2015. The logged cases were correlated with the operations extracted from the SCORE curriculum. Hundred and fifty-one procedures were examined; there were 98 "core" and 53 "advanced" cases as determined by the SCORE. Twenty-eight residents graduated with an average of 1017 major cases. Each resident completed 66 (67%) core cases and 17 (32%) advanced cases an average of one or more times with 39 (40%) core cases and 6 (11%) advanced cases completed five or more times. Core procedures that are infrequently or not performed by residents should be identified in each program to focus on resident education.

Experimental analysis of robot-assisted needle insertion into porcine liver.

PubMed

Wang, Wendong; Shi, Yikai; Goldenberg, Andrew A; Yuan, Xiaoqing; Zhang, Peng; He, Lijing; Zou, Yingjie

2015-01-01

How to improve placement accuracy of needle insertion into liver tissue is of paramount interest to physicians. A robot-assisted system was developed to experimentally demonstrate its advantages in needle insertion surgeries. Experiments of needle insertion into porcine liver tissue were performed with conic tip needle (diameter 8 mm) and bevel tip needle (diameter 1.5 mm) in this study. Manual operation was designed to compare the performance of the presented robot-assisted system. The real-time force curves show outstanding advantages of robot-assisted operation in improving the controllability and stability of needle insertion process by comparing manual operation. The statistics of maximum force and average force further demonstrates robot-assisted operation causes less oscillation. The difference of liver deformation created by manual operation and robot-assisted operation is very low, 1 mm for average deformation and 2 mm for maximum deformation. To conclude, the presented robot-assisted system can improve placement accuracy of needle by stably control insertion process.

Retrospective testing and case series study of porcine delta coronavirus in U.S. swine herds.

PubMed

McCluskey, Brian J; Haley, Charles; Rovira, Albert; Main, Rodger; Zhang, Yan; Barder, Sunny

2016-01-01

Porcine deltacoronavirus (PDCoV) was first reported in the United States (US) in February 2014. This was the second novel swine enteric coronavirus detected in the US since May 2013. In this study, we conducted retrospective testing of samples submitted to three veterinary diagnostic laboratories where qualifying biological samples were derived from previously submitted diagnostic case submissions from US commercial swine farms with a clinical history of enteric disease or from cases that had been previously tested for transmissible gastroenteritis virus, PEDV, or rotavirus. Overall, 2286 banked samples were tested from 27 States. Samples were collected in 3 separate years and in 17 different months. Test results revealed 4 positive samples, 3 collected in August 2013 and 1 collected in October 2013. In addition, a case series including 42 operations in 10 States was conducted through administration of a survey. Survey data collected included information on characteristics of swine operations that had experienced PDCoV clinical signs. Special emphasis was placed on obtaining descriptive estimates of biosecurity practices and disease status over time of each operation. Clinical signs of PDCoV were reported to be similar to those of PEDV. The average number of animals on each operation exhibiting clinical signs (morbidity) and the average number of case fatalities was greatest for suckling and weaned pigs. Average operation-level weaned pig morbidity was greatest in the first week of the outbreak while average operation-level suckling pig case fatality was greatest in the second week of the outbreak. The survey included questions regarding biosecurity practices for visitors and operation employees; trucks, equipment and drivers; and feed sources. These questions attempted to identify a likely pathway of introduction of PDCoV onto the operations surveyed. Published by Elsevier B.V.

Surgical management and clinical prognosis of adrenocortical carcinoma.

PubMed

Dong, Dexin; Li, Hanzhong; Yan, Weigang; Ji, Zhigang; Mao, Quanzong

2012-01-01

To study the relationship between surgical management and prognosis of adrenocortical carcinoma (ACC) in order to guide the surgical management of ACC. Clinical data of 45 cases of ACC treated in our hospital were retrospectively analyzed. The 45 cases included 3 cases in stage I, 12 cases in stage II, 7 cases in stage III, and 23 cases in stage IV. 17 cases underwent complete excision, 14 cases underwent palliative excision, 8 cases had non-operative treatment and 6 cases gave up treatment. All patients were followed up from 2 to 141 months. The average survival time of 31 patients with surgery was 32.46 months, and the average survival time of 14 patients without surgery was 4.75 months. There were statistically significant differences between the two groups (p < 0.01). There were no statistically significant differences between the two groups in survival time in stage III and stage IV (p > 0.05). Surgery is considered to be the only method to cure ACC. For ACC in stage I and II, tumor resection is the most effective treatment, and second surgical operation is recommended for local recurrence. For ACC in stage III, extensive surgical operation is recommended, and for ACC in stage IV, surgical operation has no effect on the prognosis. Copyright © 2012 S. Karger AG, Basel.

On the non-stationary generalized Langevin equation

NASA Astrophysics Data System (ADS)

Meyer, Hugues; Voigtmann, Thomas; Schilling, Tanja

2017-12-01

In molecular dynamics simulations and single molecule experiments, observables are usually measured along dynamic trajectories and then averaged over an ensemble ("bundle") of trajectories. Under stationary conditions, the time-evolution of such averages is described by the generalized Langevin equation. By contrast, if the dynamics is not stationary, it is not a priori clear which form the equation of motion for an averaged observable has. We employ the formalism of time-dependent projection operator techniques to derive the equation of motion for a non-equilibrium trajectory-averaged observable as well as for its non-stationary auto-correlation function. The equation is similar in structure to the generalized Langevin equation but exhibits a time-dependent memory kernel as well as a fluctuating force that implicitly depends on the initial conditions of the process. We also derive a relation between this memory kernel and the autocorrelation function of the fluctuating force that has a structure similar to a fluctuation-dissipation relation. In addition, we show how the choice of the projection operator allows us to relate the Taylor expansion of the memory kernel to data that are accessible in MD simulations and experiments, thus allowing us to construct the equation of motion. As a numerical example, the procedure is applied to Brownian motion initialized in non-equilibrium conditions and is shown to be consistent with direct measurements from simulations.

Drilling from the intercondylar area for treatment of osteochondritis dissecans of the knee joint.

PubMed

Kawasaki, Kenzo; Uchio, Yuji; Adachi, Nobuo; Iwasa, Junji; Ochi, Mitsuo

2003-09-01

We demonstrate a new method in which a drilling is made from the intercondylar space, and its efficacy in treating osteochondritis dissecans (OCD) of the knee in skeletally immature patients with relatively stable lesions with an intact articular surface, in cases where there was failure of initial non-operative management. The lesions of 16 knees of 12 patients with OCD of the femoral condyles failed to heal by conservative treatment for more than 3 months (average 5-6 months) and thereafter were arthroscopically treated with drilling from not the transarticular but the intercondylar bare area without damaging the articular surface. Eight lesions involved the medial femoral condyle, and eight involved the lateral femoral condyle. The average follow-up was 16 months. All lesions healed after drilling, and the average time of healing was 4 months by X-ray and 7 months by MRI. The average Lysholm score improved from an average of 70.4 points at preoperation to an average of 97.8 points after operation. The results of the Hughston Rating Scale were similar: 10 of the 12 patients showed excellent results and the remaining two patients good results. We advocate our new and less invasive procedure of drilling from the bare area of the intercondylar space for OCD in the knee joint of skeletally immature patients who have had failure of initial non-operative management.

[Case-control study on cable-pin system in the treatment of olecranon fractures].

PubMed

Ma, Hu-Jing; Shan, Lei; Zhou, Jun-Lin; Liu, Qing-He; Lu, Tie; Sun, Song

2012-05-01

To prospectively evaluate the clinical result of Cable-Pin system in the treatment of olecranon fractures and compare with tension band wiring (TBW) method. From March 2008 to June 2010,65 patients with olecranon fractures were divided into two groups: 32 patients in Cable-Pin group were treated with Cable-Pin system, including 18 males and 14 females, ranging in age from 21 to 69 years, with an average of (53.69 +/- 13.42) years; 33 patients in TBW group were treated with Kirschner tension bend, including 20 males and 13 females, ranging in age from 20 to 70 years, with an average of (53.18 +/- 13.36) years. The incision length, operation time, the amounts of hemoglobin after operation, fracture healing time, complications and HSS elbow scores were recorded and analyzed statistically. The follow-up period ranged from 12 to 24 months, with an average period of 18.4 months. There were statistical differences (P<0.05) in fracture healing time (t= 2.588, P=0.012), complication rate (chi2=4.534, P=0.033) and HSS elbow joint scores (Z=-2.039, P=0.041) between two groups, which all were superior to TBW in Cable-Pin group. There was no statistical differences (P>0.05) in the length of incision (t= 0.416, P=0.679), operation time (t=0.816, P=0.417) and the postoperative amounts of hemoglobin (t=-0.553, P=0.294) between two groups. Cable-Pin system is an easy and reliable method for the treatment of olecranon fractures with less complications and better functions than TBW.

Development of a safe and pragmatic awake craniotomy program at Maine Medical Center.

PubMed

Rughani, Anand I; Rintel, Theodor; Desai, Rajiv; Cushing, Deborah A; Florman, Jeffrey E

2011-01-01

Awake craniotomy offers an excellent means of performing intraoperative mapping and optimizing surgical resection of brain tumors. Awake craniotomy relies on a strong collaboration between anesthesiologists, neurosurgeons, and operating room staff. The authors recently introduced awake craniotomy for tumor resection at the Maine Medical Center and propose that it can be performed safely, effectively, and efficiently in a high-volume community hospital. We describe a practical approach to performing awake craniotomy involving streamlined anesthetic protocols and simplified intraoperative testing parameters in a carefully selected group of patients. Our first 25 patients are retrospectively reviewed with particular attention to the anesthetic protocol, the extent of resection, the operative time, post-operative complications, the length of hospitalization, and their functional status at follow-up. The authors established an anesthetic protocol based primarily on midazolam, fentanyl, propofol, and local anesthetic. The authors note that all but one patient was able to tolerate the awake procedure. Gross total resection was achieved in nearly 80% of patients with a glial tumor. Operative time was short, averaging 159 minutes of entire anesthesia care. Length of stay averaged 3.7 days. Persistent new post-operative deficits were noted in 2 of 25 patients. There was no substantial difference in total hospital charges for patients undergoing awake craniotomy when compared to a matched historical control. With attention focused on patient selection and a streamlined anesthetic protocol, the authors were able to successfully implement an awake craniotomy protocol in a community setting with satisfying results, including low operative morbidity, short operative times, low anesthetic complications, and excellent patient tolerance.

Knee, Shoulder, and Fundamentals of Arthroscopic Surgery Training: Validation of a Virtual Arthroscopy Simulator.

PubMed

Tofte, Josef N; Westerlind, Brian O; Martin, Kevin D; Guetschow, Brian L; Uribe-Echevarria, Bastián; Rungprai, Chamnanni; Phisitkul, Phinit

2017-03-01

To validate the knee, shoulder, and virtual Fundamentals of Arthroscopic Training (FAST) modules on a virtual arthroscopy simulator via correlations with arthroscopy case experience and postgraduate year. Orthopaedic residents and faculty from one institution performed a standardized sequence of knee, shoulder, and FAST modules to evaluate baseline arthroscopy skills. Total operation time, camera path length, and composite total score (metric derived from multiple simulator measurements) were compared with case experience and postgraduate level. Values reported are Pearson r; alpha = 0.05. 35 orthopaedic residents (6 per postgraduate year), 2 fellows, and 3 faculty members (2 sports, 1 foot and ankle), including 30 male and 5 female residents, were voluntarily enrolled March to June 2015. Knee: training year correlated significantly with year-averaged knee composite score, r = 0.92, P = .004, 95% confidence interval (CI) = 0.84, 0.96; operation time, r = -0.92, P = .004, 95% CI = -0.96, -0.84; and camera path length, r = -0.97, P = .0004, 95% CI = -0.98, -0.93. Knee arthroscopy case experience correlated significantly with composite score, r = 0.58, P = .0008, 95% CI = 0.27, 0.77; operation time, r = -0.54, P = .002, 95% CI = -0.75, -0.22; and camera path length, r = -0.62, P = .0003, 95% CI = -0.8, -0.33. Shoulder: training year correlated strongly with average shoulder composite score, r = 0.90, P = .006, 95% CI = 0.81, 0.95; operation time, r = -0.94, P = .001, 95% CI = -0.97, -0.89; and camera path length, r = -0.89, P = .007, 95% CI = -0.95, -0.80. Shoulder arthroscopy case experience correlated significantly with average composite score, r = 0.52, P = .003, 95% CI = 0.2, 0.74; strongly with operation time, r = -0.62, P = .0002, 95% CI = -0.8, -0.33; and camera path length, r = -0.37, P = .044, 95% CI = -0.64, -0.01, by training year. FAST: training year correlated significantly with 3 combined FAST activity average composite scores, r = 0.81, P = .0279, 95% CI = 0.65, 0.90; operation times, r = -0.86, P = .012, 95% CI = -0.93, -0.74; and camera path lengths, r = -0.85, P = .015, 95% CI = -0.92, -0.72. Total arthroscopy cases performed did not correlate significantly with overall FAST performance. We found significant correlations between both training year and knee and shoulder arthroscopy experience when compared with performance as measured by composite score, camera path length, and operation time during a simulated diagnostic knee and shoulder arthroscopy, respectively. Three FAST activities demonstrated significant correlations with training year but not arthroscopy case experience as measured by composite score, camera path length, and operation time. We attempt to validate an arthroscopy simulator that could be used to supplement arthroscopy skills training for orthopaedic residents. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Therapeutic observation of subcutaneous pedicle screw-rod system with modified placement for Tile B pelvic fractures].

PubMed

Wu, Xiao-Tian; Chen, Nong; Pan, Fu-Gen; Liu, Zuo-Qing; He, Xiao-Jian

2017-03-25

To investigate the feasibility and therapeutic effect of subcutaneous pedicle screw-rod system with modified placement in treatment of Tile B pelvic fractures. From June 2014 to August 2015, 14 patients with Tile B pelvic fractures were treated by subcutaneous pedicle screw-rod system with modified placement in the anterior inferior iliac spine and pubic tubercle. There were 8 males and 6 females, aged from 23 to 65 years with an average of 42 years. Operative time, intraoperative blood loss, fracture healing and postoperative complication were observed and clinical effects were evaluated by Matta reduction standard and Majeed score. All patients were followed up from 8 to 15 months with an average of 10.5 months. Operative time was 25 to 45 min with an average of 32 min;intraoperative blood loss was 10 to 35 ml with an average of 18 ml. All fractures got primary healing and healed time was 9 to 14 weeks with an average of 12.5 weeks. No postoperative incision infection, internal fixation failure and ectopic ossification were found, 4 cases occurred unilateral lateral femoral cutaneous nerve injury and 1 case occurred unilateral femoral nerve paralysis, but all restored finally. According to Matta criteria, reduction was excellent in 7 cases, good in 5 cases, fair in 2 case. According to Majeed score system, the functional evaluation at last follow-up was excellent in 5 cases, good in 7 cases, fair in 2 cases with the average score of 81.50±8.05. Subcutaneous pedicle screw-rod system with modified placement in the anterior inferior iliac spine and pubic tubercle have advantages of strong reduction, less trauma and complications, and is a promising surgical method in the treatment of Tile B pelvic fractures.

Riverbed Hydrologic Exchange Dynamics in a Large Regulated River Reach

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

Zhou, Tian; Bao, Jie; Huang, Maoyi

Hydrologic exchange flux (HEF) is an important hydrologic component in river corridors that includes both bidirectional (hyporheic) and unidirectional (gaining/losing) surface water – groundwater exchanges. Quantifying HEF rates in a large regulated river is difficult due to the large spatial domains, complexity of geomorphologic features and subsurface properties, and the great stage variations created by dam operations at multiple time scales. In this study, we developed a method that combined numerical modeling and field measurements for estimating HEF rates across the river bed in a 7‐km long reach of the highly regulated Columbia River. A high‐resolution computational fluid dynamics (CFD)more » modeling framework was developed and validated by field measurements and other modeling results to characterize the HEF dynamics across the river bed. We found that about 85% of the time from 2008‐2014 the river was losing water with an annual average net HEF rates across the river bed (Qz) of ‐2.3 m3 s−1 (negative indicating downwelling). June was the only month that the river gained water, with monthly averaged Qz of 0.8 m3 s−1. We also found that the daily dam operations increased the hourly gross gaining and losing rate over an average year of 8% and 2%, respectively. By investigating the HEF feedbacks at various time scales, we suggest that the dam operations could reduce the HEF at seasonal time scale by decreasing the seasonal flow variations, while also enhance the HEF at sub‐daily time scale by generating high frequency discharge variations. These changes could generate significant impacts on biogeochemical processes in the hyporheic zone.« less

Co-surgeons in breast reconstructive microsurgery: What do they bring to the table?

PubMed

Haddock, Nicholas T; Kayfan, Samar; Pezeshk, Ronnie A; Teotia, Sumeet S

2018-01-01

Current research within other surgical specialties suggests that a co-surgeon approach may reduce operative times and complications associated with complex bilateral procedures, possibly leading to improved patient and surgical outcomes. We sought to evaluate the role of the co-surgery team and its development in free flap breast reconstruction. A retrospective review of free-flap breast reconstruction by two surgeons from 2011 to 2016 was conducted. We analyzed 128 patients who underwent bilateral-DIEP breast. Surgical groups were: single-surgeon reconstruction (SSR; 35 patients), co-surgery where both surgeons are present for entire reconstruction (CSR-I; 69 patients), and co-surgery reconstruction where co-surgeons appropriately assist in two concurrent or staggered cases (CSR-II; 24 patients). Efficiency data collected was OR time and patient length-of-stay (LOS). The rate of flap-failure, return to OR, infection, wound breakdown, seroma, hematoma, and PE/DVT were compared. Single-surgeon reconstruction had significantly longer OR time (678 vs. 485 min, P < .0001), LOS (5 vs. 3.9 days, P < .001), higher wound occurrences of the umbilical site that required surgical correction [11.4 percent (n = 4) vs. 1.5% (n = 1); P < .043] compared to CSR-I. Similarly, SSR had significantly longer average OR time (678 vs. 527 min P < .0001), average LOS (5 vs. 4 days, P = .0005) when compared with CSR-II. There were no total increased patient related complications associated with co-surgery (CSR-I or II). The addition of a co-surgeon, even with concurrent surgery, reduces operative time, average patient LOS, and postoperative complications. This work lends a strong credence that co-surgery model is associated with increased operative efficiency. © 2017 Wiley Periodicals, Inc.

[Short-term efficacy of da Vinci robotic surgical system on rectal cancer in 101 patients].

PubMed

Zeng, Dong-Zhu; Shi, Yan; Lei, Xiao; Tang, Bo; Hao, Ying-Xue; Luo, Hua-Xing; Lan, Yuan-Zhi; Yu, Pei-Wu

2013-05-01

To investigate the feasibility and safety of da Vinci robotic surgical system in rectal cancer radical operation, and to summarize its short-term efficacy and clinical experience. Data of 101 cases undergoing da Vinci robotic surgical system for rectal cancer radical operation from March 2010 to September 2012 were retrospectively analyzed. Evaluation was focused on operative procedure, complication, recovery and pathology. All the 101 cases underwent operation successfully and safely without conversion to open procedure. Rectal cancer radical operation with da Vinci robotic surgical system included 73 low anterior resections and 28 abdominoperineal resections. The average operative time was (210.3±47.2) min. The average blood lose was (60.5±28.7) ml without transfusion. Lymphadenectomy harvest was 17.3±5.4. Passage of first flatus was (2.7±0.7) d. Distal margin was (5.3±2.3) cm without residual cancer cells. The complication rate was 6.9%, including anastomotic leakage(n=2), perineum incision infection(n=2), pulmonary infection (n=2), urinary retention (n=1). There was no postoperative death. The mean follow-up time was(12.9±8.0) months. No local recurrence was found except 2 cases with distant metastasis. Application of da Vinci robotic surgical system in rectal cancer radical operation is safe and patients recover quickly The short-term efficacy is satisfactory.

How Does the Supply Requisitioning Process Affect Average Customer Wait Time Onboard U.S. Navy Destroyers?

DTIC Science & Technology

2013-06-01

17  D.  NAVAL TACTICAL COMMAND SUPPORT SYSTEM .........................17  1.  Operational Maintenance Management System–Next Generation...Management .......................................................................................21  4.  Method ...Business Administration MDT Mean Down Time MTBM Mean Time Between Maintenance NAVSUP Naval Supply Systems Command NC Not Carried NIS Not in Stock

[Comparison of clinical effect on locking plate for proximal humeral fracture with or without application of inferomedial screws].

PubMed

Guo, Xiu-wu; Fan, Jian; Yuan, Feng

2016-06-01

To compare clinical outcomes of locking plate for proximal humeral fracture whether application of inferomedial screws. From January 2012 to July 2013, 46 patients with proximal humeral fracture underwent locking plates were retrospectively analyzed. There were 25 males and 21 females aged from 29 to 80 years old with an average of 55.1 years old. Among them, 25 patients were treated with inferomedial screws (support group), including 13 males and 12 females aged from 38 to 80 years old with an average of (55.8 ± 11.8) years old; 8 cases were part two fracture,10 cases were part three fracture and 7 cases were part four fracture according to Neer classification. Twenty-one patients were treated without inferomedial screws (non-support group), including 12 males and 9 females aged from 29 to 79 years old with an average of (54.2 ± 14.8)years old; 6 cases were part two fracture, 9 cases were part three fracture and 6 cases were part four fracture according to Neer classification. Operative time, fracture healing time and complications were observed and compared, Neer scoring of shoulder joint were used to evaluate clinical effect. All patients were followed up from 12 to 41 months with an average of 15.6 months. Operative time and fracture healing time in support group was (1.6 ± 0.4) h and (3.0 ± 0.6) months, and (1.5 ± 0.4) h and (3.1 ± 0.6) months in non-support group, while there was no statistical difference in operative time and fracture healing time between two groups. There was significant differences in Neer score between support group (89.7± 4.9) and non-support group (83.1 ± 7.1). No complication occurred in support group,while 4 cases occurred complications in non-support group. Locking plate with inferomedial screws for proximal humeral fracture has advantages of stable fixation, less complications, quick recovery of function and satisfied clinical effect.

Littoral Combat Ship: Deployment of USS Freedom Revealed Risks in Implementing Operational Concepts and Uncertain Costs

DTIC Science & Technology

2014-07-01

ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for...such as systems reliability and crew sleep hours . However, several factors limited the operational lessons learned. For example, mechanical problems...concepts. In February 2010, we reported several potential risks in implementing the new operational concepts for the LCS. 4 In its report

Understanding Counterinsurgency in Democratic Settings: Counterinsurgency Success and Failure in Kashmir and Nepal

DTIC Science & Technology

2014-03-01

Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instruction ...Success Demands a Balanced Approach” (Art of War Papers, Command and General Staff College , Kansas, 2012), 1. 11 Ibid. 12 Jack L. Snyder, Voting to...friendly military operations, and information operations. According to this model, the use of military operations is also considered valid as a minimum

Computed versus measured ion velocity distribution functions in a Hall effect thruster

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

Garrigues, L.; CNRS, LAPLACE, F-31062 Toulouse; Mazouffre, S.

2012-06-01

We compare time-averaged and time-varying measured and computed ion velocity distribution functions in a Hall effect thruster for typical operating conditions. The ion properties are measured by means of laser induced fluorescence spectroscopy. Simulations of the plasma properties are performed with a two-dimensional hybrid model. In the electron fluid description of the hybrid model, the anomalous transport responsible for the electron diffusion across the magnetic field barrier is deduced from the experimental profile of the time-averaged electric field. The use of a steady state anomalous mobility profile allows the hybrid model to capture some properties like the time-averaged ion meanmore » velocity. Yet, the model fails at reproducing the time evolution of the ion velocity. This fact reveals a complex underlying physics that necessitates to account for the electron dynamics over a short time-scale. This study also shows the necessity for electron temperature measurements. Moreover, the strength of the self-magnetic field due to the rotating Hall current is found negligible.« less

High efficiency endocrine operation protocol: From design to implementation.

PubMed

Mascarella, Marco A; Lahrichi, Nadia; Cloutier, Fabienne; Kleiman, Simcha; Payne, Richard J; Rosenberg, Lawrence

2016-10-01

We developed a high efficiency endocrine operative protocol based on a mathematical programming approach, process reengineering, and value-stream mapping to increase the number of operations completed per day without increasing operating room time at a tertiary-care, academic center. Using this protocol, a case-control study of 72 patients undergoing endocrine operation during high efficiency days were age, sex, and procedure-matched to 72 patients undergoing operation during standard days. The demographic profile, operative times, and perioperative complications were noted. The average number of cases per 8-hour workday in the high efficiency and standard operating rooms were 7 and 5, respectively. Mean procedure times in both groups were similar. The turnaround time (mean ± standard deviation) in the high efficiency group was 8.5 (±2.7) minutes as compared with 15.4 (±4.9) minutes in the standard group (P < .001). Transient postoperative hypocalcemia was 6.9% (5/72) and 8.3% (6/72) for the high efficiency and standard groups, respectively (P = .99). In this study, patients undergoing high efficiency endocrine operation had similar procedure times and perioperative complications compared with the standard group. The proposed high efficiency protocol seems to better utilize operative time and decrease the backlog of patients waiting for endocrine operation in a country with a universal national health care program. Copyright © 2016 Elsevier Inc. All rights reserved.

Robot-assisted extravesical ureteral reimplantation (revur) for unilateral vesico-ureteral reflux in children: results of a multicentric international survey.

PubMed

Esposito, Ciro; Masieri, Lorenzo; Steyaert, Henri; Escolino, Maria; Cerchione, Raffaele; La Manna, Angela; Cini, Chiara; Lendvay, Thomas S

2018-03-01

This multicentric international retrospective study aimed to report the outcome of robot-assisted extravesical ureteral reimplantation (REVUR) in patients with unilateral vesico-ureteral reflux (VUR). The medical records of 55 patients (35 girls, 20 boys) underwent REVUR in four international centers of pediatric robotic surgery for primary unilateral VUR were retrospectively reviewed. Patients' average age was 4.9 years. The preoperative grade of reflux was III in 12.7%, IV in 47.3% and V in 40%. Twenty-six patients (47.3%) presented a loss of renal function preoperatively and 10 (18.1%) had a duplex system. Average robot docking time was 16.2 min (range 5-30). Average total operative time was 92.2 min (range 50-170). No conversions or intra-operative complications were recorded. All patients had a bladder Foley catheter for 24 h post-operatively. Average hospital stay was 2 days (range 1-3). Average follow-up length was 28 months (range 9-60). We recorded three (5.4%) postoperative complications: 1 small urinoma resolved spontaneously (II Clavien) and 2 persistent reflux, only one requiring redo-surgery using endoscopic injection (IIIb Clavien). REVUR is a safe and effective technique for treatment of primary unilateral VUR. The procedure is easy and fast to perform thanks to the 6° of freedom of robotic arms. The learning curve is short and it is useful to begin the robotics experience with a surgeon expert in robotic surgery as proctor on the 2nd robot console. The high cost and the diameter of instruments remain the main challenges of robotics applications in pediatric urology.

Submicron particle monitoring of paving and related road construction operations.

PubMed

Freund, Alice; Zuckerman, Norman; Baum, Lisa; Milek, Debra

2012-01-01

This study identified activities and sources that contribute to ultrafine and other submicron particle exposure that could trigger respiratory symptoms in highway repair workers. Submicron particle monitoring was conducted for paving, milling, and pothole repair operations in a major metropolitan area where several highway repair workers were identified as symptomatic for respiratory illness following exposures at the 2001 World Trade Center disaster site. Exposure assessments were conducted for eight trades involved in road construction using a TSI P-Trak portable condensation particle counter. Direct readings near the workers' breathing zones and observations of activities and potential sources were logged on 7 days on 27 workers using four different models of pavers and two types of millers. Average worker exposure levels ranged from 2 to 3 times background during paving and from 1 to 4 times background during milling. During asphalt paving, average personal exposures to submicron particulates were 25,000-60,000, 28,000-70,000, and 23,000-37,000 particles/ cm(3) for paver operators, screed operators, and rakers, respectively. Average personal exposures during milling were 19,000-111,000, 28,000-81,000, and 19,000 particles/cm(3) for the large miller operators, miller screed operators, and raker, respectively. Personal peak exposures were measured up to 467,000 and 455,000 particles/cm(3) in paving and milling, respectively. Several sources of submicron particles were identified. These included the diesel and electric fired screed heaters; engine exhaust from diesel powered construction vehicles passing by or idling; raking, dumping, and paving of asphalt; exhaust from the hotbox heater; pavement dust or fumes from milling operations, especially when the large miller started and stopped; and secondhand cigarette smoke. To reduce the potential for health effects in workers, over 40 recommendations were made to control exposures, including improved maintenance of paver ventilation systems; diesel fume engineering controls; reduced idling; provision of cabs for the operators; and improved dust suppression systems on the milling machine.

Development of a New Time-Resolved Laser-Induced Fluorescence Technique

NASA Astrophysics Data System (ADS)

Durot, Christopher; Gallimore, Alec

2012-10-01

We are developing a time-resolved laser-induced fluorescence (LIF) technique to interrogate the ion velocity distribution function (VDF) of EP thruster plumes down to the microsecond time scale. Better measurements of dynamic plasma processes will lead to improvements in simulation and prediction of thruster operation and erosion. We present the development of the new technique and results of initial tests. Signal-to-noise ratio (SNR) is often a challenge for LIF studies, and it is only more challenging for time-resolved measurements since a lock-in amplifier cannot be used with a long time constant. The new system uses laser modulation on the order of MHz, which enables the use of electronic filtering and phase-sensitive detection to improve SNR while preserving time-resolved information. Statistical averaging over many cycles to further improve SNR is done in the frequency domain. This technique can have significant advantages, including (1) larger spatial maps enabled by shorter data acquisition time and (2) the ability to average data without creating a phase reference by modifying the thruster operating condition with a periodic cutoff in discharge current, which can modify the ion velocity distribution.

A Descriptive, Retrospective Study of Using an Oblique Downward-design Gluteus Maximus Myocutaneous Flap for Reconstruction of Ischial Pressure Ulcers.

PubMed

Chou, Chang-Yi; Sun, Yu-Shan; Shih, Yu-Jen; Tzeng, Yuan-Sheng; Chang, Shun-Cheng; Dai, Niann-Tzyy; Lin, Chin-Ta

2018-03-01

Despite advances in reconstruction techniques, ischial pressure ulcers continue to present a challenge for the plastic surgeon. The purpose of this retrospective study was to evaluate outcomes of using an oblique downward gluteus maximus myocutaneous (GMM) flap for coverage of grade IV ischial ulcers. Data regarding defect size, flap size, operation time, duration of wound healing, and surgical outcome were abstracted from the medical records of patients whose ischial pressure ulcers had been reconstructed using GMM island flaps between January 2010 and December 2015. The 22 patients comprised 15 men and 7 women with a mean age of 52 (range 16-81) years. Twenty (20) had paraplegia, 6 had a recurrent ischial ulcer, 2 were bedridden following a cerebrovascular accident, 1 had a myelomeningocele status post operation, and 19 were spinal cord injury patients. Follow-up time ranged from 6 to 40 months. Pressure ulcer size ranged from 3 cm x 2 cm to 10 cm x 5 cm (average 22.3 cm2). The average flap size was 158 cm2 (15.9 cm x 9.7 cm); the largest was 286 cm2 (22 cm x 13 cm). The operating time ranged from 52 minutes to 110 minutes (average, 80 minutes). In 2 cases, wound dehiscence occurred but completely healed after resuturing. One (1) ischial pressure ulcer recurred 6 months following surgery and was successfully covered with a pedicled anterolateral thigh flap. No recurrences or problems were observed in the remaining 20 patients. Time to complete wound healing ranged from 14 to 24 days (average 17.8 days). Treatment of ischial pressure ulcers with GMM flaps allowed for an easy, simple procedure that provided the adequate thickness of soft tissue needed to cover the bony prominence, fill dead space, and cover the lesion. This technique was a reliable and safe reconstructive modality for the management of ischial pressure ulcers, even in recurrent cases.

Concentrations of methoxyflurane and nitrous oxide in veterinary operating rooms

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

Ward, G.S.; Byland, R.R.

1982-02-01

The surgical rooms of 14 private veterinary practices were monitored to determined methoxyflurane (MOF) concentrations during surgical procedure under routine working conditions. The average room volume for these 14 rooms was 29 m3. The average MOF value for all rooms was 2.3 ppm, with a range of 0.7 to 7.4 ppm. Four of the 14 rooms exceeded the maximum recommended concentration of 2 ppm. Six rooms which had 6 or more air changes/hr averaged 1.1 ppm, whereas 8 rooms with less than 6 measurable air changes/hr averaged 3.2 ppm. Operating rooms that had oxygen flows of more than 1,000 cm3/minmore » averaged 4.4 ppm, whereas those with flows of less than 1,000 cm3/min averaged 1.5 ppm. The average time spent during a surgical procedure using MOF, for all 14 facilities, was 2 hours. Nitrous oxide (N/sub 2/O) concentrations were determined in 4 veterinary surgical rooms. The average N/sub 2/O concentration for 3 rooms without waste anesthetic gas scavenging was 138 ppm. Concentration of N/sub 2/O in the waste anesthetic gas-scavenged surgical room was 14 ppm, which was below the maximum recommended concentration of 25 ppm.« less

[Application of bilateral direct anterior approach total hip arthroplasty: a report of 22 cases].

PubMed

Tang, J; Lv, M; Zhou, Y X; Zhang, J

2017-04-18

To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA). We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital. A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study. There were 17 males and 5 females, and the median age was 48 years (range: 34-67 years). All the surgery was done by DAA method by two senior surgeons. The clinic characters, early surgery treatment results and complications were analyzed. We used the cementless stems in all the cases. The average operating time was (167±23) min; the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL; the wound drainage in average was (111±73) mL. Most of the patients could move out of the bed by themselves on the first day after operation, 5 patients could walk without crutches on the first operating day, and 13 patients could squat on the third days after operation. The patients were discharged averagely 4 days after operation. We followed up all the patients for averagely 16 months (range: 8-24 months). There was no loosening or failure case in the latest follow up. In the study, 2 patients had great trochanter fracture, 2 patients had thigh pain, 4 patients had lateral femoral cutaneous nerve palsy, and 3 patients had muscle damage. The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (P<0.01). The DAA THA can achieve faster recovery and flexible hip joint after operation. However it is a kind of surgery with high technique demanding. Carefully selected patients, and skilled technique, can help the surgeon avoid the early complications. It is associated with high complication rate in the learning curve for bilateral DAA THA.

Laparoscopic lateral pancreaticojejunostomy: a new remedy for an old ailment.

PubMed

Palanivelu, C; Shetty, R; Jani, K; Rajan, P S; Sendhilkumar, K; Parthasarthi, R; Malladi, V

2006-03-01

Lateral pancreaticojejunostomy is considered as the standard surgery for chronic pancreatitis. Yet there are very few reports of this procedure being done laparoscopically. We present our experience with laparoscopic lateral pancreaticojejunostomy till date and describe our technique. Since 1997, we have done 12 laparoscopic lateral pancreatojejunostomies. There were 9 females and 3 males and the average age was 29.3 years. The indication for surgery in all patients was intractable abdominal pain and significant weight loss. Additionally, two patients were also suffering from pancreatic ascites. The average diameter of the pancreatic duct was 14.7 mm. We used a four-port technique. All surgeries were completed without any conversion to open surgery. Post-operatively, there were no major morbidity and nil mortality. The average operating time was 172 minutes. Post-operative stay was short (average 5 days) and on median follow-up of 4.4 years, 83.3% patients had complete pain relief while 16.7% had partial relief. All patients had significant weight gain. Laparoscopic lateral pancreaticojejunostomy is safe, effective and feasible in experience hands. Mastery of intracorporeal knotting and suturing techniques is mandatory before embarking on this surgery.

Continuous Time in Consistent Histories

NASA Astrophysics Data System (ADS)

Savvidou, Konstantina

1999-12-01

We discuss the case of histories labelled by a continuous time parameter in the History Projection Operator consistent-histories quantum theory. We describe how the appropriate representation of the history algebra may be chosen by requiring the existence of projection operators that represent propositions about time averages of the energy. We define the action operator for the consistent histories formalism, as the quantum analogue of the classical action functional, for the simple harmonic oscillator case. We show that the action operator is the generator of two types of time transformations that may be related to the two laws of time-evolution of the standard quantum theory: the `state-vector reduction' and the unitary time-evolution. We construct the corresponding classical histories and demonstrate the relevance with the quantum histories; we demonstrate how the requirement of the temporal logic structure of the theory is sufficient for the definition of classical histories. Furthermore, we show the relation of the action operator to the decoherence functional which describes the dynamics of the system. Finally, the discussion is extended to give a preliminary account of quantum field theory in this approach to the consistent histories formalism.

Retroperitoneal laparoscopic nephrectomy: the effect of the learning curve, and concentrating expertise, on operating times.

PubMed

Skinner, Adrian; Maoate, Kiki; Beasley, Spencer

2010-05-01

Laparoscopic nephrectomy is an accepted alternative to open nephrectomy. We analyzed our first 80 procedures of laparoscopic nephrectomy to evaluate the effect of experience and configuration of service on operative times. A retrospective review of 80 consecutive children who underwent retroperitoneal laparoscopic nephrectomy or heminephrectomy during an 11-year period from 1997 at Christchurch Hospital (Christchurch, New Zealand) was conducted. Operative times, in relation to the experience of the surgeon for this procedure, were analyzed. Four surgeons, assisted by an annually rotating trainee registrar, performed the procedure in 26 girls and 54 boys (range, 8 months to 15 years). Operating times ranged from 38 to 225 minutes (mean, 104). The average operative time fell from 105 to 90 minutes. One surgeon performed 40% of the procedures and assisted with a further 55%. The operative times for all surgeons showed a tendency to reduce, but this was not marked. Most procedures were performed by two surgeons working together, although one surgeon was involved in the majority of cases. The lead surgeon is often assisted by a fellow consultant colleague. Operative times were influenced by experience, but not markedly so. The shorter operative times and minimal "learning curve," compared with other reported series, may, in part, be due to the involvement of two surgeons experienced in laparoscopy for the majority of cases.

Solving the negative impact of congestion in the postanesthesia care unit: a cost of opportunity analysis.

PubMed

Ruiz-Patiño, Alejandro; Acosta-Ospina, Laura Elena; Rueda, Juan-David

2017-04-01

Congestion in the postanesthesia care unit (PACU) leads to the formation of waiting queues for patients being transferred after surgery, negatively affecting hospital resources. As patients recover in the operating room, incoming surgeries are delayed. The purpose of this study was to establish the impact of this phenomenon in multiple settings. An operational mathematical study based on the queuing theory was performed. Average queue length, average queue waiting time, and daily queue waiting time were evaluated. Calculations were based on the mean patient daily flow, PACU length of stay, occupation, and current number of beds. Data was prospectively collected during a period of 2 months, and the entry and exit time was recorded for each patient taken to the PACU. Data was imputed in a computational model made with MS Excel. To account for data uncertainty, deterministic and probabilistic sensitivity analyses for all dependent variables were performed. With a mean patient daily flow of 40.3 and an average PACU length of stay of 4 hours, average total lost surgical opportunity time was estimated at 2.36 hours (95% CI: 0.36-4.74 hours). Cost of opportunity was calculated at $1592 per lost hour. Sensitivity analysis showed that an increase of two beds is required to solve the queue formation. When congestion has a negative impact on cost of opportunity in the surgical setting, queuing analysis grants definitive actions to solve the problem, improving quality of service and resource utilization. Copyright © 2016 Elsevier Inc. All rights reserved.

40 CFR Table 3 to Subpart Jjjjjj... - Operating Limits for Boilers With Emission Limits

Code of Federal Regulations, 2011 CFR

2011-07-01

... system alarm does not sound more than 5 percent of the operating time during each 6-month period. 2... the pressure drop at or above the lowest 1-hour average pressure drop across the wet scrubber and the... recent performance stack test. 8. Continuous Oxygen Monitor Maintain the oxygen level at or above the...

Cholecystectomy using a novel Single-Site(®) robotic platform: early experience from 45 consecutive cases.

PubMed

Konstantinidis, Konstantinos M; Hirides, Petros; Hirides, Savas; Chrysocheris, Pericles; Georgiou, Michael

2012-09-01

The aim of this work was to study the feasibility, safety, and efficacy of single-incision robotic cholecystectomy using a novel platform from Intuitive Surgical. All operations were performed by the same surgeon. Parameters assessed included patient history, indication for surgery, operation time, complication rate, conversion rate, robot-related issues, length of hospital stay, postoperative pain, and time to return to work. All patients were followed for a 2-month period postoperatively. Forty-five patients (22 women, 23 men) underwent single-incision robotic cholecystectomy from March 1 to July 15, 2011. There were no conversions to either conventional laparoscopy or laparotomy, although in three cases a second trocar was used. There were no major complications apart from a single case of postoperative hemorrhage. Average patient age was 47 ± 12 years (range = 27-80 years) and average BMI was 30 kg/m(2) (mean = 28.8 ± 4 kg/m(2), range = 18.4-46.7 kg/m(2)). The primary indication for surgery was gallstones. The mean operation time (skin-to-skin) was 84.5 ± 25.5 min (range = 51-175 min), docking time was 5.8 ± 1.5 min (range = 4-11 min), and console time (net surgical time) was 43 ± 21.9 min (range = 21-121 min). Intraoperative blood loss was negligible. There were no collisions between the robotic arms and no other robot-related problems. Average postoperative length of stay was less than 24 h. The mean Visual Analog Pain Scale Score 6 h after the operation was 2.2 ± 1.51 (range = 0-6) and patients returned to normal activities in 4.48 ± 2.3 days (range = 1-9 days). Single-Site(®) is a new platform offering a potentially more stable and reliable environment to perform single-port cholecystectomy. Both simple and complicated cholecystectomies can be performed with safety. The technique is possible in patients with a high BMI. The induction of pneumoperitoneum using the new port and the docking process require additional training.

Assessing performance of an Electronic Health Record (EHR) using Cognitive Task Analysis.

PubMed

Saitwal, Himali; Feng, Xuan; Walji, Muhammad; Patel, Vimla; Zhang, Jiajie

2010-07-01

Many Electronic Health Record (EHR) systems fail to provide user-friendly interfaces due to the lack of systematic consideration of human-centered computing issues. Such interfaces can be improved to provide easy to use, easy to learn, and error-resistant EHR systems to the users. To evaluate the usability of an EHR system and suggest areas of improvement in the user interface. The user interface of the AHLTA (Armed Forces Health Longitudinal Technology Application) was analyzed using the Cognitive Task Analysis (CTA) method called GOMS (Goals, Operators, Methods, and Selection rules) and an associated technique called KLM (Keystroke Level Model). The GOMS method was used to evaluate the AHLTA user interface by classifying each step of a given task into Mental (Internal) or Physical (External) operators. This analysis was performed by two analysts independently and the inter-rater reliability was computed to verify the reliability of the GOMS method. Further evaluation was performed using KLM to estimate the execution time required to perform the given task through application of its standard set of operators. The results are based on the analysis of 14 prototypical tasks performed by AHLTA users. The results show that on average a user needs to go through 106 steps to complete a task. To perform all 14 tasks, they would spend about 22 min (independent of system response time) for data entry, of which 11 min are spent on more effortful mental operators. The inter-rater reliability analysis performed for all 14 tasks was 0.8 (kappa), indicating good reliability of the method. This paper empirically reveals and identifies the following finding related to the performance of AHLTA: (1) large number of average total steps to complete common tasks, (2) high average execution time and (3) large percentage of mental operators. The user interface can be improved by reducing (a) the total number of steps and (b) the percentage of mental effort, required for the tasks. 2010 Elsevier Ireland Ltd. All rights reserved.

SNS Resonance Control Cooling Systems and Quadrupole Magnet Cooling Systems DIW Chemistry

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

Magda, Karoly

This report focuses on control of the water chemistry for the Spallation Neutron Source (SNS) Resonance Control Cooling System (RCCS)/Quadrupole Magnet Cooling System (QMCS) deionized water (DIW) cooling loops. Data collected from spring 2013 through spring 2016 are discussed, and an operations regime is recommended.It was found that the RCCS operates with an average pH of 7.24 for all lines (from 7.0 to 7.5, slightly alkaline), the average low dissolved oxygen is in the area of < 36 ppb, and the main loop average resistivity of is > 14 MΩ-cm. The QMCS was found to be operating in a similarmore » regime, with a slightly alkaline pH of 7.5 , low dissolved oxygen in the area of < 45 ppb, and main loop resistivity of 10 to 15 MΩ-cm. During data reading, operational corrections were done on the polishing loops to improve the water chemistry regime. Therefore some trends changed over time.It is recommended that the cooling loops operate in a regime in which the water has a resistivity that is as high as achievable, a dissolved oxygen concentration that is as low as achievable, and a neutral or slightly alkaline pH.« less

[Comparative study on graft of autogeneic iliac bone and tissue engineered bone].

PubMed

Shen, Bing; Xie, Fu-lin; Xie, Qing-fang

2002-11-01

To compare the clinical results of repairing bone defect of limbs with tissue engineering technique and with autogeneic iliac bone graft. From July 1999 to September 2001, 52 cases of bone fracture were randomly divided into two groups (group A and B). Open reduction and internal fixation were performed in all cases as routine operation technique. Autogeneic iliac bone was implanted in group A, while tissue engineered bone was implanted in group B. Routine postoperative treatment in orthopedic surgery was taken. The operation time, bleeding volume, wound healing and drainage volume were compared. The bone union was observed by the X-ray 1, 2, 3, and 5 months after operation. The sex, age and disease type had no obvious difference between groups A and B. all the wounds healed with first intention. The swelling degree of wound and drainage volume had no obvious difference. The operation time in group A was longer than that in group B (25 minutes on average) and bleeding volume in group A was larger than that in group B (150 ml on average). Bone union completed within 3 to 7 months in both groups. But there were 2 cases of delayed union in group A and 1 case in group B. Repair of bone defect with tissue engineered bone has as good clinical results as that with autogeneic iliac bone graft. In aspect of operation time and bleeding volume, tissue engineered bone graft is superior to autogeneic iliac bone.

[Papillary muscle rupture complicating acute myocardial infarction--treatment with mitral valve replacement and coronary bypass surgery in acute phase].

PubMed

Kyo, S; Miyamoto, N; Yokote, Y; Ueda, K; Takamoto, S; Omoto, R

1996-06-01

Complete rupture of a papillary muscle following acute myocardial infarction is a severe complication that is typically associated with acute left ventricular failure, pulmonary edema, and relentless clinical deterioration. The reported mortality rates without surgical intervention is almost 90%, therefore, prompt operation without prolonged attempts at medical stabilization is the key to decrease operative mortality. Although the complete coronary revascularization in conjunction with mitral valve replacement is advocated in the western medical academic society, there is only a few case of conjunct surgery has been reported in Japan. Three successful cases of conjunct surgery of mitral valve replacement and coronary complete revascularization in acute phase within one week from the onset of acute myocardial infarction (AMI) are described. There were one male and two female patients with an average age of 60-year-old (range 48-67), who developed cardiogenic shock and admitted to our hospital. The average interval between onset of AMI and the appearance of mitral regurgitation (MR) was 38 hours, and that of the appearance of MR and admission was 40 hours. Surgeries were performed within 26 hours (average 13 hours) after admission. The mitral valve was replaced with a mechanical valve (St. Jude Medical Valve) and a complete coronary revasculatization was done using saphenous vein graft. The average period of operation time and aortic cross clamping time were 6 hours 22 minutes and 109 minutes respectively. The average number of coronary grafting was 2.3 (range 1-3). Postoperative recovery from cardiogenic shock was uneventful in all three patients. The average periods of ICU stay and hospital stay were 5 days and 43 days respectively. All patients have regained their social activities with mean follow up period of 52 months. Since ischemic heart disease remains the leading cause of death in such patients, it is suggested that complete coronary revascularization should be performed immediately in conjunction with valve replacement even in the acute phase after onset of AMI.

Rapid and safe learning of robotic gastrectomy for gastric cancer: multidimensional analysis in a comparison with laparoscopic gastrectomy.

PubMed

Kim, H-I; Park, M S; Song, K J; Woo, Y; Hyung, W J

2014-10-01

The learning curve of robotic gastrectomy has not yet been evaluated in comparison with the laparoscopic approach. We compared the learning curves of robotic gastrectomy and laparoscopic gastrectomy based on operation time and surgical success. We analyzed 172 robotic and 481 laparoscopic distal gastrectomies performed by single surgeon from May 2003 to April 2009. The operation time was analyzed using a moving average and non-linear regression analysis. Surgical success was evaluated by a cumulative sum plot with a target failure rate of 10%. Surgical failure was defined as laparoscopic or open conversion, insufficient lymph node harvest for staging, resection margin involvement, postoperative morbidity, and mortality. Moving average and non-linear regression analyses indicated stable state for operation time at 95 and 121 cases in robotic gastrectomy, and 270 and 262 cases in laparoscopic gastrectomy, respectively. The cumulative sum plot identified no cut-off point for surgical success in robotic gastrectomy and 80 cases in laparoscopic gastrectomy. Excluding the initial 148 laparoscopic gastrectomies that were performed before the first robotic gastrectomy, the two groups showed similar number of cases to reach steady state in operation time, and showed no cut-off point in analysis of surgical success. The experience of laparoscopic surgery could affect the learning process of robotic gastrectomy. An experienced laparoscopic surgeon requires fewer cases of robotic gastrectomy to reach steady state. Moreover, the surgical outcomes of robotic gastrectomy were satisfactory. Copyright © 2013 Elsevier Ltd. All rights reserved.

Vibrations of a Marine Propeller Operating in a Nonuniform Inflow.

DTIC Science & Technology

1980-04-01

Expanded Blade Midsurface ......... ........................ ... 73 16 - Calculated Normalized Propeller RMS Vibration Velocity as a Function of...averaged over the blade midsurface ), rather thaft the maximum velocities near the blade tip. Then, for the two test propellers, the rms nonuniform inflow...time- averaged midsurface of the blade, then the instantaneous position S of the vibrating midsurface is _S (ric)+ qct S(r,c,t) = (rc) + q(t) i(rc

Computer-enhanced robotic telesurgery minimizes esophageal perforation during Heller myotomy.

PubMed

Melvin, W Scott; Dundon, John M; Talamini, Mark; Horgan, Santiago

2005-10-01

Laparoscopic Heller myotomy has emerged as the treatment of choice for achalasia. However, intraoperative esophageal perforation remains a significant complication. Computer-enhanced operative techniques have the potential to improve outcomes for certain operative procedures. Robotic, computer-enhanced laparoscopic telemanipulators using 3-dimensional magnified imaging and motion scaling are designed uniquely to facilitate certain operations requiring fine-tissue manipulation. We hypothesized that computer-enhanced robotic Heller myotomy would reduce intraoperative complications compared with laparoscopic techniques. All patients undergoing an operation for achalasia at 3 institutions with a robotic surgery system (DaVinci; Intuitive Surgical Corporation, Sunnyvale, Calif) were followed-up prospectively. Demographics, perioperative course, complications, and hospital stay were recorded. Follow-up evaluation was obtained via a standardized symptom survey, office visits, and medical records. Data were compared with preoperative symptoms using a Mann-Whitney U test, and operating times were compared using the ANOVA test. Between August 2000 and August 2004 there were 104 patients who underwent a robotic Heller myotomy with partial fundoplicaton. There were 53 women and 51 men. All patients were symptomatic. The operative time was 140.55 minutes overall, but improved from 162.63 minutes to 113.50 minutes from 2000-2002 to 2003-2004 (P = .0001). There were no esophageal perforations. There were 8 minor complications and 1 patient required conversion to an open operation. Sixty-six (62.3%) patients were discharged on the first postoperative day and the average hospital stay was 1.5 days. A symptom survey was completed in 79 of 104 patients (76%) at follow-up evaluation. Symptoms improved in all patients with an average follow-up symptom score of 0.48 compared with 5.0 before the operation (P = .0001). Forty-three of the 79 patients from whom follow-up data were collected had a minimum follow-up period of 1 year. The follow-up period averaged 16 months. No patients required reoperation. Computer-enhanced robotic laparoscopic techniques provide a clear advantage over standard laparoscopy for the operative treatment of achalasia. We have shown in this large series that Heller myotomy can be completed using this technology without esophageal perforation. The application of computer-enhanced operative techniques appears to provide superior outcomes in selected procedures.

Independent Analysis of Real-Time, Measured Performance Data From Microcogenerative Fuel Cell Systems Installed in Buildings

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

Dillon, Heather E.; Colella, Whitney G.

2015-06-01

Pacific Northwest National Laboratory (PNNL) is working with industry to independently monitor up to 15 distinct 5 kW-electric (kWe) combined heat and power (CHP) high temperature (HT) proton exchange membrane (PEM) fuel cell systems (FCSs) installed in light commercial buildings. This research paper discusses an evaluation of the first six months of measured performance data acquired at a 1 s sampling rate from real-time monitoring equipment attached to the FCSs at building sites. Engineering performance parameters are independently evaluated. Based on an analysis of the first few months of measured operating data, FCS performance is consistent with manufacturer-stated performance. Initialmore » data indicate that the FCSs have relatively stable performance and a long-term average production of about 4.57 kWe of power. This value is consistent with, but slightly below, the manufacturer's stated rated electric power output of 5 kWe. The measured system net electric efficiency has averaged 33.7%, based on the higher heating value (HHV) of natural gas fuel. This value, also, is consistent with, but slightly below, the manufacturer's stated rated electric efficiency of 36%. The FCSs provide low-grade hot water to the building at a measured average temperature of about 48.4 degrees C, lower than the manufacturer's stated maximum hot water delivery temperature of 65 degrees C. The uptime of the systems is also evaluated. System availability can be defined as the quotient of total operating time compared to time since commissioning. The average values for system availability vary between 96.1 and 97.3%, depending on the FCS evaluated in the field. Performance at rated value for electrical efficiency (PRVeff) can be defined as the quotient of the system time operating at or above the rated electric efficiency and the time since commissioning. The PRVeff varies between 5.6% and 31.6%, depending on the FCS field unit evaluated. Performance at rated value for electrical power (PRVp) can be defined as the quotient of the system time operating at or above the rated electric power and the time since commissioning. PRVp varies between 6.5% and 16.2%. Performance at rated value for electrical efficiency and power (PRVt) can be defined as the quotient of the system time operating at or above both the rated electric efficiency and the electric power output compared to the time since commissioning. PRVt varies between 0.2% and 1.4%. Optimization to determine the manufacturer rating required to achieve PRVt greater than 80% has been performed based on the collected data. For example, for FCS Unit 130 to achieve a PRVt of 95%, it would have to be down-rated to an electrical power output of 3.2 kWe and an electrical efficiency of 29%. The use of PRV as an assessment metric for FCSs has been developed and reported for the first time in this paper. For FCS Unit 130, a maximum decline in electric power output of approximately 18% was observed over a 500 h period in Jan. 2012.« less

Novel use of an ultrasonic bone-cutting device for endoscopic-assisted craniosynostosis surgery.

PubMed

Chaichana, Kaisorn L; Jallo, George I; Dorafshar, Amir H; Ahn, Edward S

2013-07-01

Endoscopic-assisted craniosynostosis surgery is associated with less blood loss and shorter operative times as compared to open surgery. However, in infants who have low circulating blood volumes, the endoscopic approach is still associated with significant blood loss. A major source of blood loss is the bone that is cut during surgery. We discuss the novel use of an ultrasonic bone-cutting device for craniosynostosis surgery, which decreases bone bleeding. This device, which has primarily only been used for spine and skull base surgery, may help reduce blood loss in these infants. All patients with single suture craniosynostosis who were operated on with the use of an ultrasonic bone-cutting device were identified. The information retrospectively recorded from patient charts included patient age, suture involved, blood loss, operative times, complications, preoperative hemoglobin, postoperative hemoglobin, length of hospital stay, and follow-up times. Thirteen patients (12 males, 1 female) underwent surgery with an ultrasonic bone-cutting device during the reviewed period. The average age (±standard deviation) of the patients was 11.8 (±1.6) weeks. Four patients had metopic synostosis and nine patients had sagittal synostosis. The average surgery time was 84 (±13) min. The median (interquartile range) blood loss was 20 (10-70) cc. No patients required blood transfusions. Three patients had dural tears. We demonstrate the novel use of an ultrasonic bone-cutting device for endoscopic-assisted craniosynostosis surgery. This device limited blood loss while maintaining short operative times for infants with low circulating blood volumes.

49 CFR 227.5 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... second or less. Decibel (dB) means a unit of measurement of sound pressure levels. dB(A) means the sound... operate similar equipment under similar conditions. Sound level or Sound pressure level means ten times... an eight-hour time-weighted-average sound level (TWA) of 85 dB(A), or, equivalently, a dose of 50...

Save Energy Dollars with DOE Operations and Maintenance Guide

ERIC Educational Resources Information Center

Appel, Margo

2010-01-01

At budget-crunching time, school administrators and business officials sometimes find themselves trimming the district's budget for teachers, textbooks, and technology in order to cover ballooning energy costs. Nearly one-third of the energy consumed in the average U.S. school is wasted. The country's least efficient schools use four times more…

[A feasibility research of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation for recurrent lumbar disc herniation].

PubMed

Mao, Ke-ya; Wang, Yan; Xiao, Song-hua; Zhang, Yong-gang; Liu, Bao-wei; Wang, Zheng; Zhang, Xi-Feng; Cui, Geng; Zhang, Xue-song; Li, Peng; Mao, Ke-zheng

2013-08-01

To investigate the feasibility of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) using hybrid internal fixation of pedicle screws and a translaminar facet screw for recurrent lumbar disc herniation. From January 2010 to December 2011, 16 recurrent lumbar disc herniation patients, 10 male and 6 female patients with an average age of 45 years (35-68 years) were treated with unilateral incision MIS-TLIF through working channel. After decompression, interbody fusion and fixation using unilateral pedicle screws, a translaminar facet screw was inserted from the same incision through spinous process and laminar to the other side facet joint. The results of perioperative parameters, radiographic images and clinical outcomes were assessed. The repeated measure analysis of variance was applied in the scores of visual analogue scale (VAS) and Oswestry disablity index (ODI). All patients MIS-TLIF were accomplished under working channel including decompression, interbody fusion and hybrid fixation without any neural complication. The average operative time was (148 ± 75) minutes, the average operative blood loss was (186 ± 226) ml, the average postoperative ambulation time was (32 ± 15) hours, and the average hospitalization time was (6 ± 4) days. The average length of incision was (29 ± 4) mm, and the average length of translaminar facets screw was (52 ± 6) mm. The mean follow-up was 16.5 months with a range of 12-24 months. The postoperative X-ray and CT images showed good position of the hybrid internal fixation, and all facets screws penetrate through facets joint. The significant improvement could be found in back pain VAS, leg pain VAS and ODI scores between preoperative 1 day and postoperative follow-up at all time-points (back pain VAS:F = 52.845, P = 0.000;leg pain VAS:F = 113.480, P = 0.000;ODI:F = 36.665, P = 0.000). Recurrent lumbar disc herniation could be treated with MIS-TLIF using hybrid fixation through unilateral incision, and the advantage including less invasion and quickly recovery.

Laparoscopic Extracorporeal Oophorectomy and Ovarian Cystectomy in Second Trimester Pregnant Obese Patients

PubMed Central

Chung, Maurice K.; Chung, Rosemary P.

2001-01-01

Objectives: To determine whether a modified technique for laparoscopic extracorporal oophorectomy is less complicated and safer than traditional laparoscopic oophorectomy. Methods: Four obese patients in their second trimester underwent open laparoscopy for treatment of large ovarian cysts. A Cook Ob/Gyn special cyst aspirator with a 14-gauge aspirating needle was inserted into the abdomen to drain the ovary through a separate 10-mm port; the site of insertion depends on the location of the ovary. After the cyst was decompressed, the 10-mm incision was enlarged to 3 cm, and either extracorporal oophorectomy or cystectomy was performed. Results: No complications occurred. Average blood loss was less than 15 cc; average carbon dioxide insufflation time was less than 20 minutes. Average operating time was 40 minutes, which was significantly less than traditional laparoscopic oophorectomy. The patients were discharged in less than 23 hours. Patient A had a 500-cc dermoid cyst, and subsequently had a normal vaginal delivery at term. Patient B had a 1600-cc cyst removed. She had a cesarian delivery due to cephalopelvic dispro-portion. Pathological analysis of the specimen identified the mass as a dermoid cyst and serous cystadenoma. Patient C had a 3200-cc ovarian cyst. Currently, she is in her 24th week of gestation. Patient D had a 700-cc simple ovarian cyst removed at her 16th week of gestation. Conclusions: Laparoscopic extracorporal oophorectomy requires significantly less CO2 insufflation time and a shorter operation time, hence, decreasing the adverse effects on the fetus. The enlarged second trimester uterus made traditional laparoscopy more complicated. Performing the procedure extracorporally decreased the possibility of operative complications. PMID:11548835

Successful strategies for improving operating room efficiency at academic institutions.

PubMed

Overdyk, F J; Harvey, S C; Fishman, R L; Shippey, F

1998-04-01

In this prospective study, we evaluated the etiology of operating room (OR) delays in an academic institution, examined the impact of multidisciplinary strategies to improve OR efficiency, and established OR timing benchmarks for use in future OR efficiency studies. OR times and delay etiologies were collected for 94 cases during the initial phase of the study. Timing data and delay etiologies were analyzed, and 2 wk of multidisciplinary OR efficiency awareness education was conducted for the nursing, surgical, and anesthesia staff. After the education period, timing data were collected from 1787 cases, and monthly reports listing individual case delays and timing data were sent to the Chiefs of Service. For the first case of the day, patient in room, anesthesia ready, surgical preparation start, and procedure start time were significantly earlier (P < 0.01) in the posteducation period compared with the preeducation period, and the procedure start time for the first case of the day occurred, on average, 22 min earlier than all other procedures. For all cases combined, turnover time decreased, on average, by 16 min. Unavailability of surgeons, anesthesiologists, and residents decreased significantly (P < 0.05) as causes of OR delays. Anesthesia induction times were consistently longer for the vascular and cardiothoracic services, whereas surgical preparation time was increased for the neurosurgical and orthopedic services (P < 0.05). Identification of the etiology of OR inefficiency, combined with multidisciplinary awareness training and personal accountability, can improve OR efficiency. The time savings realized are probably most cost-effective when combined with more flexible OR staffing and improved OR scheduling. We achieved significant improvements in operating room efficiency by analyzing operating room data on causes of delays, devising strategies for minimizing the most common delays, and subsequently measuring delay data. Personal accountability, streamlining of procedures, interdisciplinary team work, and accurate data collection were all important contributors to improved efficiency.

The effect of intermittent operation on a wind-powered membrane system for brackish water desalination.

PubMed

Park, G L; Schäfer, A I; Richards, B S

2012-01-01

Renewable energy powered membrane systems that are directly-connected must take account of both the inherent fluctuations and the intermittency of the energy resource. In order to determine the effect of intermittent operation, a membrane system was tested with variables of (i) amplitude from 60 to 300 W and (ii) length of time with no power from 0.5 to 3 min. This was performed over one hour periods with six on/off cycles to simulate the system operating under intermittent operation for short periods of time when directly-connected to a small wind turbine. The setup used a Filmtec BW30-4040 brackish water reverse osmosis membrane with feed waters of 2,750 mg/L and 5,500 mg/L NaCl. The results showed that the membrane system produced potable water under the majority of intermittency experiments performed. There was a relatively large increase in the average salt concentration of the permeate, especially when the system was off for shorter periods of time (0.5-1 min). Longer periods of no power (1-3 min) did not have as significant an effect on the average water quality. This is important when the need for energy buffering or short term storage is considered for these systems as it shows the potential for improving the overall flux and water quality using temporary energy storage.

Instrument to average 100 data sets

NASA Technical Reports Server (NTRS)

Tuma, G. B.; Birchenough, A. G.; Rice, W. J.

1977-01-01

An instrumentation system is currently under development which will measure many of the important parameters associated with the operation of an internal combustion engine. Some of these parameters include mass-fraction burn rate, ignition energy, and the indicated mean effective pressure. One of the characteristics of an internal combustion engine is the cycle-to-cycle variation of these parameters. A curve-averaging instrument has been produced which will generate the average curve, over 100 cycles, of any engine parameter. the average curve is described by 2048 discrete points which are displayed on an oscilloscope screen to facilitate recording and is available in real time. Input can be any parameter which is expressed as a + or - 10-volt signal. Operation of the curve-averaging instrument is defined between 100 and 6000 rpm. Provisions have also been made for averaging as many as four parameters simultaneously, with a subsequent decrease in resolution. This provides the means to correlate and perhaps interrelate the phenomena occurring in an internal combustion engine. This instrument has been used successfully on a 1975 Chevrolet V8 engine, and on a Continental 6-cylinder aircraft engine. While this instrument was designed for use on an internal combustion engine, with some modification it can be used to average any cyclically varying waveform.

The effect of data structures on INGRES performance

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

Creighton, J.R.

1987-01-01

Computer experiments were conducted to determine the effect of using Heap, ISAM, Hash and B-tree data structures for INGRES relations. Average times for retrieve, append and update were determined for searches by unique key and non-key data. The experiments were conducted on relations of approximately 1000 tuples of 332 byte width. Multiple operations were performed, where appropriate, to obtain average times. Simple models of the data structures are presented and shown to be consistent with experimental results. The models can be used to predict performance, and to select the appropriate data structure for various applications.

Convergence to equilibrium under a random Hamiltonian.

PubMed

Brandão, Fernando G S L; Ćwikliński, Piotr; Horodecki, Michał; Horodecki, Paweł; Korbicz, Jarosław K; Mozrzymas, Marek

2012-09-01

We analyze equilibration times of subsystems of a larger system under a random total Hamiltonian, in which the basis of the Hamiltonian is drawn from the Haar measure. We obtain that the time of equilibration is of the order of the inverse of the arithmetic average of the Bohr frequencies. To compute the average over a random basis, we compute the inverse of a matrix of overlaps of operators which permute four systems. We first obtain results on such a matrix for a representation of an arbitrary finite group and then apply it to the particular representation of the permutation group under consideration.

Convergence to equilibrium under a random Hamiltonian

NASA Astrophysics Data System (ADS)

Brandão, Fernando G. S. L.; Ćwikliński, Piotr; Horodecki, Michał; Horodecki, Paweł; Korbicz, Jarosław K.; Mozrzymas, Marek

2012-09-01

We analyze equilibration times of subsystems of a larger system under a random total Hamiltonian, in which the basis of the Hamiltonian is drawn from the Haar measure. We obtain that the time of equilibration is of the order of the inverse of the arithmetic average of the Bohr frequencies. To compute the average over a random basis, we compute the inverse of a matrix of overlaps of operators which permute four systems. We first obtain results on such a matrix for a representation of an arbitrary finite group and then apply it to the particular representation of the permutation group under consideration.

Operative Treatment of Traumatic Hallux Valgus in Elite Athletes.

PubMed

Covell, D Jeff; Lareau, Craig R; Anderson, Robert B

2017-06-01

Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique variant of turf toe. Failure to appropriately recognize and treat these injuries can lead to continued pain, decreased performance, progressive deformities, and ultimately degeneration of the hallux metatarsophalangeal joint. Limited literature currently exists to assist in the diagnosis, management, and operative treatment. Nineteen patients were reviewed in this series, including 12 National Football League, 6 college, and 1 high school player who was a college prospect. The average age for all patients at the time of surgery was 24.4 years (range, 19-33 years). Return to play and complications were evaluated. Overall, good operative results were obtained, with 74% of patients returning to their preinjury level of play at an average recovery time of 3.4 months. Traumatic hallux valgus is an increasingly common injury in the athletic population and represents a unique variant of turf toe. The impact of this injury cannot be overstated, as one-quarter of players were unable to return to play. Level IV, case series.

Laparoscopic Adrenalectomy for Adrenal Tumors

PubMed Central

Chuan-yu, Sun; Yat-faat, Ho; Wei-hong, Ding; Yuan-cheng, Gou; Qing-feng, Hu; Ke, Xu; Bin, Gu; Guo-wei, Xia

2014-01-01

Objective. To evaluate the indication and the clinical value of laparoscopic adrenalectomy of different types of adrenal tumor. Methods. From 2009 to 2014, a total of 110 patients were diagnosed with adrenal benign tumor by CT scan and we performed laparoscopic adrenalectomy. The laparoscopic approach has been the procedure of choice for surgery of benign adrenal tumors, and the upper limit of tumor size was thought to be 6 cm. Results. 109 of 110 cases were successful; only one was converted to open surgery due to bleeding. The average operating time and intraoperative blood loss of pheochromocytoma were significantly more than the benign tumors (P < 0.05). After 3 months of follow-up, the preoperative symptoms were relieved and there was no recurrence. Conclusions. Laparoscopic adrenalectomy has the advantages of minimal invasion, less blood loss, fewer complications, quicker recovery, and shorter hospital stay. The full preparation before operation can decrease the average operating time and intraoperative blood loss of pheochromocytomas. Laparoscopic adrenalectomy should be considered as the first choice treatment for the resection of adrenal benign tumor. PMID:25132851

Monitoring worksite clinic performance using a cost-benefit tool.

PubMed

Tao, Xuguang; Chenoweth, David; Alfriend, Amy S; Baron, David M; Kirkland, Tracie W; Scherb, Jill; Bernacki, Edward J

2009-10-01

The purpose of this study was to explore the usefulness of continuously assessing the return on investment (ROI) of worksite medical clinics as a means of evaluating clinic performance. Visit data from January 1, 2007, to December 31, 2008, were collected from all the on-site clinics operated for the Pepsi Bottling Group. An average system-wide ROI was calculated from the time of each clinic's opening and throughout the study period. A multivariate linear regression model was used to determine the association of average ROI with penetration/utilization rate and plant size. A total of 26 on-site clinics were actively running as of December 2008. The average ROI at the time of start up was 0.4, which increased to 1.2 at approximately 4 months and 1.6 at the end of the first year of operation. Overall, it seems that the cost of operating a clinic becomes equal to the cost of similar care purchased in the community (ROI = 1) at approximately 3 months after a clinic's opening and flattens out at the end of the first year. The magnitude of the ROI was closely related to the number of visits (a function of the penetration/utilization rate) and the size of the plant population served. Serial monitoring of ROIs is a useful metric in assessing on-site clinic performance and quantifying the effect of new initiatives aimed at increasing a clinic's cost effectiveness.

Periodic venting of MABR lumen allows high removal rates and high gas-transfer efficiencies.

PubMed

Perez-Calleja, P; Aybar, M; Picioreanu, C; Esteban-Garcia, A L; Martin, K J; Nerenberg, R

2017-09-15

The membrane-aerated biofilm reactor (MABR) is a novel treatment technology that employs gas-supplying membranes to deliver oxygen directly to a biofilm growing on the membrane surface. When operated with closed-end membranes, the MABR provides 100-percent oxygen transfer efficiencies (OTE), resulting in significant energy savings. However, closed-end MABRs are more sensitive to back-diffusion of inert gases, such as nitrogen. Back-diffusion reduces the average oxygen transfer rates (OTR), consequently decreasing the average contaminant removal fluxes (J). We hypothesized that venting the membrane lumen periodically would increase the OTR and J. Using an experimental flow cell and mathematical modeling, we showed that back-diffusion gas profiles developed over relatively long timescales. Thus, very short ventings could re-establish uniform gas profiles for relatively long time periods. Using modeling, we systematically explored the effect of the venting interval (time between ventings). At moderate venting intervals, opening the membrane for 20 s every 30 min, the venting significantly increased the average OTR and J without substantially impacting the OTEs. When the interval was short enough, in this case shorter than 20 min, the OTR was actually higher than for continuous open-end operation. Our results show that periodic venting is a promising strategy to combine the advantages of open-end and closed end operation, maximizing both the OTR and OTE. Copyright © 2017 Elsevier Ltd. All rights reserved.

Bulk shielding facility quarterly report, October, November, and December 1976

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

Hurt, III, S. S.; Lance, E. D.; Thomas, J. R.

1977-08-01

The BSR operated at an average power level of 1,836 kw for 78.01 percent of the time during October, November, and December. Water-quality control in both the reactor primary and secondary cooling systems was satisfactory. The PCA was used in training programs and was operated on two occasions when the University of Kentucky students actively participated in training laboratories.

Comparison Between Civilian Burns and Combat burns From Operation Iraqi Freedom and Operation Enduring Freedom

DTIC Science & Technology

2006-06-01

to the average burn size reported from the ABA Burn Registry in 1995 (14% TBSA).20 We also found that the time to death in those who died, time on...after a prolonged stay in theater (up to 30 days, COL (retired) Basil A. Pruitt, personal commu- nication). They found a mortality rate of 7.9% in...from the green books that you know about. When we have that, we may be able to make that same comparison from the Vietnam era. DR. BASIL A. PRUITT, JR

Bacterial, viral and turbidity removal by intermittent slow sand filtration for household use in developing countries: experimental investigation and modeling.

PubMed

Jenkins, Marion W; Tiwari, Sangam K; Darby, Jeannie

2011-11-15

A two-factor three-block experimental design was developed to permit rigorous evaluation and modeling of the main effects and interactions of sand size (d(10) of 0.17 and 0.52 mm) and hydraulic head (10, 20, and 30 cm) on removal of fecal coliform (FC) bacteria, MS2 bacteriophage virus, and turbidity, under two batch operating modes ('long' and 'short') in intermittent slow sand filters (ISSFs). Long operation involved an overnight pause time between feeding of two successive 20 L batches (16 h average batch residence time (RT)). Short operation involved no pause between two 20 L batch feeds (5h average batch RT). Conditions tested were representative of those encountered in developing country field settings. Over a ten week period, the 18 experimental filters were fed river water augmented with wastewater (influent turbidity of 5.4-58.6 NTU) and maintained with the wet harrowing method. Linear mixed modeling allowed systematic estimates of the independent marginal effects of each independent variable on each performance outcome of interest while controlling for the effects of variations in a batch's actual residence time, days since maintenance, and influent turbidity. This is the first study in which simultaneous measurement of bacteria, viruses and turbidity removal at the batch level over an extended duration has been undertaken with a large number of replicate units to permit rigorous modeling of ISSF performance variability within and across a range of likely filter design configurations and operating conditions. On average, the experimental filters removed 1.40 log fecal coliform CFU (SD 0.40 log, N=249), 0.54 log MS2 PFU (SD 0.42 log, N=245) and 89.0 percent turbidity (SD 6.9 percent, N=263). Effluent turbidity averaged 1.24 NTU (SD 0.53 NTU, N=263) and always remained below 3 NTU. Under the best performing design configuration and operating mode (fine sand, 10 cm head, long operation, initial HLR of 0.01-0.03 m/h), mean 1.82 log removal of bacteria (98.5%) and mean 0.94 log removal of MS2 viruses (88.5%) were achieved. Results point to new recommendations regarding filter design, manufacture, and operation for implementing ISSFs in local settings in developing countries. Sand size emerged as a critical design factor on performance. A single layer of river sand used in this investigation demonstrated removals comparable to those reported for 2 layers of crushed sand. Pause time and increased residence time each emerged as highly beneficial for improving removal performance on all four outcomes. A relatively large and significant negative effect of influent turbidity on MS2 viral removal in the ISSF was measured in parallel with a much smaller weaker positive effect of influent turbidity on FC bacterial removal. Disturbance of the schmutzdecke by wet harrowing showed no effect on virus removal and a modest reductive effect on the bacterial and turbidity removal as measured 7 days or more after the disturbance. For existing coarse sand ISSFs, this research indicates that a reduction in batch feed volume, effectively reducing the operating head and increasing the pore:batch volume ratio, could improve their removal performance by increasing batch residence time. Copyright © 2011 Elsevier Ltd. All rights reserved.

The intensity of knock in an internal combustion engine: An experimental and modeling study

NASA Astrophysics Data System (ADS)

Cowart, J. S.; Haghooie, M.; Newman, C. E.; Davis, G. C.; Pitz, W. J.; Westbrook, C. K.

1992-09-01

Experimental data have been obtained that characterize knock occurrence times and knock intensities in a spark ignition engine operating on indolene and 91 primary reference fuel, as spark timing and inlet temperature were varied. Individual, in-cylinder pressure histories measured under knocking conditions were conditioned and averaged to obtain representative pressure traces. These averaged pressure histories were used as input to a reduced and detailed chemical kinetic model. The time derivative of CO concentration and temperature were correlated with the measured knock intensity and percent cycles knocking. The goal was to evaluate the potential of using homogeneous, chemical kinetic models as predictive tools for knock intensity.

[Effect analysis of anterior cervical operation for severe cervical kyphosis].

PubMed

Shen, X L; Wu, H Q; Hu, Z H; Liu, Y; Wang, X W; Chen, H J; Cao, P; Tian, Y; Yang, C; Yuan, W

2017-03-01

Objective: To determine the feasibility and safety of anterior cervical decompression and fusion in severe cervical kyphosis treatment. Methods: Totally 29 patients with severe cervical kyphosis(Cobb angle>50°) underwent anterior cervical decompression and fusion from June 2008 to May 2016 were studied retrospectively. There were 19 males and 10 females. The average age was 32.6 years ranging from 14 to 53 years. According to the etiology, 12 patients had iatrogenic deformity (11 had post-laminectomy cervical kyphosis, 1 had kyphosis due to anterior graft subsidence), 5 had neurofibromatosis, 4 had infective kyphosis, 8 had idiopathic cervical kyphosis. The curvature of cervical angle was measured by two-line Cobb method. The severity of cervical kyphosis was evaluated by kyphosis index (KI). Parameters including kyphosis levels, the apex of the kyphosis, C(2-7) sagittal vertical axis(SVA) and T(1) slope were also measured on lateral radiographs in the neutral position in each patient. The pre- and post-operative Japanese Orthopaedic Association(JOA) scores, visual analogue scale (VAS) of neek pain, neck disability index (NDI) and cervical alignment were compared. All patients were treated by skull traction. Motor evoked potential and somatosensory evoked potential were applied intraoperation as the spinal cord monitor. Results: Skull traction was performed for an average of 6.3 days. The mean vertebral number in kyphotic region was 4.7. The average operation time was 155 minutes and blood loss was 135 ml. The preoperative C(2-7)Cobb angle was 46.6°±18.1° in average. It was reduced to 11.4°±6.4° in average after operation. The Cobb angle of operation region was 72.9°±19.6° in average before operation. It was reduced to 11.2°±6.4° in average after operation. The kyphosis region correction rate was 84.6%. The mean preoperative C(2-7)SVA changed from (3.8±14.6) mm to (12.6±7.8) mm postoperatively. The mean preoperative T(1) slope changed from -10.6°±16.4° to 7.1°±14.9° postoperatively. The average postoperative C(2-7) Cobb angle, Cobb angle of kyphosis region, KI, C(2-7) SVA and T(1) slope changed significantly compared with preoperation ( F =12.700-218.200, all P <0.01). The average postoperative JOA, VAS and NDI scores improved significantly compared with preoperation ( F =225.500, 217.900, 131.200, all P <0.01). Conclusion: For severe cervical kyphosis, anterior correction is a safe and effective technique, sufficient decompression will be achieved.

Domestic embedded reporter program: saving lives and securing tactical operations

DTIC Science & Technology

2017-03-01

estimated to average 1 hour per response, including the time for reviewing instruction, searching existing data sources, gathering and maintaining the...13. ABSTRACT (maximum 200 words) Advances in technology have provided journalists the tools to obtain and share real- time information during domestic...terrorist and mass-shooting incidents. This real- time information-sharing compromises the safety of first responders, victims, and reporters. Real

XDATA

DTIC Science & Technology

2017-12-01

6028 Date Cleared: 30 NOV 2017 13. SUPPLEMENTARY NOTES 14. ABSTRACT Data analysis tools which operate on varied data sources including time series ...public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions...and raw detections from geo-located tweets Micro-paths (10M) (No distance/ time filter) Raw Tracks (10M) Raw Detections (10M) APPROVED FOR PUBLIC

Minimizing patient waiting time in emergency department of public hospital using simulation optimization approach

NASA Astrophysics Data System (ADS)

Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid

2017-04-01

Emergency department (ED) is the main unit of a hospital that provides emergency treatment. Operating 24 hours a day with limited number of resources invites more problems to the current chaotic situation in some hospitals in Malaysia. Delays in getting treatments that caused patients to wait for a long period of time are among the frequent complaints against government hospitals. Therefore, the ED management needs a model that can be used to examine and understand resource capacity which can assist the hospital managers to reduce patients waiting time. Simulation model was developed based on 24 hours data collection. The model developed using Arena simulation replicates the actual ED's operations of a public hospital in Selangor, Malaysia. The OptQuest optimization in Arena is used to find the possible combinations of a number of resources that can minimize patients waiting time while increasing the number of patients served. The simulation model was modified for improvement based on results from OptQuest. The improvement model significantly improves ED's efficiency with an average of 32% reduction in average patients waiting times and 25% increase in the total number of patients served.

Suited versus unsuited analog astronaut performance using the Aouda.X space suit simulator: the DELTA experiment of MARS2013.

PubMed

Soucek, Alexander; Ostkamp, Lutz; Paternesi, Roberta

2015-04-01

Space suit simulators are used for extravehicular activities (EVAs) during Mars analog missions. Flight planning and EVA productivity require accurate time estimates of activities to be performed with such simulators, such as experiment execution or traverse walking. We present a benchmarking methodology for the Aouda.X space suit simulator of the Austrian Space Forum. By measuring and comparing the times needed to perform a set of 10 test activities with and without Aouda.X, an average time delay was derived in the form of a multiplicative factor. This statistical value (a second-over-second time ratio) is 1.30 and shows that operations in Aouda.X take on average a third longer than the same operations without the suit. We also show that activities predominantly requiring fine motor skills are associated with larger time delays (between 1.17 and 1.59) than those requiring short-distance locomotion or short-term muscle strain (between 1.10 and 1.16). The results of the DELTA experiment performed during the MARS2013 field mission increase analog mission planning reliability and thus EVA efficiency and productivity when using Aouda.X.

40 CFR 63.9920 - What are my continuous monitoring requirements?

Code of Federal Regulations, 2012 CFR

2012-07-01

... scrubber subject to the operating limits for pressure drop and scrubber water flow rates in § 63.9890(b), you must at all times monitor the hourly average pressure drop and liquid flow rate using a CPMS...

40 CFR 63.9920 - What are my continuous monitoring requirements?

Code of Federal Regulations, 2013 CFR

2013-07-01

... scrubber subject to the operating limits for pressure drop and scrubber water flow rates in § 63.9890(b), you must at all times monitor the hourly average pressure drop and liquid flow rate using a CPMS...

40 CFR 63.9920 - What are my continuous monitoring requirements?

Code of Federal Regulations, 2010 CFR

2010-07-01

... scrubber subject to the operating limits for pressure drop and scrubber water flow rates in § 63.9890(b), you must at all times monitor the hourly average pressure drop and liquid flow rate using a CPMS...

Time Management in the Operating Room: An Analysis of the Dedicated Minimally Invasive Surgery Suite

PubMed Central

Hsiao, Kenneth C.; Machaidze, Zurab

2004-01-01

Background: Dedicated minimally invasive surgery suites are available that contain specialized equipment to facilitate endoscopic surgery. Laparoscopy performed in a general operating room is hampered by the multitude of additional equipment that must be transported into the room. The objective of this study was to compare the preparation times between procedures performed in traditional operating rooms versus dedicated minimally invasive surgery suites to see whether operating room efficiency is improved in the specialized room. Methods: The records of 50 patients who underwent laparoscopic procedures between September 2000 and April 2002 were retrospectively reviewed. Twenty-three patients underwent surgery in a general operating room and 18 patients in an minimally invasive surgery suite. Nine patients were excluded because of cystoscopic procedures undergone prior to laparoscopy. Various time points were recorded from which various time intervals were derived, such as preanesthesia time, anesthesia induction time, and total preparation time. A 2-tailed, unpaired Student t test was used for statistical analysis. Results: The mean preanesthesia time was significantly faster in the minimally invasive surgery suite (12.2 minutes) compared with that in the traditional operating room (17.8 minutes) (P=0.013). Mean anesthesia induction time in the minimally invasive surgery suite (47.5 minutes) was similar to time in the traditional operating room (45.7 minutes) (P=0.734). The average total preparation time for the minimally invasive surgery suite (59.6 minutes) was not significantly faster than that in the general operating room (63.5 minutes) (P=0.481). Conclusion: The amount of time that elapses between the patient entering the room and anesthesia induction is statically shorter in a dedicated minimally invasive surgery suite. Laparoscopic surgery is performed more efficiently in a dedicated minimally invasive surgery suite versus a traditional operating room. PMID:15554269

Prospective Evaluation of Operating Room Inefficiency.

PubMed

Madni, Tarik D; Imran, Jonathan B; Clark, Audra T; Cunningham, Holly B; Taveras, Luis; Arnoldo, Brett D; Phelan, Herb A; Wolf, Steven E

2018-04-06

Previously, we identified that 60% of our facility's total operative time is nonoperative. We performed a review of our operating room to determine where inefficiencies exist in nonoperative time. Live video of operations performed in a burn operating room from 6/23/17 to 8/16/17 were prospectively reviewed. Preparation (end of induction to procedure start) and turnover (patient out of room to next patient in room) were divided into the following activities: 1) Preparation: remove dressing, position patient, clean patient, drape patient, and 2) Turnover: clean operating room, scrub tray set-up, anesthesia set-up. Ideal preparation time was calculated as the sum of time needed to perform preparation activities consecutively. Ideal turnover time was calculated as the sum of time needed to clean the operating room and to set up either the scrub tray or anesthesia (the larger of the two times as these can be done in parallel). We reviewed 101 consecutive operations. An average of 2.4±0.8 cases/day were performed. Ideal preparation and turnover time were 16.6 and 30.1 minutes, a 38.3% and 32.5% reduction compared to actual times. Attending surgeon presence in the operating room within 10 minutes of a patient's arrival was found to significantly decrease time to incision by 33% (52.7±14.3 minutes down to 35.7±20.4, p<0.0001). A reduction in preparation and turnover time could save $1.02 million and generate $1.76 million in additional revenue annually. Reducing preparation and turnover to ideal times could increase caseload to 4/day, leading to millions of dollars of savings annually.

Development of a Patient-Based Model for Estimating Operative Times for Robot-Assisted Radical Prostatectomy.

PubMed

Huben, Neil; Hussein, Ahmed; May, Paul; Whittum, Michelle; Kraswowki, Collin; Ahmed, Youssef; Jing, Zhe; Khan, Hijab; Kim, Hyung; Schwaab, Thomas; Underwood Iii, Willie; Kauffman, Eric; Mohler, James L; Guru, Khurshid A

2018-04-10

To develop a methodology for predicting operative times for robot-assisted radical prostatectomy (RARP) using preoperative patient, disease, procedural and surgeon variables to facilitate operating room (OR) scheduling. The model included preoperative metrics: BMI, ASA score, clinical stage, National Comprehensive Cancer Network (NCCN) risk, prostate weight, nerve-sparing status, extent and laterality of lymph node dissection, and operating surgeon (6 surgeons were included in the study). A binary decision tree was fit using a conditional inference tree method to predict operative times. The variables most associated with operative time were determined using permutation tests. The data was split at the value of the variable that results in the largest difference in means for surgical time across the split. This process was repeated recursively on the resultant data. 1709 RARPs were included. The variable most strongly associated with operative time was the surgeon (surgeons 2 and 4 - 102 minutes shorter than surgeons 1, 3, 5, and 6, p<0.001). Among surgeons 2 and 4, BMI had the strongest association with surgical time (p<0.001). Among patients operated by surgeons 1, 3, 5 and 6, RARP time was again most strongly associated with the surgeon performing RARP. Surgeons 1, 3, and 6 were on average 76 minutes faster than surgeon 5 (p<0.001). The regression tree output in the form of box plots showed operative time median and ranges according to patient, disease, procedural and surgeon metrics. We developed a methodology that can predict operative times for RARP based on patient, disease and surgeon variables. This methodology can be utilized for quality control, facilitate OR scheduling and maximize OR efficiency.

Optimizing the Long-Term Operating Plan of Railway Marshalling Station for Capacity Utilization Analysis

PubMed Central

Zhou, Wenliang; Yang, Xia; Deng, Lianbo

2014-01-01

Not only is the operating plan the basis of organizing marshalling station's operation, but it is also used to analyze in detail the capacity utilization of each facility in marshalling station. In this paper, a long-term operating plan is optimized mainly for capacity utilization analysis. Firstly, a model is developed to minimize railcars' average staying time with the constraints of minimum time intervals, marshalling track capacity, and so forth. Secondly, an algorithm is designed to solve this model based on genetic algorithm (GA) and simulation method. It divides the plan of whole planning horizon into many subplans, and optimizes them with GA one by one in order to obtain a satisfactory plan with less computing time. Finally, some numeric examples are constructed to analyze (1) the convergence of the algorithm, (2) the effect of some algorithm parameters, and (3) the influence of arrival train flow on the algorithm. PMID:25525614

Atmospheric Radiation Measurement Program Climate Research Facility Operations Quarterly Report July 1 – September 30, 2008

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

Sisterson, DL

2008-09-30

Individual raw data streams from instrumentation at the Atmospheric Radiation Measurement (ARM) Program Climate Research Facility (ACRF) fixed and mobile sites are collected and sent to the Data Management Facility (DMF) at Pacific Northwest National Laboratory (PNNL) for processing in near real-time. Raw and processed data are then sent daily to the ACRF Archive, where they are made available to users. For each instrument, we calculate the ratio of the actual number of data records received daily at the Archive to the expected number of data records. The results are tabulated by (1) individual data stream, site, and month formore » the current year and (2) site and fiscal year (FY) dating back to 1998. The U.S. Department of Energy (DOE) requires national user facilities to report time-based operating data. The requirements concern the actual hours of operation (ACTUAL); the estimated maximum operation or uptime goal (OPSMAX), which accounts for planned downtime; and the VARIANCE [1 – (ACTUAL/OPSMAX)], which accounts for unplanned downtime. The OPSMAX time for the fourth quarter of FY 2008 for the Southern Great Plains (SGP) site is 2,097.60 hours (0.95 x 2,208 hours this quarter). The OPSMAX for the North Slope Alaska (NSA) locale is 1,987.20 hours (0.90 x 2,208), and for the Tropical Western Pacific (TWP) locale is 1,876.80 hours (0.85 x 2,208). The OPSMAX time for the ARM Mobile Facility (AMF) is not reported this quarter because the data have not yet been released from China to the DMF for processing. The differences in OPSMAX performance reflect the complexity of local logistics and the frequency of extreme weather events. It is impractical to measure OPSMAX for each instrument or data stream. Data availability reported here refers to the average of the individual, continuous data streams that have been received by the Archive. Data not at the Archive are caused by downtime (scheduled or unplanned) of the individual instruments. Therefore, data availability is directly related to individual instrument uptime. Thus, the average percentage of data in the Archive represents the average percentage of the time (24 hours per day, 92 days for this quarter) the instruments were operating this quarter.« less

Queueing system analysis of multi server model at XYZ insurance company in Tasikmalaya city

NASA Astrophysics Data System (ADS)

Muhajir, Ahmad; Binatari, Nikenasih

2017-08-01

Queueing theory or waiting line theory is a theory that deals with the queue process from the customer comes, queue to be served, served and left on service facilities. Queue occurs because of a mismatch between the numbers of customers that will be served with the available number of services, as an example at XYZ insurance company in Tasikmalaya. This research aims to determine the characteristics of the queue system which then to optimize the number of server in term of total cost. The result shows that the queue model can be represented by (M/M/4):(GD/∞/∞), where the arrivals are Poisson distributed while the service time is following exponential distribution. The probability of idle customer service is 2,39% of the working time, the average number of customer in the queue is 3 customers, the average number of customer in a system is 6 customers, the average time of a customer spent in the queue is 15,9979 minutes, the average time a customer spends in the system is 34,4141 minutes, and the average number of busy customer servicer is 3 server. The optimized number of customer service is 5 servers, and the operational cost has minimum cost at Rp 4.323.

Predictability of Solar Radiation for Photovoltaics systems over Europe: from short-term to seasonal time-scales

NASA Astrophysics Data System (ADS)

De Felice, Matteo; Petitta, Marcello; Ruti, Paolo

2014-05-01

Photovoltaic diffusion is steadily growing on Europe, passing from a capacity of almost 14 GWp in 2011 to 21.5 GWp in 2012 [1]. Having accurate forecast is needed for planning and operational purposes, with the possibility to model and predict solar variability at different time-scales. This study examines the predictability of daily surface solar radiation comparing ECMWF operational forecasts with CM-SAF satellite measurements on the Meteosat (MSG) full disk domain. Operational forecasts used are the IFS system up to 10 days and the System4 seasonal forecast up to three months. Forecast are analysed considering average and variance of errors, showing error maps and average on specific domains with respect to prediction lead times. In all the cases, forecasts are compared with predictions obtained using persistence and state-of-art time-series models. We can observe a wide range of errors, with the performance of forecasts dramatically affected by orography and season. Lower errors are on southern Italy and Spain, with errors on some areas consistently under 10% up to ten days during summer (JJA). Finally, we conclude the study with some insight on how to "translate" the error on solar radiation to error on solar power production using available production data from solar power plants. [1] EurObserver, "Baromètre Photovoltaïque, Le journal des énergies renouvables, April 2012."

A flexible simulation platform to quantify and manage emergency department crowding.

PubMed

Hurwitz, Joshua E; Lee, Jo Ann; Lopiano, Kenneth K; McKinley, Scott A; Keesling, James; Tyndall, Joseph A

2014-06-09

Hospital-based Emergency Departments are struggling to provide timely care to a steadily increasing number of unscheduled ED visits. Dwindling compensation and rising ED closures dictate that meeting this challenge demands greater operational efficiency. Using techniques from operations research theory, as well as a novel event-driven algorithm for processing priority queues, we developed a flexible simulation platform for hospital-based EDs. We tuned the parameters of the system to mimic U.S. nationally average and average academic hospital-based ED performance metrics and are able to assess a variety of patient flow outcomes including patient door-to-event times, propensity to leave without being seen, ED occupancy level, and dynamic staffing and resource use. The causes of ED crowding are variable and require site-specific solutions. For example, in a nationally average ED environment, provider availability is a surprising, but persistent bottleneck in patient flow. As a result, resources expended in reducing boarding times may not have the expected impact on patient throughput. On the other hand, reallocating resources into alternate care pathways can dramatically expedite care for lower acuity patients without delaying care for higher acuity patients. In an average academic ED environment, bed availability is the primary bottleneck in patient flow. Consequently, adjustments to provider scheduling have a limited effect on the timeliness of care delivery, while shorter boarding times significantly reduce crowding. An online version of the simulation platform is available at http://spark.rstudio.com/klopiano/EDsimulation/. In building this robust simulation framework, we have created a novel decision-support tool that ED and hospital managers can use to quantify the impact of proposed changes to patient flow prior to implementation.

RENEW v3.2 user's manual, maintenance estimation simulation for Space Station Freedom Program

NASA Technical Reports Server (NTRS)

Bream, Bruce L.

1993-01-01

RENEW is a maintenance event estimation simulation program developed in support of the Space Station Freedom Program (SSFP). This simulation uses reliability and maintainability (R&M) and logistics data to estimate both average and time dependent maintenance demands. The simulation uses Monte Carlo techniques to generate failure and repair times as a function of the R&M and logistics parameters. The estimates are generated for a single type of orbital replacement unit (ORU). The simulation has been in use by the SSFP Work Package 4 prime contractor, Rocketdyne, since January 1991. The RENEW simulation gives closer estimates of performance since it uses a time dependent approach and depicts more factors affecting ORU failure and repair than steady state average calculations. RENEW gives both average and time dependent demand values. Graphs of failures over the mission period and yearly failure occurrences are generated. The averages demand rate for the ORU over the mission period is also calculated. While RENEW displays the results in graphs, the results are also available in a data file for further use by spreadsheets or other programs. The process of using RENEW starts with keyboard entry of the R&M and operational data. Once entered, the data may be saved in a data file for later retrieval. The parameters may be viewed and changed after entry using RENEW. The simulation program runs the number of Monte Carlo simulations requested by the operator. Plots and tables of the results can be viewed on the screen or sent to a printer. The results of the simulation are saved along with the input data. Help screens are provided with each menu and data entry screen.

Improvements in Operational Readiness by Distributing Manufacturing Capability in the Supply Chain through Additive Manufacturing

DTIC Science & Technology

2017-12-01

inefficiencies of a more complex system. Additional time may also be due to the longer distances traveled . The fulfillment time for a requisition to...Approved OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time ...advanced manufacturing methods with additive manufacturing. This work decomposes the additive manufacturing processes into 11 primary functions. The time

Physician Education on Controllable Costs Significantly Reduces Cost of Laparoscopic Hysterectomy.

PubMed

Croft, Katherine; Mattingly, Patricia J; Bosse, Patrick; Naumann, R Wendel

2017-01-01

To determine whether educating surgeons about their controllable instrumentation costs by providing cost data on total laparoscopic hysterectomy (LH) would reduce the cost of this procedure. Prospective cohort study (Canadian Task Force classification III). Academic-affiliated community hospital. Patients who underwent LH between April 2014 and March 2015 with surgeons who performed at least 10 LHs during that time period, along with a second group who underwent LH with the same cohort of surgeons between July 2015 and September 2015. The cost of LH was calculated for all surgeons who performed more than 10 LHs between April 2014 and March 2015. Itemized cost data were collected. The individual costs, as well as a summary of the data, were shared with all of the physicians to highlight areas of potential cost savings. The costs were then measured for 3 months after the educational intervention (July-September 2015) to gauge the impact of physician cost education. Thirteen surgeons met the criteria for inclusion in this analysis. Together, they performed 271 hysterectomies, with an average instrumentation cost of $1539.47 ± $294.16 and an average operating room time of 178 ± 26 minutes. Bipolar instrument choice represented 37% of the baseline costs, followed by 10% for trocar, 9% for cuff closure, and 8% for uterine manipulator. This same group of surgeons performed a total of 69 hysterectomies in the 3-month follow-up period of July-September 2015, with an average instrumentation cost of $1282.62 ± $235.03 and an average operating room time of 163 ± 50 minutes. There was statistically significant cost reduction of $256.85 ± $190.69 (p = .022), with no significant change in operating room time. Bipolar instrument cost decreased significantly, by $130.02 ± $125.02 (p = .021), representing 51% of the total cost savings. Trocar, cuff closure, and uterine manipulator costs were not significant sources of cost savings on average, but did represent sources of cost savings for some surgeons individually. Given adequate education about the products available for use in their institution, surgeons make informed decisions regarding the choice of instrumentation, allowing them to directly impact the cost of total LH, resulting in cost savings. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

[Design and clinical application of the drilling guide in the treatment of acromioclavicular joint dislocation with closed reduction and Kirschner fixation].

PubMed

Zhou, Song; Hao, Yong-qiang; Shi, Xiao-lin; Zhao, Huan-li; Gao, Kai-tuo; Sun, Jin-xu

2011-03-01

To investigate a drilling guide in the treatment of acromioclavicular joint dislocation with closed reduction and Kirschner fixation and explore the therapeutic effect. From June 2008 to December 2009, 36 patients with acromioclavicular joint dislocation (Tossy III) were treated with closed reduction and Kirschner fixation using a self-designed drilling guide as well as percutaneous repair of acromioclavicular joint. Among the patients, 24 patients were male and 12 patients were female,ranging in age from 20 to 61 years, averaged 38.6 years. The duration from injury to operation ranged from 3.5 to 72 h,with a mean of 15.2 h. No clavicle fracture was found in all cases. The operative time, intra-operative bleeding and therapeutic effects were observed. There were no complications including neurovascular problems. The mean operating time were 20 min,mean blood loss were about 10 ml. According to the observation of postoperative X-ray examination, all Kirschners in acromioclavicular joint were in place. All Kirschners were removed in 6 postoperative weeks. All the patients were followed up ranging from 2 to 26 months (averaged 14.3 months). According to the Karlsson standard,22 patients got an excellent result, 13 good and 1 poor. This method has following advantages: easy operation and fixation; minimum injuries to articular surface; and which would be widely used in clinical practice.

Assessment of operative times of multiple surgical specialties in a public university hospital

PubMed Central

Costa, Altair da Silva

2017-01-01

ABSTRACT Objective To evaluate the indicators duration of anesthesia, operative time and time patients stay in the operating rooms of different surgical specialties at a public university hospital. Methods It was done by a descriptive cross-sectional study based on the operating room database. The following stages were measured: duration of anesthesia, procedure time and patient length of stay in the room of the various specialties. We included surgeries carried out in sequence in the same room, between 7:00 a.m. and 5 p.m., either elective or emergency. We calculated the 80th percentile of the stages, where 80% of procedures were below this value. Results The study measured 8,337 operations of 12 surgical specialties performed within one year. The overall mean duration of anesthesia of all specialties was 178.12±110.46 minutes, and the 80th percentile was 252 minutes. The mean operative time was 130.45±97.23 minutes, and the 80th percentile was 195 minutes. The mean total time of the patient in the operating room was 197.30±113.71 minutes, and the 80th percentile was 285 minutes. Thus, the variation of the overall mean compared to the 80th percentile was 41% for anesthesia, 49% for surgeries and 44% for operating room time. In average, anesthesia took up 88% of the operating room period, and surgery, 61%. Conclusion This study identified patterns in the duration of surgery stages. The mean values of the specialties can assist with operating room planning and reduce delays. PMID:28767919

Progress in Operational Analysis of Launch Vehicles in Nonstationary Flight

NASA Technical Reports Server (NTRS)

James, George; Kaouk, Mo; Cao, Timothy

2013-01-01

This paper presents recent results in an ongoing effort to understand and develop techniques to process launch vehicle data, which is extremely challenging for modal parameter identification. The primary source of difficulty is due to the nonstationary nature of the situation. The system is changing, the environment is not steady, and there is an active control system operating. Hence, the primary tool for producing clean operational results (significant data lengths and data averaging) is not available to the user. This work reported herein uses a correlation-based two step operational modal analysis approach to process the relevant data sets for understanding and development of processes. A significant drawback for such processing of short time histories is a series of beating phenomena due to the inability to average out random modal excitations. A recursive correlation process coupled to a new convergence metric (designed to mitigate the beating phenomena) is the object of this study. It has been found in limited studies that this process creates clean modal frequency estimates but numerically alters the damping.

Is there a successful business case for telepharmacy?

PubMed

Khan, Shamima; Snyder, Herbert W; Rathke, Ann M; Scott, David M; Peterson, Charles D

2008-04-01

The purpose of this study was to assess the financial operation of a Single Business Unit (SBU), consisting of one central retail pharmacy and two remote retail telepharmacies. Analyses of income statements and balance sheets for three consecutive years (2002-2004) were conducted. Several items from these statements were compared to the industry average. Gross profit increased from $260,093 in 2002 to $502,262 in 2004. The net operating income percent was 2.9 percentage points below the industry average in 2002, 3.9 percentage points below in 2003, and 1.3 percentage points above in 2004. The inventory turnover ratio remained consistently below the industry average, but it also increased over the period. This is an area of concern, given the high cost of pharmaceuticals and a higher likelihood of obsolescence that exists with a time-sensitive inventory. Despite these concerns, the overall trend for the SBU is positive. The rate of growth between 2002 and 2004 shows that it is getting close to median sales as reported in the NCPA Digest. The results of this study indicate that multiple locations become profitable when a sufficient volume of patients (sales) is reached, combined with efficient use of the pharmacist's time.

The modified distal horizontal metatarsal osteotomy for correction of bunionette deformity.

PubMed

Radl, Roman; Leithner, Andreas; Koehler, Wolfgang; Scheipl, Susanne; Windhager, Reinhard

2005-06-01

Bunionette is a common deformity for which a number of operative procedures have been described. The objective of this study was to evaluate the results of a modified distal horizontal metatarsal osteotomy in the correction of symptomatic bunionette. Metatarsal osteotomies were done in 21 feet in 14 patients (11 females, three males) with an average age of 44 (range 20 to 67) years at the time of operation. The average followup was 32 (range 12 to 52) months. The average Lesser Toe Metatarsophalangeal-Interphalangeal Score of the American Orthopaedic Foot and Ankle Society increased from 42 points (range 24 to 50) preoperatively to 87 points (range 60 to 100) at the last followup. The fifth metatarsophalangeal angle averaged 18 degrees (5 to 38 degrees) preoperatively and 5 degrees (-5 to 26 degrees) at final followup. The 4-5 intermetatarsal angle averaged 14 degrees (10 to 20 degrees) preoperatively and 9 degrees (5 to 12 degrees) at final followup. Hardware was removed from two feet and scheduled for a third foot because of symptomatic skin irritation. The modified distal horizontal metatarsal osteotomy is a stable and reliable method for correction of bunionette. Unsatisfactory results in our patients were related to prominent hardware.

Military Review. Volume 92, Number 4, July-August 2012

DTIC Science & Technology

2012-08-01

shared the information . Although it took more than a year to become accepted within the community , the resulting intelligence community message... information operations message and then plan an operation to support it. According to a report from the Army War College , “Insur­ gents use kinetic actions to... information is estimated to average 1 hour per response, including the time for reviewing instructions , searching existing data sources, gathering and

Hardwood sawmill downtime costs

Treesearch

Jan Wiedenbeck; Kyle Blackwell

2003-01-01

How time flies when you don't pay attention to it. With hardwood sawmill operating costs ranging from $4 to $25 per operating minute ($95/MBF to $335/MBF) and gross profit margins ranging from $0.10/BF to $0.35/BF, five extra minutes of downtime per day will cost a sawmill that produces an average of 20,000 BF per day (5 MMBF annually) between $21 and $73 per day...

Collaboration Technology in Military Operations: Lessons Learned from the Corporate Domain

DTIC Science & Technology

2006-02-01

Learned from the Corporate Domain Topics: Social Domain Issues, Cognitive Domain Issues, C2 Experimentation Authors: Stacey D. Scott, M. L. Cummings, David...AFRL-HE-WP-TP-2006-0029 AIR FORCE RESEARCH LABORATORY Collaboration Technology in Military Operations: Lessons Learned from the Corporate Domain...OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response , including the time for

Outcomes in patients undergoing robotic reconstructive uterovaginal anastomosis of congenital cervical and vaginal atresia.

PubMed

Zhang, Ying; Chen, Yisong; Hua, Keqin

2017-09-01

To introduce our experience of robotic surgery of reconstructive uterovaginal anastomosis and operative outcomes in congenital cervical and vaginal atresia patients. Clinical observation and follow-up of four patients with congenital cervical and vaginal atresia who underwent robotic reconstruction of cervix and vagina by SIS (small intestinal submucosa, SIS) graft. Average patient age was 13.8 ± 2.2. Patients complained of severe periodic abdominal pain. Diagnosis was made according to clinical characteristics, physical examination, MRI and classified by ESHRE/ESGE system. All patients underwent reconstruction of cervix and vagina by uterovaginal anastomosis by SIS graft. Average operation time was 232.5 ± 89.2 min, average blood loss was 225.0 ± 95.7 mL. After surgery, all patients have regular menstruation without pain. Average follow up was 12 months, average vagina length was 8.9 ± 0.3 cm, average vagina width was 2.9 ± 0.1 cm. Robotic assisted reconstruction of cervix and vagina is feasible from our experience, enlarged cases and additional studies are required. © 2017 The Authors The International Journal of Medical Robotics and Computer Assisted Surgery Published by John Wiley & Sons Ltd.

Development of a Semi-Autonomous Underwater Vehicle for Intervention Missions (SAUVIM Phase III-B)

DTIC Science & Technology

2009-03-20

burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing...phase 7 people have been working under the SAUVIM project in ASL, consisting of 1 faculty member, 3 full- time researchers, 2 undergraduate interns...and significant time delay inherent in acoustic subsea communications represent a considerable obstacle to remotely operate a manipulation system

30 Brigade Combat Teams: Is the Army too Small

DTIC Science & Technology

2016-12-01

are described in Table 3. Each entity travels through five servers.  Deploy: This server represents the time it takes to deploy from home station...estimated to average 1 hour per response, including the time for reviewing instruction, searching existing data sources, gathering and maintaining...ABSTRACT (maximum 200 words) The purpose of this thesis is to determine the impact of a contingency operation on Army dwell time . The Department of

Practical UXO Classification: Enhanced Data Processing Strategies for Technology Transition - Fort Ord: Dynamic and Cued Metalmapper Processing and Classification

DTIC Science & Technology

2017-06-06

OMB No. 0704-0188 Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for...Geophysical Mapping, Electromagnetic Induction, Instrument Verification Strip, Time Domain Electromagnetic, Unexploded Ordnance 16. SECURITY...Munitions Response QA Quality Assurance QC Quality Control ROC Receiver Operating Characteristic RTK Real- time Kinematic s Second SNR

Impact of the reduction of anaesthesia turnover time on operating room efficiency.

PubMed

Sokolovic, E; Biro, P; Wyss, P; Werthemann, C; Haller, U; Spahn, D; Szucs, T

2002-08-01

We investigated whether an increase in anaesthesia staffing to permit induction of anaesthesia before the previous case had ended ('overlapping') would increase overall efficiency in the operating room. Hitherto, the average duration of operating sessions was too long, thus impeding the timely commencement of physicians' ward duties. The investigation was designed as a prospective, non-randomized, interrupted time-series analysis divided into three phases: (a) a baseline of 3.5 months, (b) a 2.5 month intervention phase, in which anaesthesia staffing was increased by one attending physician and one nurse, and (c) a further 2 months under baseline conditions. Data focussed on process management were collected from operating room staff, anaesthesia personnel and surgeons using a structured questionnaire collected daily during the entire study. Turnover time between consecutive operations decreased from 65 to 52 min per operation (95% CI: 9; 17; P = 0.0001). Operating room occupancy increased from 4:28 to 5:27 h day-1 (95% CI: 50; 68; P = 0.005). The surgeons began their work on the ward 35 min (95% CI: 30; 40) later than before the intervention and their overtime increased from 22:36 to 139:50 h. The time between surgical operations decreased significantly. Increased operating room efficiency owing to overlapping induction of anaesthesia allows more intense scheduling of operations. Thus, physicians and nurses can be released to spend more time with their patients in the ward. Improving the efficiency of the operating room alone is insufficient to improve human resource management at all levels of a surgical clinic.

How to successfully implement a robotic pediatric surgery program: lessons learned after 96 procedures.

PubMed

de Lambert, Guénolée; Fourcade, Laurent; Centi, Joachim; Fredon, Fabien; Braik, Karim; Szwarc, Caroline; Longis, Bernard; Lardy, Hubert

2013-06-01

Both our teams were the first to implement pediatric robotic surgery in France. The aim of this study was to define the key points we brought to light so other pediatric teams that want to set up a robotic surgery program will benefit. We reviewed the medical records of all children who underwent robotic surgery between Nov 2007 and June 2011 in both departments, including patient data, installation and changes, operative time, hospital stay, intraoperative complications, and postoperative outcome. The department's internal organization, the organization within the hospital complex, and cost were evaluated. A total of 96 procedures were evaluated. There were 38 girls and 56 boys with average age at surgery of 7.6 years (range, 0.7-18 years) and average weight of 26 kg (range, 6-77 kg). Thirty-six patients had general surgery, 57 patients urologic surgery, and 1 thoracic surgery. Overall average operative time was 189 min (range, 70-550 min), and average hospital stay was 6.4 days (range, 2-24 days). The procedures of 3 patients were converted. Median follow-up was 18 months (range, 0.5-43 months). Robotic surgical procedure had an extra cost of 1934 compared to conventional open surgery. Our experience was similar to the findings described in the literature for feasibility, security, and patient outcomes; we had an overall operative success rate of 97 %. Three main actors are concerned in the implementation of a robotic pediatric surgery program: surgeons and anesthetists, nurses, and the administration. The surgeon is at the starting point with motivation for minimally invasive surgery without laparoscopic constraints. We found that it was possible to implement a long-lasting robotic surgery program with comparable quality of care.

Patellofemoral arthroplasty conversion to total knee arthroplasty: Retrieval analysis and clinical correlation.

PubMed

Christ, Alexander B; Baral, Elexis; Koch, Chelsea; Shubin Stein, Beth E; Gonzalez Della Valle, Alejandro; Strickland, Sabrina M

2017-10-01

Patellofemoral arthroplasty (PFA) can be a successful, bone-sparing treatment for isolated patellofemoral arthritis. However, progression of tibio-femoral arthritis or incorrect indications may predispose patients to early conversion to total knee arthroplasty (TKA). The purpose of this study was to review the clinical cases and perform retrieval analysis of PFA conversions to TKA at our institution. Twenty one patellofemoral arthroplasties in 18 patients that were converted to TKA were identified through our implant retrieval registry. Sixteen implants were available for review by biomechanical engineers, who recorded surface markings, wear patterns, and integrity of fixation. Patient charts were reviewed and time to conversion, tourniquet time, conversion implant, additional surgeries, infections, and Kellgren & Lawrence grade of the tibio-femoral joint on pre-operative radiographs were recorded. PFAs converted to TKAs at our institution were implanted for an average of 2.7years. The most common reason for conversion was pain, but most patients had significant tibio-femoral arthritis, as indicated by an average Kellgren & Lawrence grade of 2.6. The average tourniquet time for these conversions was 67min. These patients underwent an average of one additional surgery per PFA converted, and the infection rate of these conversions was approximately 14%. Success of PFA depends upon correct patient selection rather than implant failure or wear. Conversion of PFA to TKA is technically similar to primary TKA, with similar post-operative pain relief and range of motion. However, infection rates and complications requiring further surgery are more consistent with results seen in revision TKA. IV. Copyright © 2017 Elsevier B.V. All rights reserved.

High-order noise filtering in nontrivial quantum logic gates.

PubMed

Green, Todd; Uys, Hermann; Biercuk, Michael J

2012-07-13

Treating the effects of a time-dependent classical dephasing environment during quantum logic operations poses a theoretical challenge, as the application of noncommuting control operations gives rise to both dephasing and depolarization errors that must be accounted for in order to understand total average error rates. We develop a treatment based on effective Hamiltonian theory that allows us to efficiently model the effect of classical noise on nontrivial single-bit quantum logic operations composed of arbitrary control sequences. We present a general method to calculate the ensemble-averaged entanglement fidelity to arbitrary order in terms of noise filter functions, and provide explicit expressions to fourth order in the noise strength. In the weak noise limit we derive explicit filter functions for a broad class of piecewise-constant control sequences, and use them to study the performance of dynamically corrected gates, yielding good agreement with brute-force numerics.

[The use of staplers for intestinal anastomosis in newborns].

PubMed

Kozlov, Iu A; Novozhilov, V A; Podkamenev, A V; Veber, I N

2013-01-01

The comparative experience of mechanical and manual intestinal anastomoses in newborns was analyzed. The main group (mechanical suture) consisted of 23 patients; the group of control consisted of 21 little patients. The mechanical intestinal suture was performed with the use of linear endoscopic stapler with 2.5 mm high staples. There were no differences in age and body weight between the two groups. The mean operative time was 77.4 min for the 1st group, whereas for the 2nd group it was 56.4 min. There were no significant difference in time before enteral feeding after the operation - 6.7 days on average. The hospital stay time was also identical (13.3 vs. 14.1 days). Postoperative period was uncomplicated in both groups. Thus, the use of mechanical stapler for intestinal anastomosis allows shorten the operative time, though preserving the same results of hospital stay and enteral feeding beginning.

National outcomes of laparoscopic Heller myotomy: operative complications and risk factors for adverse events.

PubMed

Ross, Samuel W; Oommen, Bindhu; Wormer, Blair A; Walters, Amanda L; Matthews, Brent D; Heniford, B T; Augenstein, Vedra A

2015-11-01

Laparoscopic Heller myotomy (LHM) has supplanted an open approach due to decreased operative morbidity. Our goal was to quantify the incidence of peri-operative complications and identify risk factors for adverse outcomes in LHM. All LHM were queried from 2005 to 2011 from the National Surgical Quality Improvement Program database. Adverse outcomes were identified, and univariate and stepwise logistic regression (MVR) was then performed to quantify association. There were 1,237 LHM in the study period. Patient averages were: age 51.9 ± 16.8 years, BMI 27.3 ± 6.6 kg/m(2), Charlson comorbidity index (CCI) 0.2 ± 0.6. 15.3 % had >10 % body mass loss in the preoperative 6 months. During surgery, 10.2 % underwent concomitant EGD, and mean operative time was 141.6 ± 63.4 min. There were 7(0.06 %) wound complications, 22(1.8 %) general complications, and 30(2.4 %) major complications. Average length of stay (LOS) was 2.8 ± 5.5 days. The rate of readmission and reoperation were 3.1 and 2.3 %, respectively, and there were 4(0.03 %) deaths. General and major complications were associated with alcohol use, pack-years of smoking, weight loss, history of stroke, radiation therapy, and longer operative times (p < 0.05); however, these factors did not remain significant on MVR (p > 0.05). Operative time was found to be significantly longer by 35.3 min for inpatients, 43.1 min in functionally dependent patients, 50.0 min in preoperative septic patients, and 17.2 min with concomitant EGD (p < 0.01 for all). LOS was found to be longer by 1.9 days for inpatients, 1.8 days in ASA category ≥3, and 1.2 days per one point increase in CCI (p < 0.001 for all). LHM is being performed nationally with a low incidence of operative complications and mortality. General and major complications following LHM are associated with patient alcohol use, pack-years of smoking, weight loss, history of stroke, radiation therapy, and longer operative times. Additionally, independent predictors of longer operative time and LOS were identified.

Improved laparoscopic nephron-sparing surgery for renal cell carcinoma based on the precise anatomy of the nephron.

PubMed

Guo, Gang; Cai, Wei; Zhang, Xu

2016-11-01

The aim of the present study was to investigate a method of laparoscopic nephron-sparing surgery (LNSS) for renal cell carcinoma (RCC) based on the precise anatomy of the nephron, and to decrease the incidence of hemorrhage and urinary leakage. Between January 2012 and December 2013, 31 patients who presented to the General Hospital of the People's Liberation Army (Beijing, China) were treated for RCC. The mean tumor size was 3.4±0.7 cm in diameter (range, 1.2-6.0 cm). During surgery, the renal artery was blocked, and subsequently, an incision in the renal capsule and renal cortex was performed, at 3-5 mm from the tumor edge. Subsequent to the incision of the renal parenchyma, scissors with blunt and sharp edge were used to separate the base of the tumor from the normal renal medulla, in the direction of the ray medullary in the renal pyramids. The basal blood vessels were incised following the hemostasis of the region using bipolar coagulation. The minor renal calyces were stripped carefully and the wound was closed with an absorbable sutures. The arterial occlusion time, duration of surgery, intraoperative bleeding volume, post-operative drainage volume, pathological results and complications were recorded. The surgery was successful for all patients. The estimated average intraoperative bleeding volume was 55.7 ml, the average surgical duration was 95.5 min, the average arterial occlusion time was 21.2 min, the average post-operative drainage volume was 92.3 ml and the average post-operative length of hospital stay was 6.1 days. No hemorrhage or urinary leakage was observed in the patients following the surgery. LNSS for RCC based on the precise anatomy of the nephron was concluded to be effective and feasible. The surgery is useful for the complete removal of tumors and guarantees a negative margin, which may also decrease the incidence of hemorrhage and urinary leakage following surgery.

Radial nerve palsy in mid/distal humeral fractures: is early exploration effective?

PubMed

Keighley, Geffrey; Hermans, Deborah; Lawton, Vidya; Duckworth, David

2018-03-01

Radial nerve palsies are a common complication with displaced distal humeral fractures. This case series examines the outcomes of early operative exploration and decompression of the nerve with fracture fixation with the view that this provides a solid construct for optimisation of nerve recovery. A total of 10 consecutive patients with a displaced distal humeral fracture and an acute radial nerve palsy were treated by the senior author by open reduction and internal fixation of the distal humerus and exploration and decompression of the radial nerve. Motor function and sensation of the radial nerve was assessed in the post-operative period every 2 months or until full recovery of the radial nerve function had occurred. All patients (100%) had recovery of motor and sensation function of their upper limb in the radial nerve distribution over a 12-month period. Recovery times ranged between 4 and 32 weeks, with the median time to recovery occurring at 26 weeks and the average time to full recovery being 22.9 weeks. Wrist extension recovered by an average of 3 months (range 2-26 weeks) and then finger extension started to recover 2-6 weeks after this. Disability of the arm, shoulder and hand scores ranged from 0 to 11.8 at greater than 1 year post-operatively. Our study demonstrated that early operative exploration of the radial nerve when performing an open stabilization of displaced distal humeral fractures resulted in a 100% recovery of the radial nerve. © 2017 Royal Australasian College of Surgeons.

Real-time LMR control parameter generation using advanced adaptive synthesis

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

King, R.W.; Mott, J.E.

1990-01-01

The reactor delta T'', the difference between the average core inlet and outlet temperatures, for the liquid-sodium-cooled Experimental Breeder Reactor 2 is empirically synthesized in real time from, a multitude of examples of past reactor operation. The real-time empirical synthesis is based on reactor operation. The real-time empirical synthesis is based on system state analysis (SSA) technology embodied in software on the EBR 2 data acquisition computer. Before the real-time system is put into operation, a selection of reactor plant measurements is made which is predictable over long periods encompassing plant shutdowns, core reconfigurations, core load changes, and plant startups.more » A serial data link to a personal computer containing SSA software allows the rapid verification of the predictability of these plant measurements via graphical means. After the selection is made, the real-time synthesis provides a fault-tolerant estimate of the reactor delta T accurate to {plus}/{minus}1{percent}. 5 refs., 7 figs.« less

Development of a high average current polarized electron source with long cathode operational lifetime

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

C. K. Sinclair; P. A. Adderley; B. M. Dunham

Substantially more than half of the electromagnetic nuclear physics experiments conducted at the Continuous Electron Beam Accelerator Facility of the Thomas Jefferson National Accelerator Facility (Jefferson Laboratory) require highly polarized electron beams, often at high average current. Spin-polarized electrons are produced by photoemission from various GaAs-based semiconductor photocathodes, using circularly polarized laser light with photon energy slightly larger than the semiconductor band gap. The photocathodes are prepared by activation of the clean semiconductor surface to negative electron affinity using cesium and oxidation. Historically, in many laboratories worldwide, these photocathodes have had short operational lifetimes at high average current, and havemore » often deteriorated fairly quickly in ultrahigh vacuum even without electron beam delivery. At Jefferson Lab, we have developed a polarized electron source in which the photocathodes degrade exceptionally slowly without electron emission, and in which ion back bombardment is the predominant mechanism limiting the operational lifetime of the cathodes during electron emission. We have reproducibly obtained cathode 1/e dark lifetimes over two years, and 1/e charge density and charge lifetimes during electron beam delivery of over 2?105???C/cm2 and 200 C, respectively. This source is able to support uninterrupted high average current polarized beam delivery to three experimental halls simultaneously for many months at a time. Many of the techniques we report here are directly applicable to the development of GaAs photoemission electron guns to deliver high average current, high brightness unpolarized beams.« less

Technical results and effects of operator experience on uterine artery embolization for fibroids: the Ontario Uterine Fibroid Embolization Trial.

PubMed

Pron, Gaylene; Bennett, John; Common, Andrew; Sniderman, Kenneth; Asch, Murray; Bell, Stuart; Kozak, Roman; Vanderburgh, Leslie; Garvin, Greg; Simons, Martin; Tran, Cuong; Kachura, John

2003-05-01

To document the technical results and spectrum of practice of uterine artery embolization (UAE) for fibroids in the health care setting in Canada. The effects of interventional radiologist's (IR's) experience with UAE on procedure and fluoroscopy time were also investigated. The study involved a multicenter prospective single-arm clinical treatment trial and included the practices of 11 IRs at eight university-affiliated teaching and community hospitals. Vascular access with percutaneous femoral artery approach was followed by transcatheter delivery of polyvinyl alcohol (PVA) particles into uterine arteries with fluoroscopic guidance. Technical success, complications, procedural time, fluoroscopy time, and effects of operator experience were outcomes analyzed. Between November 1998 and November 2000, 570 embolization procedures were performed in 555 patients. UAE was bilaterally successful in 97% (95% CI: 95%-98%). Variant anatomy was the most common reason for failure to embolize bilaterally. The procedural complication rate was 5.3% (95% CI: 3.6%-7.4%). Of the 30 events, three involved major complications (one seizure and two allergic reactions) that resulted in additional care or extended hospital stay. Procedure time and fluoroscopy time averaged 61 minutes (95% CI; 58-63 minutes) and 18.9 minutes (95% CI; 18-19.8) and varied significantly among IRs (P <.001; P <.001). The average 27% reduction in procedure time (20 minutes; P <.001) and 24% reduction in fluoroscopy time (5.1 minutes; P <.001) with increasing UAE experience were significant. A high level of technical success with few complications was obtained with a variety of operators in diverse practice settings. Increased experience in UAE significantly reduced procedure and fluoroscopy time.

Dokan Hydropower Reservoir Operation under Stochastic Conditions as Regards the Inflows and the Energy Demands

NASA Astrophysics Data System (ADS)

Izat Rashed, Ghamgeen

2018-03-01

This paper presented a way of obtaining certain operating rules on time steps for the management of a large reservoir operation with a peak hydropower plant associated to it. The rules were allowed to have the form of non-linear regression equations which link a decision variable (here the water volume in the reservoir at the end of the time step) by several parameters influencing it. This paper considered the Dokan hydroelectric development KR-Iraq, which operation data are available for. It was showing that both the monthly average inflows and the monthly power demands are random variables. A model of deterministic dynamic programming intending the minimization of the total amount of the squares differences between the demanded energy and the generated energy is run with a multitude of annual scenarios of inflows and monthly required energies. The operating rules achieved allow the efficient and safe management of the operation and it is quietly and accurately known the forecast of the inflow and of the energy demand on the next time step.

Operation of Dokan Reservoir under Stochastic Conditions as Regards the Inflows and the Energy Demands

NASA Astrophysics Data System (ADS)

Rashed, G. I.

2018-02-01

This paper presented a way of obtaining certain operating rules on time steps for the management of a large reservoir operation with a peak hydropower plant associated to it. The rules were allowed to have the form of non-linear regression equations which link a decision variable (here the water volume in the reservoir at the end of the time step) by several parameters influencing it. This paper considered the Dokan hydroelectric development KR-Iraq, which operation data are available for. It was showing that both the monthly average inflows and the monthly power demands are random variables. A model of deterministic dynamic programming intending the minimization of the total amount of the squares differences between the demanded energy and the generated energy is run with a multitude of annual scenarios of inflows and monthly required energies. The operating rules achieved allow the efficient and safe management of the operation and it is quietly and accurately known the forecast of the inflow and of the energy demand on the next time step.

40 CFR 63.8005 - What requirements apply to my process vessels?

Code of Federal Regulations, 2012 CFR

2012-07-01

... temperature, as required by § 63.1257(d)(3)(iii)(B), you may elect to measure the liquid temperature in the... the daily averages specified in § 63.998(b)(3). An operating block is a period of time that is equal to the time from the beginning to end of an emission episode or sequence of emission episodes. (g...

40 CFR 63.8005 - What requirements apply to my process vessels?

Code of Federal Regulations, 2013 CFR

2013-07-01

... temperature, as required by § 63.1257(d)(3)(iii)(B), you may elect to measure the liquid temperature in the... the daily averages specified in § 63.998(b)(3). An operating block is a period of time that is equal to the time from the beginning to end of an emission episode or sequence of emission episodes. (g...

40 CFR 63.8005 - What requirements apply to my process vessels?

Code of Federal Regulations, 2014 CFR

2014-07-01

... temperature, as required by § 63.1257(d)(3)(iii)(B), you may elect to measure the liquid temperature in the... the daily averages specified in § 63.998(b)(3). An operating block is a period of time that is equal to the time from the beginning to end of an emission episode or sequence of emission episodes. (g...

Radiology operations: what you don't know could be costing you millions.

PubMed

Joffe, Sam; Drew, Donna; Bansal, Manju; Hase, Michael

2007-01-01

Rapid growth in advanced imaging procedures has left hospital radiology departments struggling to keep up with demand, resulting in loss of patients to facilities that can offer service more quickly. While the departments appear to be working at full capacity, an operational analysis of over 400 hospital radiology departments in the US by GE Healthcare has determined that, paradoxically, many departments are in fact underutilized and operating for below their potential capacity. While CT cycle time in hospitals that were studied averaged 35 minutes, top performing hospitals operated the same equipment at a cycle time of 15 minutes, yielding approximately double the throughput volume. Factors leading to suboptimal performance include accounting metrics that mask true performance, leadership focus on capital investment rather than operations, under staffing, under scheduling, poorly aligned incentives, a fragmented view of operations, lack of awareness of latent opportunities, and lack of sufficient skills and processes to implement improvements. The study showed how modest investments in radiology operations can dramatically improve access to services and profitability.

Parapharyngeal space surgery via a transoral approach using a robotic surgical system: transoral robotic surgery.

PubMed

Park, Young Min; De Virgilio, Armando; Kim, Won Shik; Chung, Hyun Pil; Kim, Se-Heon

2013-03-01

In transoral robotic surgery (TORS), if an endoscopic arm equipped with two integrated cameras is placed close to a lesion, a three-dimensionally magnified view of the operative field can be obtained. More important is that the operation can be performed precisely and bimanually using two instrument arms that can move freely within a limited working space. We performed TORS to treat several diseases that occur in the parapharyngeal space (PPS) and subsequently analyzed the treatment outcomes to confirm the validity of this procedure. Between February 2009 and February 2012, 11 patients who required surgical treatment for the removal of a parapharyngeal lesion were enrolled in this prospective study. Nine patients received TORS for parapharyngeal tumor resection, and 2 patients with stylohyoid syndrome underwent TORS for resection of an elongated styloid process. The average age of the patients included in this study was 42 years. Five patients were male, and 6 patients were female. TORS was successfully performed in all 11 patients. The average robotic system docking and operation times were 9.9 minutes (range, 5-24 minutes) and 54.2 minutes (range, 26-150 minutes), respectively. Patients were able to swallow normally the day after the operation. The average blood loss during the robotic operation was minimal (11.8 mL). The average hospital stay was 2.6 days. There were no significant complications in the perioperative or postoperative period. All patients were extremely satisfied with their cosmetic outcomes. PPS surgery via a transoral approach using a robotic surgical system is technically feasible and secures a better cosmetic outcome than the transcervical, transparotid, or transmandibular approach. This new surgical method is safe and effective for benign diseases of the PPS.

Utility of Early Post-operative High Resolution Volumetric MR Imaging after Transsphenoidal Pituitary Tumor Surgery

PubMed Central

Patel, Kunal S.; Kazam, Jacob; Tsiouris, Apostolos J.; Anand, Vijay K.; Schwartz, Theodore H.

2014-01-01

Objective Controversy exists over the utility of early post-operative magnetic resonance imaging (MRI) after transsphenoidal pituitary surgery for macroadenomas. We investigate whether valuable information can be derived from current higher resolution scans. Methods Volumetric MRI scans were obtained in the early (<10 days) and late (>30 days) post-operative periods in a series of patients undergoing transsphenoidal pituitary surgery. The volume of the residual tumor, resection cavity, and corresponding visual field tests were recorded at each time point. Statistical analyses of changes in tumor volume and cavity size were calculated using the late MRI as the gold standard. Results 40 patients met the inclusion criteria. Pre-operative tumor volume averaged 8.8 cm3. Early postoperative assessment of average residual tumor volume (1.18 cm3) was quite accurate and did not differ statistically from late post-operative volume (1.23 cm3, p=.64), indicating the utility of early scans to measure residual tumor. Early scans were 100% sensitive and 91% specific for predicting ≥ 98% resection (p<.001, Fisher’s exact test). The average percent decrease in cavity volume from pre-operative MRI (tumor volume) to early post-operative imaging was 45% with decreases in all but 3 patients. There was no correlation between the size of the early cavity and the visual outcome. Conclusions Early high resolution volumetric MRI is valuable in determining the presence or absence of residual tumor. Cavity volume almost always decreases after surgery and a lack of decrease should alert the surgeon to possible persistent compression of the optic apparatus that may warrant re-operation. PMID:25045791

ENSURF: multi-model sea level forecast - implementation and validation results for the IBIROOS and Western Mediterranean regions

NASA Astrophysics Data System (ADS)

Pérez, B.; Brower, R.; Beckers, J.; Paradis, D.; Balseiro, C.; Lyons, K.; Cure, M.; Sotillo, M. G.; Hacket, B.; Verlaan, M.; Alvarez Fanjul, E.

2011-04-01

ENSURF (Ensemble SURge Forecast) is a multi-model application for sea level forecast that makes use of existing storm surge or circulation models today operational in Europe, as well as near-real time tide gauge data in the region, with the following main goals: - providing an easy access to existing forecasts, as well as to its performance and model validation, by means of an adequate visualization tool - generation of better forecasts of sea level, including confidence intervals, by means of the Bayesian Model Average Technique (BMA) The system was developed and implemented within ECOOP (C.No. 036355) European Project for the NOOS and the IBIROOS regions, based on MATROOS visualization tool developed by Deltares. Both systems are today operational at Deltares and Puertos del Estado respectively. The Bayesian Modelling Average technique generates an overall forecast probability density function (PDF) by making a weighted average of the individual forecasts PDF's; the weights represent the probability that a model will give the correct forecast PDF and are determined and updated operationally based on the performance of the models during a recent training period. This implies the technique needs the availability of sea level data from tide gauges in near-real time. Results of validation of the different models and BMA implementation for the main harbours will be presented for the IBIROOS and Western Mediterranean regions, where this kind of activity is performed for the first time. The work has proved to be useful to detect problems in some of the circulation models not previously well calibrated with sea level data, to identify the differences on baroclinic and barotropic models for sea level applications and to confirm the general improvement of the BMA forecasts.

A medico-legal review of cases involving quadriplegia following cervical spine surgery: Is there an argument for a no-fault compensation system?

PubMed

Epstein, Nancy E

2010-04-07

To determine whether patients who become quadriplegic following cervical spine surgery are adequately compensated by our present medico-legal system. The outcomes of malpractice suits obtained from Verdict Search (East Islip, NY, USA), a medico-legal journal, were evaluated over a 20-year period. Although the present malpractice system generously rewards many quadriplegic patients with substantial settlements/ Plaintiffs' verdicts, a subset receive lesser reimbursements (verdicts/settlements], while others with defense verdicts receive no compensatory damages. Utilizing Verdict Search, 54 cases involving quadriplegia following cervical spine surgery were reviewed for a 20-year interval (1988-2008). The reason(s) for the suit, the defendants, the legal outcome, and the time to outcome were identified. Operations included 25 anterior cervical procedures, 22 posterior cervical operations, 1 circumferential cervical procedure, and 6 cases in which the cervical operations were not defined. The four most prominent legal allegations for suits included negligent surgery (47 cases), lack of informed consent (23 cases), failure to diagnose/treat (33 cases), and failure to brace (15 cases). Forty-four of the 54 suits included spine surgeons. There were 19 Plaintiffs' verdicts (average US $5.9 million, range US $540,000-US $18.4 million), and 20 settlements (average US $2.8 million, range US $66,500-US $12.0 million). Fifteen quadriplegic patients with defense verdicts received no compensatory damages. The average time to verdicts/settlements was 4.3 years. For 54 patients who were quadriplegic following cervical spine surgery, 15 (28%) with defense verdicts received no compensatory damages. Under a No-Fault system, quadriplegic patients would qualify for a "reasonable" level of compensation over a "shorter" time frame.

Concurrent orthopedic and neurosurgical procedures in pediatric patients with spinal deformity.

PubMed

Mooney, James F; Glazier, Stephen S; Barfield, William R

2012-11-01

The management of pediatric patients with complex spinal deformity often requires both an orthopedic and a neurosurgical intervention. The reasons for multiple subspecialty involvement include, but are not limited to, the presence of a tethered cord requiring release or a syrinx requiring decompression. It has been common practice to perform these procedures in a staged manner, although there is little evidence in the literature to support separate interventions. We reviewed a series of consecutive patients who underwent spinal deformity correction and a neurosurgical intervention concurrently in an attempt to assess the safety, efficacy, and possible complications associated with such an approach. Eleven patients were reviewed who underwent concurrent orthopedic and neurosurgical procedures. Data were collected for patient demographics, preoperative diagnosis, procedures performed, intraoperative and perioperative complications, as well as any unexpected return to the operating room for any reason. Operative notes and anesthesia records were reviewed to determine estimated blood loss, surgical time, and the use of intraoperative neurological monitoring. Patient diagnoses included myelodysplasia (N=6), congenital scoliosis and/or kyphosis (N=4), and scoliosis associated with Noonan syndrome (N=1). Age at the time of surgery averaged 9 years 2 months (range=14 months to 17 years 2 months). Estimated blood loss averaged 605 ml (range=50-3000 ml). The operative time averaged 313 min (range=157-477 min). There were no intraoperative complications, including incidental dural tears or deterioration in preoperative neurological status. One patient developed a sore associated with postoperative cast immobilization that led to a deep wound infection. It appears that concurrent orthopedic and neurosurgical procedures in pediatric patients with significant spinal deformities can be performed safely and with minimal intraoperative and postoperative complications when utilizing modern surgical and neuromonitoring techniques. Level of evidence=Level IV. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

The Efficacy of Simultaneous Breast Reconstruction and Contralateral Balancing Procedures in Reducing the Need for Second Stage Operations

PubMed Central

Clarke-Pearson, Emily M; Vornovitsky, Michael; Dayan, Joseph H; Samson, William; Sultan, Mark R

2014-01-01

Background Patients having unilateral breast reconstruction often require a second stage procedure on the contralateral breast to improve symmetry. In order to provide immediate symmetry and minimize the frequency and extent of secondary procedures, we began performing simultaneous contralateral balancing operations at the time of initial reconstruction. This study examines the indications, safety, and efficacy of this approach. Methods One-hundred and two consecutive breast reconstructions with simultaneous contralateral balancing procedures were identified. Data included patient age, body mass index (BMI), type of reconstruction and balancing procedure, specimen weight, transfusion requirement, complications and additional surgery under anesthesia. Unpaired t-tests were used to compare BMI, specimen weight and need for non-autologous transfusion. Results Average patient age was 48 years. The majority had autologous tissue-only reconstructions (94%) and the rest prosthesis-based reconstructions (6%). Balancing procedures included reduction mammoplasty (50%), mastopexy (49%), and augmentation mammoplasty (1%). Average BMI was 27 and average reduction specimen was 340 grams. Non-autologous blood transfusion rate was 9%. There was no relationship between BMI or reduction specimen weight and need for transfusion. We performed secondary surgery in 24% of the autologous group and 100% of the prosthesis group. Revision rate for symmetry was 13% in the autologous group and 17% in the prosthesis group. Conclusions Performing balancing at the time of breast reconstruction is safe and most effective in autologous reconstructions, where 87% did not require a second operation for symmetry. PMID:25276646

Thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage.

PubMed

Pang, Xiaoyang; Shen, Xiongjie; Wu, Ping; Luo, Chenke; Xu, Zhengquan; Wang, Xiyang

2013-06-01

Retrospective analysis of the clinical efficacy and feasibility of patients with thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. A total of 18 patients with thoracolumbar tuberculosis (TB), between February 2007 and February 2011, underwent one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. And the clinical efficacy was evaluated based on surgery duration time, the blood loss, the postural drainage of time, neurological status that was recorded by American Spinal Injury Association (ASIA) Impairment Scale, the fate of bone graft fusion, kyphosis angle, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which were collected at certain time. The average follow-up period was 34 months (range 18-48 months). 18 patients suffered from seriously neurological deficits pre-operatively, of which 16 patients returned to normal at final follow-up. The surgery duration time was 197 ± 37.9 min, and the blood loss was 815 ± 348.5 ml. The postural drainage of time was 7.2 ± 2.7 days. The psoas abscesses disappeared in all cases, within the time range of 6-9 months (mean 7.4 ± 1.2 months). All patients of the grafted bones were thoroughly fused, with a fusion time ranging from 4 to 12 months (mean 7.8 months). Kyphosis angle was 44.32 ± 7.26° on average pre-operative and returned to 11.72 ± 2.85° at 6 weeks after operation; kyphosis angle was 13.10 ± 2.39° at final follow-up. The values of ESR and CRP were significant declined at 6 weeks post-operative, and returned to normal levels at final follow-up. With standardized anti-TB chemotherapy, thoracolumbar spinal tuberculosis with psoas abscesses could be effectively treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage.

Laparoscopic nephrectomy using the harmonic scalpel.

PubMed

Helal, M; Albertini, J; Lockhart, J; Albrink, M

1997-08-01

Laparoscopic nephrectomy is gaining popularity. Improved instrumentation is making surgery easier with fewer complications. Our first three laparoscopic nephrectomies using the Harmonic Scalpel were performed on two women and one man. The surgical indications were nonfunctioning kidneys (two left, one right) with hypertension in one patient and stone disease in two. The three patients had a mean age of 46.3 years. The average hospital stay was 4 days, the average operative time 3.7 hours, and the average blood loss 160 mL. No complications occurred. Patients resumed oral intake within 8 hours postoperatively. We found the Harmonic Scalpel easy and safe to use. It saved time, was cost effective, and was capable of easily controlling small-vessel bleeding. In conclusion, the Harmonic Scalpel could be used effectively for both dissection and bleeding control without suction or other instrumentation.

Robotic inferior vena cava surgery.

PubMed

Davila, Victor J; Velazco, Cristine S; Stone, William M; Fowl, Richard J; Abdul-Muhsin, Haidar M; Castle, Erik P; Money, Samuel R

2017-03-01

Inferior vena cava (IVC) surgery is uncommon and has traditionally been performed through open surgical approaches. Renal cell carcinoma with IVC extension generally requires vena cavotomy and reconstruction. Open removal of malpositioned IVC filters (IVCF) is occasionally required after endovascular retrieval attempts have failed. As our experience with robotic surgery has advanced, we have applied this technology to surgery of the IVC. We reviewed our institution's experience with robotic surgical procedures involving the IVC to determine its safety and efficacy. All patients undergoing robotic surgery that included cavotomy and repair from 2011 to 2014 were retrospectively reviewed. Data were obtained detailing preoperative demographics, operative details, and postoperative morbidity and mortality. Ten patients (6 men) underwent robotic vena caval procedures at our institution. Seven patients underwent robotic nephrectomy with removal of IVC tumor thrombus and retroperitoneal lymph node dissection. Three patients underwent robotic explantation of an IVCF after multiple endovascular attempts at removal had failed. The patients with renal cell carcinoma were a mean age of was 65.4 years (range, 55-74 years). Six patients had right-sided malignancy. All patients had T3b lesions at time of diagnosis. Mean tumor length extension into the IVC was 5 cm (range, 1-8 cm). All patients underwent robotic radical nephrectomy, with caval tumor thrombus removal and retroperitoneal lymph node dissection. The average operative time for patients undergoing surgery for renal cell carcinoma was 273 minutes (range, 137-382 minutes). Average intraoperative blood loss was 428 mL (range, 150-1200 mL). The patients with IVCF removal were a mean age of 33 years (range, 24-41 years). Average time from IVCF placement until robotic removal was 35.5 months (range, 4.3-57.3 months). Before robotic IVCF removal, a minimum of two endovascular retrievals were attempted. Average operative time for patients undergoing IVCF removal was 163 minutes (range, 131-202 minutes). Intraoperative blood loss averaged 250 mL (range, 150-350 mL). All procedures were completed robotically. The mean length of stay for all patients was 3.5 days (range, 1-8 days). All patients resumed ambulation on postoperative day 1. Nine patients resumed a regular diet on postoperative day 2. One patient with a renal tumor sustained a colon injury during initial adhesiolysis, before robotic radical nephrectomy, which was recognized at the initial operation and repaired robotically. Robotic radical nephrectomy and caval tumor removal were then completed. No blood transfusions were required intraoperatively, but three patients required blood transfusions postoperatively. Although robotic IVC surgery is uncommon, our initial limited experience demonstrates it is safe and efficacious. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Some induced intuitionistic fuzzy aggregation operators applied to multi-attribute group decision making

NASA Astrophysics Data System (ADS)

Su, Zhi-xin; Xia, Guo-ping; Chen, Ming-yuan

2011-11-01

In this paper, we define various induced intuitionistic fuzzy aggregation operators, including induced intuitionistic fuzzy ordered weighted averaging (OWA) operator, induced intuitionistic fuzzy hybrid averaging (I-IFHA) operator, induced interval-valued intuitionistic fuzzy OWA operator, and induced interval-valued intuitionistic fuzzy hybrid averaging (I-IIFHA) operator. We also establish various properties of these operators. And then, an approach based on I-IFHA operator and intuitionistic fuzzy weighted averaging (WA) operator is developed to solve multi-attribute group decision-making (MAGDM) problems. In such problems, attribute weights and the decision makers' (DMs') weights are real numbers and attribute values provided by the DMs are intuitionistic fuzzy numbers (IFNs), and an approach based on I-IIFHA operator and interval-valued intuitionistic fuzzy WA operator is developed to solve MAGDM problems where the attribute values provided by the DMs are interval-valued IFNs. Furthermore, induced intuitionistic fuzzy hybrid geometric operator and induced interval-valued intuitionistic fuzzy hybrid geometric operator are proposed. Finally, a numerical example is presented to illustrate the developed approaches.

Use of cameras for monitoring visibility impairment

NASA Astrophysics Data System (ADS)

Malm, William; Cismoski, Scott; Prenni, Anthony; Peters, Melanie

2018-02-01

Webcams and automated, color photography cameras have been routinely operated in many U.S. national parks and other federal lands as far back as 1988, with a general goal of meeting interpretive needs within the public lands system and communicating effects of haze on scenic vistas to the general public, policy makers, and scientists. Additionally, it would be desirable to extract quantifiable information from these images to document how visibility conditions change over time and space and to further reflect the effects of haze on a scene, in the form of atmospheric extinction, independent of changing lighting conditions due to time of day, year, or cloud cover. Many studies have demonstrated a link between image indexes and visual range or extinction in urban settings where visibility is significantly degraded and where scenes tend to be gray and devoid of color. In relatively clean, clear atmospheric conditions, clouds and lighting conditions can sometimes affect the image radiance field as much or more than the effects of haze. In addition, over the course of many years, cameras have been replaced many times as technology improved or older systems wore out, and therefore camera image pixel density has changed dramatically. It is shown that gradient operators are very sensitive to image resolution while contrast indexes are not. Furthermore, temporal averaging and time of day restrictions allow for developing quantitative relationships between atmospheric extinction and contrast-type indexes even when image resolution has varied over time. Temporal averaging effectively removes the variability of visibility indexes associated with changing cloud cover and weather conditions, and changes in lighting conditions resulting from sun angle effects are best compensated for by restricting averaging to only certain times of the day.

On measurement noise in the European TWSTFT network.

PubMed

Piester, Dirk; Bauch, Andreas; Becker, Jürgen; Staliuniene, Egle; Schlunegger, Christian

2008-09-01

Two-way satellite time and frequency transfer (TWSTFT) using geostationary telecommunication satellites is widely used in the timing community today and has also been chosen as the primary means to effect synchronization of elements of the ground segment of the European satellite navigation system Galileo. We investigated the link performance in a multistation network based on operational parameters such as the number of simultaneously transmitting stations, transmit and receive power, and chip rates of the pseudorandom noise modulation of the transmitted signals. Our work revealed that TWSTFT through a "quiet" transponder channel (2 stations transmitting only) leads to a measurement noise, expressed by the 1 pps jitter, reduced by a factor of 1.4 compared with a busy transponder carrying signals of 12 stations. The frequency transfer capability expressed by the Allan deviation is reduced at short averaging times by the same amount. At averaging times of >1 d, no such reduction could be observed, which points to the fact that other noise sources dominate at such averaging times. We also found that higher transmit power increases the carrier-to-noise density ratio at the receive station and thus entails lower jitter but causes interference with other station's signals. In addition, the use of lower chip rates, which could be accommodated by a reduced assigned bandwidth on the satellite transponder, is not recommended. The 1 pps jitter would go up by a factor of 2.5 when going from 2.5 MCh/s to 1 MCh/s. The 2 Galileo precise timing facilities (PTFs) can be included in the currently operated network of 12 stations in Europe and all requirements on the TWSTFT performance can be met, provided that suitable ground equipment will be installed in the Galileo ground segment.

Fixed-angle plates in patella fractures - a pilot cadaver study

PubMed Central

2011-01-01

Objective Modified anterior tension wiring with K-wires and cannulated lag screws with anterior tension wiring are currently the fixation of choice for patellar fractures. Failure of fixation, migration of the wires, postoperative pain and resulting revision surgery, however, are not uncommon. After preliminary biomechanical testing of a new fixed-angle plate system especially designed for fixation of patella fractures the aim of this study was to evaluate the surgical and anatomical feasibility of implanting such a plate-device at the human patella. Methods In six fresh unfixed female cadavers without history of previous fractures around the knee (average age 88.8 years) a bilateral fixed-angle plate fixation of the patella was carried out after previous placement of a transverse central osteotomy. Operative time, intra-operative problems, degree of retropatellar arthritis (following Outerbridge), quality of reduction and existence of any intraarticular screw placement have been raised. In addition, lateral and anteroposterior radiographs of all specimens were made. Results Due to the high average age of 88.8 years no patella showed an unimpaired retropatellar articular surface and all were severely osteoporotic, which made a secure fixation of the reduction forceps during surgery difficult. The operation time averaged 49 minutes (range: 36-65). Although in postoperative X-rays the fracture gap between the fragments was still visible, the analysis of the retropatellar surface showed no residual articular step or dehiscence > 0.5 mm. Also in a total of 24 inserted screws not one intraarticular malposition was found. No intraoperative complications were noticed. Conclusions Osteosynthesis of a medial third patella fracture with a bilateral fixed-angle plate-device is surgically and anatomically feasible without difficulties. Further studies have to depict whether the bilateral fixed-angle plate-osteosynthesis of the patella displays advantages over the established operative procedures. PMID:21345769

Bulk Shielding Facility quarterly report, April, May and June 1984

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

Corbett, B.L.; Lance, E.D.

1984-12-01

The BSR operated at an average power level of 1310 kW for 3.8% of the time during April, May, and June. Water-quality control in both the reactor primary and secondary cooling systems was satisfactory. The PCA was used in training startups and was operated on five occasions for the NBS and HEDL recheck of a previous experiment run on the LWR pressure vessel surveillance dosimetry improvement program.

A Study to Determine the Cost of Quality Assurance to the Department of Surgery at US Army Medical Department Activity. Fort Benning, Georgia

DTIC Science & Technology

1984-07-01

to make maximum use of available time. General Surgery averaged ninety-six operative procedures per month during 1983, ophthalmology averaged fifteen...health care providers 2. Document evaluation of: a) Surgical care review (tissue review) b) Blood utilization c) Antibiotics utilization d) Pharmacy and...21. Number Surgical Procedures Performed 470 470 on Patients Undergoing all Types of Surgery APPENDIX L EXAMPLES OF AUDIT CRITERIA 103 SERVICE MONTH

Marine Fuel Cell Technology Verification Trainer Program: Operator Curriculum Development

DTIC Science & Technology

2004-06-01

collection of tnormiratin is estimiate to average 1 hour per response, Including the time INr reviewing InatruCtlona. ear-ching existing =ata aourcas...guidelines and standards are provided. With the anticipation that up to several years’ delay will occur between the time of this report and the maturity of...reference only, given as foundation sources available at the time of this project. The supplemental references to published materials are considered the

Thermoelectric integrated membrane evaporation water recovery technology

NASA Technical Reports Server (NTRS)

Roebelen, G. J., Jr.; Winkler, H. E.; Dehner, G. F.

1982-01-01

The recently developed Thermoelectric Integrated Membrane Evaporation Subsystem (TIMES) offers a highly competitive approach to water recovery from waste fluids for future on-orbit stations such as the Space Operations Center. Low power, compactness and gravity insensitive operation are featured in this vacuum distillation subsystem that combines a hollow fiber membrane evaporator with a thermoelectric heat pump. The hollow fiber elements provide positive liquid/gas phase control with no moving parts other than pumps and an accumulator, thus solving problems inherent in other reclamation subsystem designs. In an extensive test program, over 850 hours of operation were accumulated during which time high quality product water was recovered from both urine and wash water at an average steady state production rate of 2.2 pounds per hour.

[Applying the clustering technique for characterising maintenance outsourcing].

PubMed

Cruz, Antonio M; Usaquén-Perilla, Sandra P; Vanegas-Pabón, Nidia N; Lopera, Carolina

2010-06-01

Using clustering techniques for characterising companies providing health institutions with maintenance services. The study analysed seven pilot areas' equipment inventory (264 medical devices). Clustering techniques were applied using 26 variables. Response time (RT), operation duration (OD), availability and turnaround time (TAT) were amongst the most significant ones. Average biomedical equipment obsolescence value was 0.78. Four service provider clusters were identified: clusters 1 and 3 had better performance, lower TAT, RT and DR values (56 % of the providers coded O, L, C, B, I, S, H, F and G, had 1 to 4 day TAT values:

Simulation of the Francis-99 Hydro Turbine During Steady and Transient Operation

NASA Astrophysics Data System (ADS)

Dewan, Yuvraj; Custer, Chad; Ivashchenko, Artem

2017-01-01

Numerical simulation of the Francis-99 hydroturbine with correlation to experimental measurements are presented. Steady operation of the hydroturbine is analyzed at three operating conditions: the best efficiency point (BEP), high load (HL), and part load (PL). It is shown that global quantities such as net head, discharge and efficiency are well predicted. Additionally, time-averaged velocity predictions compare well with PIV measurements obtained in the draft tube immediately downstream of the runner. Differences in vortex rope structure between operating points are discussed. Unsteady operation of the hydroturbine from BEP to HL and from BEP to PL are modeled. It is shown that simulation methods used to model the steady operation produce predictions that correlate well with experiment for transient operation. Time-domain unsteady simulation is used for both steady and unsteady operation. The full-fidelity geometry including all components is meshed using an unstructured polyhedral mesh with body-fitted prism layers. Guide vane rotation for transient operation is imposed using fully-conservative, computationally efficient mesh morphing. The commercial solver STAR-CCM+ is used for all portions of the analysis including meshing, solving and post-processing.

Muscle gap approach under a minimally invasive channel technique for treating long segmental lumbar spinal stenosis

PubMed Central

Bin, Yang; De cheng, Wang; wei, Wang Zong; Hui, Li

2017-01-01

Abstract This study aimed to compare the efficacy of muscle gap approach under a minimally invasive channel surgical technique with the traditional median approach. In the Orthopedics Department of Traditional Chinese and Western Medicine Hospital, Tongzhou District, Beijing, 68 cases of lumbar spinal canal stenosis underwent surgery using the muscle gap approach under a minimally invasive channel technique and a median approach between September 2013 and February 2016. Both approaches adopted lumbar spinal canal decompression, intervertebral disk removal, cage implantation, and pedicle screw fixation. The operation time, bleeding volume, postoperative drainage volume, and preoperative and postoperative visual analog scale (VAS) score and Japanese Orthopedics Association score (JOA) were compared between the 2 groups. All patients were followed up for more than 1 year. No significant difference between the 2 groups was found with respect to age, gender, surgical segments. No diversity was noted in the operation time, intraoperative bleeding volume, preoperative and 1 month after the operation VAS score, preoperative and 1 month after the operation JOA score, and 6 months after the operation JOA score between 2 groups (P > .05). The amount of postoperative wound drainage (260.90 ± 160 mL vs 447.80 ± 183.60 mL, P < .001) and the VAS score 6 months after the operation (1.71 ± 0.64 vs 2.19 ± 0.87, P = .01) were significantly lower in the muscle gap approach group than in the median approach group (P < .05). In the muscle gap approach under a minimally invasive channel group, the average drainage volume was reduced by 187 mL, and the average VAS score 6 months after the operation was reduced by an average of 0.48. The muscle gap approach under a minimally invasive channel technique is a feasible method to treat long segmental lumbar spinal canal stenosis. It retains the integrity of the posterior spine complex to the greatest extent, so as to reduce the adjacent spinal segmental degeneration and soft tissue trauma. Satisfactory short-term and long-term clinical results were obtained. PMID:28796075

The relationship between the expression of TN and the efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis

PubMed Central

Jiang, Guohua; Zhang, Yinshun; Sun, Xianjie

2018-01-01

Abstract Background: This study was conducted with the aim to investigate the relationship between Tetranectin (TN) and efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis. Methods: Ninety-two patients with traumatic kyphosis admitted in our hospital from February 2014 to June 2016 were included whose serum TN levels were examined by ELISA. Using the mean level of TN as cut-off value, patients were classified into TN high level group (group I) and TN low level group (group II). The observation indexes, including operation time, intra-operational loss of blood, Cobb angle, postoperative complications and recurrence rate of kyphosis within post-operational 6 months were recorded for comparison. Results: TN level was significantly higher in group I [(6.19 ± 0.33) μmol/L] than that in group II [(5.29 ± 0.34) μmol/L] (P < .05). There was no significant difference in average age, sex, lesion site and average time from injury to operation between the two groups (all P > 0.05). Compared to group II, operation time in group I was significantly shortened (5.02 ± 1.15 VS 4.58 ± 0.53, P = .023), the intra-operational loss of blood decreased (2418.56 ± 362.06 VS 2235.84 ± 325.63, P = .013), post-operational Cobb angle decreased (11.10 ± 1.31 VS 6.93 ± 1.04, P = .000), and the incidence of postoperative complications (nail-breaking, rod-breaking and looseness) and recurrence rate decreased (18.8% VS 4.5%, P = .036; 10.4% VS 0.0%, P = .028). Conclusion: Serum TN level is proved to be related to the efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis, and may serve as a possible indicator for clinical treatment. PMID:29384840

The relationship between the expression of TN and the efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis.

PubMed

Jiang, Guohua; Zhang, Yinshun; Sun, Xianjie

2018-02-01

This study was conducted with the aim to investigate the relationship between Tetranectin (TN) and efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis. Ninety-two patients with traumatic kyphosis admitted in our hospital from February 2014 to June 2016 were included whose serum TN levels were examined by ELISA. Using the mean level of TN as cut-off value, patients were classified into TN high level group (group I) and TN low level group (group II). The observation indexes, including operation time, intra-operational loss of blood, Cobb angle, postoperative complications and recurrence rate of kyphosis within post-operational 6 months were recorded for comparison. TN level was significantly higher in group I [(6.19 ± 0.33) μmol/L] than that in group II [(5.29 ± 0.34) μmol/L] (P < .05). There was no significant difference in average age, sex, lesion site and average time from injury to operation between the two groups (all P > 0.05). Compared to group II, operation time in group I was significantly shortened (5.02 ± 1.15 VS 4.58 ± 0.53, P = .023), the intra-operational loss of blood decreased (2418.56 ± 362.06 VS 2235.84 ± 325.63, P = .013), post-operational Cobb angle decreased (11.10 ± 1.31 VS 6.93 ± 1.04, P = .000), and the incidence of postoperative complications (nail-breaking, rod-breaking and looseness) and recurrence rate decreased (18.8% VS 4.5%, P = .036; 10.4% VS 0.0%, P = .028). Serum TN level is proved to be related to the efficiency of posterior spinal V osteotomy in patients with traumatic kyphosis, and may serve as a possible indicator for clinical treatment.

[Analysis of operative complications of photoselective vaporization of prostate (120 W) for treatment of benign prostatic hyperplasia].

PubMed

Huang, Chen; Chen, Li-jun; Zhao, Li; Qu, Nan; Mai, Hai-xing; Tang, Fei

2013-02-01

To explore operative complications of photoselective vaporization of prostate (120 W) for treatment of benign prostatic hyperplasia (BPH). The clinical data of 186 cases who underwent photoselective vaporization of prostate (120 W) for the treatment of BPH from May 2010 to April 2012, was statistically analyzed. The operative time ranged from 7 to 147 minutes, and the average time was (37.7 ± 21.5) minutes. No patient accepted intraoperative blood transfusion, and occurred transurethral resection syndrome or capsular perforation. The time of postoperative indwelling catheter ranged from 1 to 11 days, and average time was (4.3 ± 2.2) days. Surgical outcome was satisfactory. Early postoperative complications included bladder spasm (3 cases), transient dysuria (19 cases), urinary tractirritation (94 cases), secondary hemorrhage (26 cases), transient urge incontinence (19 cases), all cases were relieved after treatment. Long-term complications, including recurrence (1 case), bladder neck stenosis (2 cases) and urethral stricture (2 cases), who had required reoperation. Postoperative patients with international prostate symptom score (29.4 ± 3.4), maximum urinary flow rate ((6.0 ± 1.6) ml/s) and residual urine ((167 ± 150) ml) had improved (t = -76.0 - 61.4, P < 0.01). With less invasive, less bleeding and rapid postoperative recovery, photoselective vaporization of prostate (120 W) is a safe and effective minimally invasive treatment techniques for BPH. But there is still some complications after surgery and proper handling is required.

The Application of Waiting Lines System in Improving Customer Service Management: The Examination of Malaysia Fast Food Restaurants Industry

NASA Astrophysics Data System (ADS)

Ismail, Zurina; Shokor, Shahrul Suhaimi AB

2016-03-01

Rapid life time change of the Malaysian lifestyle had served the overwhelming growth in the service operation industry. On that occasion, this paper will provide the idea to improve the waiting line system (WLS) practices in Malaysia fast food chains. The study will compare the results in between the single server single phase (SSSP) and the single server multi-phase (SSMP) which providing Markovian Queuing (MQ) to be used for analysis. The new system will improve the current WLS, plus intensifying the organization performance. This new WLS were designed and tested in a real case scenario and in order to develop and implemented the new styles, it need to be focusing on the average number of customers (ANC), average number of customer spending time waiting in line (ACS), and the average time customers spend in waiting and being served (ABS). We introduced new WLS design and there will be prompt discussion upon theories of benefits and potential issues that will benefit other researchers.

Direct cost comparison of minimally invasive punch technique versus traditional approaches for percutaneous bone anchored hearing devices.

PubMed

Sardiwalla, Yaeesh; Jufas, Nicholas; Morris, David P

2017-06-12

Minimally Invasive Ponto Surgery (MIPS) was recently described as a new technique to facilitate the placement of percutaneous bone anchored hearing devices. The procedure has resulted in a simplification of the surgical steps and a dramatic reduction in surgical time while maintaining excellent patient outcomes. Given these developments, our group sought to move the procedure from the main operating suite where they have traditionally been performed. This study aims to test the null hypothesis that MIPS and open approaches have the same direct costs for the implantation of percutaneous bone anchored hearing devices in a Canadian public hospital setting. A retrospective direct cost comparison of MIPS and open approaches for the implantation of bone conduction implants was conducted. Indirect and future costs were not included in the fiscal analysis. A simple cost comparison of the two approaches was made considering time, staff and equipment needs. All 12 operations were performed on adult patients from 2013 to 2016 by the same surgeon at a single hospital site. MIPS has a total mean reduction in cost of CAD$456.83 per operation from the hospital perspective when compared to open approaches. The average duration of the MIPS operation was 7 min, which is on average 61 min shorter compared with open approaches. The MIPS technique was more cost effective than traditional open approaches. This primarily reflects a direct consequence of a reduction in surgical time, with further contributions from reduced staffing and equipment costs. This simple, quick intervention proved to be feasible when performed outside the main operating room. A blister pack of required equipment could prove convenient and further reduce costs.

Validation of the GreenLight™ Simulator and development of a training curriculum for photoselective vaporisation of the prostate.

PubMed

Aydin, Abdullatif; Muir, Gordon H; Graziano, Manuela E; Khan, Muhammad Shamim; Dasgupta, Prokar; Ahmed, Kamran

2015-06-01

To assess face, content and construct validity, and feasibility and acceptability of the GreenLight™ Simulator as a training tool for photoselective vaporisation of the prostate (PVP), and to establish learning curves and develop an evidence-based training curriculum. This prospective, observational and comparative study, recruited novice (25 participants), intermediate (14) and expert-level urologists (seven) from the UK and Europe at the 28th European Association of Urological Surgeons Annual Meeting 2013. A group of novices (12 participants) performed 10 sessions of subtask training modules followed by a long operative case, whereas a second group (13) performed five sessions of a given case module. Intermediate and expert groups performed all training modules once, followed by one operative case. The outcome measures for learning curves and construct validity were time to task, coagulation time, vaporisation time, average sweep speed, average laser distance, blood loss, operative errors, and instrument cost. Face and content validity, feasibility and acceptability were addressed through a quantitative survey. Construct validity was demonstrated in two of five training modules (P = 0.038; P = 0.018) and in a considerable number of case metrics (P = 0.034). Learning curves were seen in all five training modules (P < 0.001) and significant reduction in case operative time (P < 0.001) and error (P = 0.017) were seen. An evidence-based training curriculum, to help trainees acquire transferable skills, was produced using the results. This study has shown the GreenLight Simulator to be a valid and useful training tool for PVP. It is hoped that by using the training curriculum for the GreenLight Simulator, novice trainees can acquire skills and knowledge to a predetermined level of proficiency. © 2014 The Authors. BJU International © 2014 BJU International.

The 2009 Future Years Defense Program: Implications and Alternatives

DTIC Science & Technology

2009-02-04

be published, transmitted, or otherwise communicated by any print, broadcast, or electronic media before that time. Report Documentation Page Form...ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for...burden, to Washington Headquarters Services, Directorate for Information Operations and Reports , 1215 Jefferson Davis Highway, Suite 1204, Arlington

Comparison of small diameter stone baskets in an in vitro caliceal and ureteral model.

PubMed

Korman, Emily; Hendlin, Kari; Chotikawanich, Ekkarin; Monga, Manoj

2011-01-01

Three small diameter (<1.5F) stone baskets have recently been introduced. Our objective was to evaluate the stone capture rate of these baskets in an in vitro ureteral model and an in vitro caliceal model using novice, resident, and expert operators. Sacred Heart Medical Halo™ (1.5F), Cook N-Circle(®) Nitinol Tipless Stone Extractor (1.5F), and Boston Scientific OptiFlex(®) (1.3F) stone baskets were tested in an in vitro ureteral and a caliceal model by three novices, three residents, and three experts. The caliceal model consisted of a 7-cm length of 10-mm O.D. plastic tubing with a convex base. Each operator was timed during removal of a 3-mm calculus from each model with three repetitions for each basket. Data were analyzed by analysis of variance single factor tests and t tests assuming unequal variances. In the ureteral model, the Halo had the fastest average rate of stone extraction for experts and novices (0:02 ± 0:01 and 0:08 ± 0:04 min, respectively), as well as the overall fastest average stone extraction rate (0:08 ± 0:06 min). No statistical significant differences in extraction times between baskets were identified in the resident group. In the novice group, the Halo stone extraction rate was significantly faster than the OptiFlex (P=0.029). In the expert group, the OptiFlex had statistically significant slower average extraction rates compared with the Halo (P=0.005) and the N-Circle (P=0.017). In the caliceal model, no statistically significant differences were noted. While no significant differences were noted in extraction times for the caliceal model, the extraction times for the ureteral model were slowest with the OptiFlex basket. Other variables important in selection of the appropriate basket include operator preference, clinical setting, and cost.

Arthroscopic treatment of patients with moderate arthrofibrosis after total knee replacement.

PubMed

Jerosch, Joerg; Aldawoudy, Akram M

2007-01-01

The purpose of this study was to document the effect of arthroscopic management in patients with knee stiffness after total knee replacement. We present a case series study, in which 32 patients have been treated for moderate arthrofibrosis of the knee after total knee replacement, with the same regimen. We have excluded all cases of stiffness, because of infection, mechanical mal-alignment, loosening of the implants and other obvious reasons of stiffness of the knee, rather than pure arthrofibrosis. All patients first underwent a trial of conservative treatment before going for arthroscopic management. A pain catheter for femoral nerve block was inserted just before anesthesia for post-operative pain management. Arthroscopic arthrolysis of the intra-articular pathology was performed in a standardized technique with release of all fibrous bands in the suprapatellar pouch, reestablishing the medial and lateral gutter, release of the patella, resection of the remaining meniscal tissue or an anterior cyclops, if needed. Intensive physiotherapy and continuous passive motion were to start immediately post-operatively. All the patients were available for the follow up and they were evaluated using the knee society rating system. A total of 25 of the 32 procedures resulted in an improvement of the patients knee score. All the knees operated upon had intra-articular fibrous bands, hypertrophic synovitis and peri-patellar adhesions. A total of eight patients suffered from an anterior cyclops lesion and six patients showed pseudomenicus. In 19 cases a medial and lateral relapse of the patella was performed; only 5 patients got an isolated lateral release. The mean knee flexion was 119 degrees (100-130) at the end of arthroscopy and was 97 degrees (75-115) at the last follow up. The eight patients with extension lags decreased from 27 degrees (10 degrees-35 degrees) pre-operatively to 4 degrees (0-10) at time of follow up. The average knee society ratings increased from 70 points prior to the arthroscopy to 86 at time of follow up, which was found to be statistically significant (P < 0.01, student's t test). The average function score also showed improvement from 68 points pre-operatively to 85 at the time of final follow up. The average pain scores improved from 30 points pre-operatively to 41 at the time of final follow up. Our results showed that arthroscopic management of knee stiffness following total knee replacement is a safe and efficient method of treatment. Pain and functional knee scores can improve markedly.

Effect of average flow and capacity utilization on effluent water quality from US municipal wastewater treatment facilities.

PubMed

Weirich, Scott R; Silverstein, Joann; Rajagopalan, Balaji

2011-08-01

There is increasing interest in decentralization of wastewater collection and treatment systems. However, there have been no systematic studies of the performance of small treatment facilities compared with larger plants. A statistical analysis of 4 years of discharge monthly report (DMR) data from 210 operating wastewater treatment facilities was conducted to determine the effect of average flow rate and capacity utilization on effluent biochemical oxygen demand (BOD), total suspended solids (TSS), ammonia, and fecal coliforms relative to permitted values. Relationships were quantified using generalized linear models (GLMs). Small facilities (40 m³/d) had violation rates greater than 10 times that of the largest facilities (400,000 m³/d) for BOD, TSS, and ammonia. For facilities with average flows less than 40,000 m³/d, increasing capacity utilization was correlated with increased effluent levels of BOD and TSS. Larger facilities tended to operate at flows closer to their design capacity while maintaining treatment suggesting greater efficiency. Copyright © 2011 Elsevier Ltd. All rights reserved.

Orange Peel Excision of Gland: A Novel Surgical Technique for Treatment of Gynecomastia.

PubMed

S S, Shirol

2016-12-01

Gynecomastia is a common aesthetic problem faced by men with reported incidence as high as 65% with serious psychosocial impact. Although various techniques of liposculpture combined with glandular excision is the standard of treatment, many of the glandular excision techniques have inherent limitations and complications such as leaving a long scar, long operative time, contour abnormalities, and increased risk of hematoma. Here, we describe an innovative "the orange peel excision of gland (OPEG) technique" which overcomes these limitations with excellent cosmetic results. A total of 38 breasts were operated in 20 patients (18 bilateral and 2 unilateral). All the patients underwent suction-assisted liposuction and glandular excision under general anesthesia by our OPEG technique. The average operative time per breast was 60 minutes. One patient had a small hematoma which did not require evacuation. The patient satisfaction rate was 95%. The technique has reduced operative time and avoids residual gland and hematoma with excellent aesthetic outcome.

Unsteady Adjoint Approach for Design Optimization of Flapping Airfoils

NASA Technical Reports Server (NTRS)

Lee, Byung Joon; Liou, Meng-Sing

2012-01-01

This paper describes the work for optimizing the propulsive efficiency of flapping airfoils, i.e., improving the thrust under constraining aerodynamic work during the flapping flights by changing their shape and trajectory of motion with the unsteady discrete adjoint approach. For unsteady problems, it is essential to properly resolving time scales of motion under consideration and it must be compatible with the objective sought after. We include both the instantaneous and time-averaged (periodic) formulations in this study. For the design optimization with shape parameters or motion parameters, the time-averaged objective function is found to be more useful, while the instantaneous one is more suitable for flow control. The instantaneous objective function is operationally straightforward. On the other hand, the time-averaged objective function requires additional steps in the adjoint approach; the unsteady discrete adjoint equations for a periodic flow must be reformulated and the corresponding system of equations solved iteratively. We compare the design results from shape and trajectory optimizations and investigate the physical relevance of design variables to the flapping motion at on- and off-design conditions.

Current control of time-averaged magnetization in superparamagnetic tunnel junctions

NASA Astrophysics Data System (ADS)

Bapna, Mukund; Majetich, Sara A.

2017-12-01

This work investigates spin transfer torque control of time-averaged magnetization in a small 20 nm × 60 nm nanomagnet with a low thermal stability factor, Δ ˜ 11. Here, the nanomagnet is a part of a magnetic tunnel junction and fluctuates between parallel and anti-parallel magnetization states with respect to the magnetization of the reference layer generating a telegraph signal in the current versus time measurements. The response of the nanomagnet to an external field is first analyzed to characterize the magnetic properties. We then show that the time-averaged magnetization in the telegraph signal can be fully controlled between +1 and -1 by voltage over a small range of 0.25 V. NIST Statistical Test Suite analysis is performed for testing true randomness of the telegraph signal that the device generates when operated at near critical current values for spin transfer torque. Utilizing the probabilistic nature of the telegraph signal generated at two different voltages, a prototype demonstration is shown for multiplication of two numbers using an artificial AND logic gate.

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

Singer, Brett C.; Less, Brennan D.; Delp, William W.

To inform efforts to improve combustion appliance testing in residential energy efficiency programs, we studied the frequency of coincident fan use and depressurization-induced downdrafting and spillage from atmospherically vented (i.e., natural draft) wall furnaces in airtight apartments. Indoor environmental conditions, heating appliance operation, use of exhaust fans, and cooking with stovetop or oven were monitored for approximately three weeks each in 16 apartment units in two buildings in Northern California. Apartments also were assessed using standard combustion appliance safety test methods and enhanced protocols. Monitoring occurred in February and March of 2016, with heating demand corresponding to 7.3 ± 0.5more » heating degree-days at a 65ºF reference temperature. Most of the furnaces spilled combustion products when the apartments were depressurized in the “worst-case” challenge condition of all exhaust fans operating at their highest settings and all windows closed. Many also spilled under less challenging conditions (e.g., with kitchen exhaust fan on low and bathroom fan operating). On average, bathroom exhaust fans were operated 3.9% of monitored minutes (13.5% max), and cooking (burner or kitchen fan operation) occurred 4.6% of minutes (max 13.3%). Event lengths averaged 17 minutes (max 540) and 34 minutes (max 324), respectively. Their coincident operation averaged 0.34% of minutes (max 2.0%), with average event length of 13 minutes (max 92 minutes). This suggests that the operation of apartment units at or near the currently used worst-case challenge condition is quite rare. Wall furnace burners operated an average of 2.8% of minutes (max of 8.9%), with average burner cycle length of 14 minutes (max 162). Coincident bath fan use, cooking and wall furnace operation was very rare, occurring only a handful of times across all apartments. The highest rate was 0.075% of monitored minutes in one apartment, and the longest event length was 12 minutes. Exhaust fan operation in this study may have been more frequent than typical as participants were asked to use an exhaust fan whenever cooking or bathing. Consistent with the low levels of coincident operation, unambiguous spillage occurred in only 4 apartments and the longest event was 5 minutes. The frequency of partial spillage is unknown, owing to a lack of a clear signal from monitored parameters. Downdrafting during exhaust fan use occurred in all 13 of the apartments with relevant data, and 9 of these units had 10 or more events. Exhaust fans also sometimes led to weakened draft, even if downdrafting did not occur. Each unambiguous spillage event identified in the study was immediately preceded by downdrafting. The observed occurrence of downdrafting and spillage may have been impacted in those apartments with the most severe drafting problems (i.e., appliances spilled combustion pollutants under ‘natural’ test conditions), because occupants in these units were instructed to open windows whenever using the kitchen exhaust fan.« less

40 CFR Appendix D to Part 60 - Required Emission Inventory Information

Code of Federal Regulations, 2010 CFR

2010-07-01

... one device operates in series. The method of control efficiency determination shall be indicated (e.g., design efficiency, measured efficiency, estimated efficiency). (iii) Annual average control efficiency, in percent, taking into account control equipment down time. This shall be a combined efficiency when...

40 CFR Appendix D to Part 60 - Required Emission Inventory Information

Code of Federal Regulations, 2011 CFR

2011-07-01

... one device operates in series. The method of control efficiency determination shall be indicated (e.g., design efficiency, measured efficiency, estimated efficiency). (iii) Annual average control efficiency, in percent, taking into account control equipment down time. This shall be a combined efficiency when...

40 CFR Appendix D to Part 60 - Required Emission Inventory Information

Code of Federal Regulations, 2012 CFR

2012-07-01

... one device operates in series. The method of control efficiency determination shall be indicated (e.g., design efficiency, measured efficiency, estimated efficiency). (iii) Annual average control efficiency, in percent, taking into account control equipment down time. This shall be a combined efficiency when...

40 CFR Appendix D to Part 60 - Required Emission Inventory Information

Code of Federal Regulations, 2013 CFR

2013-07-01

... one device operates in series. The method of control efficiency determination shall be indicated (e.g., design efficiency, measured efficiency, estimated efficiency). (iii) Annual average control efficiency, in percent, taking into account control equipment down time. This shall be a combined efficiency when...

40 CFR Appendix D to Part 60 - Required Emission Inventory Information

Code of Federal Regulations, 2014 CFR

2014-07-01

... one device operates in series. The method of control efficiency determination shall be indicated (e.g., design efficiency, measured efficiency, estimated efficiency). (iii) Annual average control efficiency, in percent, taking into account control equipment down time. This shall be a combined efficiency when...

40 CFR 61.356 - Recordkeeping requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... also establish the design minimum and average temperature in the combustion zone and the combustion... temperatures, combustion zone residence time, and description of method and location where the vent stream is... control device are not operated as designed including all periods and the duration when: (i) Any valve car...

The use of the AOA TTR-4P GPS receiver in operation at the BIPM for real-time restitution of GPS time

NASA Technical Reports Server (NTRS)

Thomas, Claudine

1994-01-01

The Global Positioning System is an outstanding tool for the dissemination of time. Using mono-channel C/A-code GPS time receivers, the restitution of GPS time through the satellite constellation presents a peak-to-peak discrepancy of several tens of nanoseconds without SA but may be as high as several hundreds of nanoseconds with SA. As a consequence, civil users are more and more interested in implementing hardware and software methods for efficient restitution of GPS time, especially in the framework of the project of a real-time prediction of UTC (UTCp) which could be available in the form of time differences (UTCp - GPS time). Previous work, for improving the real-time restitution of GPS time with SA, to the level obtained without SA, focused on the implementation of a Kalman filter based on past data and updated at each new observation. An alternative solution relies upon the statistical features of the noise brought about by SA; it has already been shown that the SA noise is efficiently reduced by averaging data from numerous satellites observed simultaneously over a sufficiently long time. This method was successfully applied to data from a GPS time receiver, model AOA TTR-4P, connected to the cesium clock kept at the BIPM. This device, a multi-channel, dual frequency, P-code GPS time receiver, is one of the first TTR-4P units in operation in a civil laboratory. Preliminary comparative studies of this new equipment with conventional GPS time receivers are described in this paper. The results of an experimental restitution of GPS time, obtained in June 1993, are also detailed: 3 to 6 satellites were observed simultaneously with a sample interval of 15 s, an efficient smoothing of SA noise was realized by averaging data on all observed satellites over more than 1 hour. When the GPS system is complete in 1994, 8 satellites will be observable continuously from anywhere in the world and the same level of uncertainty will be obtained using a shorter averaging time.

Cost-effectiveness of the Federal stream-gaging program in Virginia

USGS Publications Warehouse

Carpenter, D.H.

1985-01-01

Data uses and funding sources were identified for the 77 continuous stream gages currently being operated in Virginia by the U.S. Geological Survey with a budget of $446,000. Two stream gages were identified as not being used sufficiently to warrant continuing their operation. Operation of these stations should be considered for discontinuation. Data collected at two other stations were identified as having uses primarily related to short-term studies; these stations should also be considered for discontinuation at the end of the data collection phases of the studies. The remaining 73 stations should be kept in the program for the foreseeable future. The current policy for operation of the 77-station program requires a budget of $446,000/yr. The average standard error of estimation of streamflow records is 10.1%. It was shown that this overall level of accuracy at the 77 sites could be maintained with a budget of $430,500 if resources were redistributed among the gages. A minimum budget of $428,500 is required to operate the 77-gage program; a smaller budget would not permit proper service and maintenance of the gages and recorders. At the minimum budget, with optimized operation, the average standard error would be 10.4%. The maximum budget analyzed was $650,000, which resulted in an average standard error of 5.5%. The study indicates that a major component of error is caused by lost or missing data. If perfect equipment were available, the standard error for the current program and budget could be reduced to 7.6%. This also can be interpreted to mean that the streamflow data have a standard error of this magnitude during times when the equipment is operating properly. (Author 's abstract)

Improving a Dental School's Clinic Operations Using Lean Process Improvement.

PubMed

Robinson, Fonda G; Cunningham, Larry L; Turner, Sharon P; Lindroth, John; Ray, Deborah; Khan, Talib; Yates, Audrey

2016-10-01

The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes. One of the core concepts is relentless elimination of waste (non-value-added components of a process). Another key concept is utilization of individuals closest to the actual work to analyze and improve the process. When the medical center of the University of Kentucky adopted the Lean process for improving clinical operations, members of the College of Dentistry trained in the process applied the techniques to improve inefficient operations at the Walk-In Dental Clinic. The purpose of this project was to reduce patients' average in-the-door-to-out-the-door time from over four hours to three hours within 90 days. Achievement of this goal was realized by streamlining patient flow and strategically relocating key phases of the process. This initiative resulted in patient benefits such as shortening average in-the-door-to-out-the-door time by over an hour, improving satisfaction by 21%, and reducing negative comments by 24%, as well as providing opportunity to implement the electronic health record, improving teamwork, and enhancing educational experiences for students. These benefits were achieved while maintaining high-quality patient care with zero adverse outcomes during and two years following the process improvement project.

Thoracic robotics at the Heart Hospital Baylor Plano: the first 20 cases

PubMed Central

2012-01-01

A da Vinci Robotic Surgical System was purchased for The Heart Hospital Baylor Plano in fall 2011 and a program for robotic-assisted thoracic surgery commenced at the facility. Successive thoracic patients were offered and accepted a robotic-assisted operation. No patient was excluded because of age, height, weight, or comorbidities. The first 20 patients are summarized herein. Of the first 10 operations, only one was a lobectomy. As the program staff gained experience, seven of the latter 10 procedures were lobectomies. The average length of stay was 2.6 days (longest, 4 days). The average operating room time was 147 minutes overall and 200 minutes for lobectomies. The longest operating room time was 337 minutes in a patient who underwent a right middle lobectomy that was converted to a video-assisted thoracic surgery. Two patients developed atrial fibrillation, one of whom had a pacemaker and a history of paroxysmal atrial fibrillation. One patient developed a bronchopleural fistula on the first postoperative day, following a coughing episode. One patient was readmitted 6 days after hospital discharge with a pneumothorax, which was successfully treated with a small-bore catheter. In conclusion, robotic-assisted thoracic surgery has many advantages. Decreased complications can lead to improved outcomes, and hospitals can achieve cost savings as a result of reduced length of stay. PMID:23077378

Efficient Thread Labeling for Monitoring Programs with Nested Parallelism

NASA Astrophysics Data System (ADS)

Ha, Ok-Kyoon; Kim, Sun-Sook; Jun, Yong-Kee

It is difficult and cumbersome to detect data races occurred in an execution of parallel programs. Any on-the-fly race detection techniques using Lamport's happened-before relation needs a thread labeling scheme for generating unique identifiers which maintain logical concurrency information for the parallel threads. NR labeling is an efficient thread labeling scheme for the fork-join program model with nested parallelism, because its efficiency depends only on the nesting depth for every fork and join operation. This paper presents an improved NR labeling, called e-NR labeling, in which every thread generates its label by inheriting the pointer to its ancestor list from the parent threads or by updating the pointer in a constant amount of time and space. This labeling is more efficient than the NR labeling, because its efficiency does not depend on the nesting depth for every fork and join operation. Some experiments were performed with OpenMP programs having nesting depths of three or four and maximum parallelisms varying from 10,000 to 1,000,000. The results show that e-NR is 5 times faster than NR labeling and 4.3 times faster than OS labeling in the average time for creating and maintaining the thread labels. In average space required for labeling, it is 3.5 times smaller than NR labeling and 3 times smaller than OS labeling.

Repressing the effects of variable speed harmonic orders in operational modal analysis

NASA Astrophysics Data System (ADS)

Randall, R. B.; Coats, M. D.; Smith, W. A.

2016-10-01

Discrete frequency components such as machine shaft orders can disrupt the operation of normal Operational Modal Analysis (OMA) algorithms. With constant speed machines, they have been removed using time synchronous averaging (TSA). This paper compares two approaches for varying speed machines. In one method, signals are transformed into the order domain, and after the removal of shaft speed related components by a cepstral notching method, are transformed back to the time domain to allow normal OMA. In the other simpler approach an exponential shortpass lifter is applied directly in the time domain cepstrum to enhance the modal information at the expense of other disturbances. For simulated gear signals with speed variations of both ±5% and ±15%, the simpler approach was found to give better results The TSA method is shown not to work in either case. The paper compares the results with those obtained using a stationary random excitation.

Use of Lean methodology to improve operating room efficiency in hospitals across the Kingdom of Saudi Arabia.

PubMed

Hassanain, Mazen; Zamakhshary, Mohammed; Farhat, Ghada; Al-Badr, Ahmed

2017-04-01

The objective of this study was to assess whether an intervention on process efficiency using the Lean methodology leads to improved utilization of the operating room (OR), as measured by key performance metrics of OR efficiency. A quasi-experimental design was used to test the impact of the intervention by comparing pre-intervention and post-intervention data on five key performance indicators. The ORs of 12 hospitals were selected across regions of the Kingdom of Saudi Arabia (KSA). The participants were patients treated at these hospitals during the study period. The intervention comprised the following: (i) creation of visual dashboards that enable starting the first case on time; (ii) use of computerized surgical list management; (iii) optimization of time allocation; (iv) development of an operating model with policies and procedures for the pre-anesthesia clinic; and (iv) creation of a governance structure with policies and procedures for day surgeries. The following were the main outcome measures: on-time start for the first case, room turnover times, percent of overrun cases, average weekly procedure volume and OR utilization. The hospital exhibited statistically significant improvements in the following performance metrics: on-time start for the first case, room turnover times and percent of overrun cases. A statistically significant difference in OR utilization or average weekly procedure volumes was not detected. The implementation of a Lean-based intervention targeting process efficiency applied in ORs across various KSA hospitals resulted in encouraging results on some metrics at some sites, suggesting that the approach has the potential to produce significant benefit in the future. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Adaptive pitch control for variable speed wind turbines

DOEpatents

Johnson, Kathryn E [Boulder, CO; Fingersh, Lee Jay [Westminster, CO

2012-05-08

An adaptive method for adjusting blade pitch angle, and controllers implementing such a method, for achieving higher power coefficients. Average power coefficients are determined for first and second periods of operation for the wind turbine. When the average power coefficient for the second time period is larger than for the first, a pitch increment, which may be generated based on the power coefficients, is added (or the sign is retained) to the nominal pitch angle value for the wind turbine. When the average power coefficient for the second time period is less than for the first, the pitch increment is subtracted (or the sign is changed). A control signal is generated based on the adapted pitch angle value and sent to blade pitch actuators that act to change the pitch angle of the wind turbine to the new or modified pitch angle setting, and this process is iteratively performed.

Current conserving theory at the operator level

NASA Astrophysics Data System (ADS)

Yuan, Jiangtao; Wang, Yin; Wang, Jian

The basic assumption of quantum transport in mesoscopic systems is that the total charge inside the scattering region is zero. This means that the potential deep inside reservoirs is effectively screened and therefore the electric field at interface of scattering region is zero. Thus the current conservation condition can be satisfied automatically which is an important condition in mesoscopic transport. So far the current conserving ac theory is well developed by considering the displacement current which is due to Coulomb interaction if we just focus on the average current. However, the frequency dependent shot noise does not satisfy the conservation condition since we do not consider the current conservation at the operator level. In this work, we formulate a generalized current conserving theory at the operator level using non-equilibrium Green's function theory which could be applied to both average current and frequency dependent shot noise. A displacement operator is derived for the first time so that the frequency dependent correlation of displacement currents could be investigated. Moreover, the equilibrium shot noise is investigated and a generalized fluctuation-dissipation relationship is presented.

Measurements of the cesium flow from a surface-plasma H/sup -/ ion source

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

Smith, H.V.; Allison, P.W.

1979-01-01

A surface ionization gauge (SIG) was constructed and used to measure the Cs/sup 0/ flow rate through the emission slit of a surface-plasma source (SPS) of H/sup -/ ions with Penning geometry. The equivalent cesium density in the SPS discharge is deduced from these flow measurements. For dc operation the optimum H/sup -/ current occurs at an equivalent cesium density of approx. 7 x 10/sup 12/ cm/sup -3/ (corresponding to an average cesium consumption rate of 0.5 mg/h). For pulsed operation the optimum H/sup -/ current occurs at an equivalent cesium density of approx. 2 x 10/sup 13/ cm/sup -3/more » (1-mg/h average cesium consumption rate). Cesium trapping by the SPS discharge was observed for both dc and pulsed operation. A cesium energy of approx. 0.1 eV is deduced from the observed time of flight to the SIG. In addition to providing information on the physics of the source, the SIG is a useful diagnostic tool for source startup and operation.« less

Time estimation as a secondary task to measure workload. [attention sharing effect on operator performance

NASA Technical Reports Server (NTRS)

Hart, S. G.

1975-01-01

Variation in the length of time productions and verbal estimates of duration was investigated to determine the influence of concurrent activity on operator time perception. The length of 10-, 20-, and 30-sec intervals produced while performing six different compensatory tracking tasks was significantly longer, 23% on the average, than those produced while performing no other task. Verbal estimates of session duration, taken at the end of each of 27 experimental sessions, reflected a parallel increase in subjective underestimation of the passage of time as the difficulty of the task performed increased. These data suggest that estimates of duration made while performing a manual control task provide stable and sensitive measures of the workload imposed by the primary task, with minimal interference.

Computed tomography image-guided surgery in complex acetabular fractures.

PubMed

Brown, G A; Willis, M C; Firoozbakhsh, K; Barmada, A; Tessman, C L; Montgomery, A

2000-01-01

Eleven complex acetabular fractures in 10 patients were treated by open reduction with internal fixation incorporating computed tomography image guided software intraoperatively. Each of the implants placed under image guidance was found to be accurate and without penetration of the pelvis or joint space. The setup time for the system was minimal. Accuracy in the range of 1 mm was found when registration was precise (eight cases) and was in the range of 3.5 mm when registration was only approximate (three cases). Added benefits included reduced intraoperative fluoroscopic time, less need for more extensive dissection, and obviation of additional surgical approaches in some cases. Compared with a series of similar fractures treated before this image guided series, the reduction in operative time was significant. For patients with complex anterior and posterior combined fractures, the average operation times with and without application of three-dimensional imaging technique were, respectively, 5 hours 15 minutes and 6 hours 14 minutes, revealing 16% less operative time for those who had surgery using image guidance. In the single column fracture group, the operation time for those with three-dimensional imaging application, was 2 hours 58 minutes and for those with traditional surgery, 3 hours 42 minutes, indicating 20% less operative time for those with imaging modality. Intraoperative computed tomography guided imagery was found to be an accurate and suitable method for use in the operative treatment of complex acetabular fractures with substantial displacement.

Intuitionistic fuzzy evidential power aggregation operator and its application in multiple criteria decision-making

NASA Astrophysics Data System (ADS)

Jiang, Wen; Wei, Boya

2018-02-01

The theory of intuitionistic fuzzy sets (IFS) is widely used for dealing with vagueness and the Dempster-Shafer (D-S) evidence theory has a widespread use in multiple criteria decision-making problems under uncertain situation. However, there are many methods to aggregate intuitionistic fuzzy numbers (IFNs), but the aggregation operator to fuse basic probability assignment (BPA) is rare. Power average (P-A) operator, as a powerful operator, is useful and important in information fusion. Motivated by the idea of P-A power, in this paper, a new operator based on the IFS and D-S evidence theory is proposed, which is named as intuitionistic fuzzy evidential power average (IFEPA) aggregation operator. First, an IFN is converted into a BPA, and the uncertainty is measured in D-S evidence theory. Second, the difference between BPAs is measured by Jousselme distance and a satisfying support function is proposed to get the support degree between each other effectively. Then the IFEPA operator is used for aggregating the original IFN and make a more reasonable decision. The proposed method is objective and reasonable because it is completely driven by data once some parameters are required. At the same time, it is novel and interesting. Finally, an application of developed models to the 'One Belt, One road' investment decision-making problems is presented to illustrate the effectiveness and feasibility of the proposed operator.

40 CFR 63.1192 - What recordkeeping requirements must I meet?

Code of Federal Regulations, 2013 CFR

2013-07-01

... detection system alarms. Include the date and time of the alarm, when corrective actions were initiated, the... operating temperature and results of incinerator inspections. For all periods when the average temperature... microfilm, on a computer, on computer disks, on magnetic tape disks, or on microfiche. (e) Report the...

40 CFR 63.1192 - What recordkeeping requirements must I meet?

Code of Federal Regulations, 2011 CFR

2011-07-01

... detection system alarms. Include the date and time of the alarm, when corrective actions were initiated, the... operating temperature and results of incinerator inspections. For all periods when the average temperature... microfilm, on a computer, on computer disks, on magnetic tape disks, or on microfiche. (e) Report the...

40 CFR 63.1192 - What recordkeeping requirements must I meet?

Code of Federal Regulations, 2014 CFR

2014-07-01

... detection system alarms. Include the date and time of the alarm, when corrective actions were initiated, the... operating temperature and results of incinerator inspections. For all periods when the average temperature... microfilm, on a computer, on computer disks, on magnetic tape disks, or on microfiche. (e) Report the...

40 CFR 63.1192 - What recordkeeping requirements must I meet?

Code of Federal Regulations, 2010 CFR

2010-07-01

... detection system alarms. Include the date and time of the alarm, when corrective actions were initiated, the... operating temperature and results of incinerator inspections. For all periods when the average temperature... microfilm, on a computer, on computer disks, on magnetic tape disks, or on microfiche. (e) Report the...

40 CFR 63.1192 - What recordkeeping requirements must I meet?

Code of Federal Regulations, 2012 CFR

2012-07-01

... detection system alarms. Include the date and time of the alarm, when corrective actions were initiated, the... operating temperature and results of incinerator inspections. For all periods when the average temperature... microfilm, on a computer, on computer disks, on magnetic tape disks, or on microfiche. (e) Report the...

23 CFR 635.127 - Agreement provisions regarding overruns in contract time.

Code of Federal Regulations, 2012 CFR

2012-04-01

... ENGINEERING AND TRAFFIC OPERATIONS CONSTRUCTION AND MAINTENANCE Contract Procedures § 635.127 Agreement... types. These rates shall, as a minimum, be established to cover the estimated average daily construction... proportional share, as used in this section, is the ratio of the final contract construction costs eligible for...

23 CFR 635.127 - Agreement provisions regarding overruns in contract time.

Code of Federal Regulations, 2013 CFR

2013-04-01

... ENGINEERING AND TRAFFIC OPERATIONS CONSTRUCTION AND MAINTENANCE Contract Procedures § 635.127 Agreement... types. These rates shall, as a minimum, be established to cover the estimated average daily construction... proportional share, as used in this section, is the ratio of the final contract construction costs eligible for...

23 CFR 635.127 - Agreement provisions regarding overruns in contract time.

Code of Federal Regulations, 2010 CFR

2010-04-01

... ENGINEERING AND TRAFFIC OPERATIONS CONSTRUCTION AND MAINTENANCE Contract Procedures § 635.127 Agreement... types. These rates shall, as a minimum, be established to cover the estimated average daily construction... proportional share, as used in this section, is the ratio of the final contract construction costs eligible for...

23 CFR 635.127 - Agreement provisions regarding overruns in contract time.

Code of Federal Regulations, 2014 CFR

2014-04-01

... ENGINEERING AND TRAFFIC OPERATIONS CONSTRUCTION AND MAINTENANCE Contract Procedures § 635.127 Agreement... types. These rates shall, as a minimum, be established to cover the estimated average daily construction... proportional share, as used in this section, is the ratio of the final contract construction costs eligible for...

23 CFR 635.127 - Agreement provisions regarding overruns in contract time.

Code of Federal Regulations, 2011 CFR

2011-04-01

... ENGINEERING AND TRAFFIC OPERATIONS CONSTRUCTION AND MAINTENANCE Contract Procedures § 635.127 Agreement... types. These rates shall, as a minimum, be established to cover the estimated average daily construction... proportional share, as used in this section, is the ratio of the final contract construction costs eligible for...

The reamer-irrigator-aspirator as a device for harvesting bone graft compared with iliac crest bone graft: union rates and complications.

PubMed

Dawson, John; Kiner, Dirk; Gardner, Warren; Swafford, Rachel; Nowotarski, Peter J

2014-10-01

This study was performed to compare patient outcomes after Reamer-Irrigator-Aspirator (RIA)-harvested bone grafting with the current gold standard, either anterior or posterior iliac crest bone graft (ICBG). Prospective randomized controlled trial. Multicenter study at 3 geographically separate Level 1 trauma centers. One hundred thirty-three patients with nonunion or posttraumatic segmental bone defect requiring operative intervention. Patients were prospectively randomized to receive ICBG or RIA autograft. Supplemental internal fixation was performed per surgeon preference. Operative data included amount of graft, time of harvest, and associated surgical costs. The Short Musculoskeletal Functional Assessment and the Visual Analog Scale were used to document baseline and postoperative function and pain. Clinical and radiographic union was the defined end point; patients considered to have failed treatment if they either developed an infection requiring operative treatment or had a persistent nonunion of the grafted extremity. One hundred thirteen of the 133 enrolled patients were followed until union and included in the final analysis. Intraoperative data showed anterior ICBG to yield 20.7 ± 12.8 (5-60) cm of autograft with an average harvest time of 33.2 ± 16.2 minutes, posterior ICBG yielded 36.1 ± 21.3 (20-100) cm of autograft in 40.6 ± 11.2 minutes, and RIA yielded 37.7 ± 12.9 (5-90) cm in 29.4 ± 15.1 minutes. Anterior ICBG produced significantly less bone graft than either RIA or posterior ICBG (P < 0.001). The RIA harvest was completed in significantly less operative time compared with posterior ICBG (P = 0.005). At $738, the RIA setup was considerably more expensive than the ∼$100 cost of a bone graft tray; however, when compared with posterior ICBG, the longer operative time required for a posterior harvest came at an additional incremental cost of $990-1880, making RIA the less expensive option. Patients were followed for an average of 56.9 ± 42.1 (11-250) weeks. Forty-nine of 57 patients (86.0%) who received ICBG united in an average of 22.5 ± 13.2 weeks; 46 of 56 patients (82.1%) who received RIA healed in an average of 25.8 ± 17.0 weeks. Union rates and time to union were comparable between the 2 procedures. There was no difference in complications requiring reoperation for persistent nonunion or infection at the grafted site, nor there was any difference in donor-site complications. Postoperative follow-up showed that RIA patients had significantly lower donor-site pain scores throughout follow-up. When compared with autograft obtained from the iliac crest, autograft harvested using the RIA technique achieves similar union rates with significantly less donor-site pain. RIA also yields a greater volume of graft compared with anterior ICBG and has a shorter harvest time compared with posterior ICBG. For larger volume harvests, cost analysis favors using RIA. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Ibuprofen timing for hand surgery in ambulatory care

PubMed Central

Giuliani, Enrico; Bianchi, Anna; Marcuzzi, Augusto; Landi, Antonio; Barbieri, Alberto

2015-01-01

OBJECTIVE: To evaluate the effect of pre-operative administration of ibuprofen on post-operative pain control vs. early post-operative administration for hand surgery procedures performed under local anaesthesia in ambulatory care. METHODS: Candidates to trigger finger release by De Quervain tenosynovitis and carpal tunnel operation under local anesthesia were enrolled in the study. Group A received 400 mg ibuprofen before the operation and placebo after the procedure; group B received placebo before the operation and ibuprofen 400 mg at the end of the procedure; both groups received ibuprofen 400 mg every 6h thereafter. Visual analogue scale (VAS) was measured at fixed times before and every 6h after surgery, for a total follow-up of 18h. RESULTS: Groups were similar according to age, gender and type of surgery. Median VAS values did not produce any statistical significance, while there was a statistically significant difference on pre-operative and early post-operative VAS values between groups (A -8.53 mm vs. B 3.36 mm, p=0.0085). CONCLUSION: Average pain levels were well controlled by local anesthesia and post-operative ibuprofen analgesia. Pre-operative ibuprofen administration can contribute to improve early pain management. Level of Evidence II, Therapeutic Studies. PMID:26327799

Linear optical quantum computing in a single spatial mode.

PubMed

Humphreys, Peter C; Metcalf, Benjamin J; Spring, Justin B; Moore, Merritt; Jin, Xian-Min; Barbieri, Marco; Kolthammer, W Steven; Walmsley, Ian A

2013-10-11

We present a scheme for linear optical quantum computing using time-bin-encoded qubits in a single spatial mode. We show methods for single-qubit operations and heralded controlled-phase (cphase) gates, providing a sufficient set of operations for universal quantum computing with the Knill-Laflamme-Milburn [Nature (London) 409, 46 (2001)] scheme. Our protocol is suited to currently available photonic devices and ideally allows arbitrary numbers of qubits to be encoded in the same spatial mode, demonstrating the potential for time-frequency modes to dramatically increase the quantum information capacity of fixed spatial resources. As a test of our scheme, we demonstrate the first entirely single spatial mode implementation of a two-qubit quantum gate and show its operation with an average fidelity of 0.84±0.07.

[Case-control study on minimally invasive percutaneous locking compression plate internal fixation for the treatment of type II and III pilon fractures].

PubMed

Zhang, Zhi-Da; Ye, Xiu-Yi; Shang, Li-Yong; Xu, Rong-Ming; Zhu, Yan-Zhao

2011-12-01

To explore the clinical efficacy of delayed open reduction and internal fixation with minimally invasive percutaneous locking compression plate for the treatment of type II and III Pilon fractures. From January 2007 to September 2009, 32 patients with type II and III Pilon fractures were treated with open reduction and anatomic plate fixation (AP group) and minimally invasive percutaneous locking compression plate osteosynthesis (LCP group). There were 11 males and 6 females in AP group, with an average age of (37.4 +/- 13.3) years (ranged, 19 to 55 years). And there were 10 males and 5 females in LCP group, with an average age of (34.6 +/- 11.3) years(ranged, 21 to 56 years). The operating time, fracture healing time, aligned angulation and ankle function were compared between the two groups. All the patients were followed up, and the during ranged from 12 to 25 months, with a mean of (15.0 +/- 1.7) months. The average operation time was (76.5 +/- 8.3) min for AP group and (58.3 +/- 3.4) min for LCP group; the average time of fracture healing was (20.5 +/- 0.4) weeks for AP group and (15.7 +/- 0.2) weeks for LCP group; the total angulation between anterior posterior film and lateral film was averaged (6.6 +/- 0.5) degrees for AP group and (3.6 +/- 0.2) degrees for LCP group. As to above index, the results of LCP group were better than those of AP group (P < 0.05). According to Kofoed criteria for ankle joint, the results of LCP group were better than those of AP group in ankle joint pain, wakling and ankle joint function (P < 0.05). The method of minimally invasive percutaneous locking compression plate internal fixation is effective in the treatment of Pilon fracture with less invasion, faster bone union, more stabilized fixation, quicker recovery of ankle function and fewer complications, which is more advantaged for type II and III Pilon fractures.

[Short-term clinical effects of Achillon in repair of acute Achilles tendon rupture].

PubMed

Diao, Zhen-Bin; Chu, Hai-Kun; Li, Na; Sha, Xian-Hui; Chang, Shu-Song

2012-11-01

To study the clinical effects of Achillon for the treatment of acute Achilles tendon rupture (AATR). From April 2009 to April 2010, 19 patients with AATR who were treated with Achillon were retrospectively analyzed. There were 17 males and 2 females, with an average age of 40.2 years (30 to 58 years). There were 9 cases of sports injury, and 2 case of fall injury. The time from injury to surgery ranged from 0 to 8 days (2.2 days on average). The results of Thompson test and single heel rise test were positive in 19 cases. Clinical data were assessed with the patient satisfaction and the AOFAS hindfoot score during follow-up. All the patients were followed up, and the duration ranged from 12 to 28 months (19.9 months on average). The average operation time was 41 minutes. There were no wound infections, recurrent rupture, or sural nerve complications. At the latest follow-up, 18 patients were totally satisfied with the surgical result, 1 patient feel generally due to mild pain when running. None of the patients were dissatisfied with the final results the latest follow-up. At the latest follow-up, the AOFAS score was 98.42 +/- 3.29 (89 to 100). All the patients regained normal range of motion and were able to resume their previous activities at six months after operation, with a high rate of satisfaction. Average decreased of mid-calf circumference was (0.82 +/- 0.85) cm (ranged from 0 to 3 cm). Treatment with Achillon is safe, effective for AATR with low incidence of complications and early active rehabilitation can be carried out. It is a good method to treat AATR.

40 CFR 63.1185 - How do I establish the average operating temperature of an incinerator?

Code of Federal Regulations, 2014 CFR

2014-07-01

... operating temperature of an incinerator? 63.1185 Section 63.1185 Protection of Environment ENVIRONMENTAL... operating temperature of an incinerator? (a) During the performance test, you must establish the average operating temperature of an incinerator as follows: (1) Continuously measure the operating temperature of...

40 CFR 63.1185 - How do I establish the average operating temperature of an incinerator?

Code of Federal Regulations, 2011 CFR

2011-07-01

... operating temperature of an incinerator? 63.1185 Section 63.1185 Protection of Environment ENVIRONMENTAL... operating temperature of an incinerator? (a) During the performance test, you must establish the average operating temperature of an incinerator as follows: (1) Continuously measure the operating temperature of...

40 CFR 63.1185 - How do I establish the average operating temperature of an incinerator?

Code of Federal Regulations, 2013 CFR

2013-07-01

... operating temperature of an incinerator? 63.1185 Section 63.1185 Protection of Environment ENVIRONMENTAL... operating temperature of an incinerator? (a) During the performance test, you must establish the average operating temperature of an incinerator as follows: (1) Continuously measure the operating temperature of...

40 CFR 63.1185 - How do I establish the average operating temperature of an incinerator?

Code of Federal Regulations, 2010 CFR

2010-07-01

... operating temperature of an incinerator? 63.1185 Section 63.1185 Protection of Environment ENVIRONMENTAL... operating temperature of an incinerator? (a) During the performance test, you must establish the average operating temperature of an incinerator as follows: (1) Continuously measure the operating temperature of...

40 CFR 63.1185 - How do I establish the average operating temperature of an incinerator?

Code of Federal Regulations, 2012 CFR

2012-07-01

... operating temperature of an incinerator? 63.1185 Section 63.1185 Protection of Environment ENVIRONMENTAL... operating temperature of an incinerator? (a) During the performance test, you must establish the average operating temperature of an incinerator as follows: (1) Continuously measure the operating temperature of...

20 CFR 416.1133 - What is a pro rata share of household operating expenses.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., water, sewerage, and garbage collection service. (The term does not include the cost of these items if... of household operating expenses is the average monthly household operating expenses (based on a..., regardless of age. (c) Average household operating expenses. Household operating expenses are the household's...

20 CFR 416.1133 - What is a pro rata share of household operating expenses.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., water, sewerage, and garbage collection service. (The term does not include the cost of these items if... of household operating expenses is the average monthly household operating expenses (based on a..., regardless of age. (c) Average household operating expenses. Household operating expenses are the household's...

20 CFR 416.1133 - What is a pro rata share of household operating expenses.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., water, sewerage, and garbage collection service. (The term does not include the cost of these items if... of household operating expenses is the average monthly household operating expenses (based on a..., regardless of age. (c) Average household operating expenses. Household operating expenses are the household's...

20 CFR 416.1133 - What is a pro rata share of household operating expenses.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., water, sewerage, and garbage collection service. (The term does not include the cost of these items if... of household operating expenses is the average monthly household operating expenses (based on a..., regardless of age. (c) Average household operating expenses. Household operating expenses are the household's...

Mesophilic biomethanation and treatment of poultry waste-water using pilot scale UASB reactor.

PubMed

Atuanya, Ernest I; Aigbirior, Moses

2002-07-01

The feasibility of applying the up-flow anaerobic sludge blanket (UASB) treatment for poultry waste (faeces) water was examined. A continuous-flow UASB pilot scale reactor of 3.50 L capacity using mixed culture was operated for 95 days to assess the treatability of poultry waste-water and its methane production. The maximum chemical oxygen demand (COD) removed was found to be 78% when organic loading rate (OLR) was 2.9 kg COD m(-3) day(-1) at hydraulic retention times (HRT) of 13.2 hr. The average biogas recovery was 0.26 m3 CH4 kg COD with an average methane content of 57% at mean temperature of 30 degrees C. Data indicate more rapid methanogenesis with higher loading rates and shorter hydraulic retention times. At feed concentration of 4.8 kg COD m(-3) day(-1), anaerobic digestion was severely retarded at all hydraulic retention time tested. This complication in the reactor operations may be linked to build-up of colloidal solids often associated with poultry waste water and ammonia toxicity. Isolates from granular sludge and effluent were found to be facultative anaerobes most of which were Pseudomonas genera.

A simple and efficient algorithm operating with linear time for MCEEG data compression.

PubMed

Titus, Geevarghese; Sudhakar, M S

2017-09-01

Popularisation of electroencephalograph (EEG) signals in diversified fields have increased the need for devices capable of operating at lower power and storage requirements. This has led to a great deal of research in data compression, that can address (a) low latency in the coding of the signal, (b) reduced hardware and software dependencies, (c) quantify the system anomalies, and (d) effectively reconstruct the compressed signal. This paper proposes a computationally simple and novel coding scheme named spatial pseudo codec (SPC), to achieve lossy to near lossless compression of multichannel EEG (MCEEG). In the proposed system, MCEEG signals are initially normalized, followed by two parallel processes: one operating on integer part and the other, on fractional part of the normalized data. The redundancies in integer part are exploited using spatial domain encoder, and the fractional part is coded as pseudo integers. The proposed method has been tested on a wide range of databases having variable sampling rates and resolutions. Results indicate that the algorithm has a good recovery performance with an average percentage root mean square deviation (PRD) of 2.72 for an average compression ratio (CR) of 3.16. Furthermore, the algorithm has a complexity of only O(n) with an average encoding and decoding time per sample of 0.3 ms and 0.04 ms respectively. The performance of the algorithm is comparable with recent methods like fast discrete cosine transform (fDCT) and tensor decomposition methods. The results validated the feasibility of the proposed compression scheme for practical MCEEG recording, archiving and brain computer interfacing systems.

Real-time validation of receiver state information in optical space-time block code systems.

PubMed

Alamia, John; Kurzweg, Timothy

2014-06-15

Free space optical interconnect (FSOI) systems are a promising solution to interconnect bottlenecks in high-speed systems. To overcome some sources of diminished FSOI performance caused by close proximity of multiple optical channels, multiple-input multiple-output (MIMO) systems implementing encoding schemes such as space-time block coding (STBC) have been developed. These schemes utilize information pertaining to the optical channel to reconstruct transmitted data. The STBC system is dependent on accurate channel state information (CSI) for optimal system performance. As a result of dynamic changes in optical channels, a system in operation will need to have updated CSI. Therefore, validation of the CSI during operation is a necessary tool to ensure FSOI systems operate efficiently. In this Letter, we demonstrate a method of validating CSI, in real time, through the use of moving averages of the maximum likelihood decoder data, and its capacity to predict the bit error rate (BER) of the system.

In vivo porcine training model for laparoscopic Roux-en-Y choledochojejunostomy.

PubMed

Lee, Jun Suh; Hong, Tae Ho

2015-06-01

The purpose of this study was to develop a porcine training model for laparoscopic choledochojejunostomy (CJ) that can act as a bridge between simulation models and actual surgery for novice surgeons. The feasibility of this model was evaluated. Laparoscopic CJ using intracorporeal sutures was performed on ten animals by a surgical fellow with no experience in human laparoscopic CJ. A single layer of running sutures was placed in the posterior and anterior layers. Jejunojejunostomy was performed using a linear stapler, and the jejunal opening was closed using absorbable unidirectional sutures (V-Loc 180). The average operation time was 131.3 ± 36.4 minutes, and the CJ time was 57.5 ± 18.4 minutes. Both the operation time and CJ time showed a steady decrease with an increasing number of cases. The average diameter of the CBD was 6.4 ± 0.8 mm. Of a total of ten animals, eight were sacrificed after the procedure. In two animals, a survival model was evaluated. Both pigs recovered completely and survived for two weeks, after which both animals were sacrificed. None of the animals exhibited any signs of bile leakage or anastomosis site stricture. The porcine training model introduced in this paper is an adequate model for practicing laparoscopic CJ. Human tissue simulation is excellent.

General Anesthesia Time for Pediatric Dental Cases

PubMed Central

Forsyth, Anna R.; Seminario, Ana Lucia; Scott, JoAnna; Berg, Joel; Ivanova, Iskra; Lee, Helen

2012-01-01

Purpose The purpose of this study was to describe the use of operating room (OR) time for pediatric dental procedures performed under general anesthesia (GA) at a regional children’s hospital over a 2-year period. Methods A cross-sectional review of a pediatric dental GA records was performed at Seattle Children’s Hospital. Data were collected for 709 0- to 21-year-old patients from January 2008 to December 2009. Demographic data, dental and anesthesia operator types, and procedures were recorded. Utilization of OR time was analyzed. Results The mean age of patients was 7.1 years (±4.2 SD), and 58% were male. Distribution by American Society of Anesthesiology (ASA) classifications were: ASA I 226 (32%); ASA II 316 (45%); ASA III 167 (24%). Cases finished earlier than the scheduled time by an average of 14 minutes (±28). Overrun time was significantly associated with: patient age (P=.01); ASA classification (P=.006); treatment type (P<.001); number of teeth treated (P<.001); and dentist operator type (P=.005). Conclusions Overall, 73% of dental procedures under GA finished early or on time. Significant variables included patient age, medical status, treatment type and extent, and dentist operator type. Assessing factors that impact the time needed in GA may enhance efficiency for pediatric dental procedures. PMID:23211897

A new method of two-phase anaerobic digestion for fruit and vegetable waste treatment.

PubMed

Wu, Yuanyuan; Wang, Cuiping; Liu, Xiaoji; Ma, Hailing; Wu, Jing; Zuo, Jiane; Wang, Kaijun

2016-07-01

A novel method of two-phase anaerobic digestion where the acid reactor is operated at low pH 4.0 was proposed and investigated. A completely stirred tank acid reactor and an up-flow anaerobic sludge bed methane reactor were operated to examine the possibility of efficient degradation of lactate and to identify their optimal operating conditions. Lactate with an average concentration of 14.8g/L was the dominant fermentative product and Lactobacillus was the predominant microorganism in the acid reactor. The effluent from the acid reactor was efficiently degraded in the methane reactor and the average methane yield was 261.4ml/gCOD removed. Organisms of Methanosaeta were the predominant methanogen in granular sludge of methane reactor, however, after acclimation hydrogenotrophic methanogens enriched, which benefited for the conversion of lactate to acetate. The two-phase AD system exhibited a low hydraulic retention time of 3.56days and high methane yield of 348.5ml/g VS removed. Copyright © 2016 Elsevier Ltd. All rights reserved.

Cloth media filtration and membrane microfiltration: serial operation.

PubMed

Tooker, Nicholas Brewster; Darby, Jeannie L

2007-02-01

A combined system comprised of a cloth media filter and a membrane microfilter operated in series was used to treat secondary effluent. The study objective was to investigate the effect of premembrane filtration on the maximum sustainable membrane flux, transmembrane pressure, and effluent quality. The maximum sustainable time-averaged flux under predefined operating conditions (i.e., 15-minute process cycle, 24-hour chemical cleaning cycle, and 30-day intensive cleaning cycle) was 127 L/m(2)x h. Typical flux rates for secondary effluent ranged from 40 to 55 L/m(2) x h. Effluent water quality from the combined system was high and independent of membrane flux and influent quality. Average membrane effluent water quality values were 0.04 NTU for turbidity and 1.4 mg/L for 5-day biochemical oxygen demand. Neither total nor fecal coliforms were detected. Based on the results presented herein, prefiltration would provide an annualized cost savings of approximately 12% over microfiltration alone for a 3.8 x 10(3) m(3)/d treatment facility.

Enhanced Airport Capacity Through Safe, Dynamic Reductions in Aircraft Separation: NASA's Aircraft VOrtex Spacing System (AVOSS)

NASA Technical Reports Server (NTRS)

OConnor, Cornelius J.; Rutishauser, David K.

2001-01-01

An aspect of airport terminal operations that holds potential for efficiency improvements is the separation criteria applied to aircraft for wake vortex avoidance. These criteria evolved to represent safe spacing under weather conditions conducive to the longest wake hazards, and are consequently overly conservative during a significant portion of operations. Under many ambient conditions, such as moderate crosswinds or turbulence, wake hazard durations are substantially reduced. To realize this reduction NASA has developed a proof-of-concept Aircraft Vortex Spacing System (AVOSS). Successfully operated in a real-time field demonstration during July 2000 at the Dallas Ft. Worth International Airport, AVOSS is a novel integration of weather sensors, wake sensors, and analytical wake prediction algorithms. Gains in airport throughput using AVOSS spacing as compared to the current criteria averaged 6%, with peak values approaching the theoretical maximum of 16%. The average throughput gain translates to 15-40% reductions in delay when applied to realistic capacity ratios at major airports.

Occupational exposure to electric fields and induced currents associated with 400 kV substation tasks from different service platforms.

PubMed

Korpinen, Leena H; Elovaara, Jarmo A; Kuisti, Harri A

2011-01-01

The aim of the study was to investigate the occupational exposure to electric fields, average current densities, and average total contact currents at 400 kV substation tasks from different service platforms (main transformer inspection, maintenance of operating device of disconnector, maintenance of operating device of circuit breaker). The average values are calculated over measured periods (about 2.5 min). In many work tasks, the maximum electric field strengths exceeded the action values proposed in the EU Directive 2004/40/EC, but the average electric fields (0.2-24.5 kV/m) were at least 40% lower than the maximum values. The average current densities were 0.1-2.3 mA/m² and the average total contact currents 2.0-143.2 µA, that is, clearly less than the limit values of the EU Directive. The average values of the currents in head and contact currents were 16-68% lower than the maximum values when we compared the average value from all cases in the same substation. In the future it is important to pay attention to the fact that the action and limit values of the EU Directive differ significantly. It is also important to take into account that generally, the workers' exposure to the electric fields, current densities, and total contact currents are obviously lower if we use the average values from a certain measured time period (e.g., 2.5 min) than in the case where exposure is defined with only the help of the maximum values. © 2010 Wiley-Liss, Inc.

A cross-sectional study of the temporal evolution of electricity consumption of six commercial buildings.

PubMed

Pickering, Ethan M; Hossain, Mohammad A; Mousseau, Jack P; Swanson, Rachel A; French, Roger H; Abramson, Alexis R

2017-01-01

Current approaches to building efficiency diagnoses include conventional energy audit techniques that can be expensive and time consuming. In contrast, virtual energy audits of readily available 15-minute-interval building electricity consumption are being explored to provide quick, inexpensive, and useful insights into building operation characteristics. A cross sectional analysis of six buildings in two different climate zones provides methods for data cleaning, population-based building comparisons, and relationships (correlations) of weather and electricity consumption. Data cleaning methods have been developed to categorize and appropriately filter or correct anomalous data including outliers, missing data, and erroneous values (resulting in < 0.5% anomalies). The utility of a cross-sectional analysis of a sample set of building's electricity consumption is found through comparisons of baseload, daily consumption variance, and energy use intensity. Correlations of weather and electricity consumption 15-minute interval datasets show important relationships for the heating and cooling seasons using computed correlations of a Time-Specific-Averaged-Ordered Variable (exterior temperature) and corresponding averaged variables (electricity consumption)(TSAOV method). The TSAOV method is unique as it introduces time of day as a third variable while also minimizing randomness in both correlated variables through averaging. This study found that many of the pair-wise linear correlation analyses lacked strong relationships, prompting the development of the new TSAOV method to uncover the causal relationship between electricity and weather. We conclude that a combination of varied HVAC system operations, building thermal mass, plug load use, and building set point temperatures are likely responsible for the poor correlations in the prior studies, while the correlation of time-specific-averaged-ordered temperature and corresponding averaged variables method developed herein adequately accounts for these issues and enables discovery of strong linear pair-wise correlation R values. TSAOV correlations lay the foundation for a new approach to building studies, that mitigates plug load interferences and identifies more accurate insights into weather-energy relationship for all building types. Over all six buildings analyzed the TSAOV method reported very significant average correlations per building of 0.94 to 0.82 in magnitude. Our rigorous statistics-based methods applied to 15-minute-interval electricity data further enables virtual energy audits of buildings to quickly and inexpensively inform energy savings measures.

A cross-sectional study of the temporal evolution of electricity consumption of six commercial buildings

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

Pickering, Ethan M.; Hossain, Mohammad A.; Mousseau, Jack P.

Current approaches to building efficiency diagnoses include conventional energy audit techniques that can be expensive and time consuming. In contrast, virtual energy audits of readily available 15-minute-interval building electricity consumption are being explored to provide quick, inexpensive, and useful insights into building operation characteristics. A cross sectional analysis of six buildings in two different climate zones provides methods for data cleaning, population-based building comparisons, and relationships (correlations) of weather and electricity consumption. Data cleaning methods have been developed to categorize and appropriately filter or correct anomalous data including outliers, missing data, and erroneous values (resulting in < 0.5% anomalies). Themore » utility of a cross-sectional analysis of a sample set of building's electricity consumption is found through comparisons of baseload, daily consumption variance, and energy use intensity. Correlations of weather and electricity consumption 15-minute interval datasets show important relationships for the heating and cooling seasons using computed correlations of a Time-Specific-Averaged- Ordered Variable (exterior temperature) and corresponding averaged variables (electricity consumption)(TSAOV method). The TSAOV method is unique as it introduces time of day as a third variable while also minimizing randomness in both correlated variables through averaging. This study found that many of the pair-wise linear correlation analyses lacked strong relationships, prompting the development of the new TSAOV method to uncover the causal relationship between electricity and weather. We conclude that a combination of varied HVAC system operations, building thermal mass, plug load use, and building set point temperatures are likely responsible for the poor correlations in the prior studies, while the correlation of time-specific-averaged-ordered temperature and corresponding averaged variables method developed herein adequately accounts for these issues and enables discovery of strong linear pair-wise correlation R values. TSAOV correlations lay the foundation for a new approach to building studies, that mitigates plug load interferences and identifies more accurate insights into weather-energy relationship for all building types. Over all six buildings analyzed the TSAOV method reported very significant average correlations per building of 0.94 to 0.82 in magnitude. Our rigorous statistics-based methods applied to 15- minute-interval electricity data further enables virtual energy audits of buildings to quickly and inexpensively inform energy savings measures.« less

A cross-sectional study of the temporal evolution of electricity consumption of six commercial buildings

DOE PAGES

Pickering, Ethan M.; Hossain, Mohammad A.; Mousseau, Jack P.; ...

2017-10-31

Current approaches to building efficiency diagnoses include conventional energy audit techniques that can be expensive and time consuming. In contrast, virtual energy audits of readily available 15-minute-interval building electricity consumption are being explored to provide quick, inexpensive, and useful insights into building operation characteristics. A cross sectional analysis of six buildings in two different climate zones provides methods for data cleaning, population-based building comparisons, and relationships (correlations) of weather and electricity consumption. Data cleaning methods have been developed to categorize and appropriately filter or correct anomalous data including outliers, missing data, and erroneous values (resulting in < 0.5% anomalies). Themore » utility of a cross-sectional analysis of a sample set of building's electricity consumption is found through comparisons of baseload, daily consumption variance, and energy use intensity. Correlations of weather and electricity consumption 15-minute interval datasets show important relationships for the heating and cooling seasons using computed correlations of a Time-Specific-Averaged- Ordered Variable (exterior temperature) and corresponding averaged variables (electricity consumption)(TSAOV method). The TSAOV method is unique as it introduces time of day as a third variable while also minimizing randomness in both correlated variables through averaging. This study found that many of the pair-wise linear correlation analyses lacked strong relationships, prompting the development of the new TSAOV method to uncover the causal relationship between electricity and weather. We conclude that a combination of varied HVAC system operations, building thermal mass, plug load use, and building set point temperatures are likely responsible for the poor correlations in the prior studies, while the correlation of time-specific-averaged-ordered temperature and corresponding averaged variables method developed herein adequately accounts for these issues and enables discovery of strong linear pair-wise correlation R values. TSAOV correlations lay the foundation for a new approach to building studies, that mitigates plug load interferences and identifies more accurate insights into weather-energy relationship for all building types. Over all six buildings analyzed the TSAOV method reported very significant average correlations per building of 0.94 to 0.82 in magnitude. Our rigorous statistics-based methods applied to 15- minute-interval electricity data further enables virtual energy audits of buildings to quickly and inexpensively inform energy savings measures.« less

A cross-sectional study of the temporal evolution of electricity consumption of six commercial buildings

PubMed Central

Hossain, Mohammad A.; Mousseau, Jack P.; Swanson, Rachel A.; French, Roger H.; Abramson, Alexis R.

2017-01-01

Current approaches to building efficiency diagnoses include conventional energy audit techniques that can be expensive and time consuming. In contrast, virtual energy audits of readily available 15-minute-interval building electricity consumption are being explored to provide quick, inexpensive, and useful insights into building operation characteristics. A cross sectional analysis of six buildings in two different climate zones provides methods for data cleaning, population-based building comparisons, and relationships (correlations) of weather and electricity consumption. Data cleaning methods have been developed to categorize and appropriately filter or correct anomalous data including outliers, missing data, and erroneous values (resulting in < 0.5% anomalies). The utility of a cross-sectional analysis of a sample set of building’s electricity consumption is found through comparisons of baseload, daily consumption variance, and energy use intensity. Correlations of weather and electricity consumption 15-minute interval datasets show important relationships for the heating and cooling seasons using computed correlations of a Time-Specific-Averaged-Ordered Variable (exterior temperature) and corresponding averaged variables (electricity consumption)(TSAOV method). The TSAOV method is unique as it introduces time of day as a third variable while also minimizing randomness in both correlated variables through averaging. This study found that many of the pair-wise linear correlation analyses lacked strong relationships, prompting the development of the new TSAOV method to uncover the causal relationship between electricity and weather. We conclude that a combination of varied HVAC system operations, building thermal mass, plug load use, and building set point temperatures are likely responsible for the poor correlations in the prior studies, while the correlation of time-specific-averaged-ordered temperature and corresponding averaged variables method developed herein adequately accounts for these issues and enables discovery of strong linear pair-wise correlation R values. TSAOV correlations lay the foundation for a new approach to building studies, that mitigates plug load interferences and identifies more accurate insights into weather-energy relationship for all building types. Over all six buildings analyzed the TSAOV method reported very significant average correlations per building of 0.94 to 0.82 in magnitude. Our rigorous statistics-based methods applied to 15-minute-interval electricity data further enables virtual energy audits of buildings to quickly and inexpensively inform energy savings measures. PMID:29088269

The Other End of the Spear: The Tooth-to-Tail Ratio (T3R) in Modern Military Operations

DTIC Science & Technology

2007-01-01

units. Such a vehicle gave infantry much more of the fi repower and survivability inherent in heavy (mechanized infantry and armored) units while...The Other End of the Spear: The Tooth- to-Tail Ratio (T3R) in Modern Military Operations John J. McGrath The Long War Series Occasional Paper 23...collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources

[Management of displaced radial neck fractures in children: elastic stable intramedullary nailing vs K-wire fixation].

PubMed

Wu, Quan-Zhou; Huang, Shu-Ming; Cai, Qi-Xun; Chu, Xu-Feng

2017-01-25

To compare the complications and clinical outcome of titanium elastic nail(TEN) versus K-wire fixation(KW) for the treatment of displaced radial neck fractures in children. From January 2009 to December 2014, 56 children with displaced radial neck fractures were studied retrospectively according to the inclusion criteria. Based on the different methods of internal fixation, patients were divided into two groups: titanium elastic nail (TEN group) and K-wire fixation (KW group). Among 25 patients(15 males and 11 females, aged from 3 to 12 years old with an average of 8.6±2.1) treated with TEN, 16 patients had type III fractures, 19 patients had type IV fractures according to Metaizeau-Judet modified classification; 20 patients were treated with closed reduction and 5 patients were treated with open reduction; the time from injury to treatment ranged from 1 to 8 days with an average of (3.6±1.7) days. Among 31 patients (20 males and 11 females, aged from 3 to 11 years old with an average of 9.1±1.9 years old) treated with KW, 19 patients had type III fractures, 12 patients had type IV fractures; 22 patients were treated with closed reduction, and 9 patients were treated with open reduction; the time from injury to treatment ranged from 2 to 7 days with an average of (3.7±1.5) days. No significant differences between two groups were found in general data. Operative time, hospitalization time, healing time of fracture, internal fixation time, postoperative complications and function recovery of the two groups were compared and evaluated. The average follow-up period of the patients was 22.1 months in TEN group(ranged, 16 to 48 months), and 21.9 months in KW group(ranged, 13 to 48 months). There were no significant differences between these 2 groups in follow-up duration, average hospitalization time and fracture healing time. The operation time, hospital costs and internal fixation time in TEN group were (56.6±11.8) min, (18 000±3 000) Yuan(RMB), (9.1±2.5) weeks respectively; and in KW group were(45.5±10.3) min, (8 000±1 000) Yuan(RMB), (4.8±1.6) weeks respectively, there were significant differences between two groups( P <0.05). Outcome scores according to Metaizeau and Tibone-Stoltz had no significant differences between two groups( P >0.05). There is no significant difference of therapeutic effects between TEN and KW for children with displaced radial neck fractures. Because the removal of TEN fixation requires the secondary anesthesia, and the TEN costs significantly more than KW, TEN still can't replace the traditional KW for the treatment of radial neck fracture in children.

MIS Single-position Lateral and Oblique Lateral Lumbar Interbody Fusion and Bilateral Pedicle Screw Fixation: Feasibility and Perioperative Results.

PubMed

Blizzard, Daniel J; Thomas, J Alex

2018-03-15

Retrospective review of prospectively collected data of the first 72 consecutive patients treated with single-position one- or two-level lateral (LLIF) or oblique lateral interbody fusion (OLLIF) with bilateral percutaneous pedicle screw and rod fixation by a single spine surgeon. To evaluate the clinical feasibility, accuracy, and efficiency of a single-position technique for LLIF and OLLIF with bilateral pedicle screw and rod fixation. Minimally-invasive lateral interbody approaches are performed in the lateral decubitus position. Subsequent repositioning prone for bilateral pedicle screw and rod fixation requires significant time and resources and does not facilitate increased lumbar lordosis. The first 72 consecutive patients (300 screws) treated with single-position LLIF or OLLIF and bilateral pedicle screws by a single surgeon between December 2013 and August 2016 were included in the study. Screw accuracy and fusion were graded using computed tomography and several timing parameters were recorded including retractor, fluoroscopy, and screw placement time. Complications including reoperation, infection, and postoperative radicular pain and weakness were recorded. Average screw placement time was 5.9 min/screw (standard deviation, SD: 1.5 min; range: 3-9.5 min). Average total operative time (interbody cage and pedicle screw placement) was 87.9 minutes (SD: 25.1 min; range: 49-195 min). Average fluoroscopy time was 15.0 s/screw (SD: 4.7 s; range: 6-25 s). The pedicle screw breach rate was 5.1% with 10/13 breaches measured as < 2 mm in magnitude. Fusion rate at 6-months postoperative was 87.5%. Two (2.8%) patients underwent reoperation for malpositioned pedicle screws with subsequent resolution of symptoms. The single-position, all-lateral technique was found to be feasible with accuracy, fluoroscopy usage, and complication rates comparable with the published literature. This technique eliminates the time and staffing associated with intraoperative repositioning and may lead to significant improvements in operative efficiency and cost savings. 4.

High accuracy OMEGA timekeeping

NASA Technical Reports Server (NTRS)

Imbier, E. A.

1982-01-01

The Smithsonian Astrophysical Observatory (SAO) operates a worldwide satellite tracking network which uses a combination of OMEGA as a frequency reference, dual timing channels, and portable clock comparisons to maintain accurate epoch time. Propagational charts from the U.S. Coast Guard OMEGA monitor program minimize diurnal and seasonal effects. Daily phase value publications of the U.S. Naval Observatory provide corrections to the field collected timing data to produce an averaged time line comprised of straight line segments called a time history file (station clock minus UTC). Depending upon clock location, reduced time data accuracies of between two and eight microseconds are typical.

[Epidemiology, treatment and results of proximal humeral fractures: experience of a district hospital in a sports- and tourism area].

PubMed

Sonderegger, J; Simmen, H-P

2003-02-01

The epidemiology, therapy and results of proximal humeral fractures in a touristic area were investigated and our concept for treatment presented. Between 1.1.1999 and 30.04.2000 adult patients with proximal humeral fractures were included, the fractures classified (Codman/Neer and AO) and results determined after an average of 9 months. 62 adults were treated. 59 (95 %) had an accident during leisure time, mainly skiing accidents (52 %). 7 patients (11 %) had an associated luxation of the shoulder. 51 (82 %) were treated conservatively, 11 (18 %) operatively with a T-plate. The conservatively treated had to wear a Gilchrist-cast for an average of 29 (operatively 13) days, started passive movement after 20 (operatively 9) days, and active movement after 44 (operatively 45) days. The 32 employed (52 %) were not able to work for 46 days on average. Overall, 52 patients (84 %) were totally or mostly satisfied with the result. 5 among the 13 patients (38.5 %) with 3- or 4-part-fractures, and 4 among the 11 operated patients (36.4 %) were not satisfied with the result. Proximal humeral fractures are common skiing injuries, they need a long and intensive treatment and are economically expensive. The Codman/Neer and AO-classifications are equal. The results for simple, mainly conservatively treated fractures (Codman/Neer 1, 2A, 2-part) are good. Complex, mainly operatively treated fractures (Codman/Neer 3- and 4-part) have a much poorer prognosis. Diagnostically the computed tomography with 3-D-reconstruction is recommended for a better representation of the fracture and a safer choice of the therapeutical strategy.

Statistics of AUV's Missions for Operational Ocean Observation at the South Brazilian Bight.

NASA Astrophysics Data System (ADS)

dos Santos, F. A.; São Tiago, P. M.; Oliveira, A. L. S. C.; Barmak, R. B.; Miranda, T. C.; Guerra, L. A. A.

2016-02-01

The high costs and logistics limitations of ship-based data collection represent an obstacle for a persistent in-situ data collection. Satellite-operated Autonomous Underwater Vehicles (AUV's) or gliders (as these AUV's are generally known by the scientific community) are presented as an inexpensive and reliable alternative to perform long-term and real-time ocean monitoring of important parameters such as temperature, salinity, water-quality and acoustics. This work is focused on the performance statistics and the reliability for continuous operation of a fleet of seven gliders navigating in Santos Basin - Brazil, since March 2013. The gliders performance were evaluated by the number of standby days versus the number of operating days, the number of interrupted missions due to (1) equipment failure, (2) weather, (3) accident versus the number of successful missions and the amount and quality of data collected. From the start of the operations in March 2013 to the preparation of this work (July 2015), a total of 16 glider missions were accomplished, operating during 728 of the 729 days passed since then. From this total, 11 missions were successful, 3 missions were interrupted due to equipment failure and 2 gliders were lost. Most of the identified issues were observed in the communication with the glider (when recovery was necessary) or the optode sensors (when remote settings solved the problem). The average duration of a successful mission was 103 days while interrupted ones ended on average in 7 days. The longest mission lasted for 139 days, performing 859 continuous profiles and covering a distance of 2734 Km. The 2 projects performed together 6856 dives, providing an average of 9,5 profiles per day or one profile every 2,5 hours each day during 2 consecutive years.

[Double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament at stage I for the treatment of acromioclavicular dislocation with Rockwood type III - V].

PubMed

Hu, Wen-yue; Yu, Chong; Huang, Zhong-ming; Han, Lei

2015-06-01

To explore clinical efficacy of double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I in treating acromioclavicular dislocation with Rockwood type III - V . From January 2010 to September 2013, 56 patients with Rockwood type III - V acromioclavicular dislocation were treated by operation, including 20 males and 36 femlaes, aged from 32 to 52 years old with an average of 38.5 years old. Twenty-five patients were on the left side and 31 cases on the right side. The time from injury to operation was from 3 to 14 days, averaged 7 days. All patients were diagnosed as acromioclavicular dislocation with Rockwood type III - V, and double Endobutto were used to reconstituting coracoclavicular ligament, line metal anchors were applied for repairing acromioclavicular ligament. Postoperative complications were observed, Karlsson and Constant-Murley evaluation standard were used to evaluate clinical effects. All patients were followed up from 8 to 24 months with average of 11 months. According to Karlsson evaluation standard at 6 months after operation,42 cases were grade A, 13 were grade B and 1 was grade C. Constant-Murley score were improved from (42.80±5.43) before operation to (91.75±4.27) at 6 months after operation. All items at 6 months after operation were better than that of preoperative items. Forty-eight patients got excellent results, 7 were moderate and only 1 with bad result. No shoulder joint adhesion, screw loosening or breakage were occurred during following up. Double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I for the treatment of acromioclavicular dislocation with Rockwood type III - V could obtain early staisfied clinical effects, and benefit for early recovery of shoulder joint function.

Automatic detection of end-diastolic and end-systolic frames in 2D echocardiography.

PubMed

Zolgharni, Massoud; Negoita, Madalina; Dhutia, Niti M; Mielewczik, Michael; Manoharan, Karikaran; Sohaib, S M Afzal; Finegold, Judith A; Sacchi, Stefania; Cole, Graham D; Francis, Darrel P

2017-07-01

Correctly selecting the end-diastolic and end-systolic frames on a 2D echocardiogram is important and challenging, for both human experts and automated algorithms. Manual selection is time-consuming and subject to uncertainty, and may affect the results obtained, especially for advanced measurements such as myocardial strain. We developed and evaluated algorithms which can automatically extract global and regional cardiac velocity, and identify end-diastolic and end-systolic frames. We acquired apical four-chamber 2D echocardiographic video recordings, each at least 10 heartbeats long, acquired twice at frame rates of 52 and 79 frames/s from 19 patients, yielding 38 recordings. Five experienced echocardiographers independently marked end-systolic and end-diastolic frames for the first 10 heartbeats of each recording. The automated algorithm also did this. Using the average of time points identified by five human operators as the reference gold standard, the individual operators had a root mean square difference from that gold standard of 46.5 ms. The algorithm had a root mean square difference from the human gold standard of 40.5 ms (P<.0001). Put another way, the algorithm-identified time point was an outlier in 122/564 heartbeats (21.6%), whereas the average human operator was an outlier in 254/564 heartbeats (45%). An automated algorithm can identify the end-systolic and end-diastolic frames with performance indistinguishable from that of human experts. This saves staff time, which could therefore be invested in assessing more beats, and reduces uncertainty about the reliability of the choice of frame. © 2017, Wiley Periodicals, Inc.

Lost opportunity cost of surgical training in the Australian private sector.

PubMed

Aitken, R James

2012-03-01

To meet Australia's future demands, surgical training in the private sector will be required. The aim of this study was to estimate the time and lost opportunity cost of training in the private sector. A literature search identified studies that compared the operation time required by a supervised trainee with a consultant. This time was costed using a business model. In 22 studies (34 operations), the median operation duration of a supervised trainee was 34% longer than the consultant. To complete a private training list in the same time as a consultant list, one major case would have to be dropped. A consultant's average lost opportunity cost was $1186 per list ($106,698 per year). Training in rooms and administration requirements increased this to $155,618 per year. To train 400 trainees in the private sector to college standards would require 54,000 training lists per year. The consultants' national lost opportunity cost would be $137 million per year. The average lost hospital case payment was $5894 per list, or $330 million per year nationally. The total lost opportunity cost of surgical training in the private sector would be about $467 million per year. When trainee salaries, other specialties and indirect expenses are included, the total cost will be substantially greater. It is unlikely that surgeons or hospitals will be prepared to absorb these costs. There needs to be a public debate about the funding implications of surgical training in the private sector. © 2012 The Author. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

A real-time freehand ultrasound calibration system with automatic accuracy feedback and control.

PubMed

Chen, Thomas Kuiran; Thurston, Adrian D; Ellis, Randy E; Abolmaesumi, Purang

2009-01-01

This article describes a fully automatic, real-time, freehand ultrasound calibration system. The system was designed to be simple and sterilizable, intended for operating-room usage. The calibration system employed an automatic-error-retrieval and accuracy-control mechanism based on a set of ground-truth data. Extensive validations were conducted on a data set of 10,000 images in 50 independent calibration trials to thoroughly investigate the accuracy, robustness, and performance of the calibration system. On average, the calibration accuracy (measured in three-dimensional reconstruction error against a known ground truth) of all 50 trials was 0.66 mm. In addition, the calibration errors converged to submillimeter in 98% of all trials within 12.5 s on average. Overall, the calibration system was able to consistently, efficiently and robustly achieve high calibration accuracy with real-time performance.

[Therapy of adult-onset laryngeal papilloma: integrallty submucosal dissection of the tumor by CO2 laser].

PubMed

Lei, W B; Liu, Q H; Chai, L P; Zhu, X L; Wang, Z F; Li, Q M; Tang, H C; Jiang, A Y; Wen, Y H; Wen, W P

2016-10-07

Objective: To evaluate the feasibility and efficacy of the integrallty submucosal resection of adult-onset laryngeal papilloma by CO 2 laser. Methods: A group of 64 cases (36 males and 28 females, multipe lesions 54 cases and single lesion 10 cases, aged 18-75 years, mean age 43.13 years) with adult-onset laryngeal papilloma encountered in the first affliated hospital of Sun Yatsen university from 2009 to 2015 was retrospectively analyzed. All cases were treated with integrallty submucosal dissection of the tumor by CO 2 laser, and observed the changes of tumor integral scope, inter-operative, operative processes, postoperative voice quality, postoperative scarring, and the tracheotomy conditions, which were analysed and evaluated. Results: A total of 64 patients were followed up from 1 year to 5 years. Preoperative tumor integral scope of these patients averaged of 7.00. A total of 62 cases kept 0 score of the tumor integral scope for at least one year, which lead to a clinical cure rate of 96.9%. The inter-operative averaged of 25.7 months. The total operative processes of these patients were 87 times (mean time 1.36). Four cases resulted in postoperative scarring. However these was a good result in postoperative voice quality with a mean score 4.25. As to the changes of tumor integral scope, all cases got a declining score (mean score 6.72), which resulted in a remission rate of 100%. Conclusion: The integrallty submucosal dissection of adult-onset 1aryngeal papilloma by CO 2 laser was an effective way to reduce the tumor integral scope; lengthen their inter-operative; decrease the operative processes, avoid the occurrence of tracheotomy; and improve the postoperative voice quality. Most of the patients could even be cured ultimately.

Comparative Analysis of Combined (First Anterior, Then Posterior) Versus Only Posterior Approach for Treating Severe Scoliosis

PubMed Central

Hero, Nikša; Vengust, Rok; Topolovec, Matevž

2017-01-01

Study Design. A retrospective, one center, institutional review board approved study. Objective. Two methods of operative treatments were compared in order to evaluate whether a two-stage approach is justified for correction of bigger idiopathic scoliosis curves. Two stage surgery, combined anterior approach in first operation and posterior instrumentation and correction in the second operation. One stage surgery included only posterior instrumentation and correction. Summary of Background Data. Studies comparing two-stage approach and only posterior approach are rather scarce, with shorter follow up and lack of clinical data. Methods. Three hundred forty eight patients with idiopathic scoliosis were operated using Cotrel–Dubousset (CD) hybrid instrumentation with pedicle screw and hooks. Only patients with curvatures more than or equal to 61° were analyzed and divided in two groups: two stage surgery (N = 30) and one stage surgery (N = 46). The radiographic parameters as well as duration of operation, hospitalization time, and number of segments included in fusion and clinical outcome were analyzed. Results. No statistically significant difference was observed in correction between two-stage group (average correction 69%) and only posterior approach group (average correction 66%). However, there were statistically significant differences regarding hospitalization time, duration of the surgery, and the number of instrumented segments. Conclusion. Two-stage surgery has only a limited advantage in terms of postoperative correction angle compared with the posterior approach. Posterior instrumentation and correction is satisfactory, especially taking into account that the patient is subjected to only one surgery. Level of Evidence: 3 PMID:28125525

Total hospital costs of surgical treatment for adult spinal deformity: an extended follow-up study.

PubMed

McCarthy, Ian M; Hostin, Richard A; Ames, Christopher P; Kim, Han J; Smith, Justin S; Boachie-Adjei, Ohenaba; Schwab, Frank J; Klineberg, Eric O; Shaffrey, Christopher I; Gupta, Munish C; Polly, David W

2014-10-01

Whereas the costs of primary surgery, revisions, and selected complications for adult spinal deformity (ASD) have been individually reported in the literature, the total costs over several years after surgery have not been assessed. The determinants of such costs are also not well understood in the literature. This study analyzes the total hospital costs and operating room (OR) costs of ASD surgery through extended follow-up. Single-center retrospective analysis of consecutive surgical patients. Four hundred eighty-four consecutive patients undergoing surgical treatment for ASD from January 2005 through January 2011 with minimum three levels fused. Costs were collected from hospital administrative data on the total hospital costs incurred for the operation and any related readmissions, expressed in 2010 dollars and discounted at 3.5% per year. Detailed data on OR costs, including implants and biologics, were also collected. We performed a series of paired t tests and Wilcoxon signed-rank tests for differences in total hospital costs over different follow-up periods. The goal of these tests was to identify a time period over which average costs plateau and remain relatively constant over time. Generalized linear model regression was used to estimate the effect of patient and surgical factors on hospital inpatient costs, with different models estimated for different follow-up periods. A similar regression analysis was performed separately for OR costs and all other hospital costs. Patients were predominantly women (n=415 or 86%) with an average age of 48 (18-82) years and an average follow-up of 4.8 (2-8) years. Total hospital costs averaged $120,394, with primary surgery averaging $103,143 and total readmission costs averaging $67,262 per patient with a readmission (n=130 or 27% of all patients). Operating room costs averaged $70,514 per patient, constituting the majority (59%) of total hospital costs. Average total hospital costs across all patients significantly increased (p<.01) after primary surgery, from $111,807 at 1-year follow-up to $126,323 at 4-year follow-up. Regression results also revealed physician preference as the largest determinant of OR costs, accounting for $14,780 of otherwise unexplained OR cost differences across patients, with no significant physician effects on all other non-OR costs (p<.05). The incidence of readmissions increased the average cost of ASD surgery by more than 70%, illustrating the financial burden of revisions/reoperations; however, the cost burden resulting from readmissions appeared to taper off within 5 years after surgery. The estimated impact of physician preference on OR costs also highlights the variation in current practice and the opportunity for large cost reductions via a more standardized approach in the use of implants and biologics. Copyright © 2014 Elsevier Inc. All rights reserved.

Comparison of outcomes for single-incision laparoscopic inguinal herniorrhaphy and traditional three-port laparoscopic herniorrhaphy at a single institution.

PubMed

Buckley, F Paul; Vassaur, Hannah; Monsivais, Sharon; Sharp, Nicole E; Jupiter, Daniel; Watson, Rob; Eckford, John

2014-01-01

Evidence in the literature regarding the potential of single-incision laparoscopic (SILS) inguinal herniorrhaphy currently is limited. A retrospective comparison of SILS and traditional multiport laparoscopic (MP) inguinal hernia repair was conducted to assess the safety and feasibility of the minimally invasive laparoscopic technique. All laparoscopic inguinal hernia repairs performed by three surgeons at a single institution during 4 years were reviewed. Statistical evaluation included descriptive analysis of demographics including age, gender, body mass index (BMI), and hernia location (uni- or bilateral), in addition to bivariate and multivariate analyses of surgical technique and outcomes including operative times, conversions, and complications. The study compared 129 patients who underwent SILS inguinal hernia repair and 76 patients who underwent MP inguinal hernia repair. The cases included 190 men (92.68 %) with a mean age of 55.36 ± 18.01 years (range, 8-86 years) and a mean BMI of 26.49 ± 4.33 kg/m(2) (range, 17.3-41.7 kg/m(2)). These variables did not differ significantly between the SILS and MP cohorts. The average operative times for the SILS and MP unilateral cases were respectively 57.51 and 66.96 min. For the bilateral cases, the average operative times were 81.07 min for SILS and 81.38 min for MP. A multivariate analysis using surgical approach, BMI, case complexity, and laterality as the covariates demonstrated noninferiority of the SILS technique in terms of operative time (p = 0.031). No conversions from SILS to MP occurred, and the rates of conversion to open procedure did not differ significantly between the cohorts (p = 1.00, Fisher's exact test), nor did the complication rates (p = 0.65, χ (2)). As shown by the findings, SILS inguinal herniorrhaphy is a safe and feasible alternative to traditional MP inguinal hernia repair and can be performed successfully with similar operative times, conversion rates, and complication rates. Prospective trials are essential to confirm equivalence in these areas and to detect differences in patient-centered outcomes.

Stress fracture as a complication of autogenous bone graft harvest from the distal tibia.

PubMed

Chou, Loretta B; Mann, Roger A; Coughlin, Michael J; McPeake, William T; Mizel, Mark S

2007-02-01

Autogenous bone graft from the distal tibia provides cancellous bone graft for foot and ankle operations, and it has osteogenic and osteoconductive properties. The site is in close proximity to the foot and ankle, and published retrospective studies show low morbidity from the procedure. One-hundred autografts were obtained from the distal tibia between 2000 and 2003. In four cases the distal tibial bone graft harvest resulted in a stress fracture. There were three women and one man. The average time of diagnosis of the stress fracture from the operation was 1.8 months. All stress fractures healed with a short course (average 2.4 months) of cast immobilization. This study demonstrated that a stress fracture from the donor site of autogenous bone graft of the distal tibia occurs and can be successfully treated nonoperatively.

926 nm laser operation in Nd:GdNbO4 crystal based on 4F3/2 → 4I9/2 transition

NASA Astrophysics Data System (ADS)

Yan, Renpeng; Li, Xudong; Yao, Wenming; Shen, Yingjie; Zhou, Zhongxiang; Peng, Fang; Zhang, Qingli; Dou, Renqing; Gao, Jing

2018-05-01

926 nm laser operation in a Nd:GdNbO4 crystal based on quasi-three-level 4F3/2 → 4I9/2 transition is reported, for the first time to our best knowledge. An average output power of 393 mW at 926 nm under 879 nm LD pumping is obtained with a slope efficiency of 33.3% and an optical-to-optical efficiency of 26.0%. The slope efficiency with respect to absorbed pump power is estimated to be 47.7%. Comparison between output characters of 926 nm laser under direct and indirect pumping is conducted. The average output power at 926 nm under 808 nm LD pumping reaches 305 mW with an optical-to-optical efficiency of 16.1%.

How Does the Supply Requisitioning Process Affect Average Customer Wait Time Onboard U.S. Navy Destroyers?

DTIC Science & Technology

2013-05-07

warfare qualifications SWSCO and NASO. Next, LCDR Saucedo reported to the Fleet Industrial Supply Center, San Diego, where she assumed the duties as the...16  D.  NAVAL TACTICAL COMMAND SUPPORT SYSTEM .................. 17  1.  Operational Maintenance ...21  4.  Method

40 CFR 63.117 - Process vent provisions-reporting and recordkeeping requirements for group and TRE determinations...

Code of Federal Regulations, 2011 CFR

2011-07-01

... Vents, Storage Vessels, Transfer Operations, and Wastewater § 63.117 Process vent provisions—reporting... incinerators, boilers or process heaters specified in table 3 of this subpart, and averaged over the same time... content determinations, flow rate measurements, and exit velocity determinations made during the...

40 CFR 63.117 - Process vent provisions-reporting and recordkeeping requirements for group and TRE determinations...

Code of Federal Regulations, 2013 CFR

2013-07-01

... Vents, Storage Vessels, Transfer Operations, and Wastewater § 63.117 Process vent provisions—reporting... incinerators, boilers or process heaters specified in table 3 of this subpart, and averaged over the same time... content determinations, flow rate measurements, and exit velocity determinations made during the...

Forecasting Techniques and Library Circulation Operations: Implications for Management.

ERIC Educational Resources Information Center

Ahiakwo, Okechukwu N.

1988-01-01

Causal regression and time series models were developed using six years of data for home borrowing, average readership, and books consulted at a university library. The models were tested for efficacy in producing short-term planning and control data. Combined models were tested in establishing evaluation measures. (10 references) (Author/MES)

43 CFR 418.18 - Diversions at Derby Dam.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Operations and Management § 418.18 Diversions at Derby Dam. (a) Diversions of Truckee River water at Derby Dam must be managed to maintain minimum terminal flow to Lahontan Reservoir or the Carson River except... achieve an average terminal flow of 20 cfs or less during times when diversions to Lahontan Reservoir are...

Ultrastable automatic frequency control

NASA Technical Reports Server (NTRS)

Sabourin, D. J.; Furiga, A.

1981-01-01

Center frequency of wideband AFC circuit drifts only hundredths of percent per day. Since circuit responds only to slow frequency drifts and modulation signal has high-pass characteristics, AFC does not interfere with normal FM operation. Stable oscillator, reset circuit, and pulse generator constitute time-averaging discriminator; digital counter in pulse generator replaces usual monostable multivibrator.

Outcome of Boyd-McLeod procedure for recalcitrant lateral epicondylitis of elbow.

PubMed

Reddy, V R M; Satheesan, K S; Bayliss, N

2011-08-01

Various surgical procedures including percutaneous and open release and arthroscopic procedures have been described to treat recalcitrant tennis elbow. We present the outcome of Boyd-McLeod surgical procedure for tennis elbow resistant to non-operative treatment in twenty-seven patients (twenty-nine limbs). Boyd McLeod procedure involves excision of the proximal portion of the annular ligament, release of the origin of the extensor muscles, excision of the bursa if present, and excision of the synovial fringe. The average time interval from the onset of symptoms of tennis elbow until surgery was 28 months (range 8-72 months). Of those patients, 91% reported complete relief of symptoms with return to full normal activities including sports. Average post-operative time for return to professional/recreational activity was 5 weeks. One case developed pain secondary to ectopic bone formation after surgery, which settled after excision, and in another there was no pain relief with Boyd McLeod procedure. Two patients had scar tenderness that did not affect the final outcome. We conclude that Boyd-McLeod procedure is an effective treatment option in patients with resistant lateral epicondylitis.

Impact of pharmacist intervention on antibiotic use and prophylactic antibiotic use in urology clean operations.

PubMed

Zhou, Y; Ma, L-Y; Zhao, X; Tian, S-H; Sun, L-Y; Cui, Y-M

2015-08-01

The use of prophylactic antibiotics in clean operations was routine in China before 2011. Along with the appeal for using antibiotics rationally by WHO in 2011, China launched a national special rectification scheme on clinical use of antibiotics from April that year. The scheme, aimed at achieving rational use of antibiotics, made pharmacists part of the responsible medical team. Our objective was to describe the impacts of pharmacist intervention on the use of antibiotics, particularly in urology clean operations. Pharmacists participated in antibiotic stewardship programmes of the hospital and urological clinical work and conducted real-time interventions at the same time from 2011 to 2013. Data on the use of antibiotics between 2010 and 2013 in urology were collected. Comparison of the 2013 data with those of 2010 showed that antibiotic use density [AUD= DDDs*100/(The number of patients who were treated the same period*Average days in hospital). DDDs = Total drug consumption (g)/DDD. DDD is the Defined Daily Dose] decreased by 57·8(58·8%); average antibiotic cost decreased by 246·94 dollars; the cost of antibiotics as a percentage of total drug cost decreased by 27·7%; the rate of use of antibiotics decreased from 100% to 7·3%. The study illustrates how an antibiotic stewardship programme with pharmacist participation including real-time interventions can promote improved antibiotic-prescribing and significantly decrease costs. © 2015 John Wiley & Sons Ltd.

[Case-control study on endobutton plate or clavicular hook plate for the repair of acromioclavicular joint dislocations].

PubMed

Zhu, Li; Yang, He-Jie; Zhao, Wan-Jun; Yang, Wu-Min; Zhou, Hui

2012-02-01

To compare the treatment results between Endobutton plate and clavicular hook plate for the treatment of acromioclavicular joint dislocations. From January 2009 to September 2010, 30 patients with acromioclavicular joint dislocations were treated with two different fixations: Endobutton plate (15 patients, including 12 males and 3 females, with a mean age of 38.5 +/- 8.2 years) and clavicular hook plate (15 patients, including 14 males and 1 female, with the mean age of 33.8 +/- 5.9 years). The mean operative time and blood loss were compared between the two groups. Joint function was assessed by the Karlsson standard. The mean operative time of the Endobutton group and the hook plate group were (61 +/- 8.6) min and (40 +/- 5.6) min. The average blood loss were (93 +/- 8.4) ml and (100 +/- 12.6) ml. There was no statistical difference between the two groups in the average blood loss and the mean operative time. According to the Karlsson standard, 13 patients got an excellent result, 2 good in the Endobutton group; and 7 patients got an excellent result and 7 good in hook plate group. The therapeutic effect in Endobutton group was better than that of hook plate group. In the treatment of acromioclavicular dislocation, fixation with Endobutton plate is believed to be better than hook plate fixation. It is an effective method for the repair of acromioclavicular joint dislocations in a short term. But its long term effects still need further follow up.

Time off work in hand injury patients.

PubMed

Wong, Joyce Y P

2008-01-01

To evaluate the average time off work for patients with hand injuries as well as factors influencing the length of time off work for subjects who had returned to work. A total of 124 subjects were recruited and followed up 2 weeks after being discharged from therapy or until they resumed work. Factors affecting the time off work such as the severity of injury, number of operations, educational level, physical job demand, and presence of compensation claims, complications, and posttraumatic stress were also examined by multiple regression. The relationship between the severity of injury, time off work, and length of rehabilitation time was also examined. In 124 subjects, 109 resumed their previous jobs, with an average of 8 weeks off work and 9 weeks in regular rehabilitation. The result shows that the severity of injury, number of operations, and presence of compensation claims were the predictors for the length of time off work in hand injury patients. In addition, the time off work and length of rehabilitation time increased with more severe injury. However, a cross-over was noted in the severe grade of severity of injury; that is, the time off work was shorter than the length of rehabilitation time for those with a less severe level of injury (minor to moderate level) and vice versa for those with major severity of injury. To a certain extent, the result enhances our understanding of prolonged time off work after hand injury and may help to optimize rehabilitation after injury. For those who are in the high-risk group with factors that are not under control, early planning and retraining should be given to avoid prolonged time off work.

Energy transduction and signal averaging of fluctuating electric fields by a single protein ion channel.

PubMed

Verdia-Baguena, C; Gomez, V; Cervera, J; Ramirez, P; Mafe, S

2016-12-21

We demonstrate the electrical rectification and signal averaging of fluctuating signals using a biological nanostructure in aqueous solution: a single protein ion channel inserted in the lipid bilayer characteristic of cell membranes. The conversion of oscillating, zero time-average potentials into directional currents permits charging of a load capacitor to significant steady-state voltages within a few minutes in the case of the outer membrane porin F (OmpF) protein, a bacterial channel of Escherichia coli. The experiments and simulations show signal averaging effects at a more fundamental level than the traditional cell and tissue scales, which are characterized by ensembles of many ion channels operating simultaneously. The results also suggest signal transduction schemes with bio-electronic interfaces and ionic circuits where soft matter nanodiodes can be coupled to conventional electronic elements.

[Comparison of LCP and locked intramedullary nailing fixation in treatment of tibial diaphysis fractures].

PubMed

Huang, Peng; Tang, Peifu; Yao, Qi

2007-11-01

To evaluate the treatment results of LCP and locked intramedullary nailing for tibial diaphysis fractures. From October 2003 to April 2006, 55 patients with tibial diaphysis fractures (58 fractures) were treated. Of them there were 39 males and 16 females with an average of 39 years years ( 14 to 62 years). The fractures were on the left side in 27 patients and on the right side in 31 patients (3 patients had bilateral involvement). Thirty-four fractures were treated by intramedullary nailing (intramedullary nailing group) and 24 fractures by LCP fixation (LCP group). The average disease course was 3 days (intramedullary nailing group) and 3.1 days (LCP group). The operation time, the range of motion of knee and ankle joints, fracture healing time, and complications were evaluated. The patients were followed up 8-26 months (13 months on average). The operation time was 84.0+/-9.2 min (intramedullary nailing group) and 69.0+/-8.4 min (LCP group); the average cost in hospital was yen 19,297.78 in the intramedullary nailing group and yen 14,116.55 in the LCP group respectively, showing significant differences (P < 0.05). The flexion and extension of knee joint was 139.0 +/- 3.7 degrees and 4.0 +/- 0.7 degrees in intramedullary nailing group and 149.0+/-4.2 degrees and 0+/-0.4 degrees in LCP group, showing no significant difference (P>0.05). The doral flexion and plantar flexion of ankle joint were 13.0+/-1.7 degrees and 41.0+/-2.6 degrees in intramedullary nailing group, and 10.0+/-1.4 degrees and 44.0+/-2.3 degrees in LCP group, showing no significant differences (P>0.05). The mean healing time was 3.3 months in intramedullary nailing group, and 3. 1 months in LCP group. Length discrepancy occurred in 1 case (2.5 cm), delayed union in 1 case and nailing end trouble in 3 cases in intramedullary nailing group; moreover rotation deformity occurred 1 case and anterior knee pain occurred in 6 cases (17.1%). One angulation and open fracture developed osteomyelitis in 1 case 1 week postoperatively and angulation deformity occurred in 1 case of distal-third tibial fractures in LCP group. LCP and locked intramedullary nailing can achieve satisfactory results in treating tibial diaphysis fracture LCP has advantages in less complication, operation time and cost in hospital.

[IMPACT OF PERIOPERATIVE AVERAGE BLOOD-GLUCOSE LEVEL ON PROGNOSIS OF PATIENTS WITH HIP FRACTURE AND DIABETES MELLITUS].

PubMed

Wang, Guoqi; Long, Anhua; Zhang, Lihai; Zhang, Hao; Yin, Peng; Tang, Peifu

2014-07-01

To explore the impact of perioperative average blood-glucose level on the prognosis of patients with hip fracture and diabetes mellitus. A retrospective analysis was made on the clinical data of 244 patients with hip fracture and diabetes mellitus who accorded with the inclusion criteria between September 2009 and September 2012. Of 244 patients, 125 patients with poorly controlled fasting blood-glucose (average fasting blood-glucose level > 7.8 mmol/L) were assigned in group A, and 119 patients with well controlled fasting blood-glucose (average fasting blood-glucose level ≤ 7.8 mmol/L) were assigned in group B according to "China guideline for type 2 diabetes" criteria. There was no significant difference in gender, age, disease duration of diabetes mellitus, serum albumin, fracture type and disease duration, surgical procedure, anaesthesia, and complications between 2 groups (P > 0.05). Group A had a higher hemoglobin level and fewer patients who can do some outdoor activities than group B (t = -2.353, P = 0.020; χ2 = 4.333, P = 0.037). The hospitalization time, days to await surgery, stitch removal time, the postoperative complication rate, the mortality at 1 month and 1 year after operation, and ambulatory ability at 1 year after operation were compared between the 2 groups. A total of 223 patients (114 in group A and 109 in group B) were followed up 12-15 months (mean, 13.5 months). The days to await surgery of group A were significantly more than those of group B (t = -2.743, P=0.007), but no significant difference was found in hospitalization time and stitch removal time between 2 groups (P > 0.05). The postoperative complication rate of group A (19.2%, 24/125) was significantly higher than that of group B (8.4%, 10/119) (χ2 =5.926, P = 0.015). Group A had a higher mortality at 1 month after operation than group B (6.1% vs. 0) (χ2 = 5.038, P = 0.025), but no significant difference was shown at 1 year after operation between groups A and B (8.8% vs. 4.6%) (χ2 = 1.555, P = 0.212). At 1 year after operation in patients who can do some outdoor activities, the proportions of patients who turned to do some indoor activities was 19.2% (15/78) in the group A and 13.5% (12/89) in group B, showing no significant difference (χ2 = l.013, P = 0.314). Poorly controlled perioperative fasting blood-glucose may lead undesirable influence on the prognosis of patients with hip fracture and diabetes mellitus. In order to reduce the complication rate and other accidents, the fasting blood-glucose level should be controlled to 7.8 mmol/L or less.

From standard alpha-stable Lévy motions to horizontal visibility networks: dependence of multifractal and Laplacian spectrum

NASA Astrophysics Data System (ADS)

Zou, Hai-Long; Yu, Zu-Guo; Anh, Vo; Ma, Yuan-Lin

2018-05-01

In recent years, researchers have proposed several methods to transform time series (such as those of fractional Brownian motion) into complex networks. In this paper, we construct horizontal visibility networks (HVNs) based on the -stable Lévy motion. We aim to study the relations of multifractal and Laplacian spectrum of transformed networks on the parameters and of the -stable Lévy motion. First, we employ the sandbox algorithm to compute the mass exponents and multifractal spectrum to investigate the multifractality of these HVNs. Then we perform least squares fits to find possible relations of the average fractal dimension , the average information dimension and the average correlation dimension against using several methods of model selection. We also investigate possible dependence relations of eigenvalues and energy on , calculated from the Laplacian and normalized Laplacian operators of the constructed HVNs. All of these constructions and estimates will help us to evaluate the validity and usefulness of the mappings between time series and networks, especially between time series of -stable Lévy motions and HVNs.

Mechanical evaluation of articulating instruments and cross-handed manipulation in laparoendoscopic single-site surgery.

PubMed

Xu, An An; Zhu, Jiang Fan; Xie, Xiaofeng; Su, Yuantao

2014-08-01

Laparoendoscopic single-site surgery (LESS) is limited by loss of triangulation and internal instruments conflict. To overcome these difficulties, some concepts have been introduced, namely, articulating instruments and cross-handed manipulation, which causes the right hand to control the left instrument tip and vice versa. The aim of this study was to compare task performance with different approaches based on a mechanical evaluation platform. A LESS mechanical evaluation platform was set up to investigate the performance of 2 tasks (suture pass-through rings and clip-cut) with 3 different settings: uncrossed manipulation with straight instruments (group A, the control group), uncrossed manipulation with articulating instruments (group B), and cross-handed manipulation with articulating instruments (group C). The operation time and average load required for accomplishment of the standard tasks were measured. Group A presented significantly better time scores than group B, and group C consumed the longest time to accomplish the 2 tasks (P < .05). Comparing of average load required to perform the suture pass-through rings task, it differed significantly between dominant and nondominant hand in all groups (P < .01) and was less in group A and group B than group C in dominant hand (P < .01), while it was almost the same in all groups in the nondominant hand. In terms of average load requirement to accomplish clip-cut task, it was almost equal not only between group A and B but also between dominant and nondominant hand while the increase reached statistical significance when comparing group C with other groups (P < .05). Compared with conventional devices and maneuvering techniques, articulating instruments and cross-handed manipulation are associated with longer operation time and higher workload. Instruments with better maneuverability should be developed in the future for LESS. © The Author(s) 2013.

Quantum and classical behavior in interacting bosonic systems

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

Hertzberg, Mark P.

It is understood that in free bosonic theories, the classical field theory accurately describes the full quantum theory when the occupancy numbers of systems are very large. However, the situation is less understood in interacting theories, especially on time scales longer than the dynamical relaxation time. Recently there have been claims that the quantum theory deviates spectacularly from the classical theory on this time scale, even if the occupancy numbers are extremely large. Furthermore, it is claimed that the quantum theory quickly thermalizes while the classical theory does not. The evidence for these claims comes from noticing a spectacular differencemore » in the time evolution of expectation values of quantum operators compared to the classical micro-state evolution. If true, this would have dramatic consequences for many important phenomena, including laboratory studies of interacting BECs, dark matter axions, preheating after inflation, etc. In this work we critically examine these claims. We show that in fact the classical theory can describe the quantum behavior in the high occupancy regime, even when interactions are large. The connection is that the expectation values of quantum operators in a single quantum micro-state are approximated by a corresponding classical ensemble average over many classical micro-states. Furthermore, by the ergodic theorem, a classical ensemble average of local fields with statistical translation invariance is the spatial average of a single micro-state. So the correlation functions of the quantum and classical field theories of a single micro-state approximately agree at high occupancy, even in interacting systems. Furthermore, both quantum and classical field theories can thermalize, when appropriate coarse graining is introduced, with the classical case requiring a cutoff on low occupancy UV modes. We discuss applications of our results.« less

Insurance status and time to completion of surgery for breast cancer.

PubMed

Solomon, Matthew; Cochrane, Colin T; Grieve, David A

2016-01-01

The aim of this study was to compare the time to re-operation, following inadequate loco-regional surgery for breast cancer, between the public and private sectors of the Sunshine Coast region. A retrospective review was performed of the medical records of all female patients undergoing guide wire-localized, breast-conserving surgery at Nambour General Hospital and in the local private sector from January 2009 until April 2010. The dates of initial consultation, operation, post-operative consultation and any subsequent reoperation were recorded. One hundred and seventeen public sector patients and 113 private sector patients were identified during the study period. Thirty-seven public patients (32%) and 46 private patients (41%) required re-operation. This difference was not significant (χ(2) = 2.06, degrees of freedom (df) = 1, P = 0.15). The mean time and standard error from the initial consultation to the first operation and re-operation in the public sector was 26 (2.3) and 62 (3.8) days, and in the private sector was 12 (1.2) and 30 (4.4) days, respectively P < 0.001. On average, 70% of public patients and 96% of private patients completed the surgical component of their breast cancer management within the Queensland Health-recommended time frame of 30 days (χ(2) = 26, df = 1, P < 0.001). While experiencing similar rates of re-operative surgery in breast cancer management in the public and private sectors, the private sector deals with this issue in a more time efficient manner. An opportunity for intervention by quarantining theatre time is explored to improve the public sector time management. © 2015 Royal Australasian College of Surgeons.

Development of an image operation system with a motion sensor in dental radiology.

PubMed

Sato, Mitsuru; Ogura, Toshihiro; Yasumoto, Yoshiaki; Kadowaki, Yuta; Hayashi, Norio; Doi, Kunio

2015-07-01

During examinations and/or treatment, a dentist in the examination room needs to view images with a proper display system. However, they cannot operate the image display system by hands, because dentists always wear gloves to be kept their hands away from unsanitized materials. Therefore, we developed a new image operating system that uses a motion sensor. We used the Leap motion sensor technique to read the hand movements of a dentist. We programmed the system using C++ to enable various movements of the display system, i.e., click, double click, drag, and drop. Thus, dentists with their gloves on in the examination room can control dental and panoramic images on the image display system intuitively and quickly with movement of their hands only. We investigated the time required with the conventional method using a mouse and with the new method using the finger operation. The average operation time with the finger method was significantly shorter than that with the mouse method. This motion sensor method, with appropriate training for finger movements, can provide a better operating performance than the conventional mouse method.

[The role of autografts in the treatment of complicated incisional hernias].

PubMed

Martis, Gábor; Damjanovich, László

2016-06-01

Complicated incisional hernias (at least one time recurrent and/or multilocular and/or infected synthetic mesh) still represent a significant problem. Presentation of operating techniques desribed so far, as well as publication of a novel procedure and results invented by the authors. Between 01/2011 and 09/2015, 41 patients with recurrent and/or infected incisional hernias with or without entero- and subcutaneous fistulas were operated using the method of the s.c. double-layer autologous tension free dermal flap technique. An accurate follow-up method and a continuous registration of the results was conducted in case of every patient. The body mass index (BMI) and presence of diabetes mellitus (DM) were distinguished factors out of the patients' clinical data. Surgical complications, bulking or laxity, recurrence and the patients' satisfactory index - among other things - were recorded considering the procedure. Patients' clinical data and results: Average age was 59.2 years (13 male / 28 female) in the cohort. 1, 2, 3 times recurrent incisional hernias had 12, 23, 6 patients, respectively. Average BMI was 32,1 kg/m2. 12 patients were treated with type II diabetes. 13 patients had entero- or subcutaneous fistulas and/or infected synthetic meshes at the time of operations. Average follow-up time was 32 months (2-58 months). Seroma formation was registered in 13 cases (31.7%). Fistula formation was registered in one case (2.4%). Bulking formation or laxity was observed in 3 patients (7.3%) and recurrence was noticed in 3 patients (7.3%), 13, 17 and 19 months later in the postoperative period. All the entero- and subcutaneous fistulas developed prior to the last procedure were completely healed. There was no lethal outcome. The method developed by the authors is recommended and suitable for the solution to complicated and/or infected incisional abdominal wall hernias especially in cases of obese (BMI ≥ 25 kg/m(2)) and diabetic, high risk patients. After acquiring the precise operative technique, the method is safe, feasible and it comes along with lower complication and recurrence rate, compared to other applied and well established ones. Further clinical trials need to be conducted in the future in order to be evaluated definetely this procedure.

Front-line managers as boundary spanners: effects of span and time on nurse supervision satisfaction.

PubMed

Meyer, Raquel M; O'Brien-Pallas, Linda; Doran, Diane; Streiner, David; Ferguson-Paré, Mary; Duffield, Christine

2011-07-01

To examine the influence of nurse manager span (number of direct report staff), time in staff contact, transformational leadership practices and operational hours on nurse supervision satisfaction. Increasing role complexity has intensified the boundary spanning functions of managers. Because work demands and scope vary by management position, time in staff contact rather than span may better explain managers' capacity to support staff. A descriptive, correlational design was used to collect cross-sectional survey and prospective work log and administrative data from a convenience sample of 558 nurses in 51 clinical areas and 31 front-line nurse managers from four acute care hospitals in 2007-2008. Data were analysed using hierarchical linear modelling. Span, but not time in staff contact, interacted with leadership and operational hours to explain supervision satisfaction. With compressed operational hours, supervision satisfaction was lower with highly transformational leadership in combination with wider spans. With extended operational hours, supervision satisfaction was higher with highly transformational leadership, and this effect was more pronounced under wider spans. Operational hours, which influence the manager's daily span (average number of direct report staff working per weekday), should be factored into the design of front-line management positions. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

[Surgical treatment of pronation and supination external rotation trimalleolar fractures].

PubMed

Xu, Ye-qing; Zhan, Bei-lei; He, Fei-xiong; Wei, Hong-da

2008-04-01

To explore the operative method and its clinical effects of pronation and supination external rotation trimalleolar fractures. From March 2000 to July 2006,42 patients of the pronation and supination external rotation trimalleolar fractures treated with open reduction and internal fixation. Thirty-one were males and 11 were females,with an average age of 40.5 years (from 19 to 76 years). Four cases were open fractures and 38 cases close fractures. The fractures were classified as pronation-external rotation (grade IV) injury in 18 cases and supination-external rotation (grade IV)in 24 cases according to the system of Lauge-Hansen. The time of injury to operation was 2 hours to 27 days. The medial, lateral and posterior malleolus were exposed by standard anteromedial and Gatellier-Chastang approaches. The reduction and internal fixation started with the posterior,then the medial and the lateral malleolus and distal tibiofibular syndesmosis in sequence. The anteroposterior, lateral and mostise X-ray films were taken after operation. All the patients were followed up for an average time of 13.5 months(from 6 to 24 months). The time of union was from 12 to 16 weeks. The results were excellent in 20,good in 16, fair in 4 and poor in 2 cases according to Baird-Jackson ankle scoring system based on pain, stability, walking ability,range of motion and radiological manifestations. The excellent and good rate was 85.7%. There were no infection,malunion and nonunion of the fractures except that the inserted screw to distal tibiofibular syndesmosis was broken in 1 case. The key of operative treatment is to restore the anatomy of ankle and to regain the ankle function maximally.

Time-resolved deposition in the remote region of the JET-ILW divertor: measurements and modelling

NASA Astrophysics Data System (ADS)

Catarino, N.; Widdowson, A.; Baron-Wiechec, A.; Coad, J. P.; Heinola, K.; Rubel, M.; Alves, E.; Contributors, JET

2017-12-01

One crucial requirement for the development of fusion power is to know where, and how much, impurities collect in the machine, and how much of the fuelling isotope tritium will be trapped therein. The most relevant information on this issue comes from the operation of the Joint European Tokamak (JET), which is the world’s largest operating tokamak and has the same interior plasma-facing materials as the next step machine, ITER. Much of the information gained so far has been from post-mortem analysis of samples collected after whole campaigns involving varied types of operation. This paper describes time-resolved measurements of the deposition rate using rotating collectors (RC) placed in remote areas of the JET divertor during the 2013-2014 campaign with the ITER-like Wall (ILW). These techniques allow the effects of different types of operation to be distinguished. Rotating collectors made of silicon discs housed behind an aperture are exposed to the plasma. Each time the magnetic field coils are ramped up for a discharge the disc rotates, providing a linear relationship between the exposed region and the discharge number. Post-mortem ion beam analyses provide information on the deposit composition as a function of the discharge number. The results show that the Be deposition average for the RC in the corners of the inner and outer divertor are 4.9 × 1016 cm-2 and 1.8 × 1017 cm-2, respectively, accumulated over an average of ˜25 pulses. Data from the rotating collector below Tile 5 in the central region of divertor indicate a Be deposition rate of 9.3 × 1015 cm-2, per ˜25 pulses.

Efficacy of honey in reduction of post tonsillectomy pain, randomized clinical trial.

PubMed

Mohebbi, Saleh; Nia, Fatemeh Hasan; Kelantari, Farbood; Nejad, Sheqhayeqh Ebrahim; Hamedi, Yaghoob; Abd, Reza

2014-11-01

Tonsillectomy is one of the most common operations performed in pediatric population. One of the most prevalent tonsillectomy complications is early or delayed post-operative hemorrhage. Other important morbidity is post-operative pain. Historically, honey has been used for wound control, reducing the inflammation, and healing acceleration. The aim of this study is to investigate the effect of honey on reducing pain after tonsillectomy in children 5-15 years old. After tonsillectomy, 80 patients were randomly divided in two equal groups. Patients in the first group were treated with antibiotic and acetaminophen, while those in the second group were treated with antibiotic, acetaminophen and honey. Data was gathered via a questionnaire and observation of tonsillar bed healing. Data was analyzed by SPSS17 software and related tests. Pain comparison between two groups showed that the average time required for pain relief in patients who received honey was less than the control. The pain intensity was higher during the first 9 days post-operatively in control group. Results also showed that acetaminophen consumption in patients who received honey is lower. In the case group, the average time to resume regular diet and the frequency of awakening at night is significantly less than the control group. Honey administration after tonsillectomy has valuable effect in pain relief and it can be used as an adjunctive regimen after surgery for better pain control. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Energetic Ion Beam Production by a Low-Pressure Plasma Focus Discharge

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

Lim, L. K.; Yap, S. L.; Wong, C. S.

Energetic ion beam emissions in a 3 kJ Mather type plasma focus operating at low-pressure regime are investigated. Deuterium gas is used and the discharge is operated in a low-pressure regime of below 1 mbar. Formation of the current sheath during the breakdown phase at the back wall is assisted by a set delayed trigger pulse. Energetic and intense ion beams with good reproducibility have been obtained for the operating pressure ranging from 0.05 mbar to 0.5 mbar. Deuteron beam is determined by time resolved measurement by making use of three biased ion collectors placed at the end on direction.more » The average energies of deuteron beams are resolved by using time-of flight method. Correlation between the ion emissions and the current sheath dynamics is also discussed.« less

Retrospective Review of Air Transportation Use for Upper Extremity Amputations at a Level-1 Trauma Center.

PubMed

Grantham, W Jeffrey; To, Philip; Watson, Jeffry T; Brywczynski, Jeremy; Lee, Donald H

2016-08-01

Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations. Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed. The distance traveled was recorded, along with the times of the injury, referral, transportation duration, arrival, and start of the operation. The results of the transfer were defined as replantation or revision amputation. Overall, 47 patients were identified with 43 patients going to the operating room, but only 14 patients (30%) undergoing replantation. Patients arrived at the tertiary hand surgery center with a mean time of 182.3 minutes following the injury, which includes 105.2 minutes of transportation time. The average distance traveled was 105.4 miles (range, 22-353 miles). The time before surgery of those who underwent replantation was 154.6 minutes. The average cost of transportation was $20,482. Air transportation for isolated upper extremity amputations is costly and is not usually the determining factor for replantation. The type of injury and patients' expectations often dictate the outcome, and these may be better determined at the time of referral with use of telecommunication photos, discussion with a hand surgeon, and patient counseling. III.

Features of Creation and Operation of Electric and Hybrid Vehicles in Countries with Difficult Climatic Conditions, for Example, in the Russian Federation

NASA Astrophysics Data System (ADS)

Karpukhin, K.; Terenchenko, A.

2016-11-01

The trend of increasing fleet of electric or hybrid vehicles and determines the extension of the geographical areas of operation, including the Northern areas with cold winter weather. Practically in all territory of Russia the average winter temperature is negative. With the winter temperatures can be below in Moscow -30°C, in Krasnoyarsk -50°C. Battery system can operate in a wide temperature range, but there are extremes that should be remembered all the time, especially in cold climates like Russia. In the operating instructions of the electric car Tesla Model S indicate that to save the battery don't use at temperatures below -15°C. The paper presents the dependence of the cooling time and heating of the battery cell at different ambient temperatures and provides guidance on allowable cooling time while using and not thermally insulated thermally containers Suggests using the temperature control on the basis of thermoelectric converters Peltier connection from the onboard electrical network of the electric vehicle.

Effect of Resident Involvement on Operative Time and Operating Room Staffing Costs.

PubMed

Allen, Robert William; Pruitt, Mark; Taaffe, Kevin M

The operating room (OR) is a major driver of hospital costs; therefore, operative time is an expensive resource. The training of surgical residents must include time spent in the OR, but that experience comes with a cost to the surgeon and hospital. The objective of this article is to determine the effect of surgical resident involvement in the OR on operative time and subsequent hospital labor costs. The Kruskal-Wallis statistical test is used to determine whether or not there is a difference in operative times between 2 groups of cases (with residents and without residents). This difference leads to an increased cost in associated hospital labor costs for the group with the longer operative time. Cases were performed at Greenville Memorial Hospital. Greenville Memorial Hospital is part of the larger healthcare system, Greenville Health System, located in Greenville, SC and is a level 1 trauma center with up to 33 staffed ORs. A total of 84,997 cases were performed at the partnering hospital between January 1st, 2011 and July 31st, 2015. Cases were only chosen for analysis if there was only one CPT code associated with the case and there were more than 5 observations for each group being studied. This article presents a comprehensive retrospective analysis of 29,134 cases covering 246 procedures. The analysis shows that 45 procedures took significantly longer with a resident present in the room. The average increase in operative time was 4.8 minutes and the cost per minute of extra operative time was determined to be $9.57 per minute. OR labor costs at the partnering hospital was found to be $2,257,433, or $492,889 per year. Knowing the affect on operative time and OR costs allows managers to make smart decisions when considering alternative educational and training techniques. In addition, knowing the connection between residents in the room and surgical duration could help provide better estimates of surgical time in the future and increase the predictability of procedure duration. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Application of the backward extrapolation method to pulsed neutron sources

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

Talamo, Alberto; Gohar, Yousry

We report particle detectors operated in pulse mode are subjected to the dead-time effect. When the average of the detector counts is constant over time, correcting for the dead-time effect is simple and can be accomplished by analytical formulas. However, when the average of the detector counts changes over time it is more difficult to take into account the dead-time effect. When a subcritical nuclear assembly is driven by a pulsed neutron source, simple analytical formulas cannot be applied to the measured detector counts to correct for the dead-time effect because of the sharp change of the detector counts overmore » time. This work addresses this issue by using the backward extrapolation method. The latter can be applied not only to a continuous (e.g. californium) external neutron source but also to a pulsed external neutron source (e.g. by a particle accelerator) driving a subcritical nuclear assembly. Finally, the backward extrapolation method allows to obtain from the measured detector counts both the dead-time value and the real detector counts.« less

Application of the backward extrapolation method to pulsed neutron sources

DOE PAGES

Talamo, Alberto; Gohar, Yousry

2017-09-23

We report particle detectors operated in pulse mode are subjected to the dead-time effect. When the average of the detector counts is constant over time, correcting for the dead-time effect is simple and can be accomplished by analytical formulas. However, when the average of the detector counts changes over time it is more difficult to take into account the dead-time effect. When a subcritical nuclear assembly is driven by a pulsed neutron source, simple analytical formulas cannot be applied to the measured detector counts to correct for the dead-time effect because of the sharp change of the detector counts overmore » time. This work addresses this issue by using the backward extrapolation method. The latter can be applied not only to a continuous (e.g. californium) external neutron source but also to a pulsed external neutron source (e.g. by a particle accelerator) driving a subcritical nuclear assembly. Finally, the backward extrapolation method allows to obtain from the measured detector counts both the dead-time value and the real detector counts.« less

Evaluation of Improved Pushback Forecasts Derived from Airline Ground Operations Data

NASA Technical Reports Server (NTRS)

Carr, Francis; Theis, Georg; Feron, Eric; Clarke, John-Paul

2003-01-01

Accurate and timely predictions of airline pushbacks can potentially lead to improved performance of automated decision-support tools for airport surface traffic, thus reducing the variability and average duration of costly airline delays. One factor which affects the realization of these benefits is the level of uncertainty inherent in the turn processes. To characterize this inherent uncertainty, three techniques are developed for predicting time-to-go until pushback as a function of available ground-time; elapsed ground-time; and the status (not-started/in-progress/completed) of individual turn processes (cleaning, fueling, etc.). These techniques are tested against a large and detailed dataset covering approximately l0(exp 4) real-world turn operations obtained through collaboration with Deutsche Lufthansa AG. Even after the dataset is filtered to obtain a sample of turn operations with minimal uncertainty, the standard deviation of forecast error for all three techniques is lower-bounded away from zero, indicating that turn operations have a significant stochastic component. This lower-bound result shows that decision-support tools must be designed to incorporate robust mechanisms for coping with pushback demand stochasticity, rather than treating the pushback demand process as a known deterministic input.

Low energy single-staged anaerobic fluidized bed ceramic membrane bioreactor (AFCMBR) for wastewater treatment.

PubMed

Aslam, Muhammad; McCarty, Perry L; Shin, Chungheon; Bae, Jaeho; Kim, Jeonghwan

2017-09-01

An aluminum dioxide (Al 2 O 3 ) ceramic membrane was used in a single-stage anaerobic fluidized bed ceramic membrane bioreactor (AFCMBR) for low-strength wastewater treatment. The AFCMBR was operated continuously for 395days at 25°C using a synthetic wastewater having a chemical oxygen demand (COD) averaging 260mg/L. A membrane net flux as high as 14.5-17L/m 2 h was achieved with only periodic maintenance cleaning, obtained by adding 25mg/L of sodium hypochlorite solution. No adverse effect of the maintenance cleaning on organic removal was observed. An average SCOD in the membrane permeate of 23mg/L was achieved with a 1h hydraulic retention time (HRT). Biosolids production averaged 0.014±0.007gVSS/gCOD removed. The estimated electrical energy required to operate the AFCMBR system was 0.039kWh/m 3 , which is only about 17% of the electrical energy that could be generated with the methane produced. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy].

PubMed

Zhang, Yu-Hang; Bi, Da-Wei; Chen, Yi-Min; Zu, Gang; Ma, Hai-Tao

2018-03-25

To explore clinical application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy. From May 2013 to May 2016, 47 patients(66 feet) with mild to moderate hallux valgus treated by Chevron osteotomy according to different preoperative design were divided into computer osteotomy group(group A) and traditional osteotomy group(group B). In group A, there were 25 patients (33 feet), including 4 males(5 feet) and 21 females(28 feet) with an average age of (47.88±6.08) years old, average weight IMA was (13.58±1.15) degree, AOFAS score was 59.00±5.86, and treated individual 3D printing technology to design operation scheme. While in group B, there were 22 patients (33 feet), including 3 males (3 feet) and 19 females (28 feet) with an average age of (48.16±6.16) years old, average weight IMA was(13.51±1.14) degree, AOFAS score was 60.67±5.85, and treated with osteotomy according to surgical experience. Operation time, blood loss, hospital stays, VAS score at 1 week after operation, wound healing and improvement of postoperative weight-bearing intermetatarsal angle(IMA) were compared between two groups, AOFAS score system was used to evaluate ankle function after surgery. There was no significant difference in following-up between group A 12.41±2.32 and group B 11.73±2.76. There was 1 patient in group B were excluded. Others perform good wounds healing on the first stage after operation. There were no significant differences in operation time, blood loss, hospital stays and VAS score at 1 week after operation( P <0.05); IMA in group A was (5.21±0.88)°, (6.42±0.85)° in group B, and had significant differences between two groups ( t =5.68, P <0.05). There was obvious meaning in AOFAS score between group A 88.15±5.19 and group B 82.90±5.01( t =4.14, P <0.05). Fourteen feet in group A obtained excellent results and 19 feet good, while 5 feet in group B obtained excellent results and 27 feet good. Compared with traditional osteotomy group, three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy could better correct IMA, improve postoperative foot function, and it is a kind of individualized and digital method to design operation. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

120 Hz pulse tube cryocooler for fast cooldown to 50 K

NASA Astrophysics Data System (ADS)

Vanapalli, Srinivas; Lewis, Michael; Gan, Zhihua; Radebaugh, Ray

2007-02-01

A pulse tube cryocooler operating at 120Hz with 3.5MPa average pressure achieved a no-load temperature of about 49.9K and a cooldown time to 80K of 5.5min. The net refrigeration power at 80K was 3.35W with an efficiency of 19.7% of Carnot when referred to input pressure-volume (PV or acoustic) power. Such low temperatures have not been previously achieved for operating frequencies above 100Hz. The high frequency operation leads to reduced cryocooler volume for a given refrigeration power, which is important to many applications and can enable development of microcryocoolers for microelectromechanical system applications.

Tactical decision making for selective expansion of operating room resources incorporating financial criteria and uncertainty in subspecialties' future workloads.

PubMed

Dexter, Franklin; Ledolter, Johannes; Wachtel, Ruth E

2005-05-01

We considered the allocation of operating room (OR) time at facilities where the strategic decision had been made to increase the number of ORs. Allocation occurs in two stages: a long-term tactical stage followed by short-term operational stage. Tactical decisions, approximately 1 yr in advance, determine what specialized equipment and expertise will be needed. Tactical decisions are based on estimates of future OR workload for each subspecialty or surgeon. We show that groups of surgeons can be excluded from consideration at this tactical stage (e.g., surgeons who need intensive care beds or those with below average contribution margins per OR hour). Lower and upper limits are estimated for the future demand of OR time by the remaining surgeons. Thus, initial OR allocations can be accomplished with only partial information on future OR workload. Once the new ORs open, operational decision-making based on OR efficiency is used to fill the OR time and adjust staffing. Surgeons who were not allocated additional time at the tactical stage are provided increased OR time through operational adjustments based on their actual workload. In a case study from a tertiary hospital, future demand estimates were needed for only 15% of surgeons, illustrating the practicality of these methods for use in tactical OR allocation decisions.

[Perthes disease--results of a containment-oriented therapy concept].

PubMed

Rühmann, O; Lazović, D; Wirth, C J; Gossé, F; Franke, J

1997-01-01

In a retrospective study a treatment concept for Perthes' disease dependent on the containment was applied. 49 hips of 41 children (9 female, 32 male) were treated between 01. 01. 1990 and 31. 12. 1995. In our concept of treatment a varus femoral osteotomy was performed in 28 cases with not contained hips or less than 4/5 coverage of the femoral head (X-ray/MRI). The other 21 well contained hips with 4/5 coverage or more were treated conservatively with physiotherapy and in case of joint effusion and pain additionally with the use of crutches (partial weight bearing) and anti-inflammatory medication. The average age in the non-operative group at the time of first investigation was 4 years and 9 months (3 y./1 m. to 7 y./1 m.) and 6 years and 3 months (4 y/2 m. to 10 y/0 m.) at our last examination (mean follow up 17.7 months, range of 6 to 72 months). At the time of indication for a varus femoral osteotomy the patients had an average age 6 years and 1 month (3 y./6 m. to 10 y./2 m.), the mean age at the last postoperative examination was 7 years and 11 months (4 y./8 m. to 12 y./5 m.) with an average follow up of 21.5 months (6 to 77 months). For the conservatively treated children we achieved good results (still well contained hips with 4/5 coverage, no decrease of function, no increase of pain) in 85.7% (18 of 21 cases). In 85.7% (24 of 28 cases) we found good results (well contained hips, increase of coverage, no decrease of function, no increase of pain) in the operation group. The presented concept of therapy in Perthes' disease was practicable for all patients and included the possibility of decision for operative or non-operative treatment. In both groups we achieved good results in 85.7% of the cases.

Returning to sport after anterior cruciate ligament reconstruction in amateur sports men: a retrospective study.

PubMed

Notarnicola, Angela; Maccagnano, Giuseppe; Barletta, Federico; Ascatigno, Leonardo; Astuto, Leopoldo; Panella, Antonio; Tafuri, Silvio; Moretti, Biagio

2016-01-01

According to the literature, 95% of professional athletes return to their sport after anterior cruciate ligament (ACL) reconstruction surgery. The main objective of this study was to verify the return to sport after ACL reconstruction in a homogenous group of amateur sportsmen and sportswomen in a series of Italian patients. We designed a retrospective study in which we analyzed the amateur sports patients operated for ACL reconstruction. We verified whether they had returned to sporting activities by comparing the pre- and post-operative Tegner activity scores. We then analyzed the average time to restart the sporting activity and the Lysholm and International Knee Documenting Committee (IKDC) scores. We analyzed 80 subjects: 47.5% restarted a sports activity, on average after eight months, with a significant reduction of their competitive level or physical commitment, as expressed by the Tegner activity score (pre-operative: 6.9; post-operative: 3.9; p<0.01). The functional knee recovery was good, as expressed by the average score of the Lyshom Knee Scoring Scale (93.5) and the IKDC (74.7). In the literature, a return to sport for international case studies and amateur sports is higher than our data. In our population we found the lack of information provided by the medical staff at discharge and follow-up. The assessment at a short-term follow up allowed us to verify that at the end of the post-surgical rehabilitation program the patients were uninformed about the timing and the ability to resume a sporting activity. An efficacious relationship between orthopedic doctor, physiotherapist and a doctor in motorial science may ensure proper treatment the patient after ACL reconstruction. It is important to guarantee the restarting of the sports activity to have a better quality of life in amateur sports. Level of evidence: V.

Returning to sport after anterior cruciate ligament reconstruction in amateur sports men: a retrospective study

PubMed Central

Notarnicola, Angela; Maccagnano, Giuseppe; Barletta, Federico; Ascatigno, Leonardo; Astuto, Leopoldo; Panella, Antonio; Tafuri, Silvio; Moretti, Biagio

2016-01-01

Summary Background According to the literature, 95% of professional athletes return to their sport after anterior cruciate ligament (ACL) reconstruction surgery. The main objective of this study was to verify the return to sport after ACL reconstruction in a homogenous group of amateur sportsmen and sportswomen in a series of Italian patients. Materials and methods We designed a retrospective study in which we analyzed the amateur sports patients operated for ACL reconstruction. We verified whether they had returned to sporting activities by comparing the pre- and post-operative Tegner activity scores. We then analyzed the average time to restart the sporting activity and the Lysholm and International Knee Documenting Committee (IKDC) scores. Results We analyzed 80 subjects: 47.5% restarted a sports activity, on average after eight months, with a significant reduction of their competitive level or physical commitment, as expressed by the Tegner activity score (pre-operative: 6.9; post-operative: 3.9; p<0.01). The functional knee recovery was good, as expressed by the average score of the Lyshom Knee Scoring Scale (93.5) and the IKDC (74.7). Conclusions In the literature, a return to sport for international case studies and amateur sports is higher than our data. In our population we found the lack of information provided by the medical staff at discharge and follow-up. The assessment at a short-term follow up allowed us to verify that at the end of the post-surgical rehabilitation program the patients were uninformed about the timing and the ability to resume a sporting activity. An efficacious relationship between orthopedic doctor, physiotherapist and a doctor in motorial science may ensure proper treatment the patient after ACL reconstruction. It is important to guarantee the restarting of the sports activity to have a better quality of life in amateur sports. Level of evidence: V. PMID:28217571

[Clinical analysis of LPFP, PFNA and BPH in treating femoral intertrochanteric fractures in elderly patients].

PubMed

Zhu, Li-Jun; Li, Xiao-Fei; Liu, Chao; Lyu, Cheng-Yu

2017-07-25

To evaluate the clinical results of locking proximal femur plate(LPFP), proximal femoral nail antirotation(PFNA) and bipolar hemiarthroplasty(BPH) in the treatment of femoral intertrochanteric fractures in elderly patients. Retrospective analysis of the 86 elderly patients with femoral intertrochanteric fractures during June 2011 and August 2016 were enrolled in this study. The patients were divided into 3 groups: 26 cases in LPFP group included 10 males and 16 females with an average age of (72.54±4.78) years old, 5 cases of type II of Evans, 12 cases of type III and 9 cases of type IV; 39 cases in PFNA group included 17 males and 22 females with an average age of 74.41±5.65, 11 cases of type II, 18 cases of type III and 10 cases of type IV; 21 cases in BPH group included 9 males and 12 females with an average age of 76.23±6.97, 1 case of type II, 10 cases of type III and 10 cases of type IV. The data of three groups were collected for statistical analysis on the following aspects: operation time, intraoperative blood loss, the length of hospital stay, postoperative complications and Harris score of the hip joint function. The wound healed well and no complication occurred. Eighty-four cases were follow-up, while 2 cases were lost, the follow-up rate was 97.6%. The patients were followed up for 22 to 41 months with an average of 26.3 months. For comparison of operation time and time of the hospital stay, BPH group was shorter than the LPFP and PFNA group( F =19.782, 21.981, P <0.05). For comparison of the intraoperative blood loss, the BPH group was less blood loss than the LPFP and PFNA group( F =12.976, P <0.05), while there was no significant means between the LPFP and PFNA group( t =10.879, P >0.05). For comparison of the postoperative complications, LPFP group was higher than BHP and PFNA group( F =30.976, P <0.05), while there was no significant means between LPFP and PFNA group( t =9.902, P >0.05). For comparison of the Harris score of the hip joint at 1 year after operation, BPH and PFNA group were both higher than LPFP group( F =19.692, P <0.05), while there was no significant means between BPH and PFNA group ( t =4.971, P >0.05). For elder patient with femoral intertrochanteric fracture, BPH could be the best optional for the shorter operation time and less complications. And the PFNA also could be optional choice for the patients while the LPFP was forbidden for the elder patients.

Evaluation of decentralized treatment of sewage employing Upflow Septic Tank/Baffled Reactor (USBR) in developing countries.

PubMed

Sabry, Tarek

2010-02-15

A new concept for a low-cost modified septic tank, named Upflow Septic Tank/Baffled Reactor (USBR), was constructed and tested in a small village in Egypt. During almost one year of continuous operation and monitoring, this system was found to have very satisfactory removal results, where the average results of COD, BOD, and TSS removal efficiencies were 84%, 81%, and 89%, respectively, and the results of the experiment proved that the second compartment (Anaerobic Baffled Reactor) was the main treatment unit in removing the pollutants during the start-up period and at the very early steady-state stage. However, after this period and during the steady-state operation conditions, the second compartment served as a polishing step. Also, it was observed that the USBR system was not affected by the imposed shock loads at the peak flow and organic periods. The results showed that the system is slightly influenced by the drop in the temperature. Decreasing in BOD and COD removal by factor of 9% was observed, when temperature decreases from the average of 35 degrees C in summer time (for the first 127 days) to the average of 22 degrees C in winter time (between day 252 and day 280). Whereas, the TSS removals were not affected by the drop in temperature. The results of the sewage flow variations during one year of operation were compared with Goodrich Formula to see the applicability of this equation in rural developing countries. MAIN FINDING OF THE WORK: The Upflow Septic Tank/Baffled Reactor system could become a promising alternative to the conventional treatment plants in rural developing countries.

Health effects of gasoline exposure. I. Exposure assessment for U.S. distribution workers.

PubMed Central

Smith, T J; Hammond, S K; Wong, O

1993-01-01

Personal exposures were estimated for a large cohort of workers in the U.S. domestic system for distributing gasoline by trucks and marine vessels. This assessment included development of a rationale and methodology for extrapolating vapor exposures prior to the availability of measurement data, analysis of existing measurement data to estimate task and job exposures during 1975-1985, and extrapolation of truck and marine job exposures before 1975. A worker's vapor exposure was extrapolated from three sets of factors: the tasks in his or her job associated with vapor sources, the characteristics of vapor sources (equipment and other facilities) at the work site, and the composition of petroleum products producing vapors. Historical data were collected on the tasks in job definitions, on work-site facilities, and on product composition. These data were used in a model to estimate the overall time-weighted-average vapor exposure for jobs based on estimates of task exposures and their duration. Task exposures were highest during tank filling in trucks and marine vessels. Measured average annual, full-shift exposures during 1975-1985 ranged from 9 to 14 ppm of total hydrocarbon vapor for truck drivers and 2 to 35 ppm for marine workers on inland waterways. Extrapolated past average exposures in truck operations were highest for truck drivers before 1965 (range 140-220 ppm). Other jobs in truck operations resulted in much lower exposures. Because there were few changes in marine operations before 1979, exposures were assumed to be the same as those measured during 1975-1985. Well-defined exposure gradients were found across jobs within time periods, which were suitable for epidemiologic analyses. PMID:8020436

Physical Therapists Forward Deployed on Aircraft Carriers: A Retrospective Look at a Decade of Service.

PubMed

Rosenthal, Michael D; Ziemke, Gregg W; Bush, Matthew L; Halfpap, Joshua

2018-04-25

Navy physical therapists (PTs) have been a part of ship's company aboard Aircraft Carriers since 2002 due to musculoskeletal injuries being the number one cause of lost duty time and disability. This article describes a decade of physical therapy services provided aboard aircraft carriers. A retrospective survey was conducted to evaluate the types of services provided, volume of workload, value of services provided, and impact of PTs on operational readiness for personnel aboard Naval aircraft carriers. Thirty-four reports documenting workload from PTs stationed onboard aircraft carriers were collected during the first decade of permanent PT assignment to aircraft carriers. This report quantifies a 10-yr period of physical therapy services (PT and PT Technician) in providing musculoskeletal care within the carrier strike group and adds to existing literature demonstrating a high demand for musculoskeletal care in operational platforms. A collective total of 144,211 encounters were reported during the 10-yr period. The number of initial evaluations performed by the PT averaged 1,448 per assigned tour. The average number of follow-up appointments performed by the PT per tour was 1,440. The average number of treatment appointments per tour provided by the PT and PT technician combined was 1,888. The average number of visits per patient, including the initial evaluation, was 3.3. Sixty-five percent (65%) of the workload occurred while deployed or out to sea during training periods. It was estimated that 213 medical evacuations were averted over the 10-yr period. There were no reports of adverse events or quality of care reviews related to the care provided by the PT and/or PT technician. Access to early PT intervention aboard aircraft carriers was associated with a better utilization ratio (lower average number of visits per condition) than has been reported in prior studies and suggests an effective utilization of medical personnel resources. The impact of Navy PTs serving afloat highlights the importance of sustaining these billets and indicates the potential benefit of additional billet establishment to support operational platforms with high volumes of musculoskeletal injury. Access to early PT intervention can prevent and rehabilitate injuries among operational forces, promote human performance optimization, increase readiness during war and peace time efforts, and accelerate rehabilitation from neuromusculoskeletal injuries. With the establishment of Electronic Health Records within all carrier medical groups a repeat study may provide additional detail related to musculoskeletal injuries to guide medical planners to staff sea-based operational platforms most effectively to care for the greatest source of battle and disease non-battle injuries and related disability in the military.

Validation of exposure assessment and assessment of recruitment methods for a prospective cohort study of mobile phone users (COSMOS) in Finland: a pilot study

PubMed Central

2011-01-01

Background The aim of the study was to evaluate the agreement between self-reported and operator-derived estimates of call time based on a three-month monitoring period, as well as the consistency of mobile phone use over time. Alternative approaches to improve participation in a cohort study of mobile phone users were also compared. Methods A total of 5,400 subjects were identified from network operators' subscriber databases for recruitment to the pilot study. Operator and questionnaire data were used to quantify mobile phone use. Operator data were available for a subset of the subjects for a three-month period in three consecutive years. We also evaluated the effect of the length of the questionnaire and one- or two-phase recruitment on participation. Results The average response rate for both questionnaires and recruitment procedures was 12%. The response rate was not affected by the length of the questionnaire or the recruitment method. Operator data were available for 83% of the participants for 2007, the first study year. The agreement between self-reported and operator-derived call times decreased with the level of use among intermediate and heavy mobile phone users. During 2007-2009, mobile phone use increased fairly constantly over time. Conclusions The agreement between self-reported mobile phone use and operator databases was moderate and overestimation of the call time by participants was common. A prospective cohort study would be feasible in Finland, although the potentially low participation rate would increase the resources required for recruitment. PMID:21385407

A longitudinal study of the incidence of pressure sores and the associated risks and strategies adopted in Italian operating theatres.

PubMed

Bulfone, Giampiera; Marzoli, Ilaria; Quattrin, Rosanna; Fabbro, Carmen; Palese, Alvisa

2012-02-01

To explore the incidence of intraoperative pressure sores, the associated risk factors and the preventive strategies adopted by nurses, we adopted a longitudinal study in a 900-bed teaching hospital with multiple operating theatres, located in the North of Italy. Patients who underwent major surgery were evaluated four times: at the moment of operating theatre admission, at operating theatre discharge, and on their third and sixth postoperative day. Of the patients included (n = 102) who had an average age of 62.3 years (range 20-87), 12.7% (13/102) developed a pressure ulcer in the operating theatre; 46.1% (6/13) of these ulcers were still present on the third postoperative day. Some health conditions (diabetes mellitus, cardiac diseases) and intra-operative factors (lying on the operating table for more than 6.15 hours, intraoperative hypothermia) are associated with the occurrence of pressure sores.

Statistical Short-Range Guidance for Peak Wind Speed Forecasts on Kennedy Space Center/Cape Canaveral Air Force Station: Phase I Results

NASA Technical Reports Server (NTRS)

Lambert, Winifred C.; Merceret, Francis J. (Technical Monitor)

2002-01-01

This report describes the results of the ANU's (Applied Meteorology Unit) Short-Range Statistical Forecasting task for peak winds. The peak wind speeds are an important forecast element for the Space Shuttle and Expendable Launch Vehicle programs. The Keith Weather Squadron and the Spaceflight Meteorology Group indicate that peak winds are challenging to forecast. The Applied Meteorology Unit was tasked to develop tools that aid in short-range forecasts of peak winds at tower sites of operational interest. A 7 year record of wind tower data was used in the analysis. Hourly and directional climatologies by tower and month were developed to determine the seasonal behavior of the average and peak winds. In all climatologies, the average and peak wind speeds were highly variable in time. This indicated that the development of a peak wind forecasting tool would be difficult. Probability density functions (PDF) of peak wind speed were calculated to determine the distribution of peak speed with average speed. These provide forecasters with a means of determining the probability of meeting or exceeding a certain peak wind given an observed or forecast average speed. The climatologies and PDFs provide tools with which to make peak wind forecasts that are critical to safe operations.

Clinical outcomes of the Cadenat procedure in the treatment of acromioclavicular joint dislocations.

PubMed

Moriyama, Hiroaki; Gotoh, Masafumi; Mitsui, Yasuhiro; Yoshikawa, Eiichirou; Uryu, Takuya; Okawa, Takahiro; Higuchi, Fujio; Shirahama, Masahiro; Shiba, Naoto

2014-01-01

We report our clinical experience using the modified Cadenat method to treat acromioclavicular joint dislocation, and discuss the usefulness of this method. This study examined 6 shoulders in 6 patients (5 males, 1 female) who were diagnosed with acromioclavicular joint dislocation and treated with the modified Cadenat method at our hospital. Average age at onset was 49.3 years (26-78 years), average time interval from injury until surgery was 263.8 days (10 to 1100 days), and the average follow-up period was 21.7 months (12 to 42 months). Post-operative assessment was performed using plain radiographs to determine shoulder joint dislocation rate and Japanese Orthopaedic Association (JOA) score. The average post-operative JOA score was 94.1 points (91 to 100 points). The acromioclavicular joint dislocation rate improved from 148.7% (72 to 236%) before surgery to 28.6% (0 to 60%) after surgery. Conservative treatment has been reported to achieve good outcomes in acromioclavicular joint dislocations. However, many patients also experience chronic pain or a sensation of fatigue upon putting the extremity in an elevated posture, and therefore ensuring the stability of the acromioclavicular joint is crucial for highly active patients. In this study, we treated acromioclavicular joint dislocations by the modified Cadenat method, and were able to achieve favorable outcomes.

[Clinical analysis of percutaneous nephrolithotomy for staghorn calculi with different stone branch number].

PubMed

Qi, Shi-yong; Zhang, Zhi-hong; Zhang, Chang-wen; Liu, Ran-lu; Shi, Qi-duo; Xu, Yong

2013-12-01

To investigate the impact of staghorn stone branch number on outcomes of percutaneous nephrolithotomy (PNL). From January 2009 to January 2013, the 371 patients with staghorn stones who were referred to our hospital for PNL were considered for this study. All calculi were showed with CT 3-dimentional reconstruction (3-DR) imaging. The computerized database of the patients had been reviewed. Our exclusion criterion was patients with congenital renal anomalies, such as horse-shoe and ectopic kidneys. And borderline stones that branched to one major calyx only were also not included. From 3-DR images, the number of stone branching into minor renal calices was recorded. We made "3" as the branch breakdown between groups. And the patients were divided into four groups. The number of percutaneous tract, operative time, staged PNL, intra-operative blood loss, complications, stone clearance rate, and postoperative hospital day were compared. The 371 patients (386 renal units) underwent PNL successfully, included 144 single-tract PNL, 242 multi-tract PNL, 97 staged PNL. The average operative time was (100 ± 50) minutes; the average intra-operative blood loss was (83 ± 67) ml. The stone clearance rate were 61.7% (3 days) and 79.5% (3 months). The postoperative hospital stay was (6.9 ± 3.4) days. A significantly higher ratio of multi-tract (χ(2) = 212.220, P < 0.01) and staged PNL (χ(2) = 49.679, P < 0.01), longer operative time (F = 4.652, P < 0.01) and postoperative hospital day (F = 2.067, P = 0.043) and lower rate of stone clearance (χ(2) = 10.691 and 47.369, P < 0.05) were found in PNL for calculi with stone branch number ≥ 5. There was no statistically meaningful difference among the 4 groups based on Clavien complication system (P = 0.460). The possibility of multi-tract and staged PNL, lower rate of stone clearance and longer postoperative hospital day increase for staghorn calculi with stone branch number more than 5.

Predicting emissions from oil and gas operations in the Uinta Basin, Utah.

PubMed

Wilkey, Jonathan; Kelly, Kerry; Jaramillo, Isabel Cristina; Spinti, Jennifer; Ring, Terry; Hogue, Michael; Pasqualini, Donatella

2016-05-01

In this study, emissions of ozone precursors from oil and gas operations in Utah's Uinta Basin are predicted (with uncertainty estimates) from 2015-2019 using a Monte-Carlo model of (a) drilling and production activity, and (b) emission factors. Cross-validation tests against actual drilling and production data from 2010-2014 show that the model can accurately predict both types of activities, returning median results that are within 5% of actual values for drilling, 0.1% for oil production, and 4% for gas production. A variety of one-time (drilling) and ongoing (oil and gas production) emission factors for greenhouse gases, methane, and volatile organic compounds (VOCs) are applied to the predicted oil and gas operations. Based on the range of emission factor values reported in the literature, emissions from well completions are the most significant source of emissions, followed by gas transmission and production. We estimate that the annual average VOC emissions rate for the oil and gas industry over the 2010-2015 time period was 44.2E+06 (mean) ± 12.8E+06 (standard deviation) kg VOCs per year (with all applicable emissions reductions). On the same basis, over the 2015-2019 period annual average VOC emissions from oil and gas operations are expected to drop 45% to 24.2E+06 ± 3.43E+06 kg VOCs per year, due to decreases in drilling activity and tighter emission standards. This study improves upon previous methods for estimating emissions of ozone precursors from oil and gas operations in Utah's Uinta Basin by tracking one-time and ongoing emission events on a well-by-well basis. The proposed method has proven highly accurate at predicting drilling and production activity and includes uncertainty estimates to describe the range of potential emissions inventory outcomes. If similar input data are available in other oil and gas producing regions, then the method developed here could be applied to those regions as well.

Quantifying exciton hopping in disordered media with quenching sites: Application to arrays of quantum dots

NASA Astrophysics Data System (ADS)

Miyazaki, Jun

2013-10-01

We present an analytical method for quantifying exciton hopping in an energetically disordered system with quenching sites. The method is subsequently used to provide a quantitative understanding of exciton hopping in a quantum dot (QD) array. Several statistical quantities that characterize the dynamics (survival probability, average number of distinct sites visited, average hopping distance, and average hopping rate in the initial stage) are obtained experimentally by measuring time-resolved fluorescence intensities at various temperatures. The time evolution of these quantities suggests in a quantitative way that at low temperature an exciton tends to be trapped at a local low-energy site, while at room temperature, exciton hopping occurs repeatedly, leading to a large hopping distance. This method will serve to facilitate highly efficient optoelectronic devices using QDs such as photovoltaic cells and light-emitting diodes, since exciton hopping is considered to strongly influence their operational parameters. The presence of a dark QD (quenching site) that exhibits fast decay is also quantified.

Vibration Signature Analysis of a Faulted Gear Transmission System

NASA Technical Reports Server (NTRS)

Choy, F. K.; Huang, S.; Zakrajsek, J. J.; Handschuh, R. F.; Townsend, D. P.

1994-01-01

A comprehensive procedure in predicting faults in gear transmission systems under normal operating conditions is presented. Experimental data was obtained from a spiral bevel gear fatigue test rig at NASA Lewis Research Center. Time synchronous averaged vibration data was recorded throughout the test as the fault progressed from a small single pit to severe pitting over several teeth, and finally tooth fracture. A numerical procedure based on the Winger-Ville distribution was used to examine the time averaged vibration data. Results from the Wigner-Ville procedure are compared to results from a variety of signal analysis techniques which include time domain analysis methods and frequency analysis methods. Using photographs of the gear tooth at various stages of damage, the limitations and accuracy of the various techniques are compared and discussed. Conclusions are drawn from the comparison of the different approaches as well as the applicability of the Wigner-Ville method in predicting gear faults.

The Cretaceous superchron geodynamo: Observations near the tangent cylinder

PubMed Central

Tarduno, John A.; Cottrell, Rory D.; Smirnov, Alexei V.

2002-01-01

If relationships exist between the frequency of geomagnetic reversals and the morphology, secular variation, and intensity of Earth's magnetic field, they should be best expressed during superchrons, intervals tens of millions of years long lacking reversals. Here we report paleomagnetic and paleointensity data from lavas of the Cretaceous Normal Polarity Superchron that formed at high latitudes near the tangent cylinder that surrounds the solid inner core. The time-averaged field recorded by these lavas is remarkably strong and stable. When combined with global results available from lower latitudes, these data define a time-averaged field that is overwhelmingly dominated by the axial dipole (octupole components are insignificant). These observations suggest that the basic features of the geomagnetic field are intrinsically related. Superchrons may reflect times when the nature of core–mantle boundary heat flux allows the geodynamo to operate at peak efficiency. PMID:12388778

Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons.

PubMed

Ichikawa, Nobuki; Homma, Shigenori; Yoshida, Tadashi; Ohno, Yosuke; Kawamura, Hideki; Kamiizumi, You; Iijima, Hiroaki; Taketomi, Akinobu

2018-01-01

The use of laparoscopic colectomy is becoming widespread and acquisition of its technique is challenging. In this study, we investigated whether supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons. The outcomes of 23 right colectomies and 19 high anterior resections for colon cancers performed by five novice surgeons (experience level of <10 cases) between 2014 and 2016 were assessed. A laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System (Japan Society for Endoscopic Surgery) participated in surgeries as the teaching assistant. In the right colectomy group, one patient (4.3%) required conversion to open surgery and postoperative morbidities occurred in two cases (8.6%). The operative time moving average gradually decreased from 216 to 150 min, and the blood loss decreased from 128 to 28 mL. In the CUSUM charts, the values for operative time decreased continuously after the 18th case, as compared to the Japanese standard. The values for blood loss also plateaued after the 18th case. In the high anterior resection group, one patient (5.2%) required conversion to open surgery and no postoperative complication occurred in any patient. The operative time moving average gradually decreased from 258 to 228 min, and the blood loss decreased from 33 to 18 mL. The CUSUM charts showed that the values of operative time plateaued after the 18th case, as compared to the Japanese standard. In the CUSUM chart for blood loss, no distinguishing peak or trend was noted. Supervision by a technically qualified surgeon affects the proficiency and safety of laparoscopic colectomy performed by novice surgeons. The trainee's learning curve in this study represents successful mentoring by the laparoscopic surgeon qualified by the Endoscopic Surgical Skill Qualification System.

Design, Development, and Evaluation of a Novel Retraction Device for Gallbladder Extraction During Laparoscopic Cholecystectomy

PubMed Central

Judge, Joshua M.; Stukenborg, George J.; Johnston, William F.; Guilford, William H.; Slingluff, Craig L.; Hallowell, Peter T.

2015-01-01

Background A source of frustration during laparoscopic cholecystectomy involves extraction of the gallbladder through port sites smaller than the gallbladder itself. We describe the development and testing of a novel device for the safe, minimal enlargement of laparoscopic port sites to extract large, stone-filled gallbladders from the abdomen. Methods The study device consists of a handle with a retraction tongue to shield the specimen and a guide for a scalpel to incise the fascia within the incision. Patients enrolled underwent laparoscopic cholecystectomy. Gallbladder extraction was attempted. If standard measures failed, the device was implemented. Extraction time and device utility scores were recorded for each patient. Patients returned 3 - 4 weeks post-operatively for assessment of pain level, cosmetic effect, and presence of infectious complications. Results Twenty (51%) of 39 patients required the device. Average extraction time for the first 8 patients was 120 seconds. After interim analysis, an improved device was used in twelve patients, and average extraction time was 24 seconds. There were no adverse events. Post-operative pain ratings and incision cosmesis were comparable between patients with and without use of the device. Conclusion The study device enables safe and rapid extraction of impacted gallbladders through the abdominal wall. PMID:23897085

Organizing the National Guard to Provide Effective Domestic Operations

DTIC Science & Technology

2011-12-01

NAVAL POSTGRADUATE SCHOOL MONTEREY, CALIFORNIA THESIS Approved for public release; distribution is unlimited ORGANIZING THE ...this collection of information is estimated to average 1 hour per response, including the time for reviewing instruction, searching existing data...sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden

Special Operations Forces Interagency Counterterrorism Reference Manual

DTIC Science & Technology

2009-03-01

information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering...and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other...Presidential Review Directives and Presidential Decision Directives (Clin- ton administration) and National Security Study Directives and National

Automated Chromium Plating Line for Gun Barrels

DTIC Science & Technology

1979-09-01

consistent pretreatments and bath dwell times. Some of the advantages of automated processing include increased productivity (average of 20^) due to...when automated processing procedures’ are used. The current method of applying chromium electrodeposits to gun tubes is a manual, batch operation...currently practiced with rotary swaged gun tubes would substantially reduce the difficulties in automated processing . RECOMMENDATIONS

Slowly changing potential problems in Quantum Mechanics: Adiabatic theorems, ergodic theorems, and scattering

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

Fishman, S., E-mail: fishman@physics.technion.ac.il; Soffer, A., E-mail: soffer@math.rutgers.edu

2016-07-15

We employ the recently developed multi-time scale averaging method to study the large time behavior of slowly changing (in time) Hamiltonians. We treat some known cases in a new way, such as the Zener problem, and we give another proof of the adiabatic theorem in the gapless case. We prove a new uniform ergodic theorem for slowly changing unitary operators. This theorem is then used to derive the adiabatic theorem, do the scattering theory for such Hamiltonians, and prove some classical propagation estimates and asymptotic completeness.

Design principles and algorithms for automated air traffic management

NASA Technical Reports Server (NTRS)

Erzberger, Heinz

1995-01-01

This paper presents design principles and algorithm for building a real time scheduler. The primary objective of the scheduler is to assign arrival aircraft to a favorable landing runway and schedule them to land at times that minimize delays. A further objective of the scheduler is to allocate delays between high altitude airspace far from the airport and low altitude airspace near the airport. A method of delay allocation is described that minimizes the average operating cost in the presence of errors in controlling aircraft to a specified landing time.

Influence of the operating parameters of the needle-plate electrostatic precipitator on the size distribution of aerosol particles

NASA Astrophysics Data System (ADS)

Arsenov, P. V.; Efimov, A. A.; Protas, N. V.; Ivanov, V. V.

2018-03-01

The influence of the operating parameters (voltage and aerosol flow rate) of the needle-plate electrostatic precipitator (NP-ESP) on the size distribution of aerosol particles has been studied. The NP-ESP consists of a needle and a plate located in the plastic tube used as aerosol transport duct. Alumina (Al2O3) particles were synthesized by a spark discharge and used as a test aerosol with a size range from 25 to 500 nm. It was found that the average particle size decreases with increasing voltage and aerosol flow rate through the NP-ESP. It was also found that the average particle size can be reduced more than in 2 times in comparison with the initial size distribution at a voltage and aerosol flow rate through the NP-ESP are equal to 16 kV and 250 l/min, respectively.

Post-operative pain following coblation or monopolar electrocautery tonsillectomy in children: a prospective, single-blinded, randomised comparison.

PubMed

Parker, N P; Walner, D L

2011-10-01

To compare post-operative pain following tonsillectomy by either coblation or monopolar electrocautery in children. A parallel-designed, prospective, single-blinded, randomised trial. Ambulatory surgical facility. Eighty otherwise healthy paediatric patients undergoing coblation or electrocautery tonsillectomy by a fellowship-trained paediatric otolaryngologist. (i) The number of post-operative days with severe pain based on subjective qualification by the caretaker, (ii) post-operative days with pain rated ≥ 5 on a scale of 1-10, (iii) post-operative days requiring oral paracetamol/acetaminophen with codeine solution and (iv) post-operative days until resumption of a regular diet were assessed and recorded daily using a post-operative pain survey as a form of daily diary that was returned at the 2-week follow-up visit. Patients were consecutively enrolled into two groups of 40 patients. Average ages were 5.2 years for coblation tonsillectomy and 6.0 years for electrocautery tonsillectomy. The average number of post-operative days with severe pain was 4.2 for coblation and 5.9 for electrocautery (P = 0.006), days rating pain ≥ 5 were 3.6 for coblation and 4.8 for electrocautery (P = 0.037), days of codeine use were 2.5 for coblation and 2.9 for electrocautery (P = 0.324), and days until resumption of a regular diet were 5.2 for coblation and 6.2 for electrocautery (0.329). Coblation tonsillectomy may reduce post-operative pain and the time until resumption of a regular diet compared to electrocautery tonsillectomy. © 2011 Blackwell Publishing Ltd.

Early Experience of Robotic Hysterectomy for Treatment of Benign Uterine Disease.

PubMed

Gutierrez, Ana Luiza; Binda, Márcia Luisa Montalvão Appel; Ramos, José Geraldo Lopes

2016-09-01

Objectives  To demonstrate the initial experience of robotic hysterectomy to treat benign uterine disease at a university hospital in Brazil. Methods  A cross-sectional study was conducted to review data from the first twenty patients undergoing robotic hysterectomy at our hospital. The surgeries were performed from November 2013 to August 2014, all of them by the same surgeon. The patients were reviewed for preoperative characteristics, including age, body mass index (BMI), indications for the hysterectomy and previous surgeries. Data of operative times, complications, postoperative pain and length of hospital stay were also collected. Results  The total operating room time was 252.9 minutes, while the operative time was 180.7 minutes and the console time was 136.6 minutes. Docking time was 4.2 minutes, and the average undocking time was 1.9 minutes. There was a strong correlation between the operative time and the patient's BMI ( r  = 0.670; p  = 0.001). The console time had significant correlation with the uterine weight and the patient's BMI ( r  = 0.468; p  = 0.037). A learning curve was observed during docking and undocking times. Conclusion  Despite its high cost, the robotic surgery is gaining more space in gynecological surgery. By the results obtained in our hospital, this surgical proposal proved to be feasible and safe. Our initial experience demonstrated a learning curve in some ways. Thieme Publicações Ltda Rio de Janeiro, Brazil.

Liquid-phase epitaxy grown PbSnTe distributed feedback laser diodes with broad continuous single-mode tuning range

NASA Technical Reports Server (NTRS)

Hsieh, H.-H.; Fonstad, C. G.

1980-01-01

Distributed feedback (DFB) pulsed laser operation has been demonstrated in stripe geometry Pb(1-x)Sn(x)Te double-heterostructures grown by liquid-phase epitaxy. The grating structure of 0.79 micron periodicity operates in first order near 12.8 microns and was fabricated prior to the liquid-phase epitaxial growth using holographic exposure techniques. These DFB lasers had moderate thresholds, 3.6 kA/sq cm, and the output power versus current curves exhibited a sharp turn-on free of kinks. Clean, single-mode emission spectra, continuously tunable over a range in excess of 20 per cm, centered about 780 per cm (12.8 microns), and at an average rate of 1.2 per cm-K from 9 to 26 K, were observed. While weaker modes could at times be seen in the spectrum, substantially single-mode operation was obtained over the entire operating range and to over 10 times threshold.

Simulator Evaluation of Airborne Information for Lateral Spacing (AILS) Concept

NASA Technical Reports Server (NTRS)

Abbott, Terence S.; Elliott, Dawn M.

2001-01-01

The Airborne Information for Lateral Spacing (AILS) concept is designed to support independent parallel approach operations to runways spaced as close as 2500 ft. This report describes the AILS operational concept and the results of a ground-based flight simulation experiment of one implementation of this concept. The focus of this simulation experiment was to evaluate pilot performance, pilot acceptability, and minimum miss-distances for the rare situation in which all aircraft oil one approach intrudes into the path of an aircraft oil the other approach. Results from this study showed that the design-goal mean miss-distance of 1200 ft to potential collision situations was surpassed with an actual mean miss-distance of 2236 ft. Pilot reaction times to the alerting system, which was an operational concern, averaged 1.11 sec, well below the design-goal reaction time 2.0 sec.These quantitative results and pilot subjective data showed that the AILS concept is reasonable from an operational standpoint.

Experimental determination of drift and PM10 cooling tower emissions: Influence of components and operating conditions.

PubMed

Ruiz, J; Kaiser, A S; Lucas, M

2017-11-01

Cooling tower emissions have become an increasingly common hazard to the environment (air polluting, ice formation and salts deposition) and to the health (Legionella disease) in the last decades. Several environmental policies have emerged in recent years limiting cooling tower emissions but they have not prevented an increasing intensity of outbreaks. Since the level of emissions depends mainly on cooling tower component design and the operating conditions, this paper deals with an experimental investigation of the amount of emissions, drift and PM 10 , emitted by a cooling tower with different configurations (drift eliminators and distribution systems) and working under several operating conditions. This objective is met by the measurement of cooling tower source emission parameters by means of the sensitive paper technique. Secondary objectives were to contextualize the observed emission rates according to international regulations. Our measurements showed that the drift rates included in the relevant international standards are significantly higher than the obtained results (an average of 100 times higher) and hence, the environmental problems may occur. Therefore, a revision of the standards is recommended with the aim of reducing the environmental and human health impact. By changing the operating conditions and the distribution system, emissions can be reduced by 52.03% and 82% on average. In the case of drift eliminators, the difference ranges from 18.18% to 98.43% on average. As the emissions level is clearly influenced by operating conditions and components, regulation tests should be referred to default conditions. Finally, guidelines to perform emission tests and a selection criterion of components and conditions for the tested cooling tower are proposed. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Challenges in building a surgical obesity center].

PubMed

Fischer, L; El Zein, Z; Bruckner, T; Hünnemeyer, K; Rudofsky, G; Reichenberger, M; Schommer, K; Gutt, C N; Büchler, M W; Müller-Stich, B P

2014-04-01

It is estimated that approximately 1 million adults in Germany suffer from grade III obesity. The aim of this article is to describe the challenges faced when constructing an operative obesity center. The inflow of patients as well as personnel and infrastructure of the interdisciplinary Diabetes and Obesity Center in Heidelberg were analyzed. The distribution of continuous data was described by mean values and standard deviation and analyzed using variance analysis. The interdisciplinary Diabetes and Obesity Center in Heidelberg was founded in 2006 and offers conservative therapeutic treatment and all currently available operative procedures. For every operative intervention carried out an average of 1.7 expert reports and 0.3 counter expertises were necessary. The time period from the initial presentation of patients in the department of surgery to an operation was on average 12.8 months (standard deviation SD ± 4.5 months). The 47 patients for whom remuneration for treatment was initially refused had an average body mass index (BMI) of 49.2 kg/m(2) and of these 39 had at least the necessity for treatment of a comorbidity. Of the 45 patients for whom the reason for the refusal of treatment costs was given as a lack of conservative treatment, 30 had undertaken a medically supervised attempt at losing weight over at least 6 months. Additionally, 19 of these patients could document participation in a course at a rehabilitation center, a Xenical® or Reduktil® therapy or had undertaken the Optifast® program. For the 20 patients who supposedly lacked a psychosomatic evaluation, an adequate psychosomatic evaluation was carried out in all cases. The establishment of an operative obesity center can last for several years. A essential prerequisite for success seems to be the constructive and targeted cooperation with the health insurance companies.

Measurements of the Time-Averaged and Instantaneous Induced Velocities in the Wake of a Helicopter Rotor Hovering at High Tip Speeds

NASA Technical Reports Server (NTRS)

Heyson, Harry H.

1960-01-01

Measurements of the time-averaged induced velocities were obtained for rotor tip speeds as great as 1,100 feet per second (tip Mach number of 0.98) and measurements of the instantaneous induced velocities were obtained for rotor tip speeds as great as 900 feet per second. The results indicate that the small effects on the wake with increasing Mach number are primarily due to the changes in rotor-load distribution resulting from changes in Mach number rather than to compressibility effects on the wake itself. No effect of tip Mach number on the instantaneous velocities was observed. Under conditions for which the blade tip was operated at negative pitch angles, an erratic circulatory flow was observed.

40 CFR 63.846 - Emission averaging.

Code of Federal Regulations, 2014 CFR

2014-07-01

... averaging. (a) General. The owner or operator of an existing potline or anode bake furnace in a State that... by total aluminum production. (c) Anode bake furnaces. The owner or operator may average TF emissions from anode bake furnaces and demonstrate compliance with the limits in Table 3 of this subpart using...

40 CFR 63.846 - Emission averaging.

Code of Federal Regulations, 2012 CFR

2012-07-01

... averaging. (a) General. The owner or operator of an existing potline or anode bake furnace in a State that... by total aluminum production. (c) Anode bake furnaces. The owner or operator may average TF emissions from anode bake furnaces and demonstrate compliance with the limits in Table 3 of this subpart using...

40 CFR 63.846 - Emission averaging.

Code of Federal Regulations, 2010 CFR

2010-07-01

... averaging. (a) General. The owner or operator of an existing potline or anode bake furnace in a State that... by total aluminum production. (c) Anode bake furnaces. The owner or operator may average TF emissions from anode bake furnaces and demonstrate compliance with the limits in Table 3 of this subpart using...

40 CFR 63.846 - Emission averaging.

Code of Federal Regulations, 2013 CFR

2013-07-01

... averaging. (a) General. The owner or operator of an existing potline or anode bake furnace in a State that... by total aluminum production. (c) Anode bake furnaces. The owner or operator may average TF emissions from anode bake furnaces and demonstrate compliance with the limits in Table 3 of this subpart using...

40 CFR 63.846 - Emission averaging.

Code of Federal Regulations, 2011 CFR

2011-07-01

... averaging. (a) General. The owner or operator of an existing potline or anode bake furnace in a State that... by total aluminum production. (c) Anode bake furnaces. The owner or operator may average TF emissions from anode bake furnaces and demonstrate compliance with the limits in Table 3 of this subpart using...

Shear-wave splitting observations of mantle anisotropy beneath Alaska

NASA Astrophysics Data System (ADS)

Bellesiles, A. K.; Christensen, D. H.; Entwistle, E.; Litherland, M.; Abers, G. A.; Song, X.

2009-12-01

Observations of seismic anisotropy were obtained from three different PASSCAL broadband experiments throughout Alaska, using shear-wave splitting from teleseismic SKS phases. The MOOS (Multidisciplinary Observations Of Subduction), BEAAR (Broadband Experiment Across the Alaska Range), and ARCTIC (Alaska Receiving Cross-Transects for the Inner Core) networks were used along with selected permanent broadband stations operated by AEIC (Alaska Earthquake Information Center) to produce seismic anisotropy results for the state of Alaska along a north south transect from the active subduction zone in the south, through continental Alaska, to the passive margin in the north. The BEAAR network is in-between the ARCTIC and MOOS networks above the subducting Pacific Plate and mantle wedge and shows a tight ~90 degree rotation of anisotropy above the 70km contour of the subducting plate. The southern stations in BEAAR yield anisotropy results that are subparallel to the Pacific Plate motion as it subducts under North America. These stations have an average fast direction of -45 degrees and 1.03 seconds of delay on average. The MOOS network in south central Alaska yielded similar results with an average fast direction of -30 degrees and delay times of .9 seconds. In the north portion of the BEAAR network the anisotropy is along strike of the subduction zone and has an average fast direction of 27 degrees with an average delay time of 1.4 seconds, although the delay times above the mantle wedge range from 1 to 2.5 seconds and are directly correlated to the length of ray path in the mantle wedge. This general trend NE/SW is seen in the ARCTIC stations to the north although the furthest north stations are oriented more NNE compared to those in BEAAR. The average fast direction for the ARCTIC network is 40 degrees with an average delay time of 1.05 seconds. These results show two distinct orientations of anisotropy in Alaska separated by the subducting Pacific Plate.

No Correlation Between Work-Hours and Operative Volumes--A Comparison Between United States and Danish Operative Volumes Achieved During Surgical Residency.

PubMed

Kjærgaard, Jane; Sillesen, Martin; Beier-Holgersen, Randi

2016-01-01

Since 2003, United States residents have been limited to an 80-hour workweek. This has prompted concerns of reduced educational quality, especially inadequate operating exposure. In contrast, the Danish surgical specialty-training program mandates a cap on working hours of 37 per week. We hypothesize that there is no direct correlation between work-hours and operative volume achieved during surgical residency. To test the hypothesis, we compare Danish and US operative volumes achieved during surgical residency training. Retrospective comparative study. The data from the US population was extracted from the Accreditation Council for Graduate Medical Education database for General Surgery residents from 2012 to 2013. For Danish residents, a questionnaire with case categories matching the Accreditation Council for Graduate Medical Education categories were sent to all Danish surgeons graduating the national surgical residency program in 2012 or 2013, 54 in total. In all, 30 graduated residents (55%) responded to the Danish survey. We found no significant differences in mean total major procedures (1002.4 vs 976.9, p = 0.28) performed during residency training, but comparing average major procedures per year, the US residents achieve significantly more (132.3 vs 195.4, p <0.01). When factoring in differences in time spent in training, this amounts to a weekly average difference of 1.2 cases throughout training. In this study, we find no difference in overall surgical volumes between Danes and US residents during their surgical training. When time in training was accounted for, differences between weekly surgical volumes achieved were minor, indicating a lack of direct correlation between weekly work-hours and operative volumes achievable. Factors other than work-hours seem to effect on operative volumes achieved during training. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Efficacy of Gastrografin® Compared with Standard Conservative Treatment in Management of Adhesive Small Bowel Obstruction at Mulago National Referral Hospital

PubMed Central

Haule, Caspar; Ongom, Peter A; Kimuli, Timothy

2013-01-01

Introduction The treatment of adhesive small bowel obstruction is controversial, with both operative and non-operative management practiced in different centers worldwide. Non-operative management is increasingly getting popular, though operative rates still remain high. A study to compare the efficacy of an oral water-soluble medium (Gastrografin®) with standard conservative management, both non-operative methods, in the management of this condition was conducted in a tertiary Sub Saharan hospital. Methods An open randomised controlled clinical trial was conducted between September 2012 and March 2013 at Mulago National Referral and Teaching Hospital, Uganda. Fifty patients of both genders, with adhesive small bowel obstruction, in the hospital’s emergency and general surgical wards were included. Randomisation was to Gastrografin® and standard conservative treatment groups. The primary outcomes were: the time interval between admission and relief of obstruction, the length of hospital stay, and the rates of operative surgery. Results All 50 recruited patients were followed up and analysed; 25 for each group. In the Gastrografin® group, 22 (88%) patients had relief of obstruction following the intervention, with 3 (12%) requiring surgery. The conservative treatment group had 16 (64%) patients relieved of obstruction conservatively, and 9 (36%) required surgery. The difference in operative rates between the two groups was not statistically significance (P = 0.67). Average time to relief of obstruction was shorter in the Gastrografin® group (72.52 hrs) compared to the conservative treatment group (117.75 hrs), a significant difference (P = 0.023). The average length of hospital stay was shorter in the Gastrografin® group (5.62 days) compared to the conservative treatment group (10.88 days), a significant difference (P = 0.04). Conclusion The use of Gastrografin® in patients with adhesive small bowel obstruction helps in earlier resolution of obstruction and reduces the length of hospital stay compared with standard conservative management. Its role in reducing the rate of laparotomies remains inconclusive. PMID:24729947

Efficacy of Gastrografin® Compared with Standard Conservative Treatment in Management of Adhesive Small Bowel Obstruction at Mulago National Referral Hospital.

PubMed

Haule, Caspar; Ongom, Peter A; Kimuli, Timothy

2013-12-01

The treatment of adhesive small bowel obstruction is controversial, with both operative and non-operative management practiced in different centers worldwide. Non-operative management is increasingly getting popular, though operative rates still remain high. A study to compare the efficacy of an oral water-soluble medium (Gastrografin ® ) with standard conservative management, both non-operative methods, in the management of this condition was conducted in a tertiary Sub Saharan hospital. An open randomised controlled clinical trial was conducted between September 2012 and March 2013 at Mulago National Referral and Teaching Hospital, Uganda. Fifty patients of both genders, with adhesive small bowel obstruction, in the hospital's emergency and general surgical wards were included. Randomisation was to Gastrografin ® and standard conservative treatment groups. The primary outcomes were: the time interval between admission and relief of obstruction, the length of hospital stay, and the rates of operative surgery. All 50 recruited patients were followed up and analysed; 25 for each group. In the Gastrografin ® group, 22 (88%) patients had relief of obstruction following the intervention, with 3 (12%) requiring surgery. The conservative treatment group had 16 (64%) patients relieved of obstruction conservatively, and 9 (36%) required surgery. The difference in operative rates between the two groups was not statistically significance ( P = 0.67 ). Average time to relief of obstruction was shorter in the Gastrografin ® group (72.52 hrs) compared to the conservative treatment group (117.75 hrs), a significant difference ( P = 0.023 ). The average length of hospital stay was shorter in the Gastrografin ® group (5.62 days) compared to the conservative treatment group (10.88 days), a significant difference ( P = 0.04 ). The use of Gastrografin ® in patients with adhesive small bowel obstruction helps in earlier resolution of obstruction and reduces the length of hospital stay compared with standard conservative management. Its role in reducing the rate of laparotomies remains inconclusive.

Analysis of the learning curve for peroral endoscopic myotomy for esophageal achalasia: Single-center, two-operator experience.

PubMed

Lv, Houning; Zhao, Ningning; Zheng, Zhongqing; Wang, Tao; Yang, Fang; Jiang, Xihui; Lin, Lin; Sun, Chao; Wang, Bangmao

2017-05-01

Peroral endoscopic myotomy (POEM) has emerged as an advanced technique for the treatment of achalasia, and defining the learning curve is mandatory. From August 2011 to June 2014, two operators in our institution (A&B) carried out POEM on 35 and 33 consecutive patients, respectively. Moving average and cumulative sum (CUSUM) methods were used to analyze the POEM learning curve for corrected operative time (cOT), referring to duration of per centimeter myotomy. Additionally, perioperative outcomes were compared among distinct learning curve phases. Using the moving average method, cOT reached a plateau at the 29th case and at the 24th case for operators A and B, respectively. CUSUM analysis identified three phases: initial learning period (Phase 1), efficiency period (Phase 2) and mastery period (Phase 3). The relatively smooth state in the CUSUM graph occurred at the 26th case and at the 24th case for operators A and B, respectively. Mean cOT of distinct phases for operator A were 8.32, 5.20 and 3.97 min, whereas they were 5.99, 3.06 and 3.75 min for operator B, respectively. Eckardt score and lower esophageal sphincter pressure significantly decreased during the 1-year follow-up period. Data were comparable regarding patient characteristics and perioperative outcomes. This single-center study demonstrated that expert endoscopists with experience in esophageal endoscopic submucosal dissection reached a plateau in learning of POEM after approximately 25 cases. © 2016 Japan Gastroenterological Endoscopy Society.

Reconstructive operations for the upper limb after brachial plexus palsy.

PubMed

Rühmann, Oliver; Schmolke, Stephan; Bohnsack, Michael; Carls, Jörg; Flamme, Christian; Wirth, Carl Joachim

2004-07-01

Limited function due to paralysis following brachial plexus lesions can be improved by secondary operations of the bony and soft tissue. Between April 1994 and December 2000, 109 patients suffering from arm-plexus lesions underwent a total of 144 reconstructive operations guided by our concept of integrated therapy. The average age at the time of surgery was 32 years (range: 15-59). The following operations were performed: shoulder arthrodesis (23), trapezius transfer (74), rotation osteotomy of humerus (9), triceps to biceps transposition (9), transposition of forearm flexors or extensors (8), latissimus transfer (7), pectoralis transfer (1), teres major transfer (1), transposition of flexor carpi ulnaris to the tendons of extensor digitorum (10), and wrist arthrodesis (2). Prospectively, in all patients, the grade of muscle power of the affected upper extremity was evaluated prior to surgery. The follow-up period for all 144 operations was, on average, 22 months (range: 6-74). By means of operative measures, almost all patients obtained an improvement of shoulder function (100%) and stability (>90%), elbow flexion (85%), and hand, finger, and thumb (100%). When muscles malfunction after brachial plexus lesions, one should take into account the individual neuromuscular defect, passive joint function, and bony deformities; different procedures such as muscle transpositions, arthrodeses, and corrective osteotomies can then be performed to improve function of the upper extremity. Each form of operative treatment presents patients with certain benefits and all are integrated into a total treatment plan for the affected extremity.

Crew factors in flight operations VII : psychophysiological responses to overnight cargo operations

DOT National Transportation Integrated Search

1996-02-01

To document the psychophysiological effects of flying overnight cargo operations, 41 B-727 crew members (average age 38 yr) were monitored before, during, and after one of two typical 8-day trip patterns. During daytime layovers, the average sleep ep...

Laparoscopic pancreaticoduodenectomy: a descriptive and comparative review.

PubMed

Merkow, Justin; Paniccia, Alessandro; Edil, Barish H

2015-08-01

Laparoscopic pancreaticoduodenectomy (LPD) is an extremely challenging surgery. First described in 1994, it has been slow to gain in popularity. Recently, however, we have seen an increase in the number of centers performing this operation, including our own institution, as well as an increase in the quantity of published data. The purpose of this review is to describe the current status of LPD as described in the literature. We performed a literature search in the PubMed database using MeSH terms "laparoscopy" and "pancreaticoduodenectomy". We then identified articles in the English language with over 20 patients that focused on LPD only. Review articles were excluded and only one article per institution was used for descriptive analysis in order to avoid overlap. There were a total of eight articles meeting review criteria, consisting of 492 patients. On descriptive analysis we found that percent of LPD due to high-grade malignancy averaged 47% over all articles. Average operative time was 452 minutes, blood loss 369 cc's, pancreatic leak rate 15%, delayed gastric emptying 8.6%, length of hospital stay 9.4 days, and short term mortality 2.3%. Comparison studies between open pancreaticoduodenectomy (OPD) and LPD suggested decreased blood loss, longer operative time, similar post-operative complication rate, decreased pain, and shorter hospital length of stay for LPD. There was also increased number of lymph nodes harvested and similar margin free resections with LPD in the majority of studies. LPD is a safe surgery, providing many of the advantages typically associated with laparoscopic procedures. We expect this operation to continue to gain in popularity as well as be offered in increasingly more complex cases. In future studies, it will be beneficial to look further at the oncologic outcome data of LPD including survival.

Laparoscopic pancreaticoduodenectomy: a descriptive and comparative review

PubMed Central

Merkow, Justin; Paniccia, Alessandro

2015-01-01

Laparoscopic pancreaticoduodenectomy (LPD) is an extremely challenging surgery. First described in 1994, it has been slow to gain in popularity. Recently, however, we have seen an increase in the number of centers performing this operation, including our own institution, as well as an increase in the quantity of published data. The purpose of this review is to describe the current status of LPD as described in the literature. We performed a literature search in the PubMed database using MeSH terms “laparoscopy” and “pancreaticoduodenectomy”. We then identified articles in the English language with over 20 patients that focused on LPD only. Review articles were excluded and only one article per institution was used for descriptive analysis in order to avoid overlap. There were a total of eight articles meeting review criteria, consisting of 492 patients. On descriptive analysis we found that percent of LPD due to high-grade malignancy averaged 47% over all articles. Average operative time was 452 minutes, blood loss 369 cc’s, pancreatic leak rate 15%, delayed gastric emptying 8.6%, length of hospital stay 9.4 days, and short term mortality 2.3%. Comparison studies between open pancreaticoduodenectomy (OPD) and LPD suggested decreased blood loss, longer operative time, similar post-operative complication rate, decreased pain, and shorter hospital length of stay for LPD. There was also increased number of lymph nodes harvested and similar margin free resections with LPD in the majority of studies. LPD is a safe surgery, providing many of the advantages typically associated with laparoscopic procedures. We expect this operation to continue to gain in popularity as well as be offered in increasingly more complex cases. In future studies, it will be beneficial to look further at the oncologic outcome data of LPD including survival. PMID:26361406

Serial office-based steroid injections for treatment of idiopathic subglottic stenosis.

PubMed

Hoffman, Matthew R; Coughlin, Adam R; Dailey, Seth H

2017-11-01

Current treatment options for idiopathic subglottic stenosis include endoscopic interventions, resection, and tracheotomy. Recently, serial office-based steroid injections were proposed as an alternative that may stabilize or induce regression of airway stenosis without the need for repeated operations. Procedure completion rate, pain, complications, effect on stenosis, time since the last operation, and limitations have not been described. Retrospective case series. Retrospective series of 19 patients undergoing serial office-based steroid injection for idiopathic subglottic stenosis. Outcome measures included completion rate, procedure-related pain scores, complications, percentage of airway stenosis, and time since the last operative intervention. Procedure completion rate was 98.8%. Average pain score during the procedure was 2.3 ± 1.7 on a 10-point scale. There were no immediate complications. One patient underwent awake tracheotomy 8 days after her second injection and was later decannulated. Average stenosis decreased from 35% ± 15% to 25% ± 15% (n = 16; P = .086) over the first of three injections and 40% ± 15% to 25% ± 10% to 20% ± 10% (n = 8; P = .002) for those patients completing two sets of three injections. Fourteen of 17 patients undergoing at least three injections have not returned to the operating room since the first injection. Office-based steroid injection represents a promising new treatment pathway for a disease that requires long-term management, offering a purely pharmacologic approach to a disorder that has traditionally been approached from a mechanical perspective. It is safe, well tolerated, and effective. Furthermore, it may help patients and physicians avoid repeated trips to the operating room and the associated risks. 4. Laryngoscope, 127:2475-2481, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Failed Surgical Management of Acute Proximal Fifth Metatarsal (Jones) Fractures: A Retrospective Case Series and Literature Review.

PubMed

Granata, Jaymes D; Berlet, Gregory C; Philbin, Terrence M; Jones, Grant; Kaeding, Christopher C; Peterson, Kyle S

2015-12-01

Nonunion, delayed union, and refracture after operative treatment of acute proximal fifth metatarsal fractures in athletes is uncommon. This study was a failure analysis of operatively managed acute proximal fifth metatarsal fractures in healthy athletes. We identified 149 patients who underwent operative treatment for fifth metatarsal fractures. Inclusion criteria isolated skeletally mature, athletic patients under the age of 40 with a minimum of 1-year follow-up. Patients were excluded with tuberosity fractures, fractures distal to the proximal metaphyseal-diaphyseal region of the fifth metatarsal, multiple fractures or operative procedures, fractures initially treated conservatively, and medical comorbidities/risk factors for nonunion. Fifty-five patients met the inclusion/exclusion criteria. Four (7.3%) patients required a secondary operative procedure due to refracture. The average time to refracture was 8 months. All refractures were associated with bent screws and occurred in male patients who participated in professional basketball, professional volleyball, and college football. The average time for release to progressive weight-bearing was 6 weeks. Three patients were revised to a bigger size screw and went on to union. One patient was revised to the same-sized screw and required a second revision surgery for nonunion. All failures were refractures in competitive athletes who were initially treated with small diameter solid or cannulated stainless steel screws. The failures were not associated with early postoperative weight-bearing protocol. Maximizing initial fixation stiffness may decrease the late failure rate in competitive athletes. More clinical studies are needed to better understand risk factors for failure after screw fixation in the competitive, athletic population. Prognostic, Level IV: Case series. © 2015 The Author(s).

[Modified stapled transanal rectal resection combined with perioperative pelvic floor biofeedback therapy in the treatment of obstructed defecation syndrome].

PubMed

Chen, Lei; Meng, Fanqi; Zhang, Tongsen; Liu, Yinan; Sha, Shuang; Chen, Si; Tai, Jiandong

2017-05-25

To investigate the clinical efficacy and safety of modified stapled transanal rectal resection (STARR) combined with perioperative pelvic floor biofeedback therapy (POPFBFT) in treating obstructed defecation syndrome (ODS). Thirty female ODS patients underwent modified STARR (resection and suture was performed in rectocele with one staple) combined with POPFBFT in Department of Colorectal and Anal Surgery, The First Hospital of Jilin university from October 2013 to March 2015. Before the modified STARR, patients received a course of POPFBFT (20 min/time, 2 times/d, 10 times as a course), and another 2 courses were carried out in clinic after discharge. Efficacy evaluation included general conditions of patients, morbidity of postoperative complication, overall subjective satisfaction (excellent: without any symptoms; good: 1 to 2 times of laxatives per month and without the need of any other auxiliary defecation; fairly good: more than 3 times of laxatives per month ; poor: with no improvement; excellent, good, fairly good are defined as effective), Longo ODS score (range 0 to 40 points, the higher the score, the more severe the symptoms), gastrointestinal quality of life index(GIQLI)(range 0 to 144 points, the lower the score, the more severe the symptoms), anorectal manometry and defecography examination. The follow-up lasted 12 months after operation (ended at April 2016). Average age of 30 patients was 57(46 to 72) years and Longo ODS score of every patient was ≥9 before operation. The modified STARR was completed successfully in all the 30 patients with average operation time of 25 (18 to 34) min and average hospital stay of 6(4 to 9) d. Postoperative complications included pain(20%, 6/30), urinary retention (16.7%, 5/30), anorectal heaviness (6.7%, 2/30), and fecal urgency(26.7%, 8/30). Anaorectal heaviness and fecal urgency disappeared within 3 months. No severe complications, such as postoperative bleeding, infection, rectovaginal fistula, anastomotic dehiscence and anal incontinence were observed. The effective rate of overall subjective satisfaction was 93.3%(28/30) during the follow-up of 12 months. There was no significant difference in Longo ODS score between pre- POPFBFT and pre-operation (pre- POPFBFT: 32.95±3.22, pre-operation: 32.85±3.62, t=1.472, P=0.163). Compared with pre-POPFBFT, Longo ODS score at 1 week after operation decreased (t=4.306, P=0.000), moreover, score at 1 month after operation was lower than that at 1 week (13.05±7.49 vs. 15.00±7.17, t=7.322, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation (F=2.111, P=0.107). Likewise, there was no significant difference in GIQLI score between pre-POPFBFT and pre-operation (pre-POPFBFT: 79.39±17.14, pre-operation: 76.65±17.56, t=1.735, P=0.096). Compared with the pre-POPFBFT, GIQLI score at 1 week after operation increased (t=4.714, P=0.000), moreover, GIQLI score at 1 month after operation was higher than that at 1 week (102.26±19.24 vs 91.31±21.35, t=5.628, P=0.000), while no significant differences were found among 1, 3, 6, 12 months after operation(F=1.211, P=0.313). In comparison with pre- POPFBFT, parameters of defecography examination at 12 months after operation showed obvious improvement: the rectocele decreased from (34.1±0.4) mm to (3.1±0.3) mm (t=6.847, P=0.000), anorectal angle during defecation increased from (123.8±6.7)degree to (134.7±8.5)degree, enlargement of anorectal angle during defecation increased from (29.1±3.5)degree to (37.1±5.3)degree, while no significant differences in descend of perineum, anorectal angles at rest as well as parameters of anorectal manometry were found (all P>0.05). Modified STARR combined with POPFBFT is safe and effective for ODS patients.

Vacuum-assisted closure device as a split-thickness skin graft bolster in the burn population.

PubMed

Waltzman, Joshua T; Bell, Derek E

2014-01-01

The vacuum-assisted closure device (VAC) is associated with improved wound healing outcomes. Its use as a bolster device to secure a split-thickness skin graft has been previously demonstrated; however, there is little published evidence demonstrating its benefits specifically in the burn population. With use of the VAC becoming more commonplace, its effect on skin graft take and overall time to healing in burn patients deserves further investigation. Retrospective review of burn registry database at a high-volume level I trauma center and regional burn center during a 16-month period was performed. Patients who had a third-degree burn injury requiring a split-thickness skin graft and who received a VAC bolster were included. Data points included age, sex, burn mechanism, burn location, grafted area in square centimeters, need for repeat grafting, percent graft take, and time to complete reepithelialization. Sixty-seven patients were included in the study with a total of 88 skin graft sites secured with a VAC. Age ranged from <1 year to 84 years (average 41 years). The average grafted area was 367 ± 545 cm. The three most common were the leg, thigh, and arm (28, 15, and 12%, respectively). Average percent graft take was 99.5 ± 1.5%. Notably, no patients returned to the operating room for repeat grafting. The average time to complete reepithelialization was 16 ± 7 days. The VAC is a highly reliable and reproducible method to bolster a split-thickness skin graft in the burn population. The observed rate of zero returns to the operating room for repeat grafting was especially encouraging. Its ability to conform to contours of the body and cover large surface areas makes it especially useful in securing a graft. This method of bolstering results in decreased repeat grafting and minimal graft loss, thus decreasing morbidity compared with conventional bolster dressings.

[A long-term follow-up of treatment of adult unicameral bone cysts with allograft of lyophilized cancellous bone].

PubMed

Zhang, Yonggang; Wang, Yan; Cheng, Jiying

2005-08-01

To investigate the long-term clinical results of treatment of adult unicameral bone cyst with cancellous allograft. From 1993 to 1998, 15 patients with unicameral bone cyst were treated by allograft with lyophilized cancellous bone. Among 15 patients, there were 5 males and 10 females, aging 19-41 years with an average of 27 years. The average follow-up time was 7.5 years (6-11 years). The X-ray films were taken and the CT scanning were carried out. The X-ray films showed that the allograft particles became vague 2-3 months after operation, that the allograft particles fused and began to form new bone and the bone density increased 5 months after operation, and that new bone formation completed after 7 months of operation. At the end of follow-up, remodelling in new bone occurred. Recurrence was not found in all patients. The symptom of pain disappeared or relieved obviously. Allograft of lyophilized cancellous bone is an effective treatment for adult unicameral bone cysts.

[Clavicular hook plate combined with suture anchor for the treatment of type Tossy III chronic acromioclavicular dislocation].

PubMed

Xu, Zhi-Bin; Wang, Jin

2014-05-01

To observe the clinical effects of clavicular hook plate combined with suture anchor in treating type Tossy III chronic acromioclavicular dislocation. From January 2008 to December 2012,18 patients with type Tossy III chronic acromioclavicular dislocation were treated with clavicular hook plate and suture anchor. There were 12 males and 6 females, aged from 20 to 56 years old with an average of 31.5 years. Ten cases were left dislocation and 8 cases were right dislocation. Operation time was 3 weeks to 4 months after injury with a mean of 1.8 months. Functional exercise was adopted 2 weeks after operation. And Karlsson standard was used to evaluate curative effect. All patients were followed up for 6 to 24 months with an average of 16 months. According to Karlsson standard, 17 cases were excellent and 1 was poor. Clavicular hook plate combined with suture anchor can repair conoid ligament and trapezoid ligament in treating type Tossy III chronic acromioclavicular dislocation, and had advantages of simple operation, less trauma, stable fixation, it can obtain satisfactory effects.

The impact of operative time on complications after plastic surgery: a multivariate regression analysis of 1753 cases.

PubMed

Hardy, Krista L; Davis, Kathryn E; Constantine, Ryan S; Chen, Mo; Hein, Rachel; Jewell, James L; Dirisala, Karunakar; Lysikowski, Jerzy; Reed, Gary; Kenkel, Jeffrey M

2014-05-01

Little evidence within plastic surgery literature supports the precept that longer operative times lead to greater morbidity. The authors investigate surgery duration as a determinant of morbidity, with the goal of defining a clinically relevant time for increased risk. A retrospective chart review was conducted of patients who underwent a broad range of complex plastic surgical procedures (n = 1801 procedures) at UT Southwestern Medical Center in Dallas, Texas, from January 1, 2008 to January 31, 2012. Adjusting for possible confounders, multivariate logistic regression assessed surgery duration as an independent predictor of morbidity. To define a cutoff for increased risk, incidence of complications was compared among quintiles of surgery duration. Stratification by type of surgery controlled for procedural complexity. A total of 1753 cases were included in multivariate analyses with an overall complication rate of 27.8%. Most operations were combined (75.8%), averaging 4.9 concurrent procedures. Each hour increase in surgery duration was associated with a 21% rise in odds of morbidity (P < .0001). Compared with the first quintile of operative time (<2.0 hours), there was no change in complications until after 3.1 hours of surgery (odds ratio, 1.6; P = .017), with progressively greater odds increases of 3.1 times after 4.5 hours (P < .0001) and 4.7 times after 6.8 hours (P < .0001). When stratified by type of surgery, longer operations continued to be associated with greater morbidity. Surgery duration is an independent predictor of complications, with a significantly increased risk above 3 hours. Although procedural complexity undoubtedly affects morbidity, operative time should factor into surgical decision making.

Costs of disposable material in the operating room do not show high correlation with surgical time: Implications for hospital payment.

PubMed

Delo, Caroline; Leclercq, Pol; Martins, Dimitri; Pirson, Magali

2015-08-01

The objectives of this study are to analyze the variation of the surgical time and of disposable costs per surgical procedure and to analyze the association between disposable costs and the surgical time. The registration of data was done in an operating room of a 419 bed general hospital, over a period of three months (n = 1556 surgical procedures). Disposable material per procedure used was recorded through a barcode scanning method. The average cost (standard deviation) of disposable material is €183.66 (€183.44). The mean surgical time (standard deviation) is 96 min (63). Results have shown that the homogeneity of operating time and DM costs was quite good per surgical procedure. The correlation between the surgical time and DM costs is not high (r = 0.65). In a context of Diagnosis Related Group (DRG) based hospital payment, it is important that costs information systems are able to precisely calculate costs per case. Our results show that the correlation between surgical time and costs of disposable materials is not good. Therefore, empirical data or itemized lists should be used instead of surgical time as a cost driver for the allocation of costs of disposable materials to patients. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Review of a single surgeon's stapedotomy cases performed with a nickel titanium prosthesis over a 14-year period.

PubMed

Justicz, Natalie; Strickland, Kaitlyn F; Motamedi, Kevin K; Mattox, Douglas E

2017-04-01

Stapes surgery with a nickel titanium prosthesis is a safe and well-tolerated procedure that leads to a significant improvement in hearing outcomes. To identify the efficacy and safety of stapedotomy procedures performed with a nickel titanium prosthesis for patients with otosclerosis. A review of 431 unique stapedotomies performed over 14 years by a single surgeon at an academic tertiary care center yielded 312 cases with nickel titanium prosthesis that met inclusion criteria of otosclerosis diagnosis, initial surgery in operative ear, and presence of pre-operative and post-operative audiograms. Pure-tone averages (PTA) at baseline and 8 weeks after surgery were calculated over four frequencies; 0.5, 1, 2, and 4 kHz. Average air-bone gaps (ABG) were calculated from pre-operative and post-operative audiograms. Average pre-operative baseline PTA was 56.7 dB in the affected ear. Post-operative PTA was 30.1 dB, a 26.6 dB improvement. Initial average ABG was 29.7 dB, while post-operative ABG averaged 5.4 dB, a 24.2 dB improvement. Surgical success (closure of ABG within 10 dB) was achieved in 263 (84%) patients. Rate of surgical success was not correlated with age, gender, race, or affected ear. Complications included recurrent conductive hearing loss (14), progressive SNHL (4), and post-operative BPPV (3).

The effect of IVPCA morphine on post-hysterectomy bowel function.

PubMed

Chan, Kuang-Cheng; Cheng, Ya-Jung; Huang, Guang-Ta; Wen, Yuan-Jui; Lin, Chen-Jung; Chen, Li-Kuei; Sun, Wei-Zen

2002-06-01

Although morphine has been shown to induce bowel dysfunction in a dose-dependent fashion, in most relevant studies it was investigated in single bolus injection. Recently, intravenous morphine via patient-controlled analgesia (IVPCA) has been widely used to provide analgesia by divided bolus doses on patients' demand with satisfactory effects. This approach, by reducing the peak serum surge, largely resembles the pharmacokinetic and pharmacodynamic advantage of continuous infusion. There is yet no report on the investigation of its effect on post-operative bowel dysfunction. Fifty-one women who underwent abdominal total hysterectomy (ATH) due to uterine myoma were enrolled to investigate the association between the doses of morphine consumption by PCA and the time of first passage of flatus. In all patients morphine was administered intravenously via a PCA pump immediately after recovery from general anesthesia. We found that 49 out of 51 patients (96%) exhibited mild pain with IVPCA morphine. They had consumed an average dose of 16.9 mg morphine (range, 0-46 mg) upon the first passage of flatus which occurred 2036.4 min (average) post-operatively. There was no correlation between the dose of morphine and the time of first passage of flatus (r = 0.053, P > 0.05). The absence of suppression of bowel movement by IVPCA morphine for post-operative pain control suggests that favorable pharmacokinetic profile of IVPCA can help reduce the morphine-induced bowel dysfunction at its therapeutic level.

Operating characteristics of a hydrogen-argon plasma torch for supersonic combustion applications

NASA Technical Reports Server (NTRS)

Barbi, E.; Mahan, J. R.; O'Brien, W. F.; Wagner, T. C.

1989-01-01

The residence time of the combustible mixture in the combustion chamber of a scramjet engine is much less than the time normally required for complete combustion. Hydrogen and hydrocarbon fuels require an ignition source under conditions typically found in a scramjet combustor. Analytical studies indicate that the presence of hydrogen atoms should greatly reduce the ignition delay in this environment. Because hydrogen plasmas are prolific sources of hydrogen atoms, a low-power, uncooled hydrogen plasma torch has been built and tested to evaluate its potential as a possible flame holder for supersonic combustion. The torch was found to be unstable when operated on pure hydrogen; however, stable operation could be obtained by using argon as a body gas and mixing in the desired amount of hydrogen. The stability limits of the torch are delineated and its electrical and thermal behavior documented. An average torch thermal efficiency of around 88 percent is demonstrated.

Bridging the gap between peak and average loads on science networks

DOE PAGES

Nickolay, Sam; Jung, Eun -Sung; Kettimuthu, Rajkumar; ...

2017-05-12

Backbone networks are typically overprovisioned in order to support peak loads. Research and education networks (RENs), for example, are often designed to operate at 20–30% of capacity. Thus, Internet2 upgrades its backbone interconnects when the weekly 95th-percentile load is reliably above 30% of link capacity, and analysis of ESnet traffic between major laboratories shows a substantial gap between peak and average utilization. As science data volumes increase exponentially, it is unclear whether this overprovisioning trend can continue into the future. Even if overprovisioning is possible, it may not be the most cost-effective (and desirable) approach going forward. Under the currentmore » mode of free access to RENs, traffic at peak load may include both flows that need to be transferred in near-real time–for example, for computation and instrument monitoring and steering–and flows that are less time-critical, for example, archival and storage replication operations. Thus, peak load does not necessarily indicate the capacity that is absolutely required at that moment. We thus examine how data transfers are impacted when the average network load is increased while the network capacity is kept at the current levels. We also classify data transfers into on-demand (time-critical) and best-effort (less time-critical) and study the impact on both classes for different proportions of both the number of on-demand transfers and amount of bandwidth allocated for on-demand transfers. For our study, we use real transfer logs from production GridFTP servers to do simulation-based experiments as well as real experiments on a testbed. We find that when the transfer load is doubled and the network capacity is fixed at the current level, the gap between peak and average throughput decreases by an average of 18% in the simulation experiments and 16% in the testbed experiments, and the average slowdown experienced by the data transfers is under 1.5×. Moreover, when transfers are classified as on-demand or best-effort, on-demand transfers experience almost no slowdown and the mean slowdown experienced by best-effort transfers is under 2× in the simulation experiments and under 1.2× in the testbed experiments.« less

Bridging the gap between peak and average loads on science networks

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

Nickolay, Sam; Jung, Eun -Sung; Kettimuthu, Rajkumar

Backbone networks are typically overprovisioned in order to support peak loads. Research and education networks (RENs), for example, are often designed to operate at 20–30% of capacity. Thus, Internet2 upgrades its backbone interconnects when the weekly 95th-percentile load is reliably above 30% of link capacity, and analysis of ESnet traffic between major laboratories shows a substantial gap between peak and average utilization. As science data volumes increase exponentially, it is unclear whether this overprovisioning trend can continue into the future. Even if overprovisioning is possible, it may not be the most cost-effective (and desirable) approach going forward. Under the currentmore » mode of free access to RENs, traffic at peak load may include both flows that need to be transferred in near-real time–for example, for computation and instrument monitoring and steering–and flows that are less time-critical, for example, archival and storage replication operations. Thus, peak load does not necessarily indicate the capacity that is absolutely required at that moment. We thus examine how data transfers are impacted when the average network load is increased while the network capacity is kept at the current levels. We also classify data transfers into on-demand (time-critical) and best-effort (less time-critical) and study the impact on both classes for different proportions of both the number of on-demand transfers and amount of bandwidth allocated for on-demand transfers. For our study, we use real transfer logs from production GridFTP servers to do simulation-based experiments as well as real experiments on a testbed. We find that when the transfer load is doubled and the network capacity is fixed at the current level, the gap between peak and average throughput decreases by an average of 18% in the simulation experiments and 16% in the testbed experiments, and the average slowdown experienced by the data transfers is under 1.5×. Moreover, when transfers are classified as on-demand or best-effort, on-demand transfers experience almost no slowdown and the mean slowdown experienced by best-effort transfers is under 2× in the simulation experiments and under 1.2× in the testbed experiments.« less

Comparative analysis of operational forecasts versus actual weather conditions in airline flight planning: Summary report

NASA Technical Reports Server (NTRS)

Keitz, J. F.

1982-01-01

The impact of more timely and accurate weather data on airline flight planning with the emphasis on fuel savings is studied. This summary report discusses the results of each of the four major tasks of the study. Task 1 compared airline flight plans based on operational forecasts to plans based on the verifying analyses and found that average fuel savings of 1.2 to 2.5 percent are possible with improved forecasts. Task 2 consisted of similar comparisons but used a model developed for the FAA by SRI International that simulated the impact of ATc diversions on the flight plans. While parts of Task 2 confirm the Task I findings, inconsistency with other data and the known impact of ATC suggests that other Task 2 findings are the result of errors in the model. Task 3 compares segment weather data from operational flight plans with the weather actually observed by the aircraft and finds the average error could result in fuel burn penalties (or savings) of up to 3.6 percent for the average 8747 flight. In Task 4 an in-depth analysis of the weather forecast for the 33 days included in the study finds that significant errors exist on 15 days. Wind speeds in the area of maximum winds are underestimated by 20 to 50 kts., a finding confirmed in the other three tasks.

Cost effectiveness of the US Geological Survey stream-gaging program in Alabama

USGS Publications Warehouse

Jeffcoat, H.H.

1987-01-01

A study of the cost effectiveness of the stream gaging program in Alabama identified data uses and funding sources for 72 surface water stations (including dam stations, slope stations, and continuous-velocity stations) operated by the U.S. Geological Survey in Alabama with a budget of $393,600. Of these , 58 gaging stations were used in all phases of the analysis at a funding level of $328,380. For the current policy of operation of the 58-station program, the average standard error of estimation of instantaneous discharge is 29.3%. This overall level of accuracy can be maintained with a budget of $319,800 by optimizing routes and implementing some policy changes. The maximum budget considered in the analysis was $361,200, which gave an average standard error of estimation of 20.6%. The minimum budget considered was $299,360, with an average standard error of estimation of 36.5%. The study indicates that a major source of error in the stream gaging records is lost or missing data that are the result of streamside equipment failure. If perfect equipment were available, the standard error in estimating instantaneous discharge under the current program and budget could be reduced to 18.6%. This can also be interpreted to mean that the streamflow data records have a standard error of this magnitude during times when the equipment is operating properly. (Author 's abstract)

Reusable single-port access device shortens operative time and reduces operative costs.

PubMed

Shussman, Noam; Kedar, Asaf; Elazary, Ram; Abu Gazala, Mahmoud; Rivkind, Avraham I; Mintz, Yoav

2014-06-01

In recent years, single-port laparoscopy (SPL) has become an attractive approach for performing surgical procedures. The pitfalls of this approach are technical and financial. Financial concerns are due to the increased cost of dedicated devices and prolonged operating room time. Our aim was to calculate the cost of SPL using a reusable port and instruments in order to evaluate the cost difference between this approach to SPL using the available disposable ports and standard laparoscopy. We performed 22 laparoscopic procedures via the SPL approach using a reusable single-port access system and reusable laparoscopic instruments. These included 17 cholecystectomies and five other procedures. Operative time, postoperative length of stay (LOS) and complications were prospectively recorded and were compared with similar data from our SPL database. Student's t test was used for statistical analysis. SPL was successfully performed in all cases. Mean operative time for cholecystectomy was 72 min (range 40-116). Postoperative LOS was not changed from our standard protocols and was 1.1 days for cholecystectomy. The postoperative course was within normal limits for all patients and perioperative morbidity was recorded. Both operative time and length of hospital stay were shorter for the 17 patients who underwent cholecystectomy using a reusable port than for the matched previous 17 SPL cholecystectomies we performed (p < 0.001). Prices of disposable SPL instruments and multiport access devices as well as extraction bags from different manufacturers were used to calculate the cost difference. Operating with a reusable port ended up with an average cost savings of US$388 compared with using disposable ports, and US$240 compared with standard laparoscopy. Single-port laparoscopic surgery is a technically challenging and expensive surgical approach. Financial concerns among others have been advocated against this approach; however, we demonstrate herein that using a reusable port and instruments reduces operative time and overall operative costs, even beyond the cost of standard laparoscopy.

Two-Phase Helical Computed Tomography Study of Salivary Gland Warthin Tumors: A Radiologic Findings and Surgical Applications

PubMed Central

Joo, Yeon Hee; Kim, Jin Pyeong; Park, Jung Je

2014-01-01

Objectives The goal of this study was to define the radiologic characteristics of two-phase computed tomography (CT) of salivary gland Warthin tumors and to compare them to pleomorphic adenomas. We also aimed to provide a foundation for selecting a surgical method on the basis of radiologic findings. Methods We prospectively enrolled 116 patients with parotid gland tumors, who underwent two-phase CT preoperatively. Early and delayed phase scans were obtained, with scanning delays of 30 and 120 seconds, respectively. The attenuation changes and enhancement patterns were analyzed. In cases when the attenuation changes were decreased, we presumed Warthin tumor preoperatively and performed extracapsular dissection. When the attenuation changes were increased, superficial parotidectomy was performed on the parotid gland tumors. We analyzed the operation times, incision sizes, complications, and recurrence rates. Results Attenuation of Warthin tumors was decreased from early to delayed scans. The ratio of CT numbers in Warthin tumors was also significantly different from other tumors. Warthin tumors were diagnosed with a sensitivity of 96.1% and specificity of 97% using two-phase CT. The mean operation time was 38 minutes and the mean incision size was 36.2 mm for Warthin tumors. However, for the other parotid tumors, the average operation time was 122 minutes and the average incision size was 91.8 mm (P<0.05). Conclusion Salivary Warthin tumor has a distinct pattern of contrast enhancement on two-phase CT, which can guide treatment decisions. The preoperative diagnosis of Warthin tumor made extracapsular dissection possible instead of superficial parotidectomy. PMID:25177439

Two-phase helical computed tomography study of salivary gland warthin tumors: a radiologic findings and surgical applications.

PubMed

Joo, Yeon Hee; Kim, Jin Pyeong; Park, Jung Je; Woo, Seung Hoon

2014-09-01

The goal of this study was to define the radiologic characteristics of two-phase computed tomography (CT) of salivary gland Warthin tumors and to compare them to pleomorphic adenomas. We also aimed to provide a foundation for selecting a surgical method on the basis of radiologic findings. We prospectively enrolled 116 patients with parotid gland tumors, who underwent two-phase CT preoperatively. Early and delayed phase scans were obtained, with scanning delays of 30 and 120 seconds, respectively. The attenuation changes and enhancement patterns were analyzed. In cases when the attenuation changes were decreased, we presumed Warthin tumor preoperatively and performed extracapsular dissection. When the attenuation changes were increased, superficial parotidectomy was performed on the parotid gland tumors. We analyzed the operation times, incision sizes, complications, and recurrence rates. Attenuation of Warthin tumors was decreased from early to delayed scans. The ratio of CT numbers in Warthin tumors was also significantly different from other tumors. Warthin tumors were diagnosed with a sensitivity of 96.1% and specificity of 97% using two-phase CT. The mean operation time was 38 minutes and the mean incision size was 36.2 mm for Warthin tumors. However, for the other parotid tumors, the average operation time was 122 minutes and the average incision size was 91.8 mm (P<0.05). Salivary Warthin tumor has a distinct pattern of contrast enhancement on two-phase CT, which can guide treatment decisions. The preoperative diagnosis of Warthin tumor made extracapsular dissection possible instead of superficial parotidectomy.

Energy-efficient approach to minimizing the energy consumption in an extended job-shop scheduling problem

NASA Astrophysics Data System (ADS)

Tang, Dunbing; Dai, Min

2015-09-01

The traditional production planning and scheduling problems consider performance indicators like time, cost and quality as optimization objectives in manufacturing processes. However, environmentally-friendly factors like energy consumption of production have not been completely taken into consideration. Against this background, this paper addresses an approach to modify a given schedule generated by a production planning and scheduling system in a job shop floor, where machine tools can work at different cutting speeds. It can adjust the cutting speeds of the operations while keeping the original assignment and processing sequence of operations of each job fixed in order to obtain energy savings. First, the proposed approach, based on a mixed integer programming mathematical model, changes the total idle time of the given schedule to minimize energy consumption in the job shop floor while accepting the optimal solution of the scheduling objective, makespan. Then, a genetic-simulated annealing algorithm is used to explore the optimal solution due to the fact that the problem is strongly NP-hard. Finally, the effectiveness of the approach is performed smalland large-size instances, respectively. The experimental results show that the approach can save 5%-10% of the average energy consumption while accepting the optimal solution of the makespan in small-size instances. In addition, the average maximum energy saving ratio can reach to 13%. And it can save approximately 1%-4% of the average energy consumption and approximately 2.4% of the average maximum energy while accepting the near-optimal solution of the makespan in large-size instances. The proposed research provides an interesting point to explore an energy-aware schedule optimization for a traditional production planning and scheduling problem.

Minimally invasive plate osteosynthesis technique for displaced midshaft clavicular fracture using the clavicle reductor.

PubMed

Zhang, Tao; Chen, Wei; Sun, Jiayuan; Zhang, Qi; Zhang, Yingze

2017-08-01

This study aims to introduce a self-designed clavicle reductor and to test the effectivity of a alternative minimally invasive plate osteosynthesis technique (MIPO) for displaced midshaft clavicular fractures (DMCFs) with the application of our self-designed clavicle reductor. From October 2012 to February 2013, 27 male patients who suffered with unilateral displaced midshaft clavicular fracture (DMCFs) were included into our study. Patients were treated by minimally invasive plate osteosynthesis (MIPO) technique with the application of our self-designed clavicle reductor and followed up regularly. Constant-Murley score was employed to test the functional outcomes at one year's follow up. The average follow-up time for the 27 patients was 15.8 months (range, 13-18 months). The average age of all patients was 32.6 (range, 21 to 48). According to OTC system, 12 cases were simple fractures (15-B1), ten cases were wedge fractures (15-B2) and five cases were comminuted fractures (15-B3). With the application of the clavicle reductor, minimally invasive plate osteosynthesis technique can be performed without any barrier in all of the 27 cases. Operative duration was 48.1 minutes (range, 35-65 minutes) and average fluoroscopy time was 12.8 seconds (range, from 7 to 22 seconds). All of the 27 cases healed from four to six months post-operatively. The average Constant-Murley-score of the 27 patients was 92.7 ± 5.88 (range, 80 to 100). No complications were noted. The self-designed clavicle reductor can effectively pave the way for the application of MIPO technique in the treatment of DMCFs. MIPO technique with locking reconstruction plate is a feasible and worthwhile alternative for displaced midshaft clavicular fractures (DMCFs).

Operating Room Time Savings with the Use of Splint Packs: A Randomized Controlled Trial

PubMed Central

Gonzalez, Tyler A.; Bluman, Eric M.; Palms, David; Smith, Jeremy T.; Chiodo, Christopher P.

2016-01-01

Background: The most expensive variable in the operating room (OR) is time. Lean Process Management is being used in the medical field to improve efficiency in the OR. Streamlining individual processes within the OR is crucial to a comprehensive time saving and cost-cutting health care strategy. At our institution, one hour of OR time costs approximately $500, exclusive of supply and personnel costs. Commercially prepared splint packs (SP) contain all components necessary for plaster-of-Paris short-leg splint application and have the potential to decrease splint application time and overall costs by making it a more lean process. We conducted a randomized controlled trial comparing OR time savings between SP use and bulk supply (BS) splint application. Methods: Fifty consecutive adult operative patients on whom post-operative short-leg splint immobilization was indicated were randomized to either a control group using BS or an experimental group using SP. One orthopaedic surgeon (EMB) prepared and applied all of the splints in a standardized fashion. Retrieval time, preparation time, splint application time, and total splinting time for both groups were measured and statistically analyzed. Results: The retrieval time, preparation time and total splinting time were significantly less (p<0.001) in the SP group compared with the BS group. There was no significant difference in application time between the SP group and BS group. Conclusion: The use of SP made the process of splinting more lean. This has resulted in an average of 2 minutes 52 seconds saved in total splinting time compared to BS, making it an effective cost-cutting and time saving technique. For high volume ORs, use of splint packs may contribute to substantial time and cost savings without impacting patient safety. PMID:26894212

Climate Variation at Flagstaff, Arizona - 1950 to 2007

USGS Publications Warehouse

Hereford, Richard

2007-01-01

INTRODUCTION Much scientific research demonstrates the existence of recent climate variation, particularly global warming. Climate prediction models forecast that climate will change; it will become warmer, droughts will increase in number and severity, and extreme climate events will recur often?desiccating aridity, extremely wet, unusually warm, or even frigid at times. However, the global models apply to average conditions in large grids approximately 150 miles on an edge (Thorpe, 2005), and how or whether specific areas within a grid are affected is unclear. Flagstaff's climate is mentioned in the context of global change, but information is lacking on the amount and trend of changes in precipitation, snowfall, and temperature. The purpose of this report is to understand what may be happening to Flagstaff's climate by reviewing local climate history. Flagstaff is in north-central Arizona south of San Francisco Mountain, which reaches 12,633 feet, the highest in Arizona (fig. 1). At 6,900 feet, surrounded by ponderosa pine forest, Flagstaff enjoys a four-season climate; winter-daytime temperatures are cool, averaging 45 degrees (Fahrenheit). Summer-daytime temperatures are comfortable, averaging 80 degrees, which is pleasant compared with nearby low-elevation deserts. Flagstaff?s precipitation averages 22-inches per year with a range of 9 to 39 inches. Snowfall occurs each season, averaging 97 inches annually. This report, written for the non-technical reader, interprets climate variation at Flagstaff as observed at the National Weather Service (NWS) station at Pulliam Field (or Airport), a first-order weather station staffed by meteorologists (Staudenmaier and others, 2007). The station is on a flat-topped ridge surrounded by forest 5-miles south of Flagstaff at an elevation of 7,003 feet. Data used in this analysis are daily measurements of precipitation (including snowfall) and temperature (maximum and minimum) covering the period from 1950, when the station began operation, through spring 2007. Conversations with Byron Peterson and Michael Staudenmaier of the NWS helped us understand the difficulties of collecting consistent weather data, operation of the station, and Flagstaff's climate. Weather is the daily or even instantaneous state of temperature and precipitation. Climate is the average or accumulation of these parameters over longer time scales such as a week, month, or year. Seasonal (winter, spring, summer, and fall) and annual averages of temperature and accumulated precipitation describe the temporal variation of Flagstaff's climate, which is shown graphically with time series (figs. 2, 4, 6, 8-15). These plots show precipitation or temperature on the ordinate plotted against time on the abscissa, which is a year for annually repeating data or the year of a particular season. The plots reveal changing patterns of precipitation and temperature related to droughts, wet episodes, and rising temperatures.

Evaluation of the safety and usability of touch gestures in operating in-vehicle information systems with visual occlusion.

PubMed

Kim, Huhn; Song, Haewon

2014-05-01

Nowadays, many automobile manufacturers are interested in applying the touch gestures that are used in smart phones to operate their in-vehicle information systems (IVISs). In this study, an experiment was performed to verify the applicability of touch gestures in the operation of IVISs from the viewpoints of both driving safety and usability. In the experiment, two devices were used: one was the Apple iPad, with which various touch gestures such as flicking, panning, and pinching were enabled; the other was the SK EnNavi, which only allowed tapping touch gestures. The participants performed the touch operations using the two devices under visually occluded situations, which is a well-known technique for estimating load of visual attention while driving. In scrolling through a list, the flicking gestures required more time than the tapping gestures. Interestingly, both the flicking and simple tapping gestures required slightly higher visual attention. In moving a map, the average time taken per operation and the visual attention load required for the panning gestures did not differ from those of the simple tapping gestures that are used in existing car navigation systems. In zooming in/out of a map, the average time taken per pinching gesture was similar to that of the tapping gesture but required higher visual attention. Moreover, pinching gestures at a display angle of 75° required that the participants severely bend their wrists. Because the display angles of many car navigation systems tends to be more than 75°, pinching gestures can cause severe fatigue on users' wrists. Furthermore, contrary to participants' evaluation of other gestures, several participants answered that the pinching gesture was not necessary when operating IVISs. It was found that the panning gesture is the only touch gesture that can be used without negative consequences when operating IVISs while driving. The flicking gesture is likely to be used if the screen moving speed is slower or if the car is in heavy traffic. However, the pinching gesture is not an appropriate method of operating IVISs while driving in the various scenarios examined in this study. Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Accelerated Testing and Preventive Maintenance in Acquisition, Maintenance and Operation of Vehicle Systems using Time-Dependent Reliability/Durability Principles

DTIC Science & Technology

2011-05-24

1 ARC 5/24/2011 UNCLASSIFIED: Distribution Statement A. Approved for public release Amandeep Singh1, Igor Baseski1,2 1U.S. Army, RDECOM TARDEC...of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering...currently valid OMB control number. 1 . REPORT DATE 24 MAY 2011 2. REPORT TYPE Briefing Charts 3. DATES COVERED 24-05-2011 to 24-05-2011 4. TITLE

High speed clinical data retrieval system with event time sequence feature: with 10 years of clinical data of Hamamatsu University Hospital CPOE.

PubMed

Kimura, M; Tani, S; Watanabe, H; Naito, Y; Sakusabe, T; Watanabe, H; Nakaya, J; Sasaki, F; Numano, T; Furuta, T; Furuta, T

2008-01-01

This paper illustrates a high speed clinical data retrieving system, from 10 years of data of operating hospital information system for the purposes of research, evidence creation, patient safety, etc., even incorporating time sequence of causal relations. Total of 73,709,298 records of 10 years at Hamamatsu University Hospital (as of June 2008) are sent from HIS to retrieval system in HL7 v2.5 format. Hierarchical variable length database is used to install them. A search for "listing patients who were prescribed Pravastatin (Mevalotin and generic drugs, any titer)" took 1.92 seconds. "Pravastatin (any) prescribed and recorded AST >150 within two weeks" took 112.22 seconds. Searching conditions can be set to be more complex, connected by Boolean operator and/or. This system called D*D is in operation at Hamamatsu University Hospital since August 2002. It is used for 48,518 times (monthly average of 703 searches). Neither searching, nor background export of data from HIS caused delay of routine operating CPOE. Search database outside of routine operating CPOE, with daily export of order data in HL7 v2.5 format, is proved to provide excellent search environment without causing trouble. Hierarchical representation gives high-speed search response, especially with time sequence of events.

Fiber-based tunable repetition rate source for deep tissue two-photon fluorescence microscopy.

PubMed

Charan, Kriti; Li, Bo; Wang, Mengran; Lin, Charles P; Xu, Chris

2018-05-01

Deep tissue multiphoton imaging requires high peak power to enhance signal and low average power to prevent thermal damage. Both goals can be advantageously achieved through laser repetition rate tuning instead of simply adjusting the average power. We show that the ideal repetition rate for deep two-photon imaging in the mouse brain is between 1 and 10 MHz, and we present a fiber-based source with an arbitrarily tunable repetition rate within this range. The performance of the new source is compared to a mode-locked Ti:Sapphire (Ti:S) laser for in vivo imaging of mouse brain vasculature. At 2.5 MHz, the fiber source requires 5.1 times less average power to obtain the same signal as a standard Ti:S laser operating at 80 MHz.

Inflow forecasting model construction with stochastic time series for coordinated dam operation

NASA Astrophysics Data System (ADS)

Kim, T.; Jung, Y.; Kim, H.; Heo, J. H.

2014-12-01

Dam inflow forecasting is one of the most important tasks in dam operation for an effective water resources management and control. In general, dam inflow forecasting with stochastic time series model is possible to apply when the data is stationary because most of stochastic process based on stationarity. However, recent hydrological data cannot be satisfied the stationarity anymore because of climate change. Therefore a stochastic time series model, which can consider seasonality and trend in the data series, named SARIMAX(Seasonal Autoregressive Integrated Average with eXternal variable) model were constructed in this study. This SARIMAX model could increase the performance of stochastic time series model by considering the nonstationarity components and external variable such as precipitation. For application, the models were constructed for four coordinated dams on Han river in South Korea with monthly time series data. As a result, the models of each dam have similar performance and it would be possible to use the model for coordinated dam operation.Acknowledgement This research was supported by a grant 'Establishing Active Disaster Management System of Flood Control Structures by using 3D BIM Technique' [NEMA-NH-12-57] from the Natural Hazard Mitigation Research Group, National Emergency Management Agency of Korea.

Need for higher fuel burnup at the Hatch Plant

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

Beckhman, J.T.

1996-03-01

Hatch is a BWR 4 and has been in operation for some time. The first unit became commercial about 1975. Obtaining higher burnups, or higher average discharge exposures, is nothing new at Hatch. Since we have started, the discharge exposure of the plant has increased. Now, of course, we are not approaching the numbers currently being discussed but, the average discharge exposure has increased from around 20,000 MWD/MTU in the early to mid-1980s to 34,000 MWD/MTU in 1994, I am talking about batch average values. There are also peak bundle and peak rod values. You will have to make themore » conversions if you think in one way or the other because I am talking in batch averages. During Hatch`s operating history we have had some problems with fuel failure. Higher burnup fuel raises a concern about how much fuel failure you are going to have. Fuel failure is, of course, an economic issue with us. Back in the early 1980s, we had a problem with crud-induced localized corrosion, known as CILC. We have gotten over that, but we had some times when it was up around 27 fuel failures a year. That is not a pleasant time to live through because it is not what you want from an economic viewpoint or any other. We have gotten that down. We have had some fuel failures recently, but they have not been related to fuel burnup or to corrosion. In fact, the number of failures has decreased from the early 1980s to the 90s even though burnup increased during that time. The fuel failures are more debris-related-type failures. In addition to increasing burnups, utilities are actively evaluating or have already incorporated power uprate and longer fuel cycles (e.g., 2-year cycles). The goal is to balance out the higher power density, longer cycles, higher burnup, and to have no leakers. Why do we as an industry want to have higher burnup fuel? That is what I want to tell you a little bit about.« less

Stirling Cooler Designed for Venus Exploration

NASA Technical Reports Server (NTRS)

Landis, Geoffrey A.; Mellott, Kenneth D.

2004-01-01

Venus having an average surface temperature of 460 degrees Celsius (about 860 degrees Fahrenheit) and an atmosphere 150 times denser than the Earth's atmosphere, designing a robot to merely survive on the surface to do planetary exploration is an extremely difficult task. This temperature is hundreds of degrees higher than the maximum operating temperature of currently existing microcontrollers, electronic devices, and circuit boards. To meet the challenge of Venus exploration, researchers at the NASA Glenn Research Center studied methods to keep a pressurized electronics package cooled, so that the operating temperature within the electronics enclosure would be cool enough for electronics to run, to allow a mission to operate on the surface of Venus for extended periods.

Operative time and cost of resident surgical experience: effect of instituting an otolaryngology residency program.

PubMed

Pollei, Taylor R; Barrs, David M; Hinni, Michael L; Bansberg, Stephen F; Walter, Logan C

2013-06-01

Describe the procedure length difference between surgeries performed by an attending surgeon alone compared with the resident surgeon supervised by the same attending surgeon. Case series with chart review. Tertiary care center and residency program. Six common otolaryngologic procedures performed between August 1994 and May 2012 were divided into 2 cohorts: attending surgeon alone or resident surgeon. This division coincided with our July 2006 initiation of an otolaryngology-head and neck surgery residency program. Operative duration was compared between cohorts with confounding factors controlled. In addition, the direct result of increased surgical length on operating room cost was calculated and applied to departmental and published resident case log report data. Five of the 6 procedures evaluated showed a statistically significant increase in surgery length with resident involvement. Operative time increased 6.8 minutes for a cricopharyngeal myotomy (P = .0097), 11.3 minutes for a tonsillectomy (P < .0001), 27.4 minutes for a parotidectomy (P = .028), 38.3 minutes for a septoplasty (P < .0001), and 51 minutes for tympanomastoidectomy (P < .0021). Thyroidectomy showed no operative time difference. Cost of increased surgical time was calculated per surgery and ranged from $286 (cricopharyngeal myotomy) to $2142 (mastoidectomy). When applied to reported national case log averages for graduating residents, this resulted in a significant increase of direct training-related costs. Resident participation in the operating room results in increased surgical length and additional system cost. Although residency is a necessary part of surgical training, associated costs need to be acknowledged.

[The Misgav-Ladach method for cesarean section compared to the Pfannenstiel technique].

PubMed

Studziński, Zbigniew

2002-08-01

The aim of the study was to evaluate the outcome of two different methods of cesarean section. To determine whether the Misgav-Ladach caesarean technique can offer benefits when compared with conventional Pfannenstiel caesarean section technique. This study describes operative details and the postoperative course of 110 patients who underwent caesarean section in May 2000 to December 2000 in Department of Gynecology and Obstetrics in Regional Hospital in Slupsk, Poland. One group (50 women) was operated with the Misgav-Ladach method for caesarean section and the other group (60 women) with Pfannenstiel method. Operating time was significantly different between the two methods, with an average of 20.2 minutes with the Misgav-Ladach method and 47.3 minutes with the Pfannenstiel method (p < 0.001). Time of child delivery was with average 1.1 minutes with the Misgav-Ladach method and 3.8 minutes with the Pfannenstiel method (p < 0.001). The amount of blood loss different significantly, with 336 ml and 483 ml respectively (p < 0.001). No significant difference was found in Apgar scores. No difference was found in overall postoperative complications, wound infection, febrile illness, febrile morbidity, wound dehiscence affected by the new technique. Significantly less suture material was used during Misgav-Ladach caesarean section compared to Pfannenstiel technique (p < 0.001). The Misgav-Ladach method of caesarean section has advantages over the Pfannenstiel technique by being significantly quicker to perform, with the reduced amounts of bleeding and suture material. The women were satisfied with the appearance of their scars. In this study no negative effects of the new operation technique were discovered.

Evaluation of salivary surface tension in a cohort of young healthy adults.

PubMed

Foglio-Bonda, P L; Laguini, E; Davoli, C; Pattarino, F; Foglio-Bonda, A

2018-03-01

To determine salivary pH, flow rate (FR) and surface tension (γs) in a cohort of 30 healthy young adults. To acquire cohort biological independent variables (age, gender, weight, height, medications, smoking, pathologies, and allergies) and to correlate them with pH, FR and γs obtained values. Evaluate the possible variation of the γs values during the time after the withdrawal and the influence of the operational abilities of the experimenting operators. Evaluate the relationship between γs, pH and FR  and the dependence between pH and FR. Non-stimulated saliva samples were taken in four different time span, for three days, with a drooling method for 15 minutes. The saliva sample was analyzed, in terms of γs, by two different operators (OP1 and OP2), twice consecutive (γs-1 and γs-2) for a total of 360 measurements. The γs was calculated using the du Noüy method. The FR was evaluated by weighing technique and pH by pH indicator papers. The measurements of γs performed by two different operators (OP1, OP2) showed respectively average values of 46.46 mN/m and 43.45 mN/m, while the mean FR was 0.29 ± 0.13 mL/min and the average pH was 7.1 ± 0.43. There were no significant correlations between γs and the biological variables analyzed. We can consider as reference values, in a sample of young adults, γs 45.56 ± 6.51 mN/m.

Development and Validation of a New Air Carrier Block Time Prediction Model and Methodology

NASA Astrophysics Data System (ADS)

Litvay, Robyn Olson

Commercial airline operations rely on predicted block times as the foundation for critical, successive decisions that include fuel purchasing, crew scheduling, and airport facility usage planning. Small inaccuracies in the predicted block times have the potential to result in huge financial losses, and, with profit margins for airline operations currently almost nonexistent, potentially negate any possible profit. Although optimization techniques have resulted in many models targeting airline operations, the challenge of accurately predicting and quantifying variables months in advance remains elusive. The objective of this work is the development of an airline block time prediction model and methodology that is practical, easily implemented, and easily updated. Research was accomplished, and actual U.S., domestic, flight data from a major airline was utilized, to develop a model to predict airline block times with increased accuracy and smaller variance in the actual times from the predicted times. This reduction in variance represents tens of millions of dollars (U.S.) per year in operational cost savings for an individual airline. A new methodology for block time prediction is constructed using a regression model as the base, as it has both deterministic and probabilistic components, and historic block time distributions. The estimation of the block times for commercial, domestic, airline operations requires a probabilistic, general model that can be easily customized for a specific airline’s network. As individual block times vary by season, by day, and by time of day, the challenge is to make general, long-term estimations representing the average, actual block times while minimizing the variation. Predictions of block times for the third quarter months of July and August of 2011 were calculated using this new model. The resulting, actual block times were obtained from the Research and Innovative Technology Administration, Bureau of Transportation Statistics (Airline On-time Performance Data, 2008-2011) for comparison and analysis. Future block times are shown to be predicted with greater accuracy, without exception and network-wide, for a major, U.S., domestic airline.

Reducing Operating Room Turnover Time for Robotic Surgery Using a Motor Racing Pit Stop Model.

PubMed

Souders, Colby P; Catchpole, Ken R; Wood, Lauren N; Solnik, Jonathon M; Avenido, Raymund M; Strauss, Paul L; Eilber, Karyn S; Anger, Jennifer T

2017-08-01

Operating room (OR) turnover time, time taken between one patient leaving the OR and the next entering, is an important determinant of OR utilization, a key value metric for hospital administrators. Surgical robots have increased the complexity and number of tasks required during an OR turnover, resulting in highly variable OR turnover times. We sought to streamline the turnover process and decrease robotic OR turnover times and increase efficiency. Direct observation of 45 pre-intervention robotic OR turnovers was performed. Following a previously successful model for handoffs, we employed concepts from motor racing pit stops, including briefings, leadership, role definition, task allocation and task sequencing. Turnover task cards for staff were developed, and card assignments were distributed for each turnover. Forty-one cases were observed post-intervention. Average total OR turnover time was 99.2 min (95% CI 88.0-110.3) pre-intervention and 53.2 min (95% CI 48.0-58.5) at 3 months post-intervention. Average room ready time from when the patient exited the OR until the surgical technician was ready to receive the next patient was 42.2 min (95% CI 36.7-47.7) before the intervention, which reduced to 27.2 min at 3 months (95% CI 24.7-29.7) post-intervention (p < 0.0001). Role definition, task allocation and sequencing, combined with a visual cue for ease-of-use, create efficient, and sustainable approaches to decreasing robotic OR turnover times. Broader system changes are needed to capitalize on that result. Pit stop and other high-risk industry models may inform approaches to the management of tasks and teams.

Early experience using the da Vinci Surgical System for the treatment of mediastinal tumors.

PubMed

Kajiwara, Naohiro; Taira, Masahiro; Yoshida, Koichi; Hagiwara, Masaru; Kakihana, Masatoshi; Usuda, Jitsuo; Uchida, Osamu; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

2011-10-01

The da Vinci Surgical System has been used in only a few cases for treating mediastinal tumors in Japan. Recently, we used the da Vinci Surgical System for various types of anterior and middle mediastinal tumors in clinical practice. We report our early experience using the da Vinci Surgical System. Seven patients gave written informed consent to undergo robotic surgery for mediastinal tumor dissection using the da Vinci Surgical System. We evaluated the safety and feasibility of this system for the surgical treatment of mediastinal tumors. Two specialists in thoracic surgery who are certified to use the da Vinci S Surgical System and another specialist acted as an assistant performed the tumor dissection. We were able to access difficult-to-reach areas, such as the mediastinum, safely. All the resected tumors were classified as benign tumors histologically. The average da Vinci setting time was 14.0 min, the average working time was 55.7 min, and the average overall operating time was 125.9 min. The learning curve for the da Vinci setup and manipulation time was short. Robotic surgery enables mediastinal tumor dissection in certain cases more safely and easily than conventional video-assisted thoracoscopic surgery and less invasively than open thoracotomy.

Frequency domain averaging based experimental evaluation of gear fault without tachometer for fluctuating speed conditions

NASA Astrophysics Data System (ADS)

Sharma, Vikas; Parey, Anand

2017-02-01

In the purview of fluctuating speeds, gear fault diagnosis is challenging due to dynamic behavior of forces. Various industrial applications employing gearbox which operate under fluctuating speed conditions. For diagnostics of a gearbox, various vibrations based signal processing techniques viz FFT, time synchronous averaging and time-frequency based wavelet transform, etc. are majorly employed. Most of the time, theories about data or computational complexity limits the use of these methods. In order to perform fault diagnosis of a gearbox for fluctuating speeds, frequency domain averaging (FDA) of intrinsic mode functions (IMFs) after their dynamic time warping (DTW) has been done in this paper. This will not only attenuate the effect of fluctuating speeds but will also extract the weak fault feature those masked in vibration signal. Experimentally signals were acquired from Drivetrain Diagnostic Simulator for different gear health conditions i.e., healthy pinion, pinion with tooth crack, chipped tooth and missing tooth and were analyzed for the different fluctuating profiles of speed. Kurtosis was calculated for warped IMFs before DTW and after DTW of the acquired vibration signals. Later on, the application of FDA highlights the fault frequencies present in the FFT of faulty gears. The result suggests that proposed approach is more effective towards the fault diagnosing with fluctuating speed.

Motor current signature analysis for gearbox condition monitoring under transient speeds using wavelet analysis and dual-level time synchronous averaging

NASA Astrophysics Data System (ADS)

Bravo-Imaz, Inaki; Davari Ardakani, Hossein; Liu, Zongchang; García-Arribas, Alfredo; Arnaiz, Aitor; Lee, Jay

2017-09-01

This paper focuses on analyzing motor current signature for fault diagnosis of gearboxes operating under transient speed regimes. Two different strategies are evaluated, extensively tested and compared to analyze the motor current signature in order to implement a condition monitoring system for gearboxes in industrial machinery. A specially designed test bench is used, thoroughly monitored to fully characterize the experiments, in which gears in different health status are tested. The measured signals are analyzed using discrete wavelet decomposition, in different decomposition levels using a range of mother wavelets. Moreover, a dual-level time synchronous averaging analysis is performed on the same signal to compare the performance of the two methods. From both analyses, the relevant features of the signals are extracted and cataloged using a self-organizing map, which allows for an easy detection and classification of the diverse health states of the gears. The results demonstrate the effectiveness of both methods for diagnosing gearbox faults. A slightly better performance was observed for dual-level time synchronous averaging method. Based on the obtained results, the proposed methods can used as effective and reliable condition monitoring procedures for gearbox condition monitoring using only motor current signature.

The contact heat transfer between the heating plate and granular materials in rotary heat exchanger under overloaded condition

NASA Astrophysics Data System (ADS)

Duan, Luanfang; Qi, Chonggang; Ling, Xiang; Peng, Hao

2018-03-01

In the present work, the contact heat transfer between the granular materials and heating plates inside plate rotary heat exchanger (PRHE) was investigated. The heat transfer coefficient is dominated by the contact heat transfer coefficient at hot wall surface of the heating plates and the heat penetration inside the solid bed. A plot scale PRHE with a diameter of Do = 273 mm and a length of L = 1000 mm has been established. Quartz sand with dp = 2 mm was employed as the experimental material. The operational parameters were in the range of ω = 1 - 8 rpm, and F = 15, 20, 25, 30%, and the effect of these parameters on the time-average contact heat transfer coefficient was analyzed. The time-average contact heat transfer coefficient increases with the increase of rotary speed, but decreases with the increase of the filling degree. The measured data of time-average heat transfer coefficients were compared with theoretical calculations from Schlünder's model, a good agreement between the measurements and the model could be achieved, especially at a lower rotary speed and filling degree level. The maximum deviation between the calculated data and the experimental data is approximate 10%.

Effectiveness of Condition-Based Maintenance in Army Aviation

DTIC Science & Technology

2009-06-12

for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data ...sources, gathering and maintaining the data needed, and completing and reviewing this collection of information. Send comments regarding this...increase in efficiency in dollars spent per operational flight hour, the data set was too small to draw major conclusions. Recommendations for

Commander’s Emergency Response Program: A Flawed Metric

DTIC Science & Technology

2012-12-06

the U.S. Department of State created the Office of the Coordinator for Reconstruction and Stabilization ( S /CRS). The mission for this office...effectiveness for reconstruction and stability projects and operations. The Department of Defense Directive 3000.5 was issued on November 2005. It...average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and

40 CFR 63.129 - Transfer operations provisions-reporting and recordkeeping for performance tests and notification...

Code of Federal Regulations, 2012 CFR

2012-07-01

...)(4) through (a)(7) of this section in the next Periodic Report as specified in § 63.152(c) of this..., or carbon adsorbers specified in table 7 of this subpart, recorded during the performance test, and... specified in table 7 of this subpart, and averaged over the time period of the performance test; and (iii...

40 CFR 63.129 - Transfer operations provisions-reporting and recordkeeping for performance tests and notification...

Code of Federal Regulations, 2013 CFR

2013-07-01

...)(4) through (a)(7) of this section in the next Periodic Report as specified in § 63.152(c) of this..., or carbon adsorbers specified in table 7 of this subpart, recorded during the performance test, and... specified in table 7 of this subpart, and averaged over the time period of the performance test; and (iii...

40 CFR 63.129 - Transfer operations provisions-reporting and recordkeeping for performance tests and notification...

Code of Federal Regulations, 2014 CFR

2014-07-01

...)(4) through (a)(7) of this section in the next Periodic Report as specified in § 63.152(c) of this..., or carbon adsorbers specified in table 7 of this subpart, recorded during the performance test, and... specified in table 7 of this subpart, and averaged over the time period of the performance test; and (iii...

40 CFR 63.129 - Transfer operations provisions-reporting and recordkeeping for performance tests and notification...

Code of Federal Regulations, 2011 CFR

2011-07-01

...)(4) through (a)(7) of this section in the next Periodic Report as specified in § 63.152(c) of this..., or carbon adsorbers specified in table 7 of this subpart, recorded during the performance test, and... specified in table 7 of this subpart, and averaged over the time period of the performance test; and (iii...

Communication Breakdown: DHS Operations During a Cyber Attack

DTIC Science & Technology

2010-12-01

is estimated to average 1 hour per response, including the time for reviewing instruction, searching existing data sources, gathering and...maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of...Presidential Directive, Malware, National Exercise, Quadrennial Homeland Security Review , Trusted Internet Connections, Zero-Day Exploits 16. PRICE CODE 17

Evaluation of Microcomposite Coatings for Chrome Replacement

DTIC Science & Technology

2009-09-02

Form ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time...of information . Send comments regarding this burden estimate or any other aspect of this collection of information , including suggestions for reducing...this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204

Adaptive Campaigning Applied: Australian Army Operations in Iraq and Afghanistan

DTIC Science & Technology

2011-05-01

of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering...and maintaining the data needed, and completing and reviewing this collection of information . Send comments regarding this burden estimate or any...other aspect of this collection of information , including suggestions for reducing this burden to Washington Headquarters Services, Directorate for

Harvesting understory biomass with a baler

Treesearch

J. Klepac; B. Rummer

2010-01-01

A model WB-55 Biobaler was evaluated while operating in a pine plantation to remove understory biomass. The harvested material was formed into round bales which averaged 1004 lbs. Mean heat content was approximately 8560 Btu/lb oven-dry. Time-study data revealed a productivity of 14.7 bales/PMH with a mean travel distance of 752 feet between bales. In-woods cost was...

Complexity Theory and Network Centric Warfare

DTIC Science & Technology

2003-09-01

realms of the unknown. Defence thinkers everywhere are searching forward for the science and alchemy that will deliver operational success. CCRP...0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing...instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send

[Laparoscopic adjustable gastric-banding treatment for morbid obesity our first year experience].

PubMed

Iordache, N; Vizeteu, R; Iorgulescu, A; Zmeu, B; Iordache, M

2003-01-01

The authors present the results of a prospective study regarding their 1st year experience in laparoscopic adjustable gastric banding (LABG), which included 21 patients (5 males, 16 females), with an average age of 39 (between 20-53 years). The follow up was made at one and six months postoperative. The medium weight was 138 kg (between 95-172 kg), with a medium excess of body mass of 66.89 kg (extremes between 27.75 and 104 kg). The medium BMI (body mass index) was 48.9 (extremes: 34.5-66), 8 patients being superobese (BMI > 50). The average operating time was 120 min, all operations were finished laparosopically. Postoperative complications were: total disfagia (1 case), parietal suppuration (2 cases) and partial intragastric migration of the prosthesis (1 case). There were no deceased patients. The medium excess of body mass at 6 months after surgery was 46.57 (only 13 patients evaluated in this interval). After 6 months postoperative the comorbidities were healed at half of the patients. Although we do not benefit of a long time follow up, the favorable initial results permits us to state that LABG must find its place in the efforts of struggling against obesity and its consequences.

Gas Consumption and Growth Rate of Hydrogenomonas eutropha in Continuous Culture

PubMed Central

Ammann, Elizabeth C. B.; Reed, Lawrence L.; Durichek, John E.

1968-01-01

The bacterium Hydrogenomonas eutropha is under consideration for use in a regenerative life-support system for manned space missions of long duration. A 4-liter continuous culture unit containing the organism was operated for a period of 272 days under autotrophic environmental conditions. The best steady-state run achieved with this unit was observed over a 22-day time interval after 181 days of operation. During this time, the culture consumed an average of 22.9 ± 2.0 ml of carbon dioxide per min, 38.1 ± 3.3 ml of oxygen per min, and 128.5 ± 10.6 ml of hydrogen per min. It required 18.7 ± 1.2 liters of fresh nutrient medium per 24 hr to maintain a constant, preestablished cell population of 1.65 g (dry weight) per liter. The ratio of consumption of carbon dioxide, oxygen, and hydrogen varied from 1:1.2:4.5 to 1:1.9:6.6, with an average of 1:1.7:5.7. Based on these values, approximately 60 liters of the culture would be necessary to balance the gas exchange of one man. Images Fig. 1 PMID:4385748

The feasibility and advantages of billroth-I reconstruction in distal gastric cancers following resection.

PubMed

Ganesh, M S; Reddy, K G; Venkata Subbareddy, D S

2012-01-01

Gastric carcinomas are common malignancies in southern India and distal stomach remains the commonest site in low socio economic groups. Surgery still remains an important modality of treatment to achieve local control and also relieve obstructive symptoms. In this study we investigated the feasibility of performing a gastrectomy and billroth-1 type of anastomosis in a rural cancer center setting, with parameters like adequacy of margins, ease of anastomosis and its functional results were analysed. Eight patients presenting to a rurally based cancer center underwent a distal gastrectomy and billroth-1 type of anastomosis for continuity restoration. All the patients had adequate proximal and distal marg. The surgical time varied between-hrs. The anastomosis was constructed without any tension on bowel ends in all patients. The average time to start oral feeds varied between- None of the patients showed symptoms of bile reflux nor dumping. The average hospital stay varied between. Billroth-1 anastomosis is a physiologically more natural way of restoring continuity following a gastrectomy and it is a procedure which would be technically more simpler and decrease per and post operative complications and allow speedier post operative recovery following surgery on distal gastric cancers.

Lagrangian Hotspots of In-Use NOX Emissions from Transit Buses.

PubMed

Kotz, Andrew J; Kittelson, David B; Northrop, William F

2016-06-07

In-use, spatiotemporal NOX emissions were measured from a conventional powertrain transit bus and a series electric hybrid bus over gradients of route kinetic intensity and ambient temperature. This paper introduces a new method for identifying NOX emissions hotspots along a bus route using high fidelity Lagrangian vehicle data to explore spatial interactions that may influence emissions production. Our study shows that the studied transit buses emit higher than regulated emissions because on-route operation does not accurately represent the range of engine operation tested according to regulatory standards. Using the Lagrangian hotspot detection, we demonstrate that NOX hotspots occurred at bus stops, during cold starts, on inclines, and for accelerations. On the selected routes, bus stops resulted in 3.3 times the route averaged emissions factor in grams/km without significant dependence on bus type or climate. The buses also emitted 2.3 times the route averaged NOX emissions factor at the beginning of each route due to cold selective catalytic reduction aftertreatment temperature. The Lagrangian hotspot detection technique demonstrated here could be employed in future connected vehicles empowered by advances in computational power, data storage capability, and improved sensor technology to optimize emissions as a function of spatial location.

GPS Time Series and Geodynamic Implications for the Hellenic Arc Area, Greece

NASA Astrophysics Data System (ADS)

Hollenstein, Ch.; Heller, O.; Geiger, A.; Kahle, H.-G.; Veis, G.

The quantification of crustal deformation and its temporal behavior is an important contribution to earthquake hazard assessment. With GPS measurements, especially from continuous operating stations, pre-, co-, post- and interseismic movements can be recorded and monitored. We present results of a continuous GPS network which has been operated in the Hellenic Arc area, Greece, since 1995. In order to obtain coordinate time series of high precision which are representative for crustal deformation, a main goal was to eliminate effects which are not of tectonic origin. By applying different steps of improvement, non-tectonic irregularities were reduced significantly, and the precision could be improved by an average of 40%. The improved time series are used to study the crustal movements in space and time. They serve as a base for the estimation of velocities and for the visualization of the movements in terms of trajectories. Special attention is given to large earthquakes (M>6), which occurred near GPS sites during the measuring time span.

A pilot project of European Working Time Directive compliant rosters in a university teaching hospital.

PubMed

Garvin, J T; McLaughlin, R; Kerin, M J

2008-04-01

In response to the requirements of the European Working Time Directive (EWTD), a national implementation group was formed to liaise with local implementation groups at nine different pilot sites. As part of this process, a pilot EWTD compliant rota was run for six weeks amongst general surgical SHOs in University Hospital Galway. A rota was devised for nine general surgical SHOs, the aim being to achieve EWTD compliance. SHOs were asked to complete questionnaires to assess the effectiveness of the pilot. During the pilot SHOs were rostered for an average of 53.6 hours. Actual hours worked were 58.1 hours. Fifty-two point five per cent of working weeks were non-compliant with the provisions of the EWTD. Seventy per cent of the time SHOs felt that continuity of care was not achieved. Eighty-one per cent felt that patient care deteriorated during the pilot. SHOs spent an average of 2.5 days per week engaged in sessional commitments with their consultant. Fifty percent of SHOs missed elective operating sessions or outpatient clinics. SHOs attended an average of 1.3 emergency operations per week (range 0-8) and 5.5 elective procedures per week (range 0-12). All SHOs reported a deterioration in quantity or quality of training. However, 69% reported an improvement in their quality of life during the pilot. With this tightly defined shift system, hours worked were in breach of the provisions of the EWTD. Sixty-nine per cent of SHOs reported an improvement in quality of life, but all reported a deterioration in training and 81% felt that patient care suffered.

Optimization of the extraction and purification of the compatible solute ectoine from Halomonas elongate in the laboratory experiment of a commercial production project.

PubMed

Chen, Ruifeng; Zhu, Lijun; Lv, Lihuo; Yao, Su; Li, Bin; Qian, Junqing

2017-06-01

Optimization of compatible solutes (ectoine) extraction and purification from Halomonas elongata cell fermentation had been investigated in the laboratory tests of a large scale commercial production project. After culturing H. elongata cells in developed medium at 28 °C for 23-30 h, we obtained an average yield and biomass of ectoine for 15.9 g/L and 92.9 (OD 600 ), respectively. Cell lysis was performed with acid treatment at moderate high temperature (60-70 °C). The downstream processing operations were designed to be as follows: filtration, desalination, cation exchange, extraction of crude product and three times of refining. Among which the cation exchange and extraction of crude product acquired a high average recovery rate of 95 and 96%; whereas a great loss rate of 19 and 15% was observed during the filtration and desalination, respectively. Combined with the recovering of ectoine from the mother liquor of the three times refining, the average of overall yield (referring to the amount of ectoine synthesized in cells) and purity of final product obtained were 43% and over 98%, respectively. However, key factors that affected the production efficiency were not yields but the time used in the extraction of crude product, involving the crystallization step from water, which spended 24-72 h according to the production scale. Although regarding to the productivity and simplicity on laboratory scale, the method described here can not compete with other investigations, in this study we acquired higher purity of ectoine and provided downstream processes that are capable of operating on industrial scale.

An Outcome and Cost Analysis Comparing Single-Level Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Intraoperative Fluoroscopy versus Computed Tomography-Guided Navigation.

PubMed

Khanna, Ryan; McDevitt, Joseph L; Abecassis, Zachary A; Smith, Zachary A; Koski, Tyler R; Fessler, Richard G; Dahdaleh, Nader S

2016-10-01

Minimally invasive transforaminal lumbar interbody fusion (TLIF) has undergone significant evolution since its conception as a fusion technique to treat lumbar spondylosis. Minimally invasive TLIF is commonly performed using intraoperative two-dimensional fluoroscopic x-rays. However, intraoperative computed tomography (CT)-based navigation during minimally invasive TLIF is gaining popularity for improvements in visualizing anatomy and reducing intraoperative radiation to surgeons and operating room staff. This is the first study to compare clinical outcomes and cost between these 2 imaging techniques during minimally invasive TILF. For comparison, 28 patients who underwent single-level minimally invasive TLIF using fluoroscopy were matched to 28 patients undergoing single-level minimally invasive TLIF using CT navigation based on race, sex, age, smoking status, payer type, and medical comorbidities (Charlson Comorbidity Index). The minimum follow-up time was 6 months. The 2 groups were compared in regard to clinical outcomes and hospital reimbursement from the payer perspective. Average surgery time, anesthesia time, and hospital length of stay were similar for both groups, but average estimated blood loss was lower in the fluoroscopy group compared with the CT navigation group (154 mL vs. 262 mL; P = 0.016). Oswestry Disability Index, back visual analog scale, and leg visual analog scale scores similarly improved in both groups (P > 0.05) at 6-month follow-up. Cost analysis showed that average hospital payments were similar in the fluoroscopy versus the CT navigation groups ($32,347 vs. $32,656; P = 0.925) as well as payments for the operating room (P = 0.868). Single minimally invasive TLIF performed with fluoroscopy versus CT navigation showed similar clinical outcomes and cost at 6 months. Copyright © 2016 Elsevier Inc. All rights reserved.

[The Efficiency and Complications of ESD and ESTD in the Treatment of Large Esophageal Mucosal Lesions].

PubMed

Wang, Jin; Qin, Jin-yu; Guo, Tian-jiao; Gan, Tao; Wang, Yi-ping; Wu, Jun-chao

2015-11-01

To study the efficiency and complications of endoscopic submucosal dissection (ESD) and endoscopic submucosal tunnel dissection (ESTD) in the treatment of large esophageal mucosal lesions. The clinical data were collected from the patients who received ESD or ESTD for the treatment of early esophageal lesions in our hospital during January 1, 2014 to July 15, 2015, including the en bloc resection rate, curative resection rate, postoperative complication rate, the risk factors of complications were explored by univariate and multivariate analysis. A total of 50 patients were involved in the study, ESD or ESTD were performed successfully in 53 times, including 6 cases of ESD,47 cases of ESTD, The average age was (61.9 +/- 6.8) yr., the average operating time was (83.57 +/- 32.33) min, the average dissected lesion was (14.82 +/- 3.18) cm2, En bloc resection rate was 94.34%, the curative rate was 84.90%. There were 1 case of bleeding, 1 case of perforation, 45 (84.90%) cases of fever, 13 cases (24.53%) of esophageal stricture. The severity of stricture was associated with the operation time Codds ratio (OR) = 1.040, 95% confidence interal (CI): 1.007-1.075) and esophageal circumference (OR=9.972, 95% CI: 1.221-81.416). The residual resection margin appeared in 8 patients, and the lesion area (OR=1.145, 95% CI: 1.013-1.294) was the only risk factor. ESD and ESTD are safe and effective in the treatment of early esophageal lesions, but seems have relatively high incidence of esopgageal stricture and residual resection margin in the treatment of large esophageal lesions.

Does age affect outcome in children with clavicle fracture treated conservatively? QuickDash and MRC evaluation of 131 consecutive cases.

PubMed

Pavone, Vito; DE Cristo, Claudia; Testa, Gianluca; Canavese, Federico; Lucenti, Ludovico; Sessa, Giuseppe

2018-04-12

Non-operative treatment with immobilization is the gold-standard for paediatric clavicular fractures. Purpose of this study is to evaluate functional outcomes and efficacy of non-operative treatment of clavicular fractures in a succession of 131 children. Between 2006 and 2012, we treated non-surgically 131 children for a clavicular fracture. All fractures have been classified according to Robinson classification. Clavicle shortening, range of movements and muscular strength through the Medical Research Council (MRC) scale were evaluated. To assess the outcomes, QuickDASH questionnaire, dividing the sample in 3 age-related group, was administered. The average follow-up was 26 months (8-84 months). Clavicle shortening at the time of injury occurred in 18 cases. All fractures reached union. Average time to union was 34 days. Mean time return to activity was 12.6 weeks. No cases of nonunion or delayed union were reported. Complications occurred in 21 cases. A shortening persisted in 2 cases. Only one patient had a slight functional restriction. Average QuickDASH score was 6.2±1.1 (range 4.3-9.4). All patients recovered to a MRC score of 5, except for one patient with a score of 4. Best QuickDASH scores were observed in the group aged under 8 years and in non-comminuted and lateral third fractures of the clavicle. Observing results, clavicle fractures have a satisfactory clinical healing as shown by the good scores at QuickDASH and MRC scale. Younger children under 8 years can achieve the best results with a conservative treatment in terms of bone healing and activity level.

40 CFR Table 2 to Subpart Mmmmm of... - Operating Limits for New or Reconstructed Flame Lamination Affected Sources

Code of Federal Regulations, 2010 CFR

2010-07-01

... scrubber, maintain the daily average pressure drop across the venturi within the operating range value... . . . You must . . . 1. Scrubber a. Maintain the daily average scrubber inlet liquid flow rate above the minimum value established during the performance test. b. Maintain the daily average scrubber effluent pH...

40 CFR Table 2 to Subpart Uuu of... - Operating Limits for Metal HAP Emissions From Catalytic Cracking Units

Code of Federal Regulations, 2010 CFR

2010-07-01

... daily average liquid-to-gas ratio above the limit established in the performance test. 4. Option 3: Ni.... Electrostatic precipitator Maintain the daily average Ni operating value no higher than the limit established...; maintain the monthly rolling average of the equilibrium catalyst Ni concentration no higher than the limit...

40 CFR Table 2 to Subpart Uuu of... - Operating Limits for Metal HAP Emissions From Catalytic Cracking Units

Code of Federal Regulations, 2011 CFR

2011-07-01

... daily average liquid-to-gas ratio above the limit established in the performance test. 4. Option 3: Ni.... Electrostatic precipitator Maintain the daily average Ni operating value no higher than the limit established...; maintain the monthly rolling average of the equilibrium catalyst Ni concentration no higher than the limit...

40 CFR Table 2 to Subpart Mmmmm of... - Operating Limits for New or Reconstructed Flame Lamination Affected Sources

Code of Federal Regulations, 2011 CFR

2011-07-01

... . . . You must . . . 1. Scrubber a. Maintain the daily average scrubber inlet liquid flow rate above the minimum value established during the performance test. b. Maintain the daily average scrubber effluent pH... scrubber, maintain the daily average pressure drop across the venturi within the operating range value...