Cleft Palate Fistula Closure Utilizing Acellular Dermal Matrix

PubMed Central

Emodi, Omri; van Aalst, John A.; Shilo, Dekel; Naddaf, Raja; Aizenbud, Dror; Rachmiel, Adi

2018-01-01

Summary: Fistulas represent failure of cleft palate repair. Secondary and tertiary fistula repair is challenging, with high recurrence rates. In the present retrospective study, we review the efficacy of using acellular dermal matrix as an interposition layer for cleft palate fistula closure in 20 consecutive patients between 2013 and 2016. Complete fistula closure was obtained in 16 patients; 1 patient had asymptomatic recurrent fistula; 2 patients had partial closure with reduction of fistula size and minimal nasal regurgitation; 1 patient developed a recurrent fistula without changes in symptoms (success rate of 85%). We conclude that utilizing acellular dermal matrix for cleft palate fistula repair is safe and simple with a high success rate. PMID:29707449

[Errors and dangers in use of the surgical stapler in lung surgery].

PubMed

Junginger, T; Walgenbach, S

1989-01-01

The staple closure of the bronchus, like the manual technique, depends on some essential prerequisites: vascular supply, the length and thickness of the bronchial stump, the resection line, the type of stapler and the size of staples used. GIA 55 or 90 instruments allow safe and simple closure of lung parenchyma. Familiarity with the stapling technique is essential for success.

Putting the Power of Configuration in the Hands of the Users

NASA Technical Reports Server (NTRS)

Al-Shihabi, Mary-Jo; Brown, Mark; Rigolini, Marianne

2011-01-01

Goal was to reduce the overall cost of human space flight while maintaining the most demanding standards for safety and mission success. In support of this goal, a project team was chartered to replace 18 legacy Space Shuttle nonconformance processes and systems with one fully integrated system Problem Reporting and Corrective Action (PRACA) processes provide a closed-loop system for the identification, disposition, resolution, closure, and reporting of all Space Shuttle hardware/software problems PRACA processes are integrated throughout the Space Shuttle organizational processes and are critical to assuring a safe and successful program Primary Project Objectives Develop a fully integrated system that provides an automated workflow with electronic signatures Support multiple NASA programs and contracts with a single "system" architecture Define standard processes, implement best practices, and minimize process variations

A simple technique of laparoscopic port closure allowing wound extension.

PubMed

Christey, G R; Poole, G

2002-04-01

Reliable and safe access to the abdominal cavity and efficient removal of the resected gallbladder are essential to laparoscopic cholecystectomy. The unpredictable size of the cholecystectomy specimen can sometimes lead to frustration at the time of removal. A simple technique has been developed that allows for tissue extraction and easy fascial closure regardless of the size of the specimen. This is achieved by using a four bite "U-shaped" purse string at the time of Hasson insertion, with cephalad advancement of the proximal two bites. This allows for variable wound extension and secure closure, without the need for additional sutures.

76 FR 17964 - Renewal of Agency Information Collection for Home-Living Programs and School Closure and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-31

... School Closure and Consolidation, currently authorized by OMB Control Number 1076-0164, to the Office of... do so. III. Data OMB Control Number: 1076-0164. Title: Home-living Programs and School Closure and...

Transcatheter closure of patent ductus arteriosus: past, present and future.

PubMed

Baruteau, Alban-Elouen; Hascoët, Sébastien; Baruteau, Julien; Boudjemline, Younes; Lambert, Virginie; Angel, Claude-Yves; Belli, Emre; Petit, Jérôme; Pass, Robert

2014-02-01

This review aims to describe the past history, present techniques and future directions in transcatheter treatment of patent ductus arteriosus (PDA). Transcatheter PDA closure is the standard of care in most cases and PDA closure is indicated in any patient with signs of left ventricular volume overload due to a ductus. In cases of left-to-right PDA with severe pulmonary arterial hypertension, closure may be performed under specific conditions. The management of clinically silent or very tiny PDAs remains highly controversial. Techniques have evolved and the transcatheter approach to PDA closure is now feasible and safe with current devices. Coils and the Amplatzer Duct Occluder are used most frequently for PDA closure worldwide, with a high occlusion rate and few complications. Transcatheter PDA closure in preterm or low-bodyweight infants remains a highly challenging procedure and further device and catheter design development is indicated before transcatheter closure is the treatment of choice in this delicate patient population. The evolution of transcatheter PDA closure from just 40 years ago with 18F sheaths to device delivery via a 3F sheath is remarkable and it is anticipated that further improvements will result in better safety and efficacy of transcatheter PDA closure techniques. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Post-Closure Strategy for Use-Restricted Sites on the Nevada National Security Site, Nevada Test and Training Range, and Tonopah Test Range, Nevada

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

Silvas, A. J.

The purpose of this Post-Closure Strategy is to provide a consistent methodology for continual evaluation of post-closure requirements for use-restricted areas on the Nevada National Security Site (NNSS), Nevada Test and Training Range (NTTR), and Tonopah Test Range (TTR) to consolidate, modify, or streamline the program. In addition, this document stipulates the creation of a single consolidated Post-Closure Plan that will detail the current post-closure requirements for all active use restrictions (URs) and outlines its implementation and subsequent revision. This strategy will ensure effective management and control of the post-closure sites. There are currently over 200 URs located on themore » NNSS, NTTR, and TTR. Post-closure requirements were initially established in the Closure Report for each site. In some cases, changes to the post-closure requirements have been implemented through addenda, errata sheets, records of technical change, or letters. Post-closure requirements have been collected from these multiple sources and consolidated into several formats, such as summaries and databases. This structure increases the possibility of inconsistencies and uncertainty. As more URs are established and the post-closure program is expanded, the need for a comprehensive approach for managing the program will increase. Not only should the current requirements be obtainable from a single source that supersedes all previous requirements, but the strategy for modifying the requirements should be standardized. This will enable more effective management of the program into the future. This strategy document and the subsequent comprehensive plan are to be implemented under the assumption that the NNSS and outlying sites will be under the purview of the U.S. Department of Energy, National Nuclear Security Administration for the foreseeable future. This strategy was also developed assuming that regulatory control of the sites remains static. The comprehensive plan is not intended to be a permanent long-term stewardship plan. However, it is intended to clarify requirements and identify components to effectively manage the sites until regulatory requirements are met or management of the site changes. The Environmental Management Program is required to manage these sites until the NNSS Environmental Restoration program is completed, currently planned for 2030. Prior to completion of the Environmental Restoration program, additional planning will be conducted to ensure that long-term stewardship of the sites is maintained. A comprehensive post-closure plan can be transitioned effectively into any future site-wide long-term stewardship program that may be developed. Therefore, the post-closure plan will include current aspects of the post-closure program that are also important aspects of long-term stewardship, including the following: • Management of physical and engineering controls such as fences, signs, and soil covers • Management of institutional and administrative controls such as use restrictions and real estate systems • Management of monitoring and maintenance programs • Management of information related to the sites such as geographic information system data and related documentation The strategy will also allow for periodic review and modification of any aspect of the program to ensure continued effectiveness.« less

Traction-compression-closure for exomphalos major.

PubMed

Morabito, Antonino; Owen, Anthony; Bianchi, Adrian

2006-11-01

We present our experience with traction-compression-closure (TCC) for exomphalos major (EM) to achieve a safe and embryologically correct midline supraumbilical aesthetic closure with preservation of the umbilicus. Nineteen neonates with EM were paralyzed and ventilated. The abdominal domain was increased by upward cord traction to assist liver-bowel reduction by gravity and sac ligation, followed by circumferential elastic body binder compression. The supraumbilical abdominal wall anomaly cicatrized spontaneously or was closed surgically as a midline scar, with preservation of the umbilicus. Over 7 years (1998-2004), 19 patients with EM were treated by TCC, 18 of whom survived. The patients' median gestational age was 36 weeks (range, 24-40 weeks); their median birth weight was 2312 g (range, 890-3000 g). The median time to reduction was 4 days (range, 3-5 days), whereas that to full enteral feeds was 6 days (range, 4-6 days). Mechanical ventilation for 7 days (range, 6-8 days) was not associated with any morbidity, and the time to home discharge was 11 days (range, 8-12 days). Five patients did not require any surgery. There was no episode of sac rupture or infection. Abdominal expansion by vertical cord traction followed by compression reduction (TCC) under muscle relaxation and ventilation is time well spent toward a safe and aesthetic midline abdominal wall closure without tension for EM.

Closing Rocky Flats by 2006

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

Tuor, N. R.; Schubert, A. L.

2002-02-26

Safely accelerating the closure of Rocky Flats to 2006 is a goal shared by many: the State of Colorado, the communities surrounding the site, the U.S. Congress, the Department of Energy, Kaiser-Hill and its team of subcontractors, the site's employees, and taxpayers across the country. On June 30, 2000, Kaiser-Hill (KH) submitted to the Department of Energy (DOE), KH's plan to achieve closure of Rocky Flats by December 15, 2006, for a remaining cost of $3.96 billion (February 1, 2000, to December 15, 2006). The Closure Project Baseline (CPB) is the detailed project plan for accomplishing this ambitious closure goal.more » This paper will provide a status report on the progress being made toward the closure goal. This paper will: provide a summary of the closure contract completion criteria; give the current cost and schedule variance of the project and the status of key activities; detail important accomplishments of the past year; and discuss the challenges ahead.« less

Pelvic flexure enterotomy closure in the horse with a TA-90 stapling device: A retrospective clinical study of 84 cases (2001–2008)

PubMed Central

Rosser, Julie; Brounts, Sabrina; Slone, Don; Lynch, Tim; Livesey, Michael; Hughes, Faith; Clark, Carol

2012-01-01

Our objective was to compare survival and complication rates of horses undergoing pelvic flexure enterotomy closure with a TA-90 stapler to those with hand-sewn closure. Medical records of horses undergoing pelvic flexure enterotomy between 2001 and 2008 were reviewed. History, clinical signs, surgical findings, surgical techniques, and post-operative complications were recorded. Long-term outcome was established by telephone questionnaire. Of 84 pelvic flexure enterotomies performed, 70 were stapled and 14 were hand-sewn. Seventy-seven horses survived to discharge (91.7%). There were no significant associations between survival and closure technique (P = 0.69). Follow-up was available for 54 horses; 50 survived long-term (93.0%). No statistical significance was identified between long-term survival and closure method (P = 0.39). Forty horses went on to athletic performance (80.0%). TA-90 stapled closure of pelvic flexure enterotomies is a safe technique resulting in survival and complication rates equivalent to those of hand-sewn closure. PMID:23204584

Catheter Closure Through a Venous Approach of Patent Ductus Arteriosus in Small Pediatric Patients Using Combined Angiographic and Echocardiographic Guidance.

PubMed

Thanopoulos, Basil Vasilios D; Ninios, Vlassis; Dardas, Petros; Giannopoulos, Andreas; Deleanou, Dan; Iancovici, Silvia

2016-11-15

The standard technique of catheter closure of patent ductus arteriosus (PDA) may be associated with arterial complications particularly in small pediatric patients. The aim of this study was to evaluate whether catheter closure of PDA in small children using an exclusive venous approach is a safe and effective alternative to closure with the standard technique. One hundred-twelve patients, aged 2 to 24 months, were randomly assigned in a 1:1 ratio to catheter closure of PDA using the standard technique (group 1) and an exclusive venous approach (group 2), respectively. In group 2, the procedure was guided using hand injections of contrast media through the delivery sheath and 2-dimensional and color Doppler echocardiography. Group 1: the PDA diameter ranged from 2 to 5.5 mm and the device diameter ranged from 4 to 8 mm. The PDA occluders were permanently implanted in all patients. Five losses of the arterial pulses that were restored with intravenous infusion of heparin and recombinant tissue plasminogen activator (rtPA), and 4 groin hematomas were the main complications of the procedure. Group 2: the mean PDA diameter ranged from 2.5 to 6 mm and the device diameter ranged from 3 to 8 mm. The PDA occluders were permanently implanted in all but 2 patients. There were no complications. Complete echocardiographic closure of PDA at 1-month follow-up was observed in all 110 patients. Exclusive transvenous PDA occlusion is an effective and safe technique that prevents the arterial complications of the standard approach in small children. Copyright © 2016 Elsevier Inc. All rights reserved.

Seven-year follow-up of percutaneous closure of patent foramen ovale.

PubMed

Mirzada, Naqibullah; Ladenvall, Per; Hansson, Per-Olof; Johansson, Magnus Carl; Furenäs, Eva; Eriksson, Peter; Dellborg, Mikael

2013-12-01

Observational studies favor percutaneous closure of patent foramen ovale (PFO) over medical treatment to reduce recurrent stroke while randomized trials fail to demonstrate significant superiority of percutaneous PFO closure. Few long-term studies are available post PFO closure. This study reports long-term clinical outcomes after percutaneous PFO closure. Between 1997 and 2006, 86 consecutive eligible patients with cerebrovascular events, presumably related to PFO, underwent percutaneous PFO closure. All 86 patients were invited to a long-term follow-up, which was carried out during 2011 and 2012. Percutaneous PFO closure was successfully performed in 85 of 86 patients. The follow-up rate was 100%. No cardiovascular or cerebrovascular deaths occurred. Two patients (both women) died from lung cancer during follow-up. Follow-up visits were conducted for 64 patients and the remaining 20 patients were followed up by phone. The mean follow-up time was 7.3 years (5 to 12.4 years). Mean age at PFO closure was 49 years. One patient had a minor stroke one month after PFO closure and a transient ischemic attack (TIA) two years afterwards. One other patient suffered from a TIA six years after closure. No long-term device-related complications were observed. Percutaneous PFO closure was associated with very low risk of recurrent stroke and is suitable in most patients. We observed no mortality and no long-term device-related complications related to PFO closure, indicating that percutaneous PFO closure is a safe and efficient treatment even in the long term.

77 FR 48529 - Notice of Temporary Closure and Temporary Restrictions of Specific Uses on Public Lands in...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-14

... are necessary to provide a safe environment for the participants of the Burning Man event and to... timeframe that is necessary to provide a safe environment for the public and for participants at the Burning... personnel to provide for public safety and to protect the environment on public lands, as well as to support...

Intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency: a safe alternative to surgical repair.

PubMed

Chen, Qiang; Chen, Liang-Wan; Cao, Hua; Zhang, Gui-Can; Chen, Dao-Zhong; Zhang, Hui

2011-03-01

Our objective was to evaluate the safety and feasibility of intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency. From January 2005 to December 2008, we enrolled 65 patients who had a secundum atrial septal defect with inferior vena cava rim deficiency closure in our institution. Patients were divided into 2 groups: 35 patients in group I underwent intraoperative device closure with a right lateral minithoracotomy and 30 in group II underwent open cardiac repair with a right lateral thoracotomy and cardiopulmonary bypass. Intraoperative device closure involved a minimal intercostal incision that was performed after full evaluation of the atrial septal defect by transthoracic echocardiography and the insertion of the device through the delivery sheath to occlude the atrial septal defect. The procedure was successful in all patients. In group I, the diameter of the atrial septal defect ranged from 30 to 44 mm (mean, 35.3 ± 3.9 mm), and the size of the implanted occluder ranged from 34 to 48 mm (mean, 40 ± 2.1 mm). The total occlusion rate was 82.9% immediately after the operation, 97.1% at 3 months, and 100% at 12 and 24 months of follow-up. In group II, all patients had successful closure. A follow-up period of 12 to 24 months was obtained in both groups. During the follow-up, there was no recurrence, thrombosis, or device failure. In our comparative studies, group II had significantly longer operative time, intensive care unit stay, and hospital stay than group I (P < .001). The cost of group I was less than that of group II (20,450.9 ± 840.8 RMB vs 25,884.9 ± 701.8; P < .001). Intraoperative device closure of atrial septal defects with inferior vena cava rim deficiency is a safe and feasible technique. It has the advantages of cost savings, cosmetic results, and less trauma than surgical closure. Early and midterm results are encouraging. Crown Copyright © 2011. Published by Mosby, Inc. All rights reserved.

Is adhesive paper-tape closure of video assisted thoracoscopic port-sites safe?

PubMed

Luckraz, Heyman; Rammohan, Kandadai S; Phillips, Mabel; O'Keefe, Peter A

2007-07-01

Video assisted thoracoscopic surgery (VATS) is used in lung surgery for diagnostic, staging, curative and palliative purposes. The port-sites are usually sutured with dissolvable sutures. The use of adhesive paper-tape for port-site closure was assessed by a prospective randomised double-blind control trial comparing sutured to adhesive paper-tape closure. The following outcomes were assessed: incidence of clinically significant pneumothorax, wound healing using the ASEPSIS score, patient's comfort (pain score using a visual analog score), the time difference between the two techniques of wound closure and cost savings. Thirty patients were recruited in each group. No clinically significant pneumothoraces occurred in either group. There were no significant differences between the two groups in terms of immediate post-operative pain scores, wound cosmesis and wound complications. It was quicker to close the wound with adhesive paper-tape with a mean time of closure per unit length of wound of 9.3 and 2.2s/mm for the groups, respectively. The cost for wound closure (per patient) was $0.8 for the adhesive paper-tape group and $4.00 for the sutures.

[Right patent ductus arteriosus with an ipsilateral aortic arch: percutaneous closure with amplatzer devices].

PubMed

Santiago, Justo; Acuña, Manuel; Arispe, Elizabeth; Camargo, Ronaldo; Neves, Juliana; Arnoni, Daniel; Fontes, Valmir F; Pedra, Carlos A

2007-03-01

The association of a right aortic arch with an ipsilateral patent ductus arteriosus is rare, especially when there are no other intracardiac anomalies. We report three female patients aged 26, 35 and 9 years with this combination in whom previous attempts at surgical closure by thoracotomy and sternotomy were unsuccessful and who subsequently underwent successful percutaneous closure of the defects using Amplatzer devices. In two patients, although angiography demonstrated the presence of type-A patent ductus arteriosus, it was not possible to determine the minimum diameter accurately and it was necessary to measure it using a sizing balloon. An Amplatzer duct occluder was used in two patients and an Amplatzer muscular ventricular septal defect occluder, in the other. In all patients, full closure was confirmed in the catheterization laboratory and the patients were discharged on the same day with no complications. Percutaneous closure of a right patent ductus arteriosus associated with a right aortic arch is feasible, safe and effective.

Cystic Duct Closure by Sealing With Bipolar Electrocoagulation

PubMed Central

Damgaard, B.; Jorgensen, L. N.; Larsen, S. S.; Kristiansen, V. B.

2010-01-01

Background: Cystic duct leakage after cholecystectomy is not uncommon and is a potentially serious complication. The aim of this study was to assess a bipolar sealing system (LigaSure®) for closure of the cystic duct. Methods: The records from consecutive laparoscopic cholecystectomies performed in 2 hospitals with closure of the cystic duct with LigaSure after informed consent were recorded and complications and morbidity registered. The records were compared with those of patients undergoing laparoscopic cholecystectomy with closure of the cystic duct with clips during the same period. Results: During the study period, 218 laparoscopic cholecystectomies were performed; 102 of these were performed with the LigaSure. One patient was excluded due to violation of the protocol. We experienced no cases of cystic duct leakage, but in one patient, bile leakage from the gallbladder bed was observed probably due to a small aberrant duct. Conclusion: The LigaSure system was safe and effective for closure and division of the cystic duct in laparoscopic cholecystectomy. PMID:20412641

Sizing of patent ductus arteriosus in adults for transcatheter closure using the balloon pull-through technique.

PubMed

Shafi, Nabil A; Singh, Gagan D; Smith, Thomas W; Rogers, Jason H

2018-05-01

To describe a novel balloon sizing technique used during adult transcatheter patent ductus arteriosus (PDA) closure. In addition, to determine the clinical and procedural outcomes in six patients who underwent PDA balloon sizing with subsequent deployment of a PDA occluder device. Transcatheter PDA closure in adults has excellent safety and procedural outcomes. However, PDA sizing in adults can be challenging due to variable defect size, high flow state, or anatomical complexity. We describe a series of six cases where the balloon- pull through technique was successfully performed for PDA sizing prior to transcatheter closure. Consecutive adult patients undergoing adult PDA closure at our institution were studied retrospectively. A partially inflated sizing balloon was pulled through the defect from the aorta into the pulmonary artery and the balloon waist diameter was measured. Procedural success and clinical outcomes were obtained. Six adult patients underwent successful balloon pull-through technique for PDA sizing during transcatheter PDA closure, since conventional angiography often gave suboptimal opacification of the defect. All PDAs were treated with closure devices based on balloon PDA sizing with complete closure and no complications. In three patients that underwent preprocedure computed tomography, the balloon size matched the CT derived measurements. The balloon pull-through technique for PDA sizing is a safe and accurate sizing modality in adults undergoing transcatheter PDA closure. © 2017 Wiley Periodicals, Inc.

Underground storage tank management plan, Oak Ridge Y-12 Plant, Oak Ridge, Tennessee

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

NONE

1997-09-01

The Underground Storage Tank (UST) Program at the Oak Ridge Y-12 Plant was established to locate UST systems at the facility and to ensure that all operating UST systems are free of leaks. UST systems have been removed or upgraded in accordance with Tennessee Department of Environment and Conservation (TDEC) regulations and guidance. With the closure of a significant portion of the USTs, the continuing mission of the UST Management Program is to manage the remaining active UST systems and continue corrective actions in a safe regulatory compliant manner. This Program outlines the compliance issues that must be addressed, reviewsmore » the current UST inventory and compliance approach, and presents the status and planned activities associated with each UST system. The UST Program provides guidance for implementing TDEC regulations and guidelines for petroleum UST systems. The plan is divided into three major sections: (1) regulatory requirements, (2) active UST sites, and (3) out-of-service UST sites. These sections describe in detail the applicable regulatory drivers, the UST sites addressed under the Program, and the procedures and guidance for compliance.« less

Predictors of Premature Match Closure in Youth Mentoring Relationships.

PubMed

Kupersmidt, Janis B; Stump, Kathryn N; Stelter, Rebecca L; Rhodes, Jean E

2017-03-01

Although mentoring is a popular and effective means of intervention with youth, the positive effects of mentoring can be diminished by premature match closure of relationships. Program, mentor, and mentee characteristics were examined as predictors of premature match closure. Secondary data analyses were conducted on a large national database of mentoring programs consisting of match and youth risk information from 170 mentoring programs and 6468 matches from across the U.S. Premature closure was associated with mentee age at match inception and 19 individual mentee characteristics. The set of mentee characteristics were examined as part of a cumulative risk index encompassing seven conceptually combined categories including family background characteristics, school functioning problems, engagement in risky health behaviors, self-regulation difficulties, engagement in illegal or criminal activities, and internalizing and externalizing behavior problems. Both the age of mentees when matched and the cumulative risk index score significantly predicted premature closure. Results are discussed in terms of directions for future research and suggestions for enhancing mentoring program practices. © Society for Community Research and Action 2017.

Software Review: A program for testing capture-recapture data for closure

USGS Publications Warehouse

Stanley, Thomas R.; Richards, Jon D.

2005-01-01

Capture-recapture methods are widely used to estimate population parameters of free-ranging animals. Closed-population capture-recapture models, which assume there are no additions to or losses from the population over the period of study (i.e., the closure assumption), are preferred for population estimation over the open-population models, which do not assume closure, because heterogeneity in detection probabilities can be accounted for and this improves estimates. In this paper we introduce CloseTest, a new Microsoft® Windows-based program that computes the Otis et al. (1978) and Stanley and Burnham (1999) closure tests for capture-recapture data sets. Information on CloseTest features and where to obtain the program are provided.

Completion of five years of safe CO2 injection and transition into the post-closure phase at the Ketzin pilot site

NASA Astrophysics Data System (ADS)

Martens, Sonja; Moeller, Fabian; Streibel, Martin; Liebscher, Axel; Ketzin Group

2014-05-01

The injection of CO2 at the Ketzin pilot site in Germany ended after five years in August 2013. We present the key results from site operation and outline future activities within the post-closure phase. From June 2008 onwards, a total amount of 67 kt of CO2 was safely injected into a saline aquifer (Upper Triassic sandstone) at a depth of 630 m - 650 m. The CO2 used was mainly of food grade quality (purity > 99.9%). In addition, 1.5 kt of CO2 from the pilot capture facility "Schwarze Pumpe" (power plant CO2 with purity > 99.7%) was injected in 2011. During regular operation, the CO2 was pre-heated on-site to 45°C before injection in order to avoid pressure build-up within the reservoir. During the final months of injection a "cold-injection" experiment with a stepwise decrease of the injection temperature down to 10°C was conducted between March and July 2013. In summer 2013, the injection of a mixture of 95% CO2 and 5% N2 was also tested. After ceasing the injection in August the injection facility and pipeline were removed in December 2013. Geological storage of CO2 at the Ketzin pilot site has so far proceeded in a safe and reliable manner. As a result of one of the most comprehensive R&D programs worldwide, a combination of different geochemical and geophysical monitoring methods is able to detect even small quantities of CO2 and map their spatial extent. After the cessation of CO2 injection a series of activities and further investigations are involved in the post-closure phase. The aim is that Ketzin will for the first time ever close the complete life-time cycle of a CO2 storage site at pilot scale. The five wells (1 injection/observation well, 4 pure observation wells) will be successively abandoned within the next few years while monitoring is continuing. The partial plugging of one observation well in the reservoir section was already completed in fall 2013. The new four-years project COMPLETE (CO2 post-injection monitoring and post-closure phase at the Ketzin pilot site) started in January 2014. Activities within COMPLETE include R&D work on well integrity, post-closure monitoring as well as two field experiments. One is a back-production test of the CO2 aiming at information on the physicochemical properties of the back-produced CO2 as well as the pressure response of the reservoir. The other experiment will focus on brine injection into the CO2 storage reservoir in order to study e.g. the residual gas saturation. Public outreach has been a key element for the project from the very beginning and accompanies the research on CO2 storage at Ketzin since 2004. Thus dissemination (e.g. www.co2ketzin.de) and activities at the visitor centre at the pilot site will continue within COMPLETE and along the entire life cycle of the Ketzin project.

The Evaluator's Role in Recommending Program Closure: A Model for Decision Making and Professional Responsibility

ERIC Educational Resources Information Center

Eddy, Rebecca M.; Berry, Tiffany

2009-01-01

Evaluators face challenges when programs consistently fail to meet expectations for performance or improvement and consequently, evaluators may recommend that closing a program is the most prudent course of action. However, the evaluation literature provides little guidance regarding when an evaluator might recommend program closure. Given…

Intra-operative device closure of perimembranous ventricular septal defect without cardiopulmonary bypass under guidance of trans-epicardial echocardiography: a single center experience.

PubMed

Sun, Yong; Zhu, Peng; Zhou, Pengyu; Guo, Yilong; Zheng, Shao-Yi

2016-05-27

Intraoperative device closure of perimembranous ventricular septal defect(VSD) through a lower mini-sternotomy is safe, less invasive, and has excellent surgical and cosmetic outcomes. Our study is to evaluate the feasibility of closing VSD under guidance of trans-epicardial echocardiography. We reviewed the clinical course of 41 patients referred to our institution for minimally invasive closure of perimembranous VSD. The trans-epicardial echocardiography(TEE) was used to monitor the whole procedure to guide the positioning of device and evaluate the operative effect instantly after operation. The procedure was successfully done in 38 patients(92.6 %) with mean age of 1.2 ± 1.5 years(range 0.5-6.1 years),mean weight of 10.78 ± 6.87 kg(range 5.2 ~ 26 kg) and VSD size of 5.1 ± 1.13 mm(range 5 ~ 10 mm). Three cases failed, including two cases whose guide-wires could not pass through VSDs and one case whose occluder could not repair VSD well. Three patients had tiny residual shunts because of the shifting of occluders. There were no major complications such as arrhythmia, valve regurgitation and the failure of occluder during follow-up(Mean 2.3 ± 1.2 years). TEE provided superior imaging of shapes and surrounding structures of the VSDs, and guide-wires passing through VSDs. Intraoperative device closure of perimembranous VSD through a lower mini-sternotomy without cardiopulmonary bypass appears to be a safe and effective procedure. The use of trans-epicardial echocardiography provides useful information for intraoperative device closure of VSD.

To close or not to close: contemporary indications for patent foramen ovale closure.

PubMed

Zier, Lucas S; Sievert, Horst; Mahadevan, Vaikom S

2016-11-01

Patent foramen ovale (PFO) is a common congenital cardiac abnormality and that has been associated with several disease processes including transient ischemic attacks (TIA), stroke, migraine headaches with aura, decompression sickness, platypnea-orthodeoxia syndrome, and shunt induced cyanosis. Controversy exists regarding closure of PFO as a therapeutic treatment modality for these disease processes. This review addresses the contemporary clinical indications for PFO closure. Areas covered: We conducted a comprehensive literature search of contemporary research studies focusing on randomized trials and meta-analyses comparing medical therapy and device closure of PFOs for the treatment of PFO associated clinical syndromes. We synthesized this literature into a review addressing indications for PFO closure in stroke, TIA, migraine headaches with aura, decompression sickness, platypnea-orthodeoxia syndrome, and shunt induced cyanosis. Expert commentary: Because in many PFO associated conditions it can be difficult to determine the degree to which the PFO is a causative factor in the disease process, we recommend a comprehensive diagnostic evaluation to exclude other obvious etiologies of PFO associated conditions before implicating the PFO and proceeding with closure. However in the properly selected patient population there is growing clinical experience and experimental evidence suggesting that closure of PFO is a safe and effective treatment modality.

Safety and efficacy of excision and direct closure in acute burns surgery: outcome analysis in a prospective series of 100 patients and a survey of UK burns surgeons' attitudes.

PubMed

Bain, Charles J; Wang, Tim; McArthur, Gordon; Williams, Greg; Atkins, Joanne; Jones, Isabel

2014-12-01

Many burns surgeons avoid excision and direct closure of acute burns owing to concerns over wound dehiscence, scarring and infection. There is no evidence in the literature to support this practice. We present outcomes of a prospective series of 100 patients who underwent excision and direct closure of 138 burns over a 2-year period, along with results from a survey sent to 33 senior burns surgeons to gauge attitudes towards direct closure in burns surgery. 47% of survey respondents never perform direct closure. Dehiscence was cited as the most common concern, followed by hypertrophic scarring (HTS). In our cohort, the superficial dehiscence rate was 12% and the HTS rate was 16%, with no scarring contractures. Patients with healing time greater than 14 days were more likely to develop HTS (p=0.008), as were those with wound dehiscence (p=0.014). Patients undergoing part-grafting in addition to direct closure took significantly longer to heal than those undergoing direct closure alone (p=0.0002), with the donor site or graft delaying healing in the majority. Excision and direct closure of acute burn wounds avoids donor site morbidity and has an acceptable complication rate. It is a safe and effective treatment for full thickness burns in selected cases. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, for Calendar Year 2014

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

Silvas, A. J.; Lantow, Tiffany A.

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2014 and includes inspection and repair activities completed at the following CAUs; CAU 400: Bomblet Pit and Five Points Landfill (TTR); CAU 407: Roller Coaster RadSafe Area (TTR); CAU 424: Area 3 Landfill Complexes (TTR); CAU 453: Area 9 UXO Landfill (TTR); and CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved Closure Reports and subsequent correspondence with the Nevada Division ofmore » Environmental Protection. The post-closure inspection plans and subsequent correspondence modifying the requirements for each CAU are included in Appendix B. The inspection checklists are included in Appendix C. Photographs taken during inspections are included in Appendix D. The annual post-closure inspections were conducted on May 28, 2014. Maintenance was required at CAU 407. Animal burrows were backfilled and erosion repairs were performed. Vegetation monitoring was performed at CAU 407 in June 2014. The vegetation monitoring report is included in Appendix E.« less

New laser soldering-based closures: a promising method in natural orifice transluminal endoscopic surgery.

PubMed

Bogni, Serge; Ortner, Maria-Anna; Vajtai, Istvan; Jost, Christian; Reinert, Michael; Dallemagne, Bernard; Frenz, Martin

2012-07-01

Complete closure of gastrotomy is the linchpin of safe natural orifice transgastric endoscopic surgery. To evaluate feasibility and efficacy of a new method of gastrotomy closure by using a sutureless laser tissue-soldering (LTS) technique in an ex vivo porcine stomach. In vitro experiment. Experimental laboratory. Histological analysis and internal and external liquid pressure with and without hydrochloric acid exposure were determined comparing gastrotomy closure with LTS and with hand-sewn surgical sutures. Comparison of LTS and hand-sewn surgical gastrotomy closure. The primary outcome parameter was the internal leak pressure. Secondary parameters were the difference between internal and external leak pressures, the impact of an acid environment on the device, histological changes, and feasibility of endoscopic placement. The internal liquid leak pressure after LTS was almost twice as high as after hand-sewn surgical closure (416 ± 53 mm Hg vs 229 ± 99 mm Hg; P = .01). The internal leak pressure (416 ± 53 mm Hg) after LTS was higher than the external leak pressure (154 ± 46 mm Hg; P < .0001). An acidic environment did not affect leak pressure after LTS. Endoscopic LTS closure was feasible in all experiments. Histopathology revealed only slight alterations beneath the soldering plug. In vitro experiments. Leak pressure after LTS closure of gastrotomy is higher than after hand-sewn surgical closure. LTS is a promising technique for closure of gastrotomies and iatrogenic perforations. Further experiments, in particular survival studies, are mandatory. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

A comparison of two endoscopic closures: over-the-scope clip (OTSC) versus KING closure (endoloop + clips) in a randomized long-term experimental study.

PubMed

Dolezel, R; Ryska, O; Kollar, M; Juhasova, J; Kalvach, J; Ryska, M; Martinek, J

2016-11-01

Both over-the-scope clip (OTSC) and KING (endoloop + clips) closures provide reliable and safe full-thickness endoscopic closure. Nevertheless, OTSC clip demonstrated significantly inferior histological healing in the short-term follow-up. To compare OTSC versus KING closure of a perforation with regard to long-term effectiveness and macroscopic and histological quality of healing. We performed a randomized experimental study with 16 mini-pigs (mean weight 43.2 ± 11.2 kg). A standardized perforation was performed on the anterior sigmoid wall. KING closure (n = 8) was attained by approximation of an endoloop fixed to the margins of a perforation with endoclips. OTSC closure (n = 8) was performed by deploying OTSC (OVESCO) over the defect. Pigs underwent a control sigmoidoscopy 8 months after the closure to assess the macroscopic quality of healing. Then, autopsy was performed and the rectosigmoid was sent for histopathological assessment. All closures were completed successfully without air leaks. The duration of closure was similar in both techniques (OTSC 17.8 ± 7.6 min vs. KING 19.6 ± 8.8 min). At autopsy, all KING closures (100 %) were healed with a flat scar without signs of leakage. Microscopically, no inflammatory changes were observed after KING closure. In the OTSC group, microscopic ulcers were present in two pigs (25 %), cryptal abscesses in three pigs (38 %) and significant neutrophil accumulation in all eight pigs (P < 0.01). Giant cell granulomas, dysplasia or abundant scarification was not observed in either group. Both OTSC and KING closures offer a long-term reliable seal of a gastrointestinal perforation without stenosis or fistulas. KING closure provides long-term histologically superior healing.

[Bath Plug Closure Method for Cerebrospinal Fluid Leakage by Endoscopic Endonasal Approach:Cooperative Treatment by Neurosurgeons and Otolaryngologists].

PubMed

Kawaguchi, Tomohiro; Arakawa, Kazuya; Nomura, Kazuhiro; Ogawa, Yoshikazu; Katori, Yukio; Tominaga, Teiji

2017-12-01

Endoscopic endonasal surgery, an innovative surgical technique, is used to approach sinus lesions, lesions of the skull base, and intradural tumors. The cooperation of experienced otolaryngologists and neurosurgeons is important to achieve safe and reliable surgical results. The bath plug closure method is a treatment option for patients with cerebrospinal fluid(CSF)leakage. Although it includes dural and/or intradural procedures, surgery tends to be performed by otolaryngologists because its indications, detailed maneuvers, and pitfalls are not well recognized by neurosurgeons. We reviewed the cases of patients with CSF leakage treated by using the bath plug closure method with an endoscopic endonasal approach at our institution. Three patients were treated using the bath plug closure method. CSF leakage was caused by a meningocele in two cases and trauma in one case. No postoperative intracranial complications or recurrence of CSF leakage were observed. The bath plug closure method is an effective treatment strategy and allows neurosurgeons to gain in-depth knowledge of the treatment options for CSF leakage by using an endoscopic endonasal approach.

Over-the-scope clip placement for closure of gastrointestinal fistula, postoperative leaks and refractory gastrointestinal bleed.

PubMed

Nasa, Mukesh; Sharma, Zubin Dev; Choudhary, Narendra S; Patil, Gaurav; Puri, Rajesh; Sud, Randhir

2016-09-01

The over-the-scope clip (OTSC) has been successfully used in the closure of fistula, perforation, dehiscence, and endoscopic hemostasis. We describe our experience with the OTSC application. Between April 2014 and April 2015, seven patients underwent OTSC application. In four patients, OTSC was applied for the closure of esophageal fistula, one had OTSC closure of persistent gastrocutaneous fistula after percutaneous endoscopic gastrostomy removal, and OTSC was applied in duodenum in two patients, for duodenal Dieulafoy's lesion after failed conventional endotherapy and massive rebleed in one and duodenal perforation in another. All procedures had technical success with no immediate complication related to OTSC application. Patients were followed up for every month with mean duration of follow up 10.2 months. One patient with bronchoesophageal fistula had development of another fistulous opening above the site of OTSC placement, which was successfully closed with another OTSC. One patient had superficial esophageal wall ulcer opposite the OTSC but it healed spontaneously. OTSC provided safe and successful closure in a number of settings.

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, for Calendar Year 2012

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

NSTec Environmental Restoration

2013-01-28

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2012 and includes inspection and repair activities completed at the following CAUs: · CAU 400: Bomblet Pit and Five Points Landfill (TTR) · CAU 407: Roller Coaster RadSafe Area (TTR) · CAU 424: Area 3 Landfill Complexes (TTR) · CAU 453: Area 9 UXO Landfill (TTR) · CAU 487: Thunderwell Site (TTR)

76 FR 4720 - Renewal of Agency Information Collection for Homeliving Programs and School Closure and...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-26

... Number 1076-0164, which expires on March 31, 2011. DATES: Interested persons are invited to submit... able to do so. III. Data OMB Control Number: 1076-0164. Title: Homeliving Programs and School Closure...

Randomized comparison of postoperative short-term and mid-term complications between T-tube and primary closure after CBD exploration.

PubMed

Muzaffar, Iqbal; Zula, Pai; Yimit, Yusp; Jaan, Ajim Tuergan; Wen, Hao

2014-11-01

To compare the postoperative short-term and mid-term complications in patients who underwent CBD exploration and closure by using T-tube or primary closure. Prospective randomized clinical trial. Hepatobiliary Department of First Affiliated Hospital of Xinjiang Medical University, Urumqi, China, from August 2009 to March 2013. A total of 148 consecutive patients with Common Bile Duct Stones (CBDS) and CBD dilation were enrolled in this randomized study to undergo open cholecystectomy with CBD exploration. Pre-operative findings, postoperative short-term complications, postoperative follow-up (mid-term), and hospital stay were recorded and analyzed. A T-tube was inserted in 76 (51.35%) patients and the primary closure was done in 72 (48.64%) patients. There were no differences in the demographic characteristics and clinical presentations between the two groups. Compared with the T-tube group 8.97 ± 1.629 days, the postoperative stay in primary closure 5.34 ± 1.25 days was significantly shorter (p < 0.01). The incidence of overall postoperative short-term complications and mid-term complications were statistically but not significantly lower in the primary closure group (9.7%) than that in T-tube group (17.10%, p=0.189). Complications in the primary closure group were lower than that in T-tube group but there was no significant statistical difference. So during open surgery for CBD stones, primary closure of CBD appeared safe and effective with shorter hospital stays and less complications.

Fenestrated Transcatheter ASD Closure in Adults with Diastolic Dysfunction and/or Pulmonary Hypertension: Case Series and Review of the Literature.

PubMed

Abdelkarim, Ayman; Levi, Daniel S; Tran, Bao; Ghobrial, Joanna; Aboulhosn, Jamil

2016-12-01

This study aims to evaluate the safety and efficacy of transcatheter fenestrated ASD closure and to summarize the literature regarding the published techniques and outcomes of transcatheter partial ASD closure. Patients with left ventricular diastolic dysfunction (LVDD) or right ventricular (RV) dysfunction and/or pulmonary hypertension (PHT) may suffer untoward consequences of complete closure of an ostium secundum atrial septal defect (ASD). Therefore, for patients that fall under these categories we suggest partial occlusion of the defect, which may be better tolerated than complete defect closure. After obtaining IRB approval, a search for patients that have undergone percutaneous ASD closure was performed in the Ahmanson/UCLA Adult Congenital Heart Disease Center database to identify which patients received a fenestrated ASD closure device. Eight consecutive patients ranging between 22 and 83 years of age (mean 48 years) with PHT and/or LVDD or RV dysfunction who underwent fenestrated transcatheter ASD closure at UCLA were identified. None of the subjects experienced complications related to the procedure. Postprocedure clinical evaluation showed improvement in symptoms and exercise capacity. Available follow-up transthoracic echocardiography data (mean 4 months, range 0-20 months) demonstrated patent fenestrations in four of eight patients. None of the patients had thromboembolic or infectious complications and there were no device migrations, erosions or embolizations. Partial ASD occlusion in patients with diastolic dysfunction or RV dysfunction and/or PHT is safe and may be better tolerated than complete ASD closure in selected patients. © 2016 Wiley Periodicals, Inc.

Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience.

PubMed

Milev, Ivan; Zafirovska, Planinka; Zimbakov, Zan; Idrizi, Shpend; Ampova-Sokolov, Vilma; Gorgieva, Emilija; Ilievska, Liljana; Tosheski, Goce; Hristov, Nikola; Georgievska-Ismail, Ljubica; Anguseva, Tanja; Mitrev, Zan

2016-12-15

Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine. Our goal was to present our experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO. Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40.7 ± 11.7 years). Patients were interviewed for subjective grading of the intensity of headaches before and after the PFO closure. During 2 years of follow-up, there was no incidence of new stroke, TIA and/or syncope. Follow-up TCD performed in 35 patients showed complete PFO closure in 20 patients (57.1%). Out of 35 patients, 22 (62.9%) reported having a migraine before the procedure with an intensity of headaches at 8.1 ± 1.9 on a scale from 1 to 10. During 2 years of follow-up, symptoms of a migraine disappeared in 4 (18.2%) and the remaining 18 patients reported the significant decrease in intensity 4.8 ± 2.04 (p = 0.0001). In addition, following PFO closure the incidence of the headaches decreased significantly (p = 0.0001). Percutaneous transcatheter closure of PFO is a safe and effective procedure showing mid-term relief of neurological symptoms in patients as well as significant reduction of migraine symptoms.

BACTERIA, BEACHES AND SWIMMABLE WATERS: INTRODUCING VIRTUAL BEACH

EPA Science Inventory

Safe beaches meet water quality standards and are valued for their aesthetics and the recreational opportunities that they afford. In the United States recreational water quality assessments and beach closure decisions are presently based on samples of enterococci or Escherichia ...

Closure of patent foramen ovale: when and how?

PubMed

Lisignoli, Veronica; Lanzone, Alberto M; Zavalloni, Dennis; Pagnotta, Paolo; Presbitero, Patrizia

2007-10-01

Percutaneous closure of a patent foramen ovale (PFO) was performed in 98 consecutive patients (mean age 52.5 +/- 13 years, 61 women). Indications included recurrent transient ischaemic attack (47%), cryptogenic stroke (34%), peripheral embolism (11%), disabling migraine with aura (4%), professional scuba diving (1 pt) and severe platypnea-orthodeoxia syndrome (1 pt). Each PFO was characterized by transesophageal echocardiography (TEE) according to anatomy, degree of shunt (1-mild, 2-moderate, 3-severe), right atrial anatomical features relevant for PFO closure (such as presence of an Eustachian valve, Chiari network, lipomatosis or absence of septum secundum) with a new classification scheme. According to this classification successful device delivery was obtained in 100% of pts. Major complications included heparin-induced thrombocytopenia in 1 pt and device dislodgment in 1 pt; minor complications were mostly related to the catheter introduction site (2 pts) and mild immediate shunt (2 pts). In conclusion, percutaneous PFO closure based on strict anatomic criteria is a safe procedure with minimal periprocedural complications.

Pan-nitinol occluder and special delivery device for closure of patent ductus arteriosus: a canine-model feasibility study.

PubMed

Jiang, Hai-bin; Bai, Yuan; Zong, Gang-jun; Han, Lin; Li, Wei-ping; Lu, Yang; Qin, Yong-wen; Zhao, Xian-xian

2013-01-01

The aim of this study was to evaluate a new type of occluder for patent ductus arteriosus. Patent ductus arteriosus was established in a canine model by anastomosing a length of autologous jugular vein to the descending aorta and the left pulmonary artery in an end-to-side fashion. Transcatheter closure of each patent ductus arteriosus was performed on 10 dogs, which were then monitored for as long as 6 months with aortography, echocardiography, and histologic evaluation. Transcatheter closure with use of the novel pan-nitinol device was successful in all canine models. Postoperative echocardiography showed that the location and shape of the occluders were normal, without any residual shunting. Further histologic evaluation confirmed that the occluder surface was completely endothelialized 3 months after implantation. Transcatheter patent ductus arteriosus closure with the pan-nitinol occluder can be performed safely and successfully in a canine model and shows good biological compatibility and low mortality rates.

[Periprocedural and late complications after percutaneous closure of patent foramen ovale: a single centre experience].

PubMed

Węglarz, Przemysław; Konarska Kuszewska, Ewa; Spisak Borowska, Katarzyna; Machowski, Jerzy; Drzewiecka-Gerber, Agnieszka; Kuszewski, Piotr; Jackson, Christopher L; Opala, Grzegorz; Trusz Gluza, Maria

2012-01-01

Patent foramen ovale (PFO) is a potential risk factor for ischaemic stroke in young individuals. An interventional method of secondary stroke prevention in PFO patients is its percutaneous closure. To assess safety and effectiveness (i.e. lack of residual shunt) of percutaneous PFO closure in patients with history of cryptogenic cerebrovascular event. 149 patients (56 men/93 women), aged 39 ± 12 years, underwent percutaneous PFO closure. The implantation was performed under local anaesthesia, guided by trans-oesophageal echocardiography (TEE) and fluoroscopy. Follow-up trans-thoracic echocardiography (TTE) was performed at 1 month and follow-up TEE at 6-months. In cases of residual shunt, additional TEE was performed after ensuing 6 months. Effective PFO closure (no residual shunt) was achieved in 91.3% patients at 6 months and 95.3% patients at 12 months. In 2 patients transient atrial fibrillation was observed during the procedure. In 2 patients, a puncture site haematoma developed and in 1 patient superficial thrombophlebitis was noted. In 1 patient a small pericardial effusion was observed, which resolved at day 3 post-procedurally, after administration of non-steroidal anti-inflammatory drugs. Percutaneous PFO closure seems to be a safe procedure when performed in a centre with adequate expertise with regard to these procedures.

Evaluation of the late merge work zone traffic control strategy.

DOT National Transportation Integrated Search

2004-01-01

Several alternative lane merge strategies have been proposed in recent years to process vehicles through work zone lane closures more safely and efficiently. Among these is the late merge. With the late merge, drivers are instructed to use all lanes ...

Redundant electronic circuit provides fail-safe control

NASA Technical Reports Server (NTRS)

Archer, J. W.

1970-01-01

Circuit using dual control amplifiers and dual position demand potentiometers powered from separate sources is used for reliable hydraulic valve controller that prevents closure of valve when control circuits fail, and maintains valve control to close tolerance for more common modes of controller failure.

Atrial septal defect closure with the new Cardia Ultrasept II™ device with interposed Goretex patch: Mexican experience - has the perforation of Ivalon's membrane been solved?

PubMed

Mijangos-Vázquez, Roberto; García-Montes, Antonio J; Soto-López, Elena M; Guarner-Lans, Verónica; Zabal, Carlos

2018-05-01

The objective of this study was to demonstrate the safety and feasibility of using the new Cardia Ultrasept II™ device with interposed Goretex patch referring to the perforation of polyvinyl alcohol membrane. Great advances have been made in the development of devices for closure of atrial septal defect. The Cardia Ultrasept II™ with interposed Goretex patch is the modified last generation of Cardia devices, having the advantage of a super-low profile within the atria and an integral locking delivery-retrieval mechanism that ensures safe deployment. In addition, with the interposition of the Goretex, it has been possible to abolish perforation of Ivalon's membrane as a complication.Methods and resultsPatients with ostium secundum atrial septal defect with surrounding rims with a minimum length of 5 mm and who underwent atrial septal defect closure with the new Ultrasept II™ with Goretex patch were included from two paediatric cardiac centres. Primary end point was to determine perforation of the Goretex membrane at follow-up; secondary end point included right ventricular diastolic diameter. In total, 30 patients underwent atrial septal defect closure at a median age of 6 (1-29) years. At follow-up for 6 (range, 1-15) months, freedom from perforations was 100%. A continuous decrease in right ventricular diastolic diameter was found with an initial median of 30 (25-49) mm and after catheterisation of 27.5 (18-33) mm, p=0.01, and Z-score of 2.6 (1.7-3.6) versus 1.9 (1-2.9) after procedure, p=0.01. The new modified generation of the Ultrasept II™ device with interposed Goretex patch is a good alternative to achieve atrial septal defect closure safely and feasibly with no membrane perforation at follow-up.

Defense Base Realignment and Closure Budget Data for the Closure of Fort Devens, Massachusetts

DTIC Science & Technology

1995-08-01

provides the results of the audit of one project, valued at $2.75 million, for the closure and realignment of Fort Devens, Massachusetts. This audit also...assessed the adequacy of the management control program as it applied to the audit objective.

Transcatheter closure of the left atrial appendage: initial experience with the WATCHMAN device

PubMed Central

Ding, Jiandong; Zhu, Jian; Lu, Jing; Ding, Xiuxia; Zhang, Xiaoli; Lu, Wenbin; Ao, Mingqiang; Ma, Genshan

2015-01-01

Background: Atrial fibrillation (AF) is the most commonly encountered clinical arrhythmia, accounting for approximately one third of hospitalizations for cardiac rhythm disturbance. In patients with non-valvular AF, approximately 90% of thrombi are thought to arise from the left atrial appendage (LAA). Anticoagulation with warfarin has been the mainstay of therapy to reduce stroke risk in these patients; however, it is not without its complications including bleeding and drug interactions. Percutaneous left atrial appendage closure can be an alternative to warfarin treatment in patients with AF at high risk for thromboembolic events and/or bleeding complications. Methods: Patients with atrial fibrillation and CHADSVASc score ≥ 2, not eligible for anticoagulation, were submitted to left atrial appendage closure using the WATCHMAN device. The procedure was performed under general anaesthesia, and was guided by fluoroscopy and transoesophageal echocardiography. Results: Percutaneous LAA closure with the WATCHMAN device was performed in all patients. At 45-day follow-up no recurrent major adverse events and especially no thromboembolic events occurred. Conclusions: Transcatheter closure of the LAA with the WATCHMAN device is generally safe and feasible. Long-term follow-up will further reveal the risk and benefits of this therapy. PMID:26629008

Impact of Vial Capping on Residual Seal Force and Container Closure Integrity.

PubMed

Mathaes, Roman; Mahler, Hanns-Christian; Roggo, Yves; Ovadia, Robert; Lam, Philippe; Stauch, Oliver; Vogt, Martin; Roehl, Holger; Huwyler, Joerg; Mohl, Silke; Streubel, Alexander

2016-01-01

The vial capping process is a critical unit operation during drug product manufacturing, as it could possibly generate cosmetic defects or even affect container closure integrity. Yet there is significant variability in capping equipment and processes, and their relation to potential defects or container closure integrity has not been thoroughly studied. In this study we applied several methods-residual seal force tester, a self-developed system of a piezo force sensor measurement, and computed tomography-to characterize different container closure system combinations that had been sealed using different capping process parameter settings. Additionally, container closure integrity of these samples was measured using helium leakage (physical container closure integrity) and compared to characterization data. The different capping equipment settings lead to residual seal force values from 7 to 115 N. High residual seal force values were achieved with high capping pre-compression force and a short distance between the capping plate and plunge. The choice of container closure system influenced the obtained residual seal force values. The residual seal force tester and piezoelectric measurements showed similar trends. All vials passed physical container closure integrity testing, and no stopper rupture was seen with any of the settings applied, suggesting that container closure integrity was warranted for the studied container closure system with the chosen capping setting ranges. The vial capping process is a critical unit operation during drug product manufacturing, as it could possibly generate cosmetic defects or even affect container closure integrity. Yet there is significant variability in capping equipment and processes, and their relation to potential defects or container closure integrity has not been thoroughly studied. In this study we applied several methods-residual seal force tester, a self-developed system of a piezo force sensor measurement, and computed tomography-to characterize different container closure system combinations that had been sealed using different capping process parameter settings. The residual seal force tester can analyze a variety of different container closure systems independent of the capping equipment. An adequate and safe residual seal force range for each container closure system configuration can be established with the residual seal force tester and additional methods like computed tomography scans and leak testing. In the residual seal force range studied, the physical container closure integrity of the container closure system was warranted. © PDA, Inc. 2016.

Short-term safety and efficacy of left atrial appendage closure with the WATCHMAN device in patients with small left atrial appendage ostia.

PubMed

Venkataraman, Ganesh; Strickberger, S Adam; Doshi, Shephal; Ellis, Christopher R; Lakkireddy, Dhanunjaya; Whalen, S Patrick; Cuoco, Frank

2018-01-01

Left atrial appendage (LAA) closure with the WATCHMAN device, according to FDA labelling, is recommended in patients with a maximal LAA ostial width between 17 and 31 mm. The safety and efficacy of LAA closure in patients with a maximal LAA ostial width < 17 mm has not been evaluated. The goal of this study was to determine the acute and short-term safety and efficacy of LAA closure with the WATCHMAN device in patients with a maximal LAA ostial width < 17 mm. Thirty-two consecutive patients with a maximal LAA ostial width < 17 mm as determined by a screening transesophageal echocardiogram (TEE) underwent LAA closure with the WATCHMAN device between March 2015 and November 2016 at five medical centers, and were included in this study. Mean age, body mass index (BMI), and CHA 2 DS 2 -VASC score were 70.8 ± 8.6 years, 29.3 ± 6.5 kg/m 2 , and 3.9 ±1.2, respectively. At the screening TEE, mean maximal LAA ostial width and depth were 15.6 ± 0.6 mm (range 14-16) and 23.2 ± 4.5 mm (range 13-31), respectively. Successful LAA closure with the WATCHMAN device was achieved in 31 of 32 patients (97%), with no major complications. TEE performed 45 days after LAA closure demonstrated no peridevice leak > 5 mm and no device related thrombi. Warfarin was discontinued in all 31 patients 45 days after LAA closure. LAA closure with the WATCHMAN device can be successfully and safely achieved in patients with a maximal LAA ostial width < 17 mm. © 2017 Wiley Periodicals, Inc.

Transverse closure of mesenterico-portal vein after vein resection in pancreatoduodenectomy.

PubMed

Chua, T C; de Reuver, P R; Staerkle, R F; Neale, M L; Arena, J; Mittal, A; Shanbhag, S T; Gill, A J; Samra, J S

2016-02-01

Resection of the involved mesenteric-portal vein (MPV) is increasingly performed in pancreatoduodenectomy. The primary aim of this study is to assess the rate of R0 resection in transverse closure (TC) versus segmental resection with end-to-end (EE) closure and the secondary aims are to assess the short-term morbidity and long-term survival of TC versus EE. Patients undergoing pancreatoduodenectomy with MPV resection were identified from a prospectively database. The reconstruction technique were examined and categorized. Clinical, pathological, short-term and long-term survival outcomes were compared between groups. 110 patients underwent PD with MPV resection of which reconstruction was performed with an end-to-end technique in 92 patients (84%) and transverse closure technique in 18 patients (16%). Patients undergoing transverse closure tended to have had a shorter segment of vein resected (≤2 cm) compared to the end-to-end (83% vs. 43%; P = 0.004) with no difference in R0 rate. Short-term morbidity was similar. The median and 5-year survival was 30.0 months and 18% respectively for patients undergoing transverse closure and 28.6 months and 7% respectively for patients undergoing end-to-end reconstruction (P = 0.766). Without compromising the R0 rate, transverse closure to reconstruct the mesenteric-portal vein is shown to be feasible and safe in the setting when a short segment of vein resection is required during pancreatoduodenectomy. Synopsis - We describe a vein closure technique, transverse closure, which avoids the need for a graft, or re-implantation of the splenic vein when resection of the mesenteric-portal vein confluence is required during pancreatoduodenectomy. Copyright © 2015 Elsevier Ltd. All rights reserved.

Suitability of Exoseal Vascular Closure Device for Antegrade Femoral Artery Puncture Site Closure

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

Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Liebl, Andrea; Poullos, Nektarios

Purpose. To assess the efficacy and safety of the Exoseal vascular closure device for antegrade puncture of the femoral artery. Methods. In a prospective study from February 2011 to January 2012, a total of 93 consecutive patients received a total of 100 interventional procedures via an antegrade puncture of the femoral artery. An Exoseal vascular closure device (6F) was used for closure in all cases. Puncture technique, duration of manual compression, and use of compression bandages were documented. All patients were monitored by vascular ultrasound and color-coded duplex sonography of their respective femoral artery puncture site within 12 to 36more » h after angiography to check for vascular complications. Results. In 100 antegrade interventional procedures, the Exoseal vascular closure device was applied successfully for closure of the femoral artery puncture site in 96 cases (96 of 100, 96.0 %). The vascular closure device could not be deployed in one case as a result of kinking of the vascular sheath introducer and in three cases because the bioabsorbable plug was not properly delivered to the extravascular space adjacent to the arterial puncture site, but instead fully removed with the delivery system (4.0 %). Twelve to 36 h after the procedure, vascular ultrasound revealed no complications at the femoral artery puncture site in 93 cases (93.0 %). Minor vascular complications were found in seven cases (7.0 %), with four cases (4.0 %) of pseudoaneurysm and three cases (3.0 %) of significant late bleeding, none of which required surgery. Conclusion. The Exoseal vascular closure device was safely used for antegrade puncture of the femoral artery, with a high rate of procedural success (96.0 %), a low rate of minor vascular complications (7.0 %), and no major adverse events.« less

The River Corridor Closure Contract How Washington Closure Hanford is Closing A Unique Department of Energy Project - 12425

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

Feist, E.T.

2012-07-01

Cleanup of the Hanford River Corridor has been one of Hanford Site's top priorities since the early 1990's. This urgency is due to the proximity of hundreds of waste sites to the Columbia River and the groundwater that continues to threaten the Columbia River. In April 2005, the U.S. Department of Energy, Richland Operations Office (DOE-RL) awarded the Hanford River Corridor Closure Contract (RCCC), a cost-plus incentive-fee closure contract with a 2015 end date and first of its kind at Hanford Site, to Washington Closure Hanford (WCH), a limited-liability company owned by URS, Bechtel National, and CH2M HILL. WCH ismore » a single-purpose company whose goal is to safely, compliantly, and efficiently accelerate cleanup in the Hanford River Corridor and reduce or eliminate future obligations to DOE-RL for maintaining long-term stewardship over the site. Accelerated performance of the work-scope while keeping a perspective on contract completion presents challenges that require proactive strategies to support the remaining work-scope through the end of the RCCC. This paper outlines the processes to address the challenges of completing work-scope while planning for contract termination. WCH is responsible for cleanup of the River Corridor 569.8 km{sup 2} (220 mi{sup 2}) of the 1,517.7 km{sup 2} (586 mi{sup 2}) Hanford Site's footprint reduction. At the end of calendar year 2011, WCH's closure implementation is well underway. Fieldwork is complete in three of the largest areas within the RCCC scope (Segments 1, 2, and 3), approximately 44.5% of the River Corridor (Figure 3). Working together, DOE-RL and WCH are in the process of completing the 'paper work' that will document the completion of the work-scope and allow DOE-RL to relieve WCH of contractual responsibilities and transition the completed areas to the Long-Term Stewardship Program, pending final action RODs. Within the next 4 years, WCH will continue to complete cleanup of the River Corridor following the completion goals. As field work-scope is completed, progressive reductions of business processes, physical facilities, and staff will occur. Organizations will collapse and flatten commensurate with workload. WCH employees will move on to new endeavors, proud of their accomplishments and the legacy they are leaving behind as being the first and largest environmental cleanup closure contract at Hanford. (authors)« less

Neither snow nor rain: contingency planning by a clinical reference laboratory courier service for weather related emergencies.

PubMed

Bankson, Daniel D; Heim, Joseph A

2014-01-01

To optimize transportation processes, we present herein a contingency plan that coordinates interim measures used to ensure continued and timely services when climate based events might cause an interruption of the usual specimen transportation processes. As an example, we outline the implementation and effectiveness of a contingency plan for network laboratory courier automobile transportation during times of mountain pass highway closure. Data available from an approximately 3-year period from October 10, 2010 through August 29, 2013 revealed a total of 690 complete closures in the eastbound or westbound lanes of the Interstate-90 highway in the Snoqualmie Pass area in the state of Washington. Despite the frequency of closures, the Washington State Department of Transportation was effective in limiting the duration of closures. Road closures of less than 1 hour accounted for 58.7% of the total closures. No recorded closures prevented dispatched couriers from completing a prescheduled Snoqualmie Pass route. We identified no delays as being clinically significant, despite that there were 5 instances of delays greater than 4 hours. We implemented a contingency plan of aiding courier logistics during all times of pass closure. The plan includes an easy to interpret Condition Dashboard as a status indicator and a Decision Tree that references and summarizes information. Overall, the contingency plan allows for an objective, robust, proactive decision support system that has enabled operational flexibility and has contributed to continued safe, on-time specimen transportation; clients and courier and reference laboratory staff have appreciated these features and associated outcomes. Copyright© by the American Society for Clinical Pathology (ASCP).

Minimizing user delay and crash potential through highway work zone planning.

DOT National Transportation Integrated Search

2014-05-01

Lane closures due to highway work zones introduce many challenges to ensuring smooth traffic operations and a : safe environment for drivers and workers. In addition, merging has been found to be one of the most stressful : aspects of driving and a m...

An economical alternative for the secondary container used for transporting infectious disease substances.

DOT National Transportation Integrated Search

1995-12-01

The safe containment of biological specimens during air transport is of growing concern as the number of shipments and hazards associated with such material increases. The purpose of this study was to examine the durability of adhesive-closure polyet...

Corporate social responsibility for regional sustainability after mine closure: a case study of mining company in Indonesia

NASA Astrophysics Data System (ADS)

Syarif, Andi Erwin; Hatori, Tsuyoshi

2017-06-01

Creating a soft-landing path for mine closure is key to the sustainability of the mining region. In this research, we presents a case of mine closure in Soroako, a small mining town in the north-east of South Sulawesi province, in the center of Sulawesi Island in Indonesia. Especially we investigates corporate social responsibility (CSR) programs of a mining company, PT Vale Indonesia Tbk (PTVI), towards a soft-landing of mine closure in this region. The data of the CSR programs are gathered from in-depth interviews, the annual reports and managerial reports. Furthermore we presents an integrated view of CSR to close mining in a sustainable manner. We then evaluate CSR strategies of the company and its performance from this viewpoint. Based on these steps, the way to improve the CSR mine closure scenario for enhancing the regional sustainability is discussed and recommended.

Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience

PubMed Central

Milev, Ivan; Zafirovska, Planinka; Zimbakov, Zan; Idrizi, Shpend; Ampova-Sokolov, Vilma; Gorgieva, Emilija; Ilievska, Liljana; Tosheski, Goce; Hristov, Nikola; Georgievska-Ismail, Ljubica; Anguseva, Tanja; Mitrev, Zan

2016-01-01

BACKGROUND: Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine. AIM: Our goal was to present our experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO. MATERIAL AND METHODS: Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40.7 ± 11.7 years). Patients were interviewed for subjective grading of the intensity of headaches before and after the PFO closure. RESULTS: During 2 years of follow-up, there was no incidence of new stroke, TIA and/or syncope. Follow-up TCD performed in 35 patients showed complete PFO closure in 20 patients (57.1%). Out of 35 patients, 22 (62.9%) reported having a migraine before the procedure with an intensity of headaches at 8.1 ± 1.9 on a scale from 1 to 10. During 2 years of follow-up, symptoms of a migraine disappeared in 4 (18.2%) and the remaining 18 patients reported the significant decrease in intensity 4.8 ± 2.04 (p = 0.0001). In addition, following PFO closure the incidence of the headaches decreased significantly (p = 0.0001). CONCLUSIONS: Percutaneous transcatheter closure of PFO is a safe and effective procedure showing mid-term relief of neurological symptoms in patients as well as significant reduction of migraine symptoms. PMID:28028400

Laparoscopic repair of perforated peptic ulcer: simple closure versus omentopexy.

PubMed

Lin, Being-Chuan; Liao, Chien-Hung; Wang, Shang-Yu; Hwang, Tsann-Long

2017-12-01

This report presents our experience with laparoscopic repair performed in 118 consecutive patients diagnosed with a perforated peptic ulcer (PPU). We compared the surgical outcome of simple closure with modified Cellan-Jones omentopexy and report the safety and benefit of simple closure. From January 2010 to December 2014, 118 patients with PPU underwent laparoscopic repair with simple closure (n = 27) or omentopexy (n = 91). Charts were retrospectively reviewed for demographic characteristics and outcome. The data were compared by Fisher's exact test, Mann-Whitney U test, Pearson's chi-square test, and the Kruskal-Wallis test. The results were considered statistically significant if P < 0.05. No patients died, whereas three incurred leakage. After matching, the simple closure and omentopexy groups had similarity in sex, systolic blood pressure, pulse rate, respiratory rate, Boey score, Charlson comorbidity index, Mannheim peritonitis index, and leakage. There were statistically significant differences in age, length of hospital stay, perforated size, and operating time. Comparison of the operating time in the ≤4.0 mm and 5.0-12 mm groups revealed that the simple closure took less time than omentopexy in both groups (≤4.0 mm, 76 versus 133 minutes, P < 0.0001; 5.0-12 mm, 97 versus 139.5 minutes; P = 0.006). Compared to the omentopexy, laparoscopic simple closure is a safe procedure and shortens the operating time. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Transition and closeout of the Fernald Closure Project

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

Bilson, H.E.; Terry, T.; Reising, J.

The U.S. Department of Energy (DOE) and Fluor Fernald have completed the majority of the cleanup of the Fernald Site. The over 1,000 acre complex for processing uranium has been demolished and soil contamination has been remediated. With acres of wetlands and prairies replacing the buildings and waste pits. At the end of the project the focus shifted to developing demonstrating the completion of the project and the contract, as well as ensuring a smooth transition of the facility from the DOE's Environmental Management (EM) Program to the DOE's Legacy Management (LM) Program. Working with the DOE, each portion ofmore » the closure contract was examined for specific closure definition. From this negotiation effort the Comprehensive Exit and Transition Plan (CE/T Plan) was written. The CE/T Plan is intended to assist DOE in the analysis that the site is ready for transfer into long-term stewardship (LTS) (also referred to as legacy management) and that Fluor Fernald, Inc. has satisfactorily completed the closure contract statement of work elements. Following the Lessons Learned from the closure of the Rocky Flats Site, the DOE's Legacy Management Program created a matrix of Transition Elements required to ensure adequate information was in place to allow the new prime contractor to perform the Legacy Management scope of work. The transition plan included over 1,000 elements broken down into functional areas and relied on specific Fernald Responsibility Transition Packages (RTPs) for detailed transition actions. The template for Closure and Transition Planning used at the Fernald Site was developed using the best Lessons Learned from across the DOE Complex. The template could be used for other sites, and lessons learned from this closure and transition will be appropriate for all closure projects. (authors)« less

Defense Base Realignment and Closure Budget Data for the Closure of Naval Training Center San Diego, California

DTIC Science & Technology

1995-06-06

provides the audit results for 4 military construction projects, valued at $14.4 million, for realignment and closure of Naval Tralning Center San Diego...California. The audit also assessed the adequacy of the management control program as it applied to the audit objective.

45 CFR 303.11 - Case closure criteria.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the best interests of the child to establish paternity in a case involving incest or forcible rape, or... 45 Public Welfare 2 2011-10-01 2011-10-01 false Case closure criteria. 303.11 Section 303.11... STANDARDS FOR PROGRAM OPERATIONS § 303.11 Case closure criteria. (a) The IV-D agency shall establish a...

Closure of hazardous and mixed radioactive waste management units at DOE facilities. [Contains glossary

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

Not Available

This is document addresses the Federal regulations governing the closure of hazardous and mixed waste units subject to Resource Conservation and Recovery Act (RCRA) requirements. It provides a brief overview of the RCRA permitting program and the extensive RCRA facility design and operating standards. It provides detailed guidance on the procedural requirements for closure and post-closure care of hazardous and mixed waste management units, including guidance on the preparation of closure and post-closure plans that must be submitted with facility permit applications. This document also provides guidance on technical activities that must be conducted both during and after closure ofmore » each of the following hazardous waste management units regulated under RCRA.« less

A new cable-tie based sternal closure system: description of the device, technique of implantation and first clinical evaluation

PubMed Central

2012-01-01

Background Wire closure still remains the preferred technique despite reasonable disadvantages. Associated complications, such as infection and sternal instability, cause time- and cost-consuming therapies. We present a new tool for sternal closure with its first clinical experience and results. Methods The sternal ZipFixTM System is based on the cable-tie principle. It primarily consists of biocompatible Poly-Ether-Ether-Ketone implants and is predominantly used peristernally through the intercostal space. The system provides a large implant-to-bone contact for better force distribution and for avoiding bone cut through. Results 50 patients were closed with the ZipFixTM system. No sternal instability was observed at 30 days. Two patients developed a mediastinitis that necessitated the removal of the device; however, the ZipFixTM were intact and the sternum remained stable. Conclusions In our initial evaluation, the short-term results have shown that the sternal ZipFixTM can be used safely and effectively. It is fast, easy to use and serves as a potential alternative for traditional wire closure. PMID:22731778

Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder.

PubMed

Xi, Er-Ping; Zhu, Jian; Zhu, Shui-Bo; Yin, Gui-Lin; Liu, Yong; Dong, Yong-Qiang; Zhang, Yu; Xia, Feng

2012-11-01

Ventricular septal defects resulting from post-traumatic cardiac injury are very rare. Percutaneous closure has emerged as a method for treating this disorder. We wish to report our experience in three patients who underwent percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. We treated three patients with post-traumatic ventricular septal defects caused by stab wounds with knives. After the heart wound was repaired, patient examinations revealed ventricular septal defects with pulmonary/systemic flow ratios (Qp/Qs) of over 1.7. The post-traumatic ventricular septal defects were closed percutaneously with a patent ductus arteriosus occluder (Lifetech Scientific (Shenzhen) Co., LTD, Guangdong, China) utilizing standard techniques. Post-operative transthoracic echocardiography revealed no residual left-to-right shunt and indicated normal ventricular function. In addition, 320-slice computerized tomography showed that the occluder was well placed and exhibited normal morphology. Our experiences indicate that closure of a post-traumatic ventricular septal defect using a patent ductus arteriosus occluder is feasible, safe, and effective.

Percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder

PubMed Central

Xi, Er-Ping; Zhu, Jian; Zhu, Shui-Bo; Yin, Gui-Lin; Liu, Yong; Dong, Yong-Qiang; Zhang, Yu; Xia, Feng

2012-01-01

OBJECTIVE: Ventricular septal defects resulting from post-traumatic cardiac injury are very rare. Percutaneous closure has emerged as a method for treating this disorder. We wish to report our experience in three patients who underwent percutaneous closure of a post-traumatic ventricular septal defect with a patent ductus arteriosus occluder. METHODS: We treated three patients with post-traumatic ventricular septal defects caused by stab wounds with knives. After the heart wound was repaired, patient examinations revealed ventricular septal defects with pulmonary/systemic flow ratios (Qp/Qs) of over 1.7. The post-traumatic ventricular septal defects were closed percutaneously with a patent ductus arteriosus occluder (Lifetech Scientific (Shenzhen) Co., LTD, Guangdong, China) utilizing standard techniques. RESULTS: Post-operative transthoracic echocardiography revealed no residual left-to-right shunt and indicated normal ventricular function. In addition, 320-slice computerized tomography showed that the occluder was well placed and exhibited normal morphology. CONCLUSION: Our experiences indicate that closure of a post-traumatic ventricular septal defect using a patent ductus arteriosus occluder is feasible, safe, and effective. PMID:23184204

Transcatheter closure of patent foramen ovale for secondary prevention of ischemic stroke: Quantitative synthesis of pooled randomized trial data.

PubMed

Hakeem, Abdul; Cilingiroglu, Mehmet; Katramados, Angelos; Boudoulas, Konstantinos Dean; Iliescu, Cezar; Gundogdu, Betul; Marmagkiolis, Konstantinos

2018-01-14

To evaluate the safety and efficacy of percutaneous device closure of patent foramen ovale (PFO) for secondary prevention of ischemic stroke BACKGROUND: Stroke remains the leading cause of serious long-term disability in the United States. The effectiveness of a percutaneous PFO closure in the prevention of recurrent cryptogenic strokes has not been established. We performed a literature search using PubMed, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar, and Internet-based sources from January 2003 to September 2017. Randomized controlled trails (RCTs) comparing percutaneous PFO closure to medical therapy alone. Five RCTs (CLOSURE I, PC Trial, REDUCE, RESPECT, and CLOSE) with 1,829 patients in the device group and 1,611 patients in the medical group met inclusion criteria. The cumulative incidence of recurrent stroke was 2.02% in the PFO closure arm and 4.4% in the medical therapy group (RR 0.42, 95%CI 0.20, 0.91; P = 0.03). There was no difference in the incidence of death [0.7% vs. 0.9%; RR 0.76 (95% CI 0.35, 1.64), P = 0.49] or adverse events during the follow-up period [24.6% vs. 23.7% (RR 1.03; 95% CI 0.91, 1.16), P = 0.65] between the closure and medical therapy groups. Incidence of atrial fibrillation was significantly higher in closure group compared to medical therapy [4% vs. 0.6% (RR 4.73; 95% CI 2.09, 10.70), P = 0.0002]. The comparative effectiveness of PFO closure (compared to medical therapy) was significantly more pronounced in those younger than 45 years, males, larger shunts and disc design platforms (P < 0.05). Based on the results of this analysis of randomized trial data, percutaneous PFO closure appears to be a safe and effective therapeutic option for the secondary prevention of ischemic stroke in patients with PFO and cryptogenic stroke. © 2018 Wiley Periodicals, Inc.

21 CFR 178.3290 - Chromic chloride complexes.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 3 2010-04-01 2009-04-01 true Chromic chloride complexes. 178.3290 Section 178... SANITIZERS Certain Adjuvants and Production Aids § 178.3290 Chromic chloride complexes. Myristo chromic chloride complex and stearato chromic chloride complex may be safely used as release agents in the closure...

50 CFR 648.55 - Framework adjustments to management measures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... criteria. Rotational Closures should be considered where projected annual change in scallop biomass is... annual change in scallop biomass is less than 15 percent. (b) The preparation of the SAFE Report shall... calculate the stock biomass and fishing mortality for the entire unit stock and consider all sources of...

Sampling and monitoring for closure

USGS Publications Warehouse

McLemore, Virginia T.; Smith, Kathleen S.; Russell, Carol C.

2007-01-01

An important aspect of planning a new mine or mine expansion within the modern regulatory framework is to design for ultimate closure. Sampling and monitoring for closure is a form of environmental risk management. By implementing a sampling and monitoring program early in the life of the mining operation, major costs can be avoided or minimized. The costs for treating mine drainage in perpetuity are staggering, especially if they are unanticipated. The Metal Mining Sector of the Acid Drainage Technology Initiative (ADTI-MMS), a cooperative government-industry-academia organization, was established to address drainage-quality technologies of metal mining and metallurgical operations. ADTI-MMS recommends that sampling and monitoring programs consider the entire mine-life cycle and that data needed for closure of an operation be collected from exploration through postclosure.

A computable expression of closure to efficient causation.

PubMed

Mossio, Matteo; Longo, Giuseppe; Stewart, John

2009-04-07

In this paper, we propose a mathematical expression of closure to efficient causation in terms of lambda-calculus; we argue that this opens up the perspective of developing principled computer simulations of systems closed to efficient causation in an appropriate programming language. An important implication of our formulation is that, by exhibiting an expression in lambda-calculus, which is a paradigmatic formalism for computability and programming, we show that there are no conceptual or principled problems in realizing a computer simulation or model of closure to efficient causation. We conclude with a brief discussion of the question whether closure to efficient causation captures all relevant properties of living systems. We suggest that it might not be the case, and that more complex definitions could indeed create crucial some obstacles to computability.

Patent foramen ovale closure using a bioabsorbable closure device: safety and efficacy at 6-month follow-up.

PubMed

Van den Branden, Ben J; Post, Martijn C; Plokker, Herbert W; ten Berg, Jurriën M; Suttorp, Maarten J

2010-09-01

The aim of this study was to assess the mid-term safety and efficacy of percutaneous patent foramen ovale (PFO) closure using a bioabsorbable device (BioSTAR, NMT Medical, Boston, Massachusetts). Closure of PFO in patients with cryptogenic stroke has proven to be safe and effective using different types of permanent devices. All consecutive patients who underwent percutaneous PFO closure with the bioabsorbable closure device between November 2007 and January 2009 were included. Residual shunt was assessed using contrast transthoracic echocardiography. Sixty-two patients (55% women, mean age 47.7 ± 11.8 years) underwent PFO closure. The in-hospital complications were a surgical device retrieval in 2 patients (3.2%), device reposition in 1 (1.6%), and a minimal groin hematoma in 6 patients (9.7%). The short-term complications at 1-month follow-up (n = 60) were a transient ischemic attack in the presence of a residual shunt in 1 patient and new supraventricular tachycardia in 7 patients (11.3%). At 6-month follow-up (n = 60), 1 patient without residual shunt developed a transient ischemic attack and 1 developed atrial fibrillation. A mild or moderate residual shunt was noted in 51.7%, 33.9%, and 23.7% after 1-day, 1-month, and 6-month follow-up, respectively. A large shunt was present in 8.3%, 3.4%, and 0% after 1-day, 1-month, and 6-month follow-up. Closure of PFO using the bioabsorbable device is associated with a low complication rate and a low recurrence rate of embolic events. However, a relatively high percentage of mild or moderate residual shunting is still present at 6-month follow-up. Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Laparoscopic common bile duct exploration. Lessons learned after 200 cases.

PubMed

Abellán Morcillo, Israel; Qurashi, Kamran; Abrisqueta Carrión, Jesús; Martinez Isla, Alberto

2014-05-01

Laparoscopic common bile duct exploration (LCBDE) is a reliable, reproducible and cost-effective treatment for common bile duct stones. Several techniques have been described for choledochotomy closure. To present our experience and the lessons learned in more than 200 cases of LCBDE. Between January 1999 and July 2012, 206 patients with common bile duct stones underwent LCBDE. At the beginning of the series, we performed the closure of the CBD over a T-tube (36 patients), subsequently we favoured closure over an antegrade stent (133 patients) but due to a high incidence of acute pancreatitis in the last 16 patients we have performed primary closure. The 3 closure groups were matched for age and sex. Jaundice was the most frequent presentation. A total of 185 (88,5%) patients underwent choledochotomy whereas in 17 (8,7%) patients the transcystic route was used. The group that underwent choledochotomy had a larger size of stones compared to the transcystic group (9,7 vs 7,6mm). In the stented group we found an 11,6% incidence of pancreatitis and 26,1% of hyperamylasemia. In the primary closure group we found a clear improvement of complications and hospital stay. The increased experience of the surgeon and age (younger than 75) had a positive impact on mortality and morbidity. Primary closure of the common bile duct after LCBDE seems to be superior to closure over a T tube and stents. The learning curve seems to have a positive impact on the outcomes making it a safe and reproducible technique especially for patients aged under 75. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications.

PubMed

Backes, Carl H; Cheatham, Sharon L; Deyo, Grace M; Leopold, Scott; Ball, Molly K; Smith, Charles V; Garg, Vidu; Holzer, Ralf J; Cheatham, John P; Berman, Darren P

2016-02-12

Percutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (<32 weeks of gestation) are minimal, and no published criteria exist establishing a minimal weight of 4 kg as a suitable cutoff. We sought to analyze outcomes of percutaneous PDA occlusion in infants born very preterm and referred for PDA closure at weights <4 kg. Retrospective analysis (January 2005-January 2014) was done at a single pediatric center. Procedural successes and adverse events were recorded. Markers of respiratory status (need for mechanical ventilation) were determined, with comparisons made before and after catheterization. A total of 52 very preterm infants with a median procedural weight of 2.9 kg (range 1.2-3.9 kg) underwent attempted PDA closure. Twenty-five percent (13/52) of infants were <2.5 kg. Successful device placement was achieved in 46/52 (88%) of infants. An adverse event occurred in 33% of cases, with an acute arterial injury the most common complication. We observed no association between weight at time of procedure and the risk of an adverse event. No deaths were attributable to the PDA closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, P<0.01). Among infants born very preterm, percutaneous PDA closure at weights <4 kg is generally safe and may improve respiratory health, but risk of arterial injury is noteworthy. Randomized clinical trials are needed to assess clinically relevant differences in outcomes following percutaneous PDA closure versus alternative (surgical ligation) management strategies. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Closure of tubular patent ductus arteriosus with the Amplatzer Vascular Plug IV: feasibility and safety.

PubMed

Baruteau, Alban-Elouen; Lambert, Virginie; Riou, Jean-Yves; Angel, Claude-Yves; Belli, Emre; Petit, Jérôme

2015-01-01

Closure of tubular patent ductus arteriosus remains a challenging procedure. Anecdotal use of Amplatzer Vascular Plug IV for tubular ductus closure has been reported but feasibility and safety in a consecutive patients' series remain unknown. We performed a monocenter prospective study at the Marie Lannelongue Hospital in Paris, France. From 2009 to 2014, a total of 47 patients (39 infants, 3 children, and 5 adults) underwent ductus closure with the Plug IV. Ductus morphology was a type E in 34 (72.3%) patients and a type C in 13 (27.7%) patients. Ductus closure occurred in 39 (83.0%) infants at a median age of seven months (range: 3-23 months) and a median weight of 6.9 kg (range: 4.1-17.0 kg). A past history of prematurity and very low birth weight was found in 33 (70.2%) of them. Twelve (25.5%) patients had pulmonary hypertension. Mean Plug IV diameter was 1.9 ± 0.1 mm larger than the mean maximal ductus diameter. Early complete closure of the ductus was obtained in all patients. Early migration of an undersized Plug IV occurred in one (2.1%) patient and was suitable for percutaneous device retrieval. After a mean follow-up of 3.4 ± 1.4 years, all patients are alive and asymptomatic, no late complication occurred. Transcatheter closure of tubular ductus with the Amplatzer Vascular Plug IV can be safe and effective, with a 100% early occlusion rate. This device, suitable for a 4F sheath, is a new alternative for tubular ductus closure in low-body-weight infants. © The Author(s) 2014.

Off-pump repair of a post-infarct ventricular septal defect: the 'Hamburger procedure'

PubMed Central

Barker, Thomas A; Ng, Alexander; Morgan, Ian S

2006-01-01

We report a novel off-pump technique for the surgical closure of post-infarct ventricular septal defects (VSDs). The case report describes the peri-operative management of a 76 year old lady who underwent the 'Hamburger procedure' for closure of her apical VSD. Refractory cardiogenic shock meant that traditional patch repairs requiring cardiopulmonary bypass would be poorly tolerated. We show that echocardiography guided off-pump posterior-anterior septal plication is a safe, effective method for closing post-infarct VSDs in unstable patients. More experience is required to ascertain whether this technique will become an accepted alternative to patch repairs. PMID:16722552

Community Environmental Response Facilitation Act (CERFA) report, Fort Holabird Crime Records Center, Baltimore, Maryland

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

Not Available

Public Laws designated more than 100 Department of Army facilities for closure and realignment. As a result, it became necessary to expedite the environmental investigation and cleanup process, as necessary, prior to the release and reuse of Army Base Realignment and Closure (BRAC) property. The BRAC environmental restoration program was established in 1989 with the first round (BRAC 88) of base closures and continued with subsequent rounds (BRAC 91, BRAC 93, etc.). As a result of the BRAC program, Fort Holabird Crime Records Center has been investigated to determine its environmental condition.

Soyuz-MS-07_Farewell-Hatch-Closure_June-3-2018_660949

NASA Image and Video Library

2018-06-04

Expedition 55 Crew Lands Safely in Kazakhstan to Complete Almost Six Months In Space------ Expedition 55 Commander Anton Shkaplerov of Roscosmos and Flight Engineers Scott Tingle of NASA and Norishige Kanai of the Japan Aerospace Exploration Agency (JAXA) landed safely near the town of Dzhezkazgan, Kazakhstan June 3 after bidding farewell to their colleagues on the complex and undocking their Soyuz MS-07 spacecraft from the Rassvet Module on the International Space Station. The trio spent almost six months in space conducting research and operational work in support of the station.

76 FR 72643 - Western Pacific Pelagic Fisheries; Closure of the Hawaii Shallow-Set Pelagic Longline Fishery Due...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-25

.... 080225267-91393-03] RIN 0648-XA370 Western Pacific Pelagic Fisheries; Closure of the Hawaii Shallow- Set...: Temporary rule; fishery closure. SUMMARY: NMFS closes the shallow-set pelagic longline fishery north of the Equator for all vessels registered under the Hawaii longline limited access program. The shallow-set...

AMPLATZER versus Figulla occluder for transcatheter patent foramen ovale closure.

PubMed

Trabattoni, Daniela; Gaspardone, Achille; Sgueglia, Gregory A; Fabbiocchi, Franco; Gioffrè, Gaetano; Montorsi, Piero; Calligaris, Giuseppe; Iamele, Maria; De Santis, Antonella; Bartorelli, Antonio L

2017-04-20

The aim of this observational study was to compare acute and 12-month results of percutaneous closure of patent foramen ovale (PFO) with two occluder devices. Between June 2007 and October 2014, 406 consecutive patients (48.1±13.3 years, 243 women) underwent percutaneous PFO closure with either the AMPLATZER (n=179) or the Figulla (n=227) device after a stroke or a transient ischaemic attack ascribed to the PFO. A right-to-left shunt grade >1 was previously detected in all patients and atrial septal aneurysm was present in 111 (27.5%) patients. Patients were followed up with a contrast transthoracic echocardiogram and clinically at 24 hours, six months, and 12 months after the procedure. A high procedural success was observed in both groups. Despite a trend towards a higher incidence of acute residual shunt immediately after device deployment among Figulla occluder patients, a residual grade ≥2 right-to-left shunt was observed in 4.5% of patients, independently of the device used for PFO closure. The only difference reported after Figulla device implantation was a lower rate of supraventricular arrhythmias (9% vs. 17%, p=0.02). According to this two-centre study, PFO closure appears safe and effective with the Figulla occluder as well as with the AMPLATZER device.

Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions.

PubMed

Basman, Craig; Parmar, Yuvrajsinh J; Kronzon, Itzhak

2017-09-06

With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions. Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures. This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.

Catheter closure of patent foramen ovale in patients with cryptogenic cerebrovascular accidents: initial experiences in Japan.

PubMed

Kijima, Yasufumi; Akagi, Teiji; Nakagawa, Koji; Taniguchi, Manabu; Ueoka, Akira; Deguchi, Kentaro; Toh, Norihisa; Oe, Hiroki; Kusano, Kengo; Sano, Shunji; Ito, Hiroshi

2014-01-01

Although numerous studies have shown an association between a patent foramen ovale (PFO) and cryptogenic cerebrovascular accidents (CVA), there has been no definitive control study that demonstrated the benefit of percutaneous device closure of a PFO compared to medical therapy in patients with CVA. Additionally, few clinical data exist for Japanese patients in this field. We demonstrate the initial experiences in catheter closure of a PFO as secondary prevention of CVA in Japan. Catheter closure of a PFO was attempted in 7 patients who were diagnosed with cryptogenic CVA. Mean age at the procedure was 54 ± 19 years. The presence of spontaneous interatrial right-to-left shunts was demonstrated by transesophageal contrast echocardiography without Valsalva maneuver in all of the patients. Amplatzer Cribriform device (n = 4) or Amplatzer PFO Occluder (n = 3) was used for the procedure and was successfully deployed. Device-related complications were not observed at the time of the procedure or during the follow-up period (mean period of 16 ± 9 months). Catheter closure of a PFO could be safely performed with Amplatzer Cribriform or Amplatzer PFO Occluder. This procedure may contribute to prevention of recurrent cryptogenic CVA in Japanese patients.

Negative pressure wound therapy management of the “open abdomen” following trauma: a prospective study and systematic review

PubMed Central

2013-01-01

Introduction The use of Negative Pressure Wound Therapy (NPWT) for temporary abdominal closure of open abdomen (OA) wounds is widely accepted. Published outcomes vary according to the specific nature and the aetiology that resulted in an OA. The aim of this study was to evaluate the effectiveness of a new NPWT system specifically used OA resulting from abdominal trauma. Methods A prospective study on trauma patients requiring temporary abdominal closure (TAC) with grade 1or 2 OA was carried out. All patients were treated with NPWT (RENASYS AB Smith & Nephew) to achieve TAC. The primary outcome measure was time taken to achieve fascial closure and secondary outcomes were complications and mortality. Results A total of 20 patients were included. Thirteen patients (65%) achieved fascial closure following a median treatment period of 3 days. Four patients (20%) died of causes unrelated to NPWT. Complications included fistula formation in one patient (5%) with spontaneous resolution during NPWT), bowel necrosis in a single patient (5%) and three cases of infection (15%). No fistulae were present at the end of NPWT. Conclusion This new NPWT kit is safe and effective and results in a high rate of fascial closure and low complication rates in the severely injured trauma patient. PMID:23305306

Preliminary experience with a new device for delayed sternal closure strategy in cardiac surgery.

PubMed

Santini, Francesco; Onorati, Francesco; Telesca, Mariassunta; Faggian, Giuseppe; Mazzucco, Alessandro

2012-06-01

Open chest management with delayed sternal closure (DSC) is a valuable strategy in the management of patients with postcardiotomy hemodynamic instability or severe coagulopathy. The conventional extemporized material available for off-label sternal stenting however may limit its efficacy. We evaluated outcomes of patients with refractory severe postcardiotomy cardiogenic shock (SPCCS) treated with DSC using a novel temporary sternal spreader (NTSS) which allows myocardial recovery by progressive controlled approximation of the sternal edges. Seven patients (4 male, mean age 66.5 ± 5 years) with refractory SPCCS showing acute hemodynamic instability at sternal closure, were implanted with the NTSS, consisting of stainless-steel branches linked to 2 diverging plates of polyether-ether ketone, whose progressive opening/closing mechanism can be controlled from outside the chest with a rotating steel wire. The sternal wound was closed by an elastic membrane to achieve a sterile field. Swan-Ganz monitoring was employed, and clinical outcomes evaluated. The device was successfully implanted in all patients without device-related complications or failures. Progressive approximation of sternal edges, titrated on cardiac index values, was successfully completed allowing subsequent uneventful sternal closure in all. Mean time from SPCCS to sternal closure was 70 ± 21 hours. No patient developed infective complications or late hemodynamic instability after device removal and sternal closure. One patient (14%) died of multiorgan failure on postoperative day 9. Despite the limited number of patients enrolled, the NTSS proved safe and effective in allowing complete myocardial recovery after SPCCS, avoiding hemodynamic instability related to abrupt sternal closure, with no occurrence of infective complications.

Transcatheter closure of patent ductus arteriosus: 11 years of clinical experience in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

PubMed

Djer, Mulyadi M; Saputro, Dimas Dwi; Putra, Sukman Tulus; Idris, Nikmah Salamia

2015-06-01

Transcatheter closure of patent ductus arteriosus (PDA) has been suggested to be the standard treatment of PDA. Although, in general, the procedure shows a high successful rate, outcomes may vary among pediatric cardiology centers. To evaluate the effectiveness of transcatheter closure of PDA in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, this was a retrospective study on patients who underwent transcatheter closure of PDA in Cipto Mangunkusumo Hospital during the period of 2002-2013. Hospital registry was reviewed and data about patients' characteristics, PDA severity, procedure, and outcomes were retrieved. There were 298 patients, of whom 90 were males, who underwent transcatheter closure of PDA during the study period. Median age was 3.4 years (1 months-18 years), and median body weight was 12 (3.6-59) kg. The diameter of PDA ranged from 1.1 to 15.4 mm with a median of 3.7 mm. Device could be deployed in all patients, in which most were the Amplatzer ductal occluder (69.8 %) and the remainders were coils. Median fluoroscopy time was 15.4 (1.5-87) min, and procedure time was 76 (30-200) min. Complete closure was achieved in most patients (97.3 %), whereas device migration occurred in a minority (0.3 %) of patients. No major complication occurred during or after the procedure. Transient anemia and bradycardia were found in 3.7 and 1.3 % patients, respectively. Most patients were discharged from the hospital at 1 day after the procedure. Transcatheter closure method is a safe and effective procedure to close PDA.

Percutaneous device closure of patent ductus arteriosus with pulmonary artery hypertension: long-term results.

PubMed

Vijayalakshmi, Ishwarappa Balekundri; Setty, Natraj; Narasimhan, Chitra; Singla, Vivek; Manjunath, Cholenahalli Nanjappa

2014-12-01

Device closure of patent ductus arteriosus (PDA) is treatment of choice. But device closure in presence of pulmonary artery hypertension (PAH) remains a challenge. Data on patient selection, technical considerations, and complications are limited. To know the challenges and efficacy of device closure of PDA with PAH. Out of 1,325 cases of device closure of PDA, 246 (18.6%) with PAH formed the study material. To test the feasibility, chosen device is used to occlude PDA for ten minutes without oxygen inhalation. The device is released only if PAH reduced. PAH decreased in all except in 1 patient after closure with muscular ventricular septal occluder (MVSDO), pulmonary artery pressure (PAP) transiently increased (became supra-systemic), without significant reduction in aortic pressure. Device embolized in 8 patients (3.3%). Percutaneous retrieval was done in 4 (by snare in 2 and by fixing the cable to device in 2) and replaced with bigger devices. The surgical removal of the embolized MVSDO and ligation was done in 4 cases. All patients were on oral sildenafil and bosentan until PAP regressed to normal. Follow up was from 6 months to 9 years. No residual shunt in any patient on follow-up. The PAP regressed to normal in all except 5 cases (2.03%) of Down's syndrome with systemic PAP. Device closure of PDA with PAH is feasible, safe in all age groups. Temporary PDA occlusion with device is effective and time saving for evaluating pulmonary vascular reactivity. Device embolization in aorta is higher with severe PAH. Novel method of retrieval is effective. © 2014, Wiley Periodicals, Inc.

Elastic-plastic analysis of a propagating crack under cyclic loading

NASA Technical Reports Server (NTRS)

Newman, J. C., Jr.; Armen, H., Jr.

1974-01-01

Development and application of a two-dimensional finite-element analysis to predict crack-closure and crack-opening stresses during specified histories of cyclic loading. An existing finite-element computer program which accounts for elastic-plastic material behavior under cyclic loading was modified to account for changing boundary conditions - crack growth and intermittent contact of crack surfaces. This program was subsequently used to study the crack-closure behavior under constant-amplitude and simple block-program loading.

Vascular closure devices in stroke patients receiving tissue plasminogen activator: A retrospective analysis from an academic tertiary medical center and a teaching community hospital stroke database.

PubMed

Patil, Mangaladevi S; Jayaraman, Mahesh V; Ahn, Sun H

2017-06-01

To determine the safety and effectiveness of vascular closure devices in prevention of access site complications in acute stroke patient receiving intravenous (IV) and/or intra-arterial (IA) IV tissue plasminogen activator (tPA). All patients with acute stroke onset treated with IV and/or IA tPA closed with vascular closure device and adult age (>18 years) were identified from an academic tertiary medical center and a teaching community hospital stroke database for 9 years (from March 2005 to June 2014). A total of 69 patients were included in the study. The mean age was 68.86±16.70 years and 49.2% female. All accesses were under fluoroscopic guidance into the right common femoral artery. We observed a 5.8% complication rate in patients receiving IV and/or IA tPA closed with vascular closure device. Access site complications included 3 cases of hematoma and 1 case of residual oozing. One patient required transfusion due to access site hematoma. Three patients were on aspirin and heparin and 1 was on no prior anticoagulation. Vascular closure device access site hemorrhagic complication rate in those receiving IV and/or IA tPA is low and similar to reported rates in those not receiving thrombolytic therapy. Vascular closure device use in patients receiving thrombolytic therapy is safe and effectively achieves hemostasis. Copyright © 2017 Elsevier B.V. All rights reserved.

Transcatheter closure of patent ductus arteriosus in children weighing 10 kg or less: Initial experience at Sohag University Hospital.

PubMed

Ali, Safaa; El Sisi, Amel

2016-04-01

To assess the challenges, feasibility, and efficacy of device closure of patent ductus arteriosus (PDA) in small children weighing ⩽10 kg for different types of devices used in an initial experience at Sohag University hospital. Between March 2011 and September 2014, 91 patients with PDA underwent transcatheter closure in our institute, among whom 54 weighed ⩽10 kg. All of these patients underwent transcatheter closure of PDA using either a Cook Detachable Coil, PFM Nit-Occlud, or Amplatzer duct occluder. A retrospective review of the treatment results and adverse events was performed. Successful device placement was achieved in 53/54 small children (98.1%). The median minimum PDA diameter was 2.4 mm [interquartile range (IQR, 1.8-3.5 mm), median weight 8 kg (IQR, 7-10 kg), and median age 10 months (IQR, 8-17 months)]. Mild aortic obstruction occurred in one case (1.9%), as the device became displaced towards the aorta after release. The device embolized in one case (1.9%) and no retrieval attempt was made. Five cases (9.3%) had minor vascular complications. With the current availability of devices for PDA closure, transcatheter closure of PDA is considered safe and efficacious in small children weighing ⩽10 kg with good mid-term outcome. The procedure had a low rate of high-severity adverse events even with the initial experience of the catheterization laboratory.

The Significance of Small Cracks in Fatigue Design Concepts as Related to Rotorcraft Metallic Dynamic Components

NASA Technical Reports Server (NTRS)

Everett, R. A., Jr.; Elber, W.

2000-01-01

In this paper the significance of the "small" crack effect as defined in fracture mechanics will be discussed as it relates to life managing rotorcraft dynamic components using the conventional safe-life, the flaw tolerant safe-life, and the damage tolerance design philosophies. These topics will be introduced starting with an explanation of the small-crack theory, then showing how small-crack theory has been used to predict the total fatigue life of fatigue laboratory test coupons with and without flaws, and concluding with how small cracks can affect the crack-growth damage tolerance design philosophy. As stated in this paper the "small" crack effect is defined in fracture mechanics where it has been observed that cracks on the order of 300 microns or less in length will propagate at higher growth rates than long cracks and also will grow at AK values below the long crack AK threshold. The small-crack effect is illustrated herein as resulting from a lack of crack closure and is explained based on continuum mechanics principles using crack-closure concepts in fracture mechanics.

Dry Storage of Research Reactor Spent Nuclear Fuel - 13321

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

Adams, T.M.; Dunsmuir, M.D.; Leduc, D.R.

2013-07-01

Spent fuel from domestic and foreign research reactors is received and stored at the Savannah River Site's L Area Material Storage (L Basin) Facility. This DOE-owned fuel consists primarily of highly enriched uranium in metal, oxide or silicide form with aluminum cladding. Upon receipt, the fuel is unloaded and transferred to basin storage awaiting final disposition. Disposition alternatives include processing via the site's H Canyon facility for uranium recovery, or packaging and shipment of the spent fuel to a waste repository. A program has been developed to provide a phased approach for dry storage of the L Basin fuel. Themore » initial phase of the dry storage program will demonstrate loading, drying, and storage of fuel in twelve instrumented canisters to assess fuel performance. After closure, the loaded canisters are transferred to pad-mounted concrete overpacks, similar to those used for dry storage of commercial fuel. Unlike commercial spent fuel, however, the DOE fuel has high enrichment, very low to high burnup, and low decay heat. The aluminum cladding presents unique challenges due to the presence of an oxide layer that forms on the cladding surface, and corrosion degradation resulting from prolonged wet storage. The removal of free and bound water is essential to the prevention of fuel corrosion and radiolytic generation of hydrogen. The demonstration will validate models predicting pressure, temperature, gas generation, and corrosion performance, provide an engineering scale demonstration of fuel handling, drying, leak testing, and canister backfill operations, and establish 'road-ready' storage of fuel that is suitable for offsite repository shipment or retrievable for onsite processing. Implementation of the Phase I demonstration can be completed within three years. Phases II and III, leading to the de-inventory of L Basin, would require an additional 750 canisters and 6-12 years to complete. Transfer of the fuel from basin storage to dry storage requires integration with current facility operations, and selection of equipment that will allow safe operation within the constraints of existing facility conditions. Examples of such constraints that are evaluated and addressed by the dry storage program include limited basin depth, varying fuel lengths up to 4 m, (13 ft), fissile loading limits, canister closure design, post-load drying and closure of the canisters, instrument selection and installation, and movement of the canisters to storage casks. The initial pilot phase restricts the fuels to shorter length fuels that can be loaded to the canister directly underwater; subsequent phases will require use of a shielded transfer system. Removal of the canister from the basin, followed by drying, inerting, closure of the canister, and transfer of the canister to the storage cask are completed with remotely operated equipment and appropriate shielding to reduce personnel radiation exposure. (authors)« less

Endonasal Suturing of Nasoseptal Flap to Nasopharyngeal Fascia Using the V-Loc™ Wound Closure Device: 2-Dimensional Operative Video.

PubMed

Zwagerman, Nathan T; Geltzeiler, Mathew N; Wang, Eric W; Fernandez-Miranda, Juan C; Snyderman, Carl H; Gardner, Paul A

2018-05-30

We present a case of cerebrospinal fluid (CSF) leak after endoscopic endonasal resection of a large clival chordoma in an obese patient. The leak was at the lower reconstruction at the craniocervical junction and had failed repositioning. Using the V-Loc™ wound closure device (Covidien, New Haven, Connecticut) to suture the nasoseptal flap to the nasopharyngeal fascia, a water-tight seal was created and, along with a lumbar drain, the patient healed successfully.CSF leak after an endoscopic endonasal approach (EEA) to intradural pathologies remains one of the more common complications.1-4 Various closure techniques have been developed5-8 with success in mitigating this risk, but all have their limitations and rely on multiple layers including vascularized flaps like the nasoseptal flap.9-11 Endonasal suturing of graft materials offers the advantage of creating a water-tight seal. We present the use of the V-Loc™ wound closure device (Covidien) to successfully seal a postoperative CSF leak. The absorbable V-Loc™ wound closure device does not require the surgeon to tie knots, which is the most challenging step in a deep, 2-dimensional corridor. The suture is barbed and is anchored by threading the needle through a prefabricated loop at the end of the suture which locks in place. Each throw of the suture through tissue maintains the suture line as the barbs catch the tissue and prevent retraction. After successful closure, the needle can simply be cut off.The V-Loc™ wound closure device (Covidien) is a safe and effective adjunct to reconstruction after endoscopic endonasal skull base surgery as it provides an option for graft/flap suturing.A written release from the patient whose name or likeness is submitted as part of this Work is on file.

Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults.

PubMed

P, Sudhakar; Jose, John; George, Oommen K

Catheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA) ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH) and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center. This single-center retrospective analysis included 70 patients (33 adolescents and 37 adults) who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications. Of 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years). Devices used were 4-Cook's detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix), 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531days). In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77mmHg to 33mmHg;P=0.014). No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred. In contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients. Copyright © 2017. Published by Elsevier B.V.

Transcatheter closure of moderate-to-large patent ductus arteriosus in infants using Amplatzer duct occluder.

PubMed

Wang, Jou-Kou; Wu, Mei-Hwan; Lin, Ming-Tai; Chiu, Shuenn-Nan; Chen, Chun-An; Chiu, Hsin-Hui

2010-02-01

There are difficulties in transcatheter closure of patent ductus arteriosus (PDA) in infants. The 46 infants (mean age 6.2+/-2.7 months; mean body weight 6.3+/-1.6 kg) who underwent PDA closure using the Amplatzer duct occluder (ADO). The indication for using an ADO was a ductus diameter > or =2.5 or 3 mm. Device diameter selected was 1-3 mm larger than ductal diameter. The mean systolic pulmonary artery pressure was 40.9+/-18.2 mmHg. The mean Qp/Qs ratio was 3.1+/-1.2. The mean ductus diameter was 3.3+/-0.8 mm. ADO was successfully deployed in 45 patients. Failure occurred in 1 case. The mean diameter of device used was 5.4+/-1.1 mm. No severe complications occurred. At the 1-month echocardiographic follow-up, a small residual shunt was present in 4 of 45 patients and had disappeared in all 4 patients at the 3-month follow-up. One patient developed a moderate degree of left ventricular outflow tract obstruction 2.3 years after the procedure. Transcatheter closure of PDA in infants using the ADO is a safe and effective method.

Perforated Sigmoid Diverticular Disease: a Management Protocol

PubMed Central

Moin, Thajammul

2008-01-01

Background: To develop an evidence-based protocol for the management of perforated sigmoid diverticular disease. Methods: A search of the literature was undertaken. All publications pertaining to perforated sigmoid diverticular disease were analyzed and then categorized according to their level of evidence. Recommendations were then made on the basis of this. Results: Multiple case reports suggest that primary closure of perforation of sigmoid diverticula is safe in the absence of peritoneal contamination. Conclusions: A 2-stage laparoscopic approach incorporating the principles of damage limitation surgery may be a safe strategy in the management of perforated diverticular disease. PMID:18435896

Maxillary orthognathic surgery.

PubMed

Bauer, Richard E; Ochs, Mark W

2014-11-01

Maxillary surgery to correct dentofacial deformity has been practiced for almost 100 years. Significant advances have made maxillary surgery a safe and efficient means of correcting midface deformities. Anesthetic techniques, specifically hypotensive anesthesia, have allowed for safer working conditions. Landmark studies have proven manipulation and segmentalization of the maxilla is safe and allowed this surgery to become a mainstay in corrective jaw surgery. This article provides an overview of surgical techniques and considerations as they pertain to maxillary surgery for orthognathic surgery. Segmental surgery, openbite closure, vertical excess, grafting, and a technology update are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

TECHNICAL AND REGULATORY CONSIDERATIONS IN USING FREIGHT CONTAINERS AS INDUSTRIAL PACKAGES

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

Opperman, E; Mark Hawk, M; Ron Natali, R

2007-10-16

The United States (US) Department of Energy (DOE), Office of Environmental Management (EM), is actively pursuing activities to reduce the radiological risk and clean up the environmental legacy of the nation's nuclear weapons programs. EM has made significant progress in recent years in the clean-up and closure of sites and is also focusing on longer-term activities necessary for the completion of the clean-up program. The packaging and transportation of contaminated demolition debris and low-level waste (LLW) materials in a safe and cost-effective manner are essential in completing this mission. Toward this end, the US Department of Transportation's (DOT) Final Rulemore » on Hazardous Materials Regulation Final Rule issued January 26, 2004, included a new provision authorizing the use of Freight Containers (e.g., 20 and 40-foot ISO Containers) as Industrial Packages Type 1, 2, or 3 (IP-1, IP-2, and IP-3). This paper will discuss the technical and regulatory considerations in using these newly authorized and large packages for the packaging and transportation of LLW materials.« less

Hybrid approach to surgical correction of tetralogy of Fallot in all patients with functioning Blalock Taussig shunts.

PubMed

Sivakumar, Kothandam; Krishnan, Prasad; Pieris, Rajeeva; Francis, Edwin

2007-08-01

In total surgical correction of tetralogy of Fallot (TOF) with functioning Blalock Taussig shunts (BTS), shunt take down increased surgical time, bleeding, and might injure phrenic and recurrent laryngeal nerve and thoracic duct. A routine hybrid approach using transcatheter BTS closure immediately before total surgical correction of TOF in all patients might reduce these problems. We analyze the safety and feasibility of this approach. Transcatheter BTS closure was achieved using single or multiple stainless steel embolization coils, Amplatzer vascular plugs, or duct occluders. When coils were released without control by bioptome forceps, coil migration in larger shunts was prevented by proximal or distal balloon occlusion. This routine hybrid strategy was followed in 22 consecutive patients aged 1-13 years over 4-year-period and 21 procedures were successful. Among the 16 patients attempted with coils, 13 had successful closure, 2 needed Amplatzer duct occluder devices, and 1 sent for surgical shunt takedown due to acute angulation of the shunt. New Amplatzer vascular plugs were used in six patients. Bioptome was used in six patients and proximal or distal balloon occlusion of flow was used in three patients. Four patients had closure of associated aortopulmonary or chest wall collaterals. Hybrid approach using routine transcatheter closure of all BTS immediately before surgical correction of TOF shunts with coils/plugs/devices is safe, feasible, and reproducible. Copyright (c) 2007 Wiley-Liss, Inc.

CIRSE Vascular Closure Device Registry

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

Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl; Mueller-Huelsbeck, Stefan; Libicher, Martin

2011-02-15

Purpose: Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. Methods: The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. Results: Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0-14.5] for antegrade access and 1.8% (95% CI 1.1-2.9) for retrograde access (Pmore » = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only <0.5% of patients. Postdeployment bleeding occurred in 6.4%, and most these (51.5%) could be managed with light manual compression. During follow-up, other device-related complications were reported in 1.3%: seven false aneurysms, three hematoma >5.9 cm, and two vessel occlusions. Conclusion: The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters.« less

Addition of rectus sheath relaxation incisions to emergency midline laparotomy for peritonitis to prevent fascial dehiscence.

PubMed

Marwah, Sanjay; Marwah, Nisha; Singh, Mandeep; Kapoor, Ajay; Karwasra, Rajender Kumar

2005-02-01

The incidence of fascial dehiscence and incisional hernia after two methods for abdominal wound closure (rectus sheath relaxation incisions and conventional mass closure) was studied in a randomized prospective clinical trial in a consecutive series of 100 patients undergoing midline laparotomy for peritonitis. The two groups were well matched for etiologies of peritonitis, the surgical procedures performed, and the presence of known risk factors for fascial dehiscence. Fifty patients each were randomized either to the conventional continuous mass closure procedure or the rectus sheath relaxation incision technique (designed to increase wound elasticity and decrease tension in the suture line) using identical polypropylene sutures. The incidence of postoperative complications such as duration of ileus, chest infection, and wound infection were not statistically different between the two groups. The intensity of postoperative pain in the rectus sheath relaxation incision group was significantly less. The incidence of wound hematoma was significantly increased in the rectus sheath relaxation incision group. The incidences of fascial dehiscence (16% vs,28%; p < 0.05) and incisional hernia (18% vs, 30%; p < 0.05) were significantly lower after rectus sheath relaxation incisions compared to conventional mass closure. Closure of the midline laparotomy wound in cases of peritonitis using the rectus sheath relaxation technique is safe and less painful, provides increased wound elasticity and decreased tension on the suture line, and significantly decreases the incidence of wound dehiscence.

Detecting the limits of bronchial closure methods in an animal model.

PubMed

Tezel, C; Urek, S; Keles, M; Kiral, H; Koşar, A; Dudu, C; Arman, B

2006-04-01

Bronchopleural fistula is a serious complication of major lung resections that may lead to mortality. An experimental animal model was designed to find out the safest bronchial closure method by comparing leakage rates under pressure. The tracheobronchial trees of 50 freshly dead sheep were prepared for either manual closure or closure with a stapler. After left pneumonectomy, the specimens were divided into five groups (n = 10); 3/0 Premilene suture was used with two "u" sutures + interrupted sutures in Group I; in Group II, 3/0 Premilene sutures with continuous horizontal mattress + over-over continuous sutures were used. In Group III and IV the same techniques were used with 3/0 Vicryl. A stapler was used in Group V. Specimens were intubated with an endotracheal tube, connected to a sphygmomanometer, and subsequently positioned under water. The pressure level at which we detected air bubbles indicated the limits of the technique. The median leakage pressure resistance was significantly lower in Group III (135 mm Hg) ( P = 0.001). The best results were achieved by using the continuous horizontal mattress + over-over continuous suture technique. No statistical significance difference was found between the stapler group, Groups I, II, and IV in terms of median leakage pressures. This trial suggests that manual suture closure using an appropriate technique and monofilament materials is as safe as the stapler.

Clinical efficiency and safety analysis of transcatheter closure of multiple atrial septal defects in adults.

PubMed

Song, Zhi-Yuan; He, Guo-Xiang; Shu, Mao-Qin; Hu, Hou-Yuan; Tong, Shi-Fei; Ran, Bo-Li; Liu, Jian-Ping; Li, Yong-Hua; Jing, Tao

2009-03-01

Transcatheter closure of atrial septal defects (ASDs) is currently a reliable alternative to surgery, even though challenging in patients with multiple ASDs. The aim of this study was to evaluate the clinical efficiency and safety of transcatheter closure in multiple ASDs. Multiple ASDs were diagnosed by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE). The occlusive condition and distance between 2 adjacent ASDs were measured by TTE examination. Then, the number and size of the occluder(s) was determined. TTE examinations were performed after transcatheter closure as follow-up. The transcatheter procedure was successful in 15 patients with multiple ASDs, using a single occluder in 9 patients and 2 occluders in the remaining 6 patients. Overall, 21 ASD occluders were implanted. During a follow-up period of 6 mo to 5 y, a slight residual shunt was found in 1 patient without any symptoms; a moderate residual shunt was identified at the inferior vena cava and the occluder was removed by surgery 1 mo after procedure. Other complications, including endocarditis, arrhythmia, thromboembolism, and atrioventricular valve damage were not recorded in any of the 15 patients during the follow-up period. Transcatheter closure of multiple ASDs is safe and efficient. Two occluders are necessary for the distance of 2 ASDs more than 7 mm, and a single occluder is sufficient for those 7 mm or less. Copyright (c) 2009 Wiley Periodicals, Inc.

[Safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance].

PubMed

Pan, Xiangbin; Ouyang, Wenbin; Li, Shoujun; Guo, Gaili; Liu, Yao; Zhang, Dawei; Zhang, Fengwen; Pang, Kunjing; Fang, Nengxin; Hu, Shengshou

2015-01-01

To avoid the radiation injuries and use of contrast agent, we assessed the safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance. From June 2013 to June 2014, thirty patients (mean age: (6.3 ± 2.5) years, mean body weight:(22.5 ± 7.3) kg) with pure patent ductus arteriosus were continuously included in this study. The mean diameter of patent ductus arteriosus was (3.8 ± 0.9) mm. Patients were all treated by percutaneous patent ductus arteriosus closure via right femoral artery solely under thoracic echocardiography guidance. The efficacy of the procedure was evaluated by thoracic echocardiography. Follow-up was performed at one month after procedure. All 30 cases were successfully treated with percutaneous patent ductus arteriosus closure solely under thracic echocardiography guidance. The procedural time was (32.8 ± 5.7) minutes. The mean diameter of Amplatzer ADO II was (4.9 ± 1.0) mm. Postoperative trivial residual shunt occurred in six patients immediately after the procedure. All patients survived without peripheral vascular injury or complications such as cardiac perforation. Hospitalization time was (3.4 ± 0.7) days. At one-month follow-up, no complications such as residual shunt or pericardial effusion were observed. Echocardiography guided percutaneous patent ductus arteriosus closure by femoral artery approach is safe and effective, and can avoid X-ray and the use of contrast agents.

CIRSE Vascular Closure Device Registry

PubMed Central

Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

2010-01-01

Purpose Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. Methods The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. Results Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0–14.5] for antegrade access and 1.8% (95% CI 1.1–2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only <0.5% of patients. Postdeployment bleeding occurred in 6.4%, and most these (51.5%) could be managed with light manual compression. During follow-up, other device-related complications were reported in 1.3%: seven false aneurysms, three hematoma >5.9 cm, and two vessel occlusions. Conclusion The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters. PMID:20981425

Landlord project multi-year program plan, fiscal year 1999, WBS 1.5

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

Dallas, M.D.

The MYWP technical baseline describes the work to be accomplished by the Project and the technical standards which govern that work. The mission of Landlord Project is to provide more maintenance replacement of general infrastructure facilities and systems to facilitate the Hanford Site cleanup mission. Also, once an infrastructure facility or system is no longer needed the Landlord Project transitions the facility to final closure/removal through excess, salvage or demolition. Landlord Project activities will be performed in an environmentally sound, safe, economical, prudent, and reliable manner. The Landlord Project consists of the following facilities systems: steam, water, liquid sanitary waste,more » electrical distribution, telecommunication, sanitary landfill, emergency services, general purpose offices, general purpose shops, general purpose warehouses, environmental supports facilities, roads, railroad, and the site land. The objectives for general infrastructure support are reflected in two specific areas, (1) Core Infrastructure Maintenance, and (2) Infrastructure Risk Mitigation.« less

Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty.

PubMed

Johnson, Jeremiah D; Nessler, Joseph M; Horazdovsky, Ryan D; Vang, Sandy; Thomas, Avis J; Marston, Scott B

2017-03-01

Periprosthetic joint infection is the most common cause of readmissions after total joint arthroplasty (TJA). Intrawound vancomycin powder (VP) has reduced infection rates in spine surgery; however, there are no data regarding VP in primary TJA. Thirty-four TJA patients received 2 g of VP intraoperatively to investigate VP's pharmacokinetics. Serum and wound concentrations were measured at multiple intervals over 24 hours after closure. All serum concentrations were subtherapeutic (<15μg/mL) and peaked 12 hours after closure (4.7μg/mL; standard deviation [SD], 3.2). Wound concentrations were 922 μg/mL (SD, 523) 3 hours after closure and 207 μg/mL (SD, 317) at 24 hours. VP had a half-life of 7.2 hours (95% confidence interval, 7.0-9.3) in TJA wounds. VP produced highly therapeutic intrawound concentrations while yielding low systemic levels in TJA. VP may serve as a safe adjunct in the prevention of periprosthetic joint infection. Copyright © 2015 Elsevier Inc. All rights reserved.

Treatment of severe pulmonary hypertension in the setting of the large patent ductus arteriosus.

PubMed

Niu, Mary C; Mallory, George B; Justino, Henri; Ruiz, Fadel E; Petit, Christopher J

2013-05-01

Treatment of the large patent ductus arteriosus (PDA) in the setting of pulmonary hypertension (PH) is challenging. Left patent, the large PDA can result in irreversible pulmonary vascular disease. Occlusion, however, may lead to right ventricular failure for certain patients with severe PH. Our center has adopted a staged management strategy using medical management, noninvasive imaging, and invasive cardiac catheterization to treat PH in the presence of a large PDA. This approach determines the safety of ductal closure but also leverages medical therapy to create an opportunity for safe PDA occlusion. We reviewed our experience with this approach. Patients with both severe PH and PDAs were studied. PH treatment history and hemodynamic data obtained during catheterizations were reviewed. Repeat catheterizations, echocardiograms, and clinical status at latest follow-up were also reviewed. Seven patients had both PH and large, unrestrictive PDAs. At baseline, all patients had near-systemic right ventricular pressures. Nine catheterizations were performed. Two patients underwent 2 catheterizations each due to poor initial response to balloon test occlusion. Six of 7 patients exhibited subsystemic pulmonary pressures during test occlusion and underwent successful PDA occlusion. One patient did not undergo PDA occlusion. In follow-up, 2 additional catheterizations were performed after successful PDA occlusion for subsequent hemodynamic assessment. At the latest follow-up, the 6 patients who underwent PDA occlusion are well, with continued improvement in PH. Five patients remain on PH treatment. A staged approach to PDA closure for patients with severe PH is an effective treatment paradigm. Aggressive treatment of PH creates a window of opportunity for PDA occlusion, echocardiography assists in identifying the timing for closure, and balloon test occlusion during cardiac catheterization is critical in determining safety of closure. By safely eliminating the large PDA, this treatment algorithm can halt the perilous combination of the large shunting from the PDA and PH in a population at high risk of morbidity and mortality.

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

Diaz, Peter

The U.S. Department of Energy's (DOE) first-of-a-kind closure project at the Hanford Site in Richland, Washington, still has more than 3 years to run, but its contractor, Washington Closure Hanford (WCH), has already started its plans for going out of business. It will be the first contract that closes in increments and, paramount to its success, will be its ability to provide a disciplined and positive approach to release personnel while at the same time retaining personnel critical to timely and safe completion of the work scope. In May 2011, WCH produced the people plan, a program that maximizes communicationmore » and support for employees being released, provides an incentivization strategy to retain personnel to the end of their assignments, and reflects a sensitivity to the long-term goals of the contract and WCH's parent companies. The combination of all of these efforts equal one thing: treating employees with respect by providing specific information in a timely manner; respecting employees by sharing as much information as possible, as soon as possible, with as much detail as possible; and respecting each individual's ability to be in control of their next step in their life or career. The project is only in the second ORW and has 13 more before the end of the contract. That time remaining will continue to bring new challenges and unknowns, but the confidence and trust of the employees is proving to be solid. This is largely as a result of the stability provided by the people plan program. A success that can only truly be measured by the continued positive response it has already received from WCH's employees. (authors)« less

Immediate and mid-term clinical course after percutaneous closure of paravalvular leakage.

PubMed

Sánchez-Recalde, Angel; Moreno, Raúl; Galeote, Guillermo; Jimenez-Valero, Santiago; Calvo, Luis; Sevillano, Joel Hernández; Arroyo-Ucar, Eduardo; López, Teresa; Mesa, José M; López-Sendón, José L

2014-08-01

Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device. We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure. Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class. Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

HANFORD SITE RIVER CORRIDOR CLEANUP

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

BAZZELL, K.D.

2006-02-01

In 2005, the US Department of Energy (DOE) launched the third generation of closure contracts, including the River Corridor Closure (RCC) Contract at Hanford. Over the past decade, significant progress has been made on cleaning up the river shore that bordes Hanford. However, the most important cleanup challenges lie ahead. In March 2005, DOE awarded the Hanford River Corridor Closure Contract to Washington Closure Hanford (WCH), a limited liability company owned by Washington Group International, Bechtel National and CH2M HILL. It is a single-purpose company whose goal is to safely and efficiently accelerate cleanup in the 544 km{sup 2} Hanfordmore » river corridor and reduce or eliminate future obligations to DOE for maintaining long-term stewardship over the site. The RCC Contract is a cost-plus-incentive-fee closure contract, which incentivizes the contractor to reduce cost and accelerate the schedule. At $1.9 billion and seven years, WCH has accelerated cleaning up Hanford's river corridor significantly compared to the $3.2 billion and 10 years originally estimated by the US Army Corps of Engineers. Predictable funding is one of the key features of the new contract, with funding set by contract at $183 million in fiscal year (FY) 2006 and peaking at $387 million in FY2012. Another feature of the contract allows for Washington Closure to perform up to 40% of the value of the contract and subcontract the balance. One of the major challenges in the next few years will be to identify and qualify sufficient subcontractors to meet the goal.« less

Transcatheter closure of patent ductus arteriosus in children weighing 10 kg or less: Initial experience at Sohag University Hospital

PubMed Central

Ali, Safaa; El Sisi, Amel

2015-01-01

Aim To assess the challenges, feasibility, and efficacy of device closure of patent ductus arteriosus (PDA) in small children weighing ⩽10 kg for different types of devices used in an initial experience at Sohag University hospital. Methods Between March 2011 and September 2014, 91 patients with PDA underwent transcatheter closure in our institute, among whom 54 weighed ⩽10 kg. All of these patients underwent transcatheter closure of PDA using either a Cook Detachable Coil, PFM Nit-Occlud, or Amplatzer duct occluder. A retrospective review of the treatment results and adverse events was performed. Results Successful device placement was achieved in 53/54 small children (98.1%). The median minimum PDA diameter was 2.4 mm [interquartile range (IQR, 1.8–3.5 mm), median weight 8 kg (IQR, 7–10 kg), and median age 10 months (IQR, 8–17 months)]. Mild aortic obstruction occurred in one case (1.9%), as the device became displaced towards the aorta after release. The device embolized in one case (1.9%) and no retrieval attempt was made. Five cases (9.3%) had minor vascular complications. Conclusion With the current availability of devices for PDA closure, transcatheter closure of PDA is considered safe and efficacious in small children weighing ⩽10 kg with good mid-term outcome. The procedure had a low rate of high-severity adverse events even with the initial experience of the catheterization laboratory. PMID:27053899

On the stability and instantaneous velocity of grasped frictionless objects

NASA Technical Reports Server (NTRS)

Trinkle, Jeffrey C.

1992-01-01

A quantitative test for form closure valid for any number of contact points is formulated as a linear program, the optimal objective value of which provides a measure of how far a grasp is from losing form closure. Another contribution of the study is the formulation of a linear program whose solution yields the same information as the classical approach. The benefit of the formulation is that explicit testing of all possible combinations of contact interactions can be avoided by the algorithm used to solve the linear program.

9 CFR 381.301 - Containers and closures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY... examination should be based upon a statistical sampling plan. (2) All empty containers, closures, and flexible... the container plant records are made available to Program employees. Additional teardown examinations...

9 CFR 381.301 - Containers and closures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY... examination should be based upon a statistical sampling plan. (2) All empty containers, closures, and flexible... the container plant records are made available to Program employees. Additional teardown examinations...

9 CFR 381.301 - Containers and closures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY... examination should be based upon a statistical sampling plan. (2) All empty containers, closures, and flexible... the container plant records are made available to Program employees. Additional teardown examinations...

9 CFR 381.301 - Containers and closures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY... examination should be based upon a statistical sampling plan. (2) All empty containers, closures, and flexible... the container plant records are made available to Program employees. Additional teardown examinations...

Amchitka Mud Pit Sites 2006 Post-Closure Monitoring and Inspection Report, Amchitka Island, Alaska, Rev. No.: 0

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

Matthews, Patrick

2006-09-01

In 2001, the U.S. Department of Energy (DOE), National Nuclear Security Administration (NNSA/NSO) remediated six areas associated with Amchitka mud pit release sites located on Amchitka Island, Alaska. This included the construction of seven closure caps. To ensure the integrity and effectiveness of remedial action, the mud pit sites are to be inspected every five years as part of DOE's long-term monitoring and surveillance program. In August of 2006, the closure caps were inspected in accordance with the ''Post-Closure Monitoring and Inspection Plan for Amchitka Island Mud Pit Release Sites'' (Rev. 0, November 2005). This post-closure monitoring report provides themore » 2006 cap inspection results.« less

VR closure rates for two vocational models.

PubMed

Fraser, Virginia V; Jones, Amanda M; Frounfelker, Rochelle; Harding, Brian; Hardin, Teresa; Bond, Gary R

2008-01-01

The Individual Placement and Support (IPS) model of supported employment is an evidence-based practice for individuals with psychiatric disabilities. To be financially viable, IPS programs require funding from the state-federal vocational rehabilitation (VR) system. However, some observers have questioned the compatibility of IPS and the VR system. Using a randomized controlled trial comparing IPS to a well-established vocational program called the Diversified Placement Approach (DPA), we examined rates of VR sponsorship and successful VR closures. We also describe the establishment of an active collaboration between a psychiatric rehabilitation agency and the state VR system to facilitate rapid VR sponsorship for IPS clients. Both IPS and DPA achieved a 44% rate of VR Status 26 closure when considering all clients entering the study. IPS and DPA averaged similar amount of time to achieve VR sponsorship. Time from vocational program entry to Status 26 was 51 days longer on average for IPS. Even though several IPS principles seem to run counter to VR practices, such as zero exclusion and rapid job search, we found IPS closure rates comparable to those for DPA, a vocational model that screens for readiness, provides prevocational preparation, and extensively uses agency-run businesses.

40 CFR 265.113 - Closure; time allowed for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... includes an amended waste analysis plan, ground-water monitoring and response program, human exposure....113 Section 265.113 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) INTERIM STATUS STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND...

Report to Congress on a Compliance Plan for the Underground Storage Tank Program

EPA Pesticide Factsheets

Learn about identification of USTs that are not in compliance with Subtitle I of the Solid Waste Disposal Act or are in temporary closure, and determine the ownership of USTs not in compliance or in temporary closure

Topical Naltrexone Is a Safe and Effective Alternative to Standard Treatment of Diabetic Wounds.

PubMed

McLaughlin, Patricia J; Cain, Jarrett D; Titunick, Michelle B; Sassani, Joseph W; Zagon, Ian S

2017-09-01

Objective: Diabetes affects more than 29 million individuals in the United States, resulting in healthcare costs approaching $245 billion. Approximately 15% of these individuals will develop a chronic, non-healing foot ulcer (diabetic foot ulcer [DFU]) that, if untreated, may lead to amputation. The current treatments for DFU are expensive, have significant side-effects, and often result in non-compliance. A new topical treatment is described that accelerates cutaneous wound repair and is disease modifying by targeting underlying aberrant diabetic pathways. Approach: The efficacy of naltrexone (NTX), an opioid receptor antagonist, and Regranex ® was compared in preclinical studies using type 1 diabetic rats. Dorsal cutaneous wounds were treated topically with 0.03% NTX, Regranex, or moisturizing cream alone. Wound closure, DNA synthesis, and cytokine production were monitored. Results: Wound closure rates with topical NTX in type 1 diabetic rats were comparable to Regranex. Topical NTX accelerated DNA synthesis, as measured by BrdU incorporation, increased mast cells, and enhanced expression of platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF), a marker for angiogenesis. Regranex had little effect on DNA synthesis, mast cells, and VEGF expression relative to vehicle-treated wounds, and it only temporarily increased PDGF expression. Fibroblast growth factor expression was not altered by either treatment. Innovation: Topical application of 0.03% NTX cream accelerates diabetic wound closure. Conclusion: Blockade of the opioid growth factor (OGF)-OGF receptor (OGFr) axis utilizing 0.03% NTX cream is comparable to standard care in preclinical studies, and it provides a safe, inexpensive, and effective alternative for treatment of diabetic wounds.

Atrioesophageal Fistula after Minimally Invasive Video-Assisted Epicardial Ablation for Lone Atrial Fibrillation.

PubMed

Kik, Charles; van Valen, Richard; Mokhles, Mostafa M; Bekkers, Jos A; Bogers, Ad J J C

2017-09-01

Minimally invasive video-assisted epicardial beating heart ablation for lone atrial fibrillation claims to be safe and effective. We, however, report on three patients with an atrioesophageal fistula after this procedure. The exact pathogenesis of this complication is unknown. All patients presented around 6 weeks after surgery with either fever or neurological deficits. Diagnosis can be made by computed tomography scan. We advocate an aggressive surgical approach with closure of the atrial defect on cardiopulmonary bypass and closure and reinforcement of the esophagus with an intercostal muscle flap in a single-stage surgery. Some caution as to the low-risk character of this procedure seems to be realistic. Georg Thieme Verlag KG Stuttgart · New York.

Functional renormalization group for the U (1 )-T56 tensorial group field theory with closure constraint

NASA Astrophysics Data System (ADS)

Lahoche, Vincent; Ousmane Samary, Dine

2017-02-01

This paper is focused on the functional renormalization group applied to the T56 tensor model on the Abelian group U (1 ) with closure constraint. For the first time, we derive the flow equations for the couplings and mass parameters in a suitable truncation around the marginal interactions with respect to the perturbative power counting. For the second time, we study the behavior around the Gaussian fixed point, and show that the theory is nonasymptotically free. Finally, we discuss the UV completion of the theory. We show the existence of several nontrivial fixed points, study the behavior of the renormalization group flow around them, and point out evidence in favor of an asymptotically safe theory.

Transcatheter Closure of Patent Ductus Arteriosus in Children with the Occlutech Duct Occluder.

PubMed

Bilici, Meki; Demir, Fikri; Akın, Alper; Türe, Mehmet; Balık, Hasan; Kuyumcu, Mahir

2017-12-01

The aim of this study was to evaluate the feasibility, efficacy and safety of transcatheter closure of patent ductus arteriosus (PDA) with the Occlutech duct occluder (ODO) in children. We reviewed the clinical records of 71 patients who underwent percutaneous closure of PDA with an ODO between September 2014 and August 2016. The Occlutech duct occluder was applied to 71 patients during the study period (September 2014-August 2016), and the results were analyzed in this study. Forty-two of the patients were female and 29 male. The median age was 20.5 months (range, 6-194 months) and median weight was 16 kg (range, 6-68 kg). The PDA was classified as type A in 54 patients (76.1%), type E in 14 (19.7%), type C in 2 (2.8%) and type B in 1 (1.4%) based on the Krichenko classification. A standard ODO device was used for the transcatheter closure procedure in 66 patients and the long-shank ODO device in 5. In the echocardiographic measurement of PDA, the median smallest diameter was 2.7 mm (range, 1.5-7.0 mm), and in the angiographic measurement, the median smallest diameter was 2.5 mm (range, 1.5-6.5 mm). All 71 patients underwent successful PDA closure with the ODO. Angiography following the procedure showed complete closure in 47 patients (66.2%), mild residual shunt in 13 patients (18.3%) and a trivial shunt in 11 patients (15.5%). Color flow Doppler echocardiogpaphy at 24 h post-implantation showed that complete closure was achieved in 65 patients (91.5%), and 6 patients (8.5%) had mild residual shunt. All patients (100%) had complete closure at 30 days of follow-up. The results of this study showed that the Occlutech PDA occluder device is safe and effective in the closure of PDA. As the pulmonary artery side of the device is wider than the aortic side, protrusion toward the aortic side and embolization are prevented, but there is residual shunt in the early period, although this residual shunt disappeared after a few months.

Bubblers Speed Nuclear Waste Processing at SRS

ScienceCinema

None

2018-05-23

At the Department of Energy's Savannah River Site, American Recovery and Reinvestment Act funding has supported installation of bubbler technology and related enhancements in the Defense Waste Processing Facility (DWPF). The improvements will accelerate the processing of radioactive waste into a safe, stable form for storage and permit expedited closure of underground waste tanks holding 37 million gallons of liquid nuclear waste.

Transportation impacts of the Chicago River closure to prevent an asian carp infestation.

DOT National Transportation Integrated Search

2012-07-01

This project develops a simple linear programming model of the Upper Midwest regions rail transportation network to test : whether a closure of the Chicago River to freight traffic would impact the capacity constraint of the rail system. The result :...

RMA Abandoned Well Closure Program. Final Task Plan, Version 3.0.

DTIC Science & Technology

1989-05-01

20503. 1 . AGENCY USE ONLY (Leave blank) 2. REPORT DATE" 0 3. REPORT TYPE AND DATES COVERED _T 05/00/89 __________________ 4. TITLE AND SUBTITLE S...AQUIFERS. THE SCOPE OF WORK INCLUDES: 1 . COMPILATION OF A WELL INVENTORY AND DATABASE 2. FIELD LOCATION OF WELLS 3. CLEANING AND CLOSURE OF...APPROXIMATELY 350 WELT- 4. DOCUMENTATION OF CLOSURE ACTIVITIES. SECTIONS OF THIS TASK PLAN DETAIL-INFORMATION ON: 1 . ABANDONED WELL IDENTIFICATION AND LOCATION

Initial experience with the Cardiva Boomerang vascular closure device in diagnostic catheterization.

PubMed

Doyle, Brendan J; Godfrey, Michael J; Lennon, Ryan J; Ryan, James L; Bresnahan, John F; Rihal, Charanjit S; Ting, Henry H

2007-02-01

The authors studied the safety and efficacy of the Cardiva Boomerang vascular closure device in patients undergoing diagnostic cardiac catheterization. Conventional vascular closure devices (sutures, collagen plugs, or metal clips) have been associated with catastrophic complications including arterial occlusion and foreign body infections; furthermore, they cannot be utilized in patients with peripheral vascular disease or vascular access site in a vessel other than the common femoral artery. The Cardiva Boomerang device facilitates vascular hemostasis without leaving any foreign body behind at the access site, can be used in peripheral vascular disease, and can be used in vessels other than the common femoral artery A total of 96 patients undergoing transfemoral diagnostic cardiac catheterization were included in this study, including 25 (26%) patients with contraindications to conventional closure devices. Femoral angiography was performed prior to deployment of the Cardiva Boomerang closure device. Patients were ambulated at 1 hr after hemostasis was achieved. The device was successfully deployed and hemostasis achieved with the device alone in 95 (99%) patients. The device failed to deploy in 1 (1%) patient and required conversion to standard manual compression. Minor complications were observed in 5 (5%) patients. No patients experienced major complications including femoral hematoma > 4 cm, red blood cell transfusion, retroperitoneal bleed, arteriovenous fistula, pseudoaneurysm, infection, arterial occlusion, or vascular surgery. The Cardiva Boomerang device is safe and effective in patients undergoing diagnostic cardiac catheterization using the transfemoral approach, facilitating early ambulation with low rates of vascular complications. (c) 2006 Wiley-Liss, Inc.

Percutaneous patent foramen ovale closure: the Paradoxical Cerebral Embolism Prevention Registry.

PubMed

Paiva, Luís; Dinis, Paulo; Providência, Rui; Costa, Marco; Margalho, Susana; Goncalves, Lino

2015-03-01

The natural history and therapeutic interventions for secondary prevention after a cerebrovascular event in patients with patent foramen ovale (PFO) are not yet established. This study aims to assess the safety and efficacy of percutaneous PFO closure in a population of patients with ischemic cerebrovascular disease of unknown etiology. This prospective observational study included patients with a history of cryptogenic transient ischemic attack (TIA) or stroke who underwent percutaneous PFO closure. The effectiveness of the device for the secondary prevention of TIA or stroke was assessed by comparing observed events in the sample with expected events for this clinical setting. The sample included 193 cases of percutaneous PFO closure (age 46.4 ± 13.1 years, 62.2% female) with a mean follow-up of 4.3 ± 2.2 years, corresponding to a total exposure to ischemic events of 542 patient-years. The high-risk characteristics of the PFO were assessed prior to device implantation. There were seven primary endpoint events during follow-up (1.3 per 100 patient-years), corresponding to a relative risk reduction of 68.2% in recurrent TIA or stroke compared to medical therapy alone. The procedure was associated with a low rate of device- or intervention-related complications (1.5%). In this long-term registry, percutaneous PFO closure was shown to be a safe and effective therapy for the secondary prevention of cryptogenic stroke or TIA. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

How to deal with atrial septal defect closure from right internal jugular vein: Role of venous-arterial circuit for sizing and over-the-wire device implantation.

PubMed

Butera, Gianfranco; Lovin, Nicusor; Basile, Domenica Paola

2017-01-01

Secundum atrial septum defect (ASD) is the most common congenital heart disease. It is usually treated by a transcatheter approach using a femoral venous access. In case of bilateral femoral vein occlusion, the internal jugular venous approach for ASD closure is an option, in particular in cases where ASD balloon occlusion test and sizing is needed. Here, we report on a new technique for ASD closure using a venous-arterial circuit from the right internal jugular vein to the femoral artery. Two patients (females, 4 and 10 years of age) had occlusion of both femoral veins because of a previous history of pulmonary atresia and intact ventricular septum, for which they underwent percutaneous radiofrequency perforation and balloon angioplasty. These subjects needed balloon occlusion test of a residual ASD to size the hole and to check for hemodynamic suitability to ASD closure. After performing a venous-arterial circuit, a 24 mm St Jude ASD sizing balloon catheter was advanced over the circuit and the defect closed for 15 min to check hemodynamics and size the defect. ASD was closed is hemodinamically suitable. This technique was safe and reliable. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

EWOLUTION: Design of a registry to evaluate real-world clinical outcomes in patients with AF and high stroke risk-treated with the WATCHMAN left atrial appendage closure technology.

PubMed

Boersma, Lucas V A; Schmidt, Boris; Betts, Tim R; Sievert, Horst; Tamburino, Corrado; Teiger, Emmanuel; Stein, Kenneth M; Bergmann, Martin W

2016-09-01

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and the rate of ischemic stroke attributed to non-valvular AF is estimated at 5% per year. Several multi-center studies established left atrial appendage closure as a safe and effective alternative to oral anticoagulation, but there is a need for additional real world data. The purpose of this observational, prospective, single-arm, multicenter clinical study is to compile real-world clinical outcome data for WATCHMAN™ LAA (left atrial appendage) Closure Technology. One thousand subjects at up to 70 institutions in Europe, the Middle East, and Russia will be enrolled. Patients will be followed for 2 years after WATCHMAN implantation, according to standard medical practice. Primary endpoints include procedural and long-term data including stroke/embolism, bleeding, and death. This article presents the background of the LAAC device and describes the design of the study. Results for peri-procedural analyses are expected toward the end of 2015; long-term follow-up data are expected in the latter half of 2017. The EWOLUTION study will formally expand knowledge of LAA closure into a broader real world setting. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

10 CFR 60.51 - License amendment for permanent closure.

Code of Federal Regulations, 2014 CFR

2014-01-01

... description of the program for post-permanent closure monitoring of the geologic repository. (2) A detailed... postclosure controlled area and geologic repository operations area by monuments that have been designed... tests, experiments, and any other analyses relating to backfill of excavated areas, shaft sealing, waste...

10 CFR 60.51 - License amendment for permanent closure.

Code of Federal Regulations, 2013 CFR

2013-01-01

... description of the program for post-permanent closure monitoring of the geologic repository. (2) A detailed... postclosure controlled area and geologic repository operations area by monuments that have been designed... tests, experiments, and any other analyses relating to backfill of excavated areas, shaft sealing, waste...

10 CFR 60.51 - License amendment for permanent closure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... description of the program for post-permanent closure monitoring of the geologic repository. (2) A detailed... postclosure controlled area and geologic repository operations area by monuments that have been designed... tests, experiments, and any other analyses relating to backfill of excavated areas, shaft sealing, waste...

10 CFR 60.51 - License amendment for permanent closure.

Code of Federal Regulations, 2011 CFR

2011-01-01

... description of the program for post-permanent closure monitoring of the geologic repository. (2) A detailed... postclosure controlled area and geologic repository operations area by monuments that have been designed... tests, experiments, and any other analyses relating to backfill of excavated areas, shaft sealing, waste...

10 CFR 60.51 - License amendment for permanent closure.

Code of Federal Regulations, 2012 CFR

2012-01-01

... description of the program for post-permanent closure monitoring of the geologic repository. (2) A detailed... postclosure controlled area and geologic repository operations area by monuments that have been designed... tests, experiments, and any other analyses relating to backfill of excavated areas, shaft sealing, waste...

Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: A single-center 8-year experience.

PubMed

Tolonen, Matti; Mentula, Panu; Sallinen, Ville; Rasilainen, Suvi; Bäcklund, Minna; Leppäniemi, Ari

2017-06-01

Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure and enteroatmospheric fistula rates. This was a single-academic-center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008 and 2016. Descriptive and univariate analyses were performed. Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54% (n = 22), and 59% (n = 24) had a postoperative peritonitis. Mortality was 29% (n = 12), and 76% (n = 31) of patients were admitted in the intensive care unit. The median duration of OA was 7 days with a median of two dressing changes. Delayed primary fascial closure rate among survivors was 92% (n = 33), and enteroatmospheric fistulas developed in 7% (n = 3). In a subgroup analysis, patients with OA in the primary laparotomy for peritonitis (n = 27) were compared with patients with OA in the subsequent laparotomies (n = 14). There were no significant differences between groups. The VAWCM technique in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulas. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk of a need of OA later. Therapeutic/care management study, level IV.

Post-Closure Inspection Report for the Tonopah Test Range, Nevada. For Calendar Year 2015, Revision 0

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

Matthews, Patrick; Petrello, Jaclyn

This report provides the results of the annual post-closure inspections conducted at the closed corrective action units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2015 and includes inspection and repair activities completed at the following CAUs; CAU 400: Bomblet Pit and Five Points Landfill (TTR); CAU 407: Roller Coaster RadSafe Area (TTR); CAU 424: Area 3 Landfill Complexes (TTR); CAU 453: Area 9 UXO Landfill (TTR); and CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved closure reports and subsequent correspondence with the Nevada Division ofmore » Environmental Protection. The post-closure inspection plans and subsequent correspondence modifying the requirements for each CAU are included in Appendix B. The inspection checklists are included in Appendix C. Field notes are included in Appendix D. The annual post-closure inspections were conducted on May 12, 2015. Maintenance was required at CAU 453. Cracking along the north trench was repaired. One monument is missing at CAU 424; it will be replaced in 2016. Postings at CAUs 407, 424, 453, and 487 contain contact information for TTR Security. It was noted that protocols may not be in place to ensure that the U.S. Department of Energy, National Nuclear Security Administration Nevada Field Office (NNSA/NFO) is notified if access is needed at these sites. NNSA/NFO is working with the U.S. Air Force and Sandia to determine whether more appropriate contact information or new protocols are warranted for each CAU. Based on these inspections, there has not been a significant change in vegetation, and vegetation monitoring was not recommended at CAU 400 or CAU 407 in 2015.« less

Perventricular double-device closure of wide-spaced multi-hole perimembranous ventricular septal defect.

PubMed

Liang, Fei; Hongxin, Li; Zhang, Hai-Zhou; Wenbin, Guo; Zou, Cheng-Wei; Farhaj, Zeeshan

2017-04-17

Device closure of a wide-spaced multi-hole PmVSD is difficult to succeed in percutaneous approach. This study is to evaluate the feasibility, safety and efficacy of perventricular device closure of wide-spaced multi-hole PmVSD using a double-device implanting technique. Sixteen patients with wide-spaced multi-hole PmVSD underwent perventricular closure with two devices through an inferior median sternotomy approach under transesophageal echocardiographic guidance. The largest hole and its adjacent small holes were occluded with an optimal-sized device. The far-away residual hole was occluded with the other device using a probe-assisted delivery system. All patients were followed up for a period of 1 to 4 years to determine the residual shunt, atrioventricular block and the adjacent valvular function. The number of the holes of the PmVSD was 2 to 4. The maximum distance between the holes was 5.0 to 10.0 mm (median, 6.4 mm). The diameter of the largest hole was 2.5 to 7.0 mm (median, 3.6 mm). The success rate of double-device closure was 100%. Immediate residual shunts were found in 6 patients (38%), and incomplete right bundle branch block at discharge occurred in 3 cases (19%). Both complications decreased to 6% at 1-year follow-up. Neither of them had a severe device-related complication. Perventricular closure of a wide-spaced multi-hole PmVSD using a double-device implanting technique is feasible, safe, and efficacious. In multi-hole PmVSDs with the distance between the holes of more than 5 mm, double-device implantation may achieve a complete occlusion.

Endoscopic closure of persistent gastrocutaneous fistulae, after percutaneous endoscopic gastrostomy (PEG) tube placement, using the over-the-scope-clip system

PubMed Central

Changela, Kinesh; Culliford, Andrea; Duddempudi, Sushil; Krishnaiah, Mahesh; Anand, Sury

2015-01-01

Objectives: The Over-The-Scope-Clip (OTSC) has had an evolving role in endoscopic closure of gastrointestinal wall defects, in hemostasis of primary or postinterventional bleeding, and approximation of postbariatric surgery defects. Rapid and effective closure of gastrocutaneous (GC) fistulae using this device has been recently described in the literature. The aim of this study was to evaluate the technical feasibility, efficacy and safety of OTSC as an effective tool in the management of persistent GC fistulae secondary to a complication of percutaneous endoscopic gastrostomy (PEG) tube placement. Method: In this multicenter prospective observational study, we describe our experience with OTSC in the closure of persistent GC fistulas secondary to PEG tube placement. Patients with GC fistulas were sequentially enrolled with a mean age of 84 years. Primary treatment outcome was the immediate successful closure of GC fistula and resolution of leak. Secondary outcome was no recurrence of the fistula and leaks on follow up. Results: A total of 10 patients were enrolled over the study period. Mean age was 84.4 ± 8.75 years. The primary treatment outcome was achieved in all the patients undergoing this intervention. Secondary outcome was observed in 9/10 (90%) subjects. No procedural complications were reported. Larger fistulae (>2.5 cm) and those with significant fibrosis were more difficult to close with the OTSC system. The mean follow-up time after OTSC application was 43.7 ± 20.57 days. A limitation of this study was that there was no control group. Conclusions: OTSC application is a safe and effective endoscopic approach for the closure of persistent GC fistulae secondary to a complication of PEG tube placement. PMID:26136836

Endoscopic closure of persistent gastrocutaneous fistulae, after percutaneous endoscopic gastrostomy (PEG) tube placement, using the over-the-scope-clip system.

PubMed

Singhal, Shashideep; Changela, Kinesh; Culliford, Andrea; Duddempudi, Sushil; Krishnaiah, Mahesh; Anand, Sury

2015-07-01

The Over-The-Scope-Clip (OTSC) has had an evolving role in endoscopic closure of gastrointestinal wall defects, in hemostasis of primary or postinterventional bleeding, and approximation of postbariatric surgery defects. Rapid and effective closure of gastrocutaneous (GC) fistulae using this device has been recently described in the literature. The aim of this study was to evaluate the technical feasibility, efficacy and safety of OTSC as an effective tool in the management of persistent GC fistulae secondary to a complication of percutaneous endoscopic gastrostomy (PEG) tube placement. In this multicenter prospective observational study, we describe our experience with OTSC in the closure of persistent GC fistulas secondary to PEG tube placement. Patients with GC fistulas were sequentially enrolled with a mean age of 84 years. Primary treatment outcome was the immediate successful closure of GC fistula and resolution of leak. Secondary outcome was no recurrence of the fistula and leaks on follow up. A total of 10 patients were enrolled over the study period. Mean age was 84.4 ± 8.75 years. The primary treatment outcome was achieved in all the patients undergoing this intervention. Secondary outcome was observed in 9/10 (90%) subjects. No procedural complications were reported. Larger fistulae (>2.5 cm) and those with significant fibrosis were more difficult to close with the OTSC system. The mean follow-up time after OTSC application was 43.7 ± 20.57 days. A limitation of this study was that there was no control group. OTSC application is a safe and effective endoscopic approach for the closure of persistent GC fistulae secondary to a complication of PEG tube placement.

IROA: International Register of Open Abdomen, preliminary results.

PubMed

Coccolini, Federico; Montori, Giulia; Ceresoli, Marco; Catena, Fausto; Ivatury, Rao; Sugrue, Michael; Sartelli, Massimo; Fugazzola, Paola; Corbella, Davide; Salvetti, Francesco; Negoi, Ionut; Zese, Monica; Occhionorelli, Savino; Maccatrozzo, Stefano; Shlyapnikov, Sergei; Galatioto, Christian; Chiarugi, Massimo; Demetrashvili, Zaza; Dondossola, Daniele; Yovtchev, Yovcho; Ioannidis, Orestis; Novelli, Giuseppe; Nacoti, Mirco; Khor, Desmond; Inaba, Kenji; Demetriades, Demetrios; Kaussen, Torsten; Jusoh, Asri Che; Ghannam, Wagih; Sakakushev, Boris; Guetta, Ohad; Dogjani, Agron; Costa, Stefano; Singh, Sandeep; Damaskos, Dimitrios; Isik, Arda; Yuan, Kuo-Ching; Trotta, Francesco; Rausei, Stefano; Martinez-Perez, Aleix; Bellanova, Giovanni; Fonseca, Vinicius Cordeiro; Hernández, Fernando; Marinis, Athanasios; Fernandes, Wellington; Quiodettis, Martha; Bala, Miklosh; Vereczkei, Andras; Curado, Rafael L; Fraga, Gustavo Pereira; Pereira, Bruno M; Gachabayov, Mahir; Chagerben, Guillermo Perez; Arellano, Miguel Leon; Ozyazici, Sefa; Costa, Gianluca; Tezcaner, Tugan; Ansaloni, Luca

2017-01-01

No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org. Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male; Mean BMI: 36±5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p <0.0001) and with the fistula development (Pearson = 0.146 p = 0.016). Pediatric patients: 33 patients. Mean age: 5.91±(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(±3.09) days. Temporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogotà-bag seem to improve results. ClinicalTrials.gov NCT02382770.

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, for Calendar Year 2013

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

Silvas, A. J.

2014-03-03

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2013 and includes inspection and repair activities completed at the following CAUs: • CAU 400: Bomblet Pit and Five Points Landfill (TTR) • CAU 407: Roller Coaster RadSafe Area (TTR) • CAU 424: Area 3 Landfill Complexes (TTR) • CAU 453: Area 9 UXO Landfill (TTR) • CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved Closure Reports and subsequent correspondence withmore » the Nevada Division of Environmental Protection. The post-closure inspection plans and subsequent correspondence modifying the requirements for each CAU are included in Appendix B. The inspection checklists are included in Appendix C. Field notes are included in Appendix D. Photographs taken during inspections are included in Appendix E. The annual post-closure inspections were conducted on May 14, 2013. Maintenance was performed at CAU 400, CAU 424, and CAU 453. At CAU 400, animal burrows were backfilled. At CAU 424, erosion repairs were completed at Landfill Cell A3-3, subsidence was repaired at Landfill Cell A3-4, and additional lava rock was placed in high-traffic areas to mark the locations of the surface grade monuments at Landfill Cell A3-3 and Landfill Cell A3-8. At CAU 453, two areas of subsidence were repaired and animal burrows were backfilled. Vegetation monitoring was performed at the CAU 400 Five Points Landfill and CAU 407 in June 2013. The vegetation monitoring report is included in Appendix F.« less

Patent foramen ovale closure following cryptogenic stroke or transient ischaemic attack: Long-term follow-up of 301 cases.

PubMed

Mirzaali, Mikaeil; Dooley, Maureen; Wynne, Dylan; Cooter, Nina; Lee, Lorraine; Haworth, Peter; Saha, Romi; Gainsborough, Nicola; Hildick-Smith, David

2015-11-15

Patent foramen ovale has been identified as a conduit for paradoxical embolism resulting in cryptogenic stroke or transient ischemic attack (TIA). We aimed to establish rates of death, recurrent stroke or TIA among patients undergoing PFO closure for stroke or TIA at our unit. A retrospective analysis of all PFO closure patients was performed between May 2004 and January 2013. Follow up was performed by mortality tracing using the Medical Research Information Service of the Office of National Statistics. With regard to stroke or TIA recurrence, written consent forms and questionnaires were mailed with follow up telephone calls. Medical notes and imaging records were consulted where adverse events were noted. 301 patients aged 48.6 ± 11.0 years, 54.4% male, with ≥1 thromboembolic neurovascular event had percutaneous PFO closure with one of eight devices, with successful implantation in 99% of cases. Follow-up duration was 40.2 ± 26.2 months (range 1.3-105.3); complete in 301 patients for mortality (100%) and 283 patients (94.0%) for neurovascular events. Two patients died during follow-up (respiratory failure n = 1; road traffic accident n = 1). Recurrent stroke (MRI or CT confirmed) was observed in five patients (0.5%; 0.55 per 100 person-years) and TIA in 9 (1.1%; 0.98 per 100 person-years). Atrial fibrillation requiring treatment was documented in 14 patients (1.7%). Percutaneous PFO closure in patients with cryptogenic stroke or TIA is a safe treatment with a low incidence of procedural complications and recurrent neurovascular events. Registry data like these may help to demonstrate the utility of PFO closure in stroke. © 2015 Wiley Periodicals, Inc.

Patent ductus arteriosus closure using Occlutech® Duct Occluder, experience in Port Elizabeth, South Africa

PubMed Central

Pepeta, Lungile; Greyling, Adele; Nxele, Mahlubandile Fintan; Makrexeni, Zongezile Masonwabe

2017-01-01

Background: Percutaneous closure of patent ductus arteriosus (PDA) has become standard therapy. Experience with the Occlutech® Duct Occluder is limited. Methods: Data regarding ductal closure using Occlutech® Duct Occluder were reviewed and prospectively collected. Demographics, hemodynamic and angiographic characteristics, complications, and outcomes were documented. Results: From March 2013 to June 2016, 65 patients (43 females and 22 males) underwent percutaneous closure of the PDA using Occlutech® Duct Occluder. The median age of the patients was 11 months (range, 1–454 months) and the median weight was 8.5 kg (range 2.5–78 kg). The mean pulmonary artery median pressure was 27 mmHg (range, 12–100 mmHg) and the QP: Qs ratio median was 1.8 (range, 1–7.5), with a pulmonary vascular resistance mean of 2.7 WU (standard deviation [SD] ±2.1). Thirty-two patients had Krichenko Type A duct (49%); 7, Type C (11%); 4, Type D (6%); and 22, Type E (34%). The ductal size (narrowest diameter at the pulmonic end) mean was 3.5 mm (SD ± 1.9 mm). The screening time mean was 17.3 min (SD ± 11.6). Out of 63 patients with successful closure of the PDA using Occlutech® Duct Occluder, there were 15 patients with small PDAs; 25 with moderate PDAs, and 23 with large PDAs. In one patient, the device dislodged to the descending aorta, and in two patients, to the right pulmonary artery immediately following deployment, with successful percutaneous (two) and surgical (one) retrieval. Complete ductal occlusion was achieved in all 63 patients on day one. Conclusion: The Occlutech® Duct Occluder is a safe and effective device for closure of ducts in appropriately selected patients. PMID:28566820

Closure of patent ductus arteriosus in children, small infants, and premature babies with Amplatzer duct occluder II additional sizes: multicenter study.

PubMed

Sungur, Metin; Karakurt, Cemsit; Ozbarlas, Nazan; Baspinar, Osman

2013-08-01

To evaluate safety and efficacy of closure of patent ductus arteriosus (PDA) with Amplatzer duct occluder II Additional Sizes (ADO II AS) and to report early and midterm results of the device in children and very young symptomatic infants. Retrospective analysis of angiographic data of 60 children from four pediatric cardiology centers. The median patient age and weight were 6.5 (0.5-168) months and 6.8 (1.19-57) kg, respectively. In the study, 26 children had a body weight of ≤ 6 kg. Of these 26 children, 9 had a body weight of ≤ 3 kg. The median narrowest diameter of PDA was 2 (1.2-4) mm. Ductal anatomy was Type A in 29, Type B in 2, Type C in 11, Type D in 1, and Type E in 16 patients, and a residual PDA after surgery in 1 patient. Closure with ADO II AS was achieved in 58 (96.6%) of 60 attempted cases. In two infants, the device was not released because of significant residual shunt. ADO II was used in one, and the other was sent to surgery. Complete closure was observed in all ADO II AS deployed children by the next day on echocardiography. Median follow-up was 12 (1-18) months. Neither death nor any major complications occurred. Our study shows that closure of medium and small sized PDA by using ADO II AS device is effective and safe in children. The use of the device will expand the field of application of PDA closure in small infants. © 2013 Wiley Periodicals, Inc.

Patent ductus arteriosus closure using Occlutech® Duct Occluder, experience in Port Elizabeth, South Africa.

PubMed

Pepeta, Lungile; Greyling, Adele; Nxele, Mahlubandile Fintan; Makrexeni, Zongezile Masonwabe

2017-01-01

Percutaneous closure of patent ductus arteriosus (PDA) has become standard therapy. Experience with the Occlutech® Duct Occluder is limited. Data regarding ductal closure using Occlutech® Duct Occluder were reviewed and prospectively collected. Demographics, hemodynamic and angiographic characteristics, complications, and outcomes were documented. From March 2013 to June 2016, 65 patients (43 females and 22 males) underwent percutaneous closure of the PDA using Occlutech® Duct Occluder. The median age of the patients was 11 months (range, 1-454 months) and the median weight was 8.5 kg (range 2.5-78 kg). The mean pulmonary artery median pressure was 27 mmHg (range, 12-100 mmHg) and the QP: Qs ratio median was 1.8 (range, 1-7.5), with a pulmonary vascular resistance mean of 2.7 WU (standard deviation [SD] ±2.1). Thirty-two patients had Krichenko Type A duct (49%); 7, Type C (11%); 4, Type D (6%); and 22, Type E (34%). The ductal size (narrowest diameter at the pulmonic end) mean was 3.5 mm (SD ± 1.9 mm). The screening time mean was 17.3 min (SD ± 11.6). Out of 63 patients with successful closure of the PDA using Occlutech® Duct Occluder, there were 15 patients with small PDAs; 25 with moderate PDAs, and 23 with large PDAs. In one patient, the device dislodged to the descending aorta, and in two patients, to the right pulmonary artery immediately following deployment, with successful percutaneous (two) and surgical (one) retrieval. Complete ductal occlusion was achieved in all 63 patients on day one. The Occlutech® Duct Occluder is a safe and effective device for closure of ducts in appropriately selected patients.

Challenges in device closure of a large patent ductus arteriosus in infants weighing less than 6 kg.

PubMed

Vijayalakshmi, I B; Chitra, Narasimhan; Praveen, Jayan; Prasanna, Simha Rao

2013-02-01

Transcatheter closure of patent ductus arteriosus (PDA) has replaced surgery in most institutions. Despite improvements in techniques and the devices available, closure of large PDA in very small infants remains a challenge. To assess the challenges, feasibility, and efficacy of device closure of large PDA, in infants weighing ≤6 kg. Analysis of device closure of a PDA was done in 61 infants ≤6 kg. Their ages, ranged from 9 days-12 months (mean 8.9 months), weight ranged from 2.2 to 6 kg (mean 5.3 kg), and PDA measured 3.2-8.7 mm (mean 4.8 mm). The fluoroscopy time was 3-18 minutes. The largest device used was 12 × 10 mm. Successful device placement was achieved in 60/61 infants (98.4%). Mild aortic obstruction occurred in 2 cases (3.3%), as the device got displaced towards the aorta after release. The device embolized in 2 cases (3.3%). In one it was retrieved by a novel method like fastening the screw in the aorta and was closed with a 4 × 6 ADO II. In the other infant, with a single kidney, died of uremia after device retrieval. Mild left pulmonary artery (LPA) obstruction occurred in one case (1.6%). Four cases (6.6%) had minor vascular complications. The postprocedure weight gain after 3 months was between 2.5 kg ± 250 mg. Device closure of large PDA in infants weighing ≤6 kg with left ventricular failure is challenging but possible, safe and effective. Retrieval of embolized device could be tricky. © 2012, Wiley Periodicals, Inc.

Device-less patent foramen ovale closure by radiofrequency thermal energy.

PubMed

Walpoth, Nazan B; Habermacher, Kathrin; Moarof, Igal; Watson, Sandy; Wahl, Andreas; Windecker, Stephan; Schönenberger, Christa; Meier, Bernhard

2008-02-23

The goal of this study was to assess the feasibility, safety and success of a system which uses radiofrequency energy (RFE) rather than a device for percutaneous closure of patent foramen ovale (PFO). Sixteen patients (10 men, 6 women, mean age 50 years) were included in the study. All of them had a proven PFO with documented right-to-left shunt (RLS) after Valsalva manoeuvre (VM) during transoesophageal echocardiography (TEE). The patients had an average PFO diameter of 6 +/- 2 mm at TEE and an average of 23 +/- 4 microembolic signals (MES) in power M-mode transcranial Doppler sonography (pm-TCD), measured over the middle cerebral artery. An atrial septal aneurysm (ASA) was present in 7 patients (44%). Balloon measurement, performed in all patients, revealed a stretched PFO diameter of 8 +/- 3 mm. In 2 patients (stretched diameter 11 and 14 mm respectively, both with ASA >10 mm), radiofrequency was not applied (PFO too large) and the PFO was closed with an Amplatzer PFO occluder instead. A 6-month follow-up TEE was performed in all patients. There were no serious adverse events during the procedure or at follow-up (12 months average). TEE 6 months after the first RFE procedure showed complete closure of the PFO in 50% of the patients (7/14). Closure appeared to be influenced by PFO diameter, complete closure being achieved in 89% (7/8) with a balloon-stretched diameter < or =7 mm but in none of the patients >7 mm. Only one of the complete closure patients had an ASA. Of the remainder, 4 (29%) had an ASA. Although the PFO was not completely closed in this group, some reduction in the diameter of the PFO and in MES was documented by TEE and pm-TCD with VM. Five of the 7 residual shunt patients received an Amplatzer PFO occluder. Except for one patient with a minimal residual shunt, all showed complete closure of PFO at 6-month follow-up TEE and pm-TCD with VM. The other two refused a closure device. The results confirm that radiofrequency closure of the PFO is safe albeit less efficacious and more complex than device closure. The technique in its current state should not be attempted in patients with a balloon-stretched PFO diameter >7 mm and an ASA.

Secondary plastic closure of gastroschisis is associated with a lower incidence of mechanical ventilation.

PubMed

Dariel, Anne; Poocharoen, Wannisa; de Silva, Nicole; Pleasants, Hazel; Gerstle, Justin Ted

2015-02-01

Nonsurgical closure after primary silo placement, secondary plastic closure (SPC), has been used as an alternative to secondary surgical closure (SSC) in gastroschisis. The benefits described were closure without formal surgical procedure, cosmetic aspect, and minimization of intra-abdominal pressures. This study compared requirements for mechanical ventilation and general anesthesia, nutritional care, and outcomes between SPC and SSC. We included patients with primary staged-silo reduction with a 1-year minimum follow-up. SPC was performed at bedside with sedation using a nonadherent dressing. SSC was performed in operating room under general anesthesia using standard surgical techniques. This retrospective study included 64 patients, 23 SPC and 41 SSC. The characteristics of the two groups were comparable. Mechanical ventilation was used for 15 SPC and 41 SSC (p=0.0001) with a comparable median duration (5.5 and 6.0 days, not significant [NS]). General anesthesia was required for 9 SPC and 41 SSC (p<0.0001). Complications included one SPC and six SSC with necrotizing enterocolitis, zero SPC and four SSC with intestinal atresia, two SPC and four SSC with small bowel obstruction, zero SPC and one SSC with abdominal compartment syndrome resulting in a short bowel syndrome (NS). Median duration of parenteral nutrition (30 and 27 days), time to first feeds (14 and 14 days), time at or above minimal enteral feeding (22 and 17 days), time to full feeds (31 and 28 days), length of stay (LOS) in neonatal intensive care unit (24 and 23.5 days) and overall hospital LOS (37 and 36 days) were not statistically different between SPC and SSC patients without complications, respectively. These data were comparable for SPC and SSC patients with complications. Five SPC and six SSC developed an umbilical hernia (NS); two patients in each group required a surgical repair (NS). Plastic closure of gastroschisis after primary silo reduction is simple, safe, reproducible, and associated with a significant lower incidence of mechanical ventilation. Nutritional management and length of hospital stay were similar to conventional surgical closure for patients. Plastic closure allows nonoperative management without general anesthesia at patient's bedside, in comparison with surgical closure that must be performed under general anesthesia in the operating room. Plastic closure does not appear to be associated with more umbilical hernias in this retrospective study. Georg Thieme Verlag KG Stuttgart · New York.

78 FR 64423 - Children's Online Privacy Protection Rule Applications for Approval of Proposed Parental Consent...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-29

..., Inc.; Application for Approval of Safe Harbor Program by kidSAFE Seal Program AGENCY: Federal Trade... kidSAFE Seal Program (``kidSAFE''), owned and operated by Samet Privacy, LLC, under the safe harbor... following the instructions on the web-based form. For comments concerning kidSAFE, write ``kidSAFE...

10 CFR 63.51 - License amendment for permanent closure.

Code of Federal Regulations, 2011 CFR

2011-01-01

... to compliance with § 63.113. (2) A description of the program for post-permanent closure monitoring... that have been designed, fabricated, and emplaced to be as permanent as is practicable; (ii) Placement..., pertinent to compliance with § 63.113. (5) The results of tests, experiments, and any other analyses...

10 CFR 63.51 - License amendment for permanent closure.

Code of Federal Regulations, 2012 CFR

2012-01-01

... to compliance with § 63.113. (2) A description of the program for post-permanent closure monitoring... that have been designed, fabricated, and emplaced to be as permanent as is practicable; (ii) Placement..., pertinent to compliance with § 63.113. (5) The results of tests, experiments, and any other analyses...

76 FR 31340 - Medicare Program; Notification of Closure of St. Vincent's Medical Center

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-31

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1587-N... & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This notice announces the closure of St. Vincent's Medical Center and the initiation of an application process for hospitals to apply to the Centers for...

78 FR 20035 - Adequacy of Oregon Municipal Solid Waste Landfill Permit Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-03

... to issue Research, Development, and Demonstration (RD&D) Permits to owners and operators of MSWLF... Landfill (MSWLF) criteria in 40 CFR part 258 to allow Research, Development, and Demonstration (RD&D... authority for variance of criteria for groundwater monitoring, closure and post-closure requirements (except...

Safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion.

PubMed

Chen, Qiang; Cao, Hua; Zhang, Gui-Can; Chen, Liang-Wan; Chen, Dao-Zhong

2012-01-01

The study aims to evaluate the safety and feasibility of intra-operative device closure of atrial septal defect with transthoracic minimal invasion. From May 2006 to June 2009, 252 patients with secundum-type atrial septal defect closure were enrolled in our institution. The patients were divided into two groups, with 182 patients in group I with intra-operative device closure and 72 in group II with surgical closure. In group I, the patients' age ranged from 3 months to 62 years (mean±standard deviation, 19.0±16.7 years). This approach involved a transthoracic minimal invasion that was performed after full evaluation of the atrial septal defect by transthoracic echocardiography, deploying the device through the delivery sheath to occlude the atrial septal defect. In group I, 180 patients were occluded successfully under this approach. The size of the occluder device implanted ranged from 6 to 48 mm. Minor complications occurred, which included transient arrhythmias (n=23) and pleural effusion (n=15). Two patients with postoperative cardiac arrest were successfully cardiopulmonary resuscitated. Another two patients with occluder dislodged back into the right atrium were turned to surgical repair with cardiopulmonary bypass on the postoperative day. In group II, all patients were occluded successfully, and almost all patients needed blood transfusion and suffered from various minor complications. All discharged patients were followed up for 1-5 years. During this period, we found no recurrence, no thrombosis, even no device failure. In our comparative studies, group II had significantly longer intensive care unit (ICU) stay and hospital stay than group I (p<0.05). The cost for group I was less than group II (p<0.05). Intra-operative device closure of atrial septal defect with transthoracic minimal invasion is a safe and feasible technique. It had the advantages of cost savings, yielding better cosmetic results, and leaving less trauma than surgical closure.

Study design of the CLOSURE I Trial: a prospective, multicenter, randomized, controlled trial to evaluate the safety and efficacy of the STARFlex septal closure system versus best medical therapy in patients with stroke or transient ischemic attack due to presumed paradoxical embolism through a patent foramen ovale.

PubMed

Furlan, Anthony J; Reisman, Mark; Massaro, Joseph; Mauri, Laura; Adams, Harold; Albers, Gregory W; Felberg, Robert; Herrmann, Howard; Kar, Saibal; Landzberg, Michael; Raizner, Albert; Wechsler, Lawrence

2010-12-01

Some strokes of unknown etiology may be the result of a paradoxical embolism traversing through a nonfused foramen ovale (patent foramen ovale [PFO]). The utility of percutaneously placed devices for treatment of patients with cryptogenic stroke or transient ischemic attack (TIA) and PFO is unknown. In addition, there are no clear data about the utility of medical interventions or other surgical procedures in this situation. Despite limited data, many patients are being treated with PFO closure devices. Thus, there is a strong need for clinical trials that test the potential efficacy of PFO occlusive devices in this situation. To address this gap in medical knowledge, we designed the CLOSURE I trial, a randomized, clinical trial comparing the use of a percutaneously placed PFO occlusive device and best medical therapy versus best medical therapy alone for prevention of recurrent ischemic neurologic symptoms among persons with TIA or ischemic stroke. This prospective, multicenter, randomized, controlled trial has finished enrollment. Two-year follow-up for all 910 patients is required. The primary end point is the 2-year incidence of stroke or TIA, all-cause mortality for the first 30 days, and neurologic mortality from ≥ 31 days of follow-up, as adjudicated by a panel of physicians who are unaware of treatment allocation. This article describes the rationale and study design of CLOSURE I. This trial should provide information as to whether the STARFlex septal closure system is safe and more effective than best medical therapy alone in preventing recurrent stroke/TIA and mortality in patients with PFO and whether the STARFlex septal closure device can demonstrate superiority compared with best medical therapy alone. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00201461.

Twenty-four month results from a randomized trial of cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins.

PubMed

Gibson, Kathleen; Morrison, Nick; Kolluri, Raghu; Vasquez, Michael; Weiss, Robert; Cher, Daniel; Madsen, Monte; Jones, Andrew

2018-06-15

We previously reported 3-month and 12-month occlusion rates after treatment of clinically symptomatic saphenous vein reflux with either cyanoacrylate closure (CAC) using the VenaSeal Closure System (Medtronic, Dublin, Ireland) or radiofrequency ablation (RFA) in a randomized, multicenter, clinical trial, VenaSeal Sapheon Closure System vs Radiofrequency Ablation for Incompetent Great Saphenous Veins (VeClose). Herein we report the 24-month follow-up results of the VeClose trial. There were 222 patients with symptomatic great saphenous vein (GSV) incompetence who were randomly assigned to receive either CAC (n = 108) or RFA (n = 114). Patients were not allowed to receive adjunctive treatment of tributary varicosities until after the 3-month visit. Duplex ultrasound of the target vein was performed at day 3 and months 1, 3, 6, 12, and 24 after treatment, and closure was assessed by ultrasound by the treating physician. Overall 24-month success rates were compared; in addition, time to first reopening of the target vein was evaluated using survival analysis. End points such as Venous Clinical Severity Score, EuroQoL-5 Dimension, and Aberdeen Varicose Vein Questionnaire were evaluated. Of 222 randomized patients, 171 completed the 24-month follow-up, which included 87 from the CAC group and 84 from the RFA group. The 24-month complete closure rate was 95.3% in the CAC group and 94.0% in the RFA group, demonstrating continued noninferiority of CAC compared with RFA (P = .0034). Symptoms and quality of life improved similarly in both groups. No clinically significant device- or procedure-related late adverse events occurred. Both CAC and RFA were effective in closure of the target GSV, resulting in similar and significant improvements in the patient's quality of life through 24 months. These results suggest that CAC of the GSV is safe and durable out to 2 years. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Multicenter Off-Label Use of Nit-Occlud Coil in Retrograde Closure of Small Patent Ductus Arteriosus.

PubMed

Zanjani, Keyhan Sayadpour; Sobhy, Rodina; El-Kaffas, Rania; El-Sisi, Amal

2017-04-01

We studied the safety and efficacy of closing patent ductus arteriosus by Nit-Occlud coils via retrograde approach. This is a retrospective study of 46 attempts to close ducts by this method in two hospitals in Egypt and Iran. Ductus arteriosus was crossed by left or right Judkins or endhole catheters. The coil was delivered via the same catheter or the provided endhole catheter after exchange. The procedure was successful in 42 out of 46 attempts. Fluoroscopy and procedural times were significantly shorter when the catheter was not exchanged. This method is effective and safe for the closure of small ducts. Crossing the duct and delivering the coil by a left Judkins catheter is the easiest and fastest way to perform this method.

Percutaneous treatment of atrial septal defects, muscular ventricular septal defects and patent ductus arteriosus in infants under one year of age.

PubMed

Prada, Fredy; Mortera, Carlos; Bartrons, Joaquim; Rissech, Miguel; Jiménez, Lorenzo; Carretero, Juan; Llevadias, Judit; Araica, Mireya

2009-09-01

Amplatzer devices are used for the percutaneous closure of ostium secundum atrial septal defects, muscular ventricular septal defects and patent ductus arteriosus. However, very little experience has been gained in using these devices in infants under 1 year of age. Between January 2001 and January 2008, 22 symptomatic infants aged under 1 year underwent percutaneous treatment: three had an ostium secundum atrial septal defect, 15 had patent ductus arteriosus, and four had a muscular ventricular septal defect. All the procedures were completed successfully. No immediate or medium-term complications were observed. Closure of these types of defect using an Amplatzer device in infants under 1 year of age, who would otherwise require surgery, is a safe and effective procedure.

Percutaneous closure of a hemodynamically significant connection between the inferior vena cava and the left atrium.

PubMed

Wiebe, Jens; Rixe, Johannes; Nef, Holger

2015-10-01

A connection between the inferior vena cava (IVC) and the left atrium (LA) can occur as a rare complication after surgical atrial septum defect (ASD) repair. We demonstrate the first case of a percutaneous closure of this connection. A 67-year-old female was admitted to hospital due to exertional dyspnea. A history of a surgical ASD repair in 1960 and 1966 with a residual shunt was already known. Transesophageal echocardiography and a CT scan revealed a hemodynamically significant drainage of the IVC into the LA. This connection was successfully closed percutaneously with an AMPLATEZR Duct Occluder I (St. Jude Medical, St. Paul, MN). Post-procedural CT-scan and transthoracic echocardiography demonstrated a stable position and there was also no evidence of a residual shunt. The patient reported a significant reduction of exertional dyspnea. Percutaneous closure of an IVC to LA connection in this case was safe and feasible. The decision about which device is optimal must be made on an individual basis. © 2015 Wiley Periodicals, Inc.

Onyx(®) in endovascular treatment of cerebral arteriovenous malformations - a review.

PubMed

Szajner, Maciej; Roman, Tomasz; Markowicz, Justyna; Szczerbo-Trojanowska, Małgorzata

2013-07-01

Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. In most cases, the disorder may be asymptomatic. The objective of endovascular AVM treatment is set individually for each case upon consultations with a neurosurgeon and a neurologist. The endpoint of the treatment should consist in prevention of AVM bleeding in a management procedure characterized by a significantly lower risk of complications as compared to the natural history of AVM. Endovascular interventions within AVM may include curative exclusion of AVM from circulation, embolization adjuvant to resection or radiation therapy, targeted closure of a previously identified bleeding site as well as palliative embolization. Onyx was first described in the 1990s. It is a non-adhesive and radiolucent compound. Onyx-based closure of the lumen of the targeted vessel is obtained by means of precipitation. The process is enhanced peripherally to the main flux of the injected mixture. This facilitates angiographic monitoring of embolization at any stage. The degree of lumen closure is associated with the location of the vessel. Supratentorial and cortical locations are most advantageous. Dense and plexiform structure of AVM nidus as well as a low number of supplying vessels and a single superficial drainage vein are usually advantageous for Onyx administration. Unfavorable factors include nidus drainage into multiple compartments as well as multiarterial supply of the AVM, particularly from meningeal arteries, en-passant arteries or perforating feeders. Onyx appears to be a safe and efficient material for embolization of cerebral AVMs, also in cases of intracranial bleeding associated with AVM. Curative embolization of small cerebral AVMs is an efficient and safe alternative to neurosurgical and radiosurgical methods. Careful angiographic assessment of individual arteriovenous malformations should be performed before each Onyx administration.

Onyx® in endovascular treatment of cerebral arteriovenous malformations – a review

PubMed Central

Szajner, Maciej; Roman, Tomasz; Markowicz, Justyna; Szczerbo-Trojanowska, Małgorzata

2013-01-01

Summary Arteriovenous malformation (AVM) is an abnormal connection between arteries and veins, bypassing the capillary system. In most cases, the disorder may be asymptomatic. The objective of endovascular AVM treatment is set individually for each case upon consultations with a neurosurgeon and a neurologist. The endpoint of the treatment should consist in prevention of AVM bleeding in a management procedure characterized by a significantly lower risk of complications as compared to the natural history of AVM. Endovascular interventions within AVM may include curative exclusion of AVM from circulation, embolization adjuvant to resection or radiation therapy, targeted closure of a previously identified bleeding site as well as palliative embolization. Onyx was first described in the 1990s. It is a non-adhesive and radiolucent compound. Onyx-based closure of the lumen of the targeted vessel is obtained by means of precipitation. The process is enhanced peripherally to the main flux of the injected mixture. This facilitates angiographic monitoring of embolization at any stage. The degree of lumen closure is associated with the location of the vessel. Supratentorial and cortical locations are most advantageous. Dense and plexiform structure of AVM nidus as well as a low number of supplying vessels and a single superficial drainage vein are usually advantageous for Onyx administration. Unfavorable factors include nidus drainage into multiple compartments as well as multiarterial supply of the AVM, particularly from meningeal arteries, en-passant arteries or perforating feeders. Onyx appears to be a safe and efficient material for embolization of cerebral AVMs, also in cases of intracranial bleeding associated with AVM. Curative embolization of small cerebral AVMs is an efficient and safe alternative to neurosurgical and radiosurgical methods. Careful angiographic assessment of individual arteriovenous malformations should be performed before each Onyx administration. PMID:24115958

78 FR 32663 - Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-31

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [CMS-1459-N... Slots AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Notice. SUMMARY: This notice announces the closure of two teaching hospitals and the initiation of an application process where hospitals...

No-migration variance petition. Appendices C--J: Volume 5, Revision 1

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

Not Available

1990-03-01

Volume V contains the appendices for: closure and post-closure plans; RCRA ground water monitoring waver; Waste Isolation Division Quality Program Manual; water quality sampling plan; WIPP Environmental Procedures Manual; sample handling and laboratory procedures; data analysis; and Annual Site Environmental Monitoring Report for the Waste Isolation Pilot Plant.

Achieving and documenting closure in plant growth facilities

NASA Technical Reports Server (NTRS)

Knott, W. M.; Sager, John C.; Wheeler, Ray

1992-01-01

As NASA proceeds with its effort to develop a Controlled Ecological Life Support System (CELSS) that will provide life support to crews during long duration space missions, it must address the question of facility and system closure. The concept of closure as it pertains to CELSS and engineering specifications, construction problems and monitoring procedures used in the development and operation of a closed plant growth facility for the CELSS program are described. A plant growth facility is one of several modules required for a CELSS. A prototype of this module at Kennedy Space Center is the large (7m tall x 3.5m diameter) Biomass Production Chamber (BPC), the central facility of the CELSS Breadboard Project. The BPC is atmospherically sealed to a leak rate of approximately 5 percent of its total volume per 24 hours. This paper will discuss the requirements for atmospheric closure in the facility, present CO2 and trace gas data from initial tests of the BPC with and without plants, and describe how the chamber was sealed atmospherically. Implications that research conducted in this type of facility will have for the CELSS program are discussed.

Technical Feasibility of Enterotomy Closure with Knotless Barbed Suture Material (V-Loc 180) in Esophagojejunostomy Using Linear Stapler during Totally Laparoscopic Total Gastrectomy for Gastric Cancer.

PubMed

Kim, Dong Jin; Kim, Wook; Lee, Jun Hyun

2017-08-01

Intra-corporeal esophagojejunostomy (EJ) using a linear stapler creates a stapler entry hole that requires secure closure during the totally laparoscopic total gastrectomy (TLTG) procedure for gastric cancer. Since a standard method has not been established yet, the feasibility of using V-loc 180 (Covidien, Mansfield, MA, USA) suture material was evaluated in this study. During January 2012 to March 2015, 25 patients who underwent linear stapling EJ and V-loc 180 closure of remaining enterotomy were included in this study. Basic clinico-pathological characteristics, surgical outcomes, and short-term complications were analyzed. The mean patient age was 60.4 ± 8.5 years. Nineteen males and six females were included in this study. The mean body mass index was 25.3 ± 2.3 kg/m 2 . There were 22 stage-I, 2 stage-II, and 1 stage-III gastric cancer patients. The mean operation time was 240.5 ± 44.6 min, and the time for anastomosis was 38.8 ± 11.2 min. The procedures were successfully performed in all cases without any intra-operative complications. There was one case of EJ leakage that occurred at the corner of EJ staple line and not at the enterotomy closure site. The closure of the remaining enterotomy site using V-loc 180 suture following linear stapler EJ is technically feasible and safe during the TLTG procedure. However, further experience and results from other surgeons are necessary to generalize this procedure.

Submucosal tunneling using endoscopic submucosal dissection for peritoneal access and closure in natural orifice transluminal endoscopic surgery: a porcine survival study.

PubMed

Yoshizumi, F; Yasuda, K; Kawaguchi, K; Suzuki, K; Shiraishi, N; Kitano, S

2009-08-01

Safe peritoneal access and gastric closure are the most important concerns in the clinical application of natural orifice transluminal endoscopic surgery (NOTES). We aimed to clarify the feasibility of a submucosal tunnel technique using endoscopic submucosal dissection (ESD) for transgastric peritoneal access and subsequent closure for NOTES. Seven female pigs, each weighing about 40 kg were included in the study. The following procedures were performed: (i) after injection of normal saline into the submucosa, the mucosa was cut with a flex knife; (ii) the submucosal layer was dissected using an insulation-tipped electrosurgical knife to make a narrow longitudinal 50-mm submucosal tunnel; (iii) a small incision was made at the end of the tunnel and enlarged with a dilation balloon. After transgastric peritoneoscopy, the mucosal incision site was closed with clips. The following outcome measures were used: (a) evaluation of the technical feasibility of making a submucosal tunnel; (b) clinical monitoring for 7 days; (c) follow-up endoscopy and necropsy; and (d) peritoneal fluid culture. Natural orifice transluminal endoscopic peritoneoscopy with a submucosal tunnel was successfully carried out in all pigs. The pigs recovered well, without signs of peritonitis. Follow-up endoscopy showed healing of mucosal incision sites without open defects. Necropsy revealed no findings of peritonitis, confirming completeness of gastric closure; there was a thin scar in one pig and adhesion of the omentum in six pigs. Peritoneal fluid culture demonstrated no bacterial growth. The submucosal tunnel technique is feasible and effective for transgastric peritoneal access and closure.

Results of the combined U.S. Multicenter Pivotal Study and the Continuing Access Study of the Nit-Occlud PDA device for percutaneous closure of patent ductus arteriosus.

PubMed

Moore, John W; Greene, Jessica; Palomares, Salvadore; Javois, Alexander; Owada, Carl Y; Cheatham, John P; Hoyer, Mark H; Jones, Thomas K; Levi, Daniel S

2014-12-01

This study aimed to compare the efficacy and safety of the Nit-Occlud PDA device (PFM Medical, Cologne, Germany) to benchmarks designed as objective performance criteria (OPC). The Nit-Occlud PDA is a nitinol coil-type patent ductus arteriosus (PDA) occluder with a reverse cone configuration, which is implanted using a controlled delivery system. Patients with <4-mm minimum diameter PDA were prospectively enrolled in the Pivotal and the Continuing Access Studies from 15 sites in the United States and were followed up for 12 months post-procedure. Investigator-reported outcomes were compared to OPC including a composite success criterion, efficacy criteria of successful closure (clinical and echocardiographic), and safety criteria incidence of adverse events (serious and of total). The Pivotal Study enrolled patients between November 1, 2002 and October 31, 2005, and the Continuing Access Study enrolled additional patients between September 1, 2006 and October 31, 2007. A total of 357 patients were enrolled, and 347 had successful device implantations. After 12 months, 96.8% had complete echocardiographic closure (OPC = 85%) and 98.1% had clinical closure (OPC = 95%). There were no deaths or serious adverse events (OPC = 1%). The total adverse event rate was 4.7% (OPC = 6%). Composite success was 95.1% in the study patients (OPC = 80%). Closure of small- and medium-sized PDA with the Nit-Occlud PDA is effective and safe when compared with OPC. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Self-expanding platinum-coated nitinol devices for transcatheter closure of atrial septal defect: prevention of nickel release.

PubMed

Lertsapcharoen, Pornthep; Khongphatthanayothin, Apichai; Srimahachota, Suphot; Leelanukrom, Ruenreong

2008-06-01

A variety of nitinol-containing devices for transcatheter closure of atrial septal defects (ASD) has been widely used. However, there is concern about the release of nickel after nitinol device implantation. In this study, a platinum-coated nitinol device was braided from nanoplatinum-coated nitinol wires in order to prevent nickel release. The serum nickel levels before and after device implantation and the 1-year results were evaluated. Thirty-one patients, aged 4-59 years, and weighing 13.7-90.0 kg, underwent transcatheter closure. Blood samples for serum nickel levels were taken before, 1 day, 1 week, 1 month and 3 months after implantation. Twenty-nine (93.6%) patients had a successful implantation. The mean ASD diameter was 19.7 +/- 4.8 mm (range 10-30 mm). Procedure-related complications included transient brachial plexus injury in 1 patient and transient dysrhythmia in 4 patients. All 29 patients had complete closure within 1 month after implantation. The mean serum nickel levels at baseline and at 1 day, 1 week, 1 month and 3 months after implantation were 0.65 +/- 0.28, 0.63 +/- 0.18, 0.67 +/- 0.34, 0.55 +/- 0.16, 0.52 +/- 0.14 ng/ml, respectively. There was no significant difference in serum nickel levels before and after implantation. There were no device-related complications at 1-year follow up. Transcatheter ASD closure using a platinum-coated nitinol device can be performed safely and successfully with good outcomes. Nano-coating of platinum on nitinol wires can prevent nickel release following device implantation.

Numerical Modeling of ROM Panel Closures at WIPP

NASA Astrophysics Data System (ADS)

Herrick, C. G.

2016-12-01

The Waste Isolation Pilot Plant (WIPP) in New Mexico is a U.S. DOE geologic repository for permanent disposal of defense-related transuranic (TRU) waste. Waste is emplaced in panels excavated in a bedded salt formation (Salado Fm.) at 655 m bgs. In 2014 the U.S. EPA approved the new Run-of-Mine Panel Closure System (ROMPCS) for WIPP. The closure system consists of 100 feet of run-of-mine (ROM) salt sandwiched between two barriers. Nuclear Waste Partnership LLC (the M&O contractor for WIPP) initiated construction of the ROMPCS. The design calls for three horizontal ROM salt layers at different compaction levels ranging from 70-85% intact salt density. Due to panel drift size constraints and equipment availability the design was modified. Three prototype panel closures were constructed: two having two layers of compacted ROM salt (one closure had 1% water added) and a third consisting of simply ROM salt with no layering or added water. Sampling of the prototype ROMPCS layers was conducted to determine the following ROM salt parameters: thickness, moisture content, emplaced density, and grain-size distribution. Previous modeling efforts were performed without knowledge of these ROM salt parameters. This modeling effort incorporates them. The program-accepted multimechanism deformation model is used to model intact salt room creep closure. An advanced crushed salt model is used to model the ROM salt. Comparison of the two models' results with the prototypes' behavior is given. Our goal is to develop a realistic, reliable model that can be used for ROM salt applications at WIPP. Sandia National Laboratories is a multi-program laboratory operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the U. S. Department of Energy's National Nuclear Security Administration under contract DE-AC04-94AL85000. This research is funded by WIPP programs administered by the Office of Environmental Management (EM) of the U.S Department of Energy SAND2016-7259A

Proposed modifications to the RCRA post-closure permit for the Chestnut Ridge Hydrogeologic Regime at the U.S. Department of Energy Y-12 Plant, Oak Ridge, Tennessee

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

NONE

1997-05-01

This report presents proposed modifications to several conditions of the Resource Conservation and Recovery Act (RCRA) Post-Closure Permit (PCP) for the Chestnut Ridge Hydrogeologic Regime (CRHR) (permit number TNHW-088, EPA ID No. TN3 89 009 0001). These permit conditions define the requirements for RCRA post-closure detection groundwater monitoring at the Chestnut Ridge Sediment Disposal Basin (CRSDB) and Kerr Hollow Quarry (KHQ), and RCRA post-closure corrective action groundwater monitoring at the Chestnut Ridge Security Pits (CRSPs). Modification of these PCP conditions is requested to: (1) clarify the planned integration of RCRA post-closure corrective action groundwater monitoring at the CRSPs with themore » monitoring program to be established in the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) record of decision (ROD), (2) revise several of the current technical requirements for groundwater monitoring based on implementation of the RCRA monitoring programs during 1996, (3) replace several of the technical procedures included in the PCP with updated versions recently issued by the Y-12 Plant Groundwater Protection Program (GWPP), and (4) correct inaccurate regulatory citations and references to permit conditions and permit attachments. With these modifications, the Y- 12 Plant will continue to meet the full intent of all regulatory obligations for post-closure care of these facilities. Section 2 provides the technical justification for each proposed permit modification. Section 3.0 contains proposed changes to Section II of the PCP. Modifications to site-specific permit conditions are presented in Section 4.0 (CRSDB), Section 5.0 (CRSPs), and Section 6.0 (KHQ). Sections 7.0 and 8.0 reference updated and revised procedures for groundwater sampling, and monitoring well plugging and abandonment, respectively. Appendix A includes all proposed revisions to the permit attachments.« less

Debris control design achievements of the booster separation motors

NASA Technical Reports Server (NTRS)

Smith, G. W.; Chase, C. A.

1985-01-01

The stringent debris control requirements imposed on the design of the Space Shuttle booster separation motor are described along with the verification program implemented to ensure compliance with debris control objectives. The principal areas emphasized in the design and development of the Booster Separation Motor (BSM) relative to debris control were the propellant formulation and nozzle closures which protect the motors from aerodynamic heating and moisture. A description of the motor design requirements, the propellant formulation and verification program, and the nozzle closures design and verification are presented.

Minimally invasive thoracoscopic closure versus thoracotomy in children with patent ductus arteriosus.

PubMed

Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Marczak, Jakub; Szymanska, Anna; Augustyn, Cyprian; Cichon, Romuald

2017-02-01

Patent ductus arteriosus (PDA) is one of the most common congenital heart defects. Once diagnosed, an immediate pharmacologic or invasive treatment should be performed. The purpose of this work was to evaluate the safety and efficacy of surgical PDA ligation in children using video-assisted thoracoscopic surgery (VATS) in comparison with a conventional muscle-sparing posterolateral thoracotomy technique (MSPLT). In this single-center, retrospective study 173 children qualified for surgical PDA closure were enrolled. Patients were divided according to their weight and type of surgery performed. The groups consisted of patients operated through thoracotomy (54%) or VATS (46%). Operative characteristics, cosmetic effect, postoperative complications and long-term survival were evaluated. Regardless of weight, fewer complications were noted in children after thoracoscopic clipping. Fifteen VATS patients required intraoperative conversion to thoracotomy; however, adverse sequelae were not observed. Aesthetics seemed to be the major complaint after conventional surgery. We did not observe any statistically significant differences in the long-term survival between both groups. Both techniques were shown to be safe and effective. Unsuccessfully performed thoracoscopic surgeries were safely converted to conventional thoracotomy. VATS, being a less invasive approach, leads to a better aesthetic effect and lower surgical complication rate. Copyright © 2016 Elsevier Inc. All rights reserved.

Loop ileostomy closure: comparison of cost effectiveness between suture and stapler.

PubMed

Horisberger, Karoline; Beldi, Guido; Candinas, Daniel

2010-12-01

Closure of loop ileostomy can be safely performed using sutures or staplers. The aim of the present study was to compare the cost effectiveness of three different techniques. A total of 128 consecutive patients who underwent closure of loop ileostomy between January 2002 and December 2008 were analyzed retrospectively. The primary outcome parameter was operative cost. Closure of ileostomy was performed in 66 patients with hand-sewn anastomosis, in 25 patients with stapler only, and in 37 patients with a combination of stapler and suture. There were no differences in terms of early and late postoperative complications. Operative time was significantly longer for "suture only" (101.4 ± 26 min) than for "stapler/suture" (-4.9 min) and "stapler only" (-17.8 min); the difference between the three groups is significant (p = 0.05). Duration of hospital stay was not different among the three groups. Operative costs with "stapler/suture" (1,755.9 ± 355.6 EUR) were significantly higher than with "suture only" (-254 EUR; p = 0.001) and "stapler only" (-236 EUR; p = 0.005). Operative time using the stapler only is significantly shorter than with hand-sewn anastomosis or combinations of stapler and suture. Operative costs are significantly higher for a procedure that includes suture and stapler.

Primary Closure Following Laparoscopic Common Bile Duct Exploration Combined with Intraoperative Choledochoscopy and D-J Tube Drainage for Treating Choledocholithiasis.

PubMed

Yu, Miao; Xue, Huanzhou; Shen, Quan; Zhang, Xiao; Li, Ke; Jia, Meng; Jia, Jiangkun; Xu, Jian

2017-09-19

BACKGROUND This study aimed to assess the clinical short-term results of a primary closure following laparoscopic common bile duct exploration (LCBDE) combined with intraoperative choledochoscopy and D-J tube drainage for choledocholithiasis treatment. MATERIAL AND METHODS Twenty-five patients (14 women and 11 men) who underwent LCBDE with primary duct closure and D-J tube drainage for choledocholithiasis were retrospectively enrolled. The D-J tube (4.7F×14 cm) was removed using a duodenoscope if there was no bile leakage. Before discharge, patients were examined for blood amylase. After discharge or D-J tube removal, all patients were routinely assessed for complications. RESULTS Mean operating time was 135±46 min (range, 78-195 min). Mean intraoperative blood loss was 71±24 mL (range, 25-110 mL). Total hospital stay was 6-9 days (mean, 8.04±1.37 days). Two patients experienced intraoperative bile leakage, which was stopped with re-suturing. None of these patients experienced postoperative bile leaks. Three patients had slight elevation of serum amylase before discharge but without pancreatitis signs. The successful clearance rate of stones was 100%. During 1-year follow-up, no recurrence or severe complications occurred. CONCLUSIONS A primary closure following LCBDE combined with intraoperative choledochoscopy and D-J tube drainage is safe and feasible for choledocholithiasis treatment.

Recent advances in Li/SO2 battery technology

NASA Astrophysics Data System (ADS)

Ralston, R. E.

The areas of improvement discussed are related to cell closure-hermetic seals, improved glass-to-metal seals, and lithium-limited cell design. Attention is given to the design of a Li/SO2 cell which can safely withstand discharge below zero volts into voltage reversal. The design characteristics of an unbalanced cell, the new lithium-limited or balanced cell, and a high rate unbalanced design are compared in a table for the 'D' size cell. It is concluded that the improvements in cell closure, glass seal stability, and cell balance have resulted in storability, reliability, and abuse resistance characteristics which make the performance of today's Li/SO2 battery without equal among competitive primary batteries. However, the Li/SO2 cell must not be used in applications where extreme electrical or environmental conditions can push the system beyond its recommended limits.

Combined perventricular septal defect closure and patent ductus arteriosus ligation via the lower ministernotomy approach.

PubMed

Voitov, Alexey; Omelchenko, Alexander; Gorbatykh, Yuriy; Bogachev-Prokophiev, Alexander; Karaskov, Alexander

2018-02-01

Over the past decade, minimally invasive approaches have been advocated for surgical correction of congenital defects to reduce costs related to hospitalization and for improved cosmesis. Minimal skin incisions and partial sternotomy reduce surgical trauma, however these techniques might not be successful in treating a number of congenital pathological conditions, particularly for combined congenital defects. We focused on cases with a combined presentation of ventricular septal defect and patent ductus arteriosus. We studied 12 infants who successfully underwent surgical treatment for a combined single-stage ventricular septal defect and patent ductus arteriosus closure through a lower ministernotomy without using cardiopulmonary bypass and X-rays. No intraoperative and early postoperative complications or mortality were noted. Postoperative echocardiography did not reveal residual shunts. The proposed technique is safe and reproducible in infants. © Crown copyright 2017.

Transcatheter umbrella closure of valvular and paravalvular leaks.

PubMed

Hourihan, M; Perry, S B; Mandell, V S; Keane, J F; Rome, J J; Bittl, J A; Lock, J E

1992-11-15

Our aim was to adapt the technique of transcatheter umbrella closure of intracardiac defects for closure of valvular and paravalvular defects. The double-umbrella device developed by Rashkind and Cuaso has been safely and effectively delivered across a host of intracardiac defects, but transcatheter closure of valvular and paravalvular leaks has not been reported. Between February 1987 and September 1990, eight patients who were believed to be poor operative candidates were taken to the catheterization laboratory for transcatheter double-umbrella closure of a valvular or a paravalvular leak. Four patients had a paravalvular leak around a prosthetic aortic valve. The other four patients had a valvular leak: one patient with a regurgitant native aortic valve after a Stansel procedure and three patients with a regurgitant porcine valve in a left ventricular apex to descending aorta conduit. Placement of a double-umbrella device was attempted in seven of the eight patients and was successful in all seven. Device placement was not attempted in one patient because of the crescentic shape of his defect. Two patients required two devices for each closure; the other five required only one device each. Angiography, performed on six patients after device closure, demonstrated that three patients had a completely occluded defect, two had trivial residual flow and one patient had mild residual flow through the device. All significant complications occurred in one patient who had hemolysis and oliguria that resolved when the initial umbrella was replaced by a larger device. In addition, two devices migrated to the patient's pulmonary arteries but were retrieved in the catheterization laboratory without difficulty. No other early or late complications occurred in 21 to 50 months of follow-up. Of the four patients with a paravalvular leak, the one who did not receive a device died at operation, one patient died at operation for an associated defect (in the operating room the umbrella was found securely in place across the paraaortic defect) and two patients are clinically well at home after 21 and 32 months, respectively. Of the four patients with closure of a valvular leak, one patient remains well at home 50 months later, one patient died at operation for associated defects and two patients had additional successful surgical treatment and remain well 29 months after device placement. Transcatheter umbrella closure appears to be a reasonable alternative for closure of a valvular or paravalvular leak in patients who are poor operative candidates.

Legal Aspects of Program Closure.

ERIC Educational Resources Information Center

Hample, Stephen R.

1982-01-01

Legal issues in program discontinuance and resulting lawsuits are considered, including liability to the faculty, students, and other constituencies; freedom of speech; due process; contractual obligations; legal defense; and consideration of program alternatives. A list of related resources is appended. (MSE)

Modeling and Simulating Passenger Behavior for a Station Closure in a Rail Transit Network

PubMed Central

Yin, Haodong; Han, Baoming; Li, Dewei; Wu, Jianjun; Sun, Huijun

2016-01-01

A station closure is an abnormal operational situation in which the entrances or exits of a rail transit station have to be closed for some time due to an unexpected incident. A novel approach is developed to estimate the impacts of the alternative station closure scenarios on both passenger behavioral choices at the individual level and passenger demand at the disaggregate level in a rail transit network. Therefore, the contributions of this study are two-fold: (1) A basic passenger behavior optimization model is mathematically constructed based on 0–1 integer programming to describe passengers’ responses to alternative origin station closure scenarios and destination station closure scenarios; this model also considers the availability of multi-mode transportation and the uncertain duration of the station closure; (2) An integrated solution algorithm based on the passenger simulation is developed to solve the proposed model and to estimate the effects of a station closure on passenger demand in a rail transit network. Furthermore, 13 groups of numerical experiments based on the Beijing rail transit network are performed as case studies with 2,074,267 records of smart card data. The comparisons of the model outputs and the manual survey show that the accuracy of our proposed behavior optimization model is approximately 80%. The results also show that our model can be used to capture the passenger behavior and to quantitatively estimate the effects of alternative closure scenarios on passenger flow demand for the rail transit network. Moreover, the closure duration and its overestimation greatly influence the individual behavioral choices of the affected passengers and the passenger demand. Furthermore, if the rail transit operator can more accurately estimate the closure duration (namely, as g approaches 1), the impact of the closure can be somewhat mitigated. PMID:27935963

Modeling and Simulating Passenger Behavior for a Station Closure in a Rail Transit Network.

PubMed

Yin, Haodong; Han, Baoming; Li, Dewei; Wu, Jianjun; Sun, Huijun

2016-01-01

A station closure is an abnormal operational situation in which the entrances or exits of a rail transit station have to be closed for some time due to an unexpected incident. A novel approach is developed to estimate the impacts of the alternative station closure scenarios on both passenger behavioral choices at the individual level and passenger demand at the disaggregate level in a rail transit network. Therefore, the contributions of this study are two-fold: (1) A basic passenger behavior optimization model is mathematically constructed based on 0-1 integer programming to describe passengers' responses to alternative origin station closure scenarios and destination station closure scenarios; this model also considers the availability of multi-mode transportation and the uncertain duration of the station closure; (2) An integrated solution algorithm based on the passenger simulation is developed to solve the proposed model and to estimate the effects of a station closure on passenger demand in a rail transit network. Furthermore, 13 groups of numerical experiments based on the Beijing rail transit network are performed as case studies with 2,074,267 records of smart card data. The comparisons of the model outputs and the manual survey show that the accuracy of our proposed behavior optimization model is approximately 80%. The results also show that our model can be used to capture the passenger behavior and to quantitatively estimate the effects of alternative closure scenarios on passenger flow demand for the rail transit network. Moreover, the closure duration and its overestimation greatly influence the individual behavioral choices of the affected passengers and the passenger demand. Furthermore, if the rail transit operator can more accurately estimate the closure duration (namely, as g approaches 1), the impact of the closure can be somewhat mitigated.

Safe Zones: Creating LGBT Safe Space Ally Programs

ERIC Educational Resources Information Center

Poynter, Kerry John; Tubbs, Nancy Jean

2008-01-01

This article discusses model LGBT Safe Space Ally programs. These programs, often called "Safe Zones," include self selected students, faculty, and employees who publicly show support by displaying stickers, signs, and other identifiable items. Issues covered in the article include history, development, training, membership, assessment, and…

Post-Closure Inspection Report for the Tonopah Test Range, Nevada, For Calendar Year 2011

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

NSTec Environmental Restoration

This report provides the results of the annual post-closure inspections conducted at the closed Corrective Action Units (CAUs) located on the Tonopah Test Range (TTR), Nevada. This report covers calendar year 2011 and includes inspection and repair activities completed at the following CAUs: (1) CAU 400: Bomblet Pit and Five Points Landfill (TTR); (2) CAU 407: Roller Coaster RadSafe Area (TTR); (3) CAU 424: Area 3 Landfill Complexes (TTR); (4) CAU 453: Area 9 UXO Landfill (TTR); and (5) CAU 487: Thunderwell Site (TTR) Inspections were conducted according to the post-closure plans in the approved Closure Reports. The post-closure inspectionmore » plan for each CAU is included in Appendix B. The inspection checklists are included in Appendix C, field notes are included in Appendix D, and photographs taken during inspections are included in Appendix E. The annual post-closure inspections were conducted May 3 and 4, 2011. Maintenance was performed at CAU 424, CAU 453, and CAU 487. At CAU 424, two surface grade monuments at Landfill Cell A3-3 could not be located during the inspection. The two monuments were located and marked with lava rock on July 13, 2011. At CAU 453, there was evidence of animal burrowing. Animal burrows were backfilled on July 13, 2011. At CAU 487, one use restriction warning sign was missing, and wording was faded on the remaining signs. A large animal burrow was also present. The signs were replaced, and the animal burrow was backfilled on July 12, 2011. As a best management practice, the use restriction warning signs at CAU 407 were replaced with standard Federal Facility Agreement and Consent Order signs on July 13, 2011. Vegetation monitoring was performed at the CAU 400 Five Points Landfill and CAU 407 in June 2011, and the vegetation monitoring report is included in Appendix F.« less

Efficacy and Safety of Transthoracic Echocardiography Alone in Transcatheter Closure of Secundum-Type Atrial Septal Defects in Adults.

PubMed

Ding, Cheng; Chang, Jia-Kan; Lin, Chang-Chyi; Wu, Yong-Jian; Hsieh, Kai-Sheng

2016-04-01

On-site transthoracic echocardiography (TTE) to guide the transcutaneous closure of secundum-type atrial septal defects (ASDs) in the catheterization laboratory remains unclear, especially in adults. Between 2005 and 2012, a total of 82 adults underwent transcutaneous closure of ASDs. The initial 15 cases underwent the procedure with both on-site transesophageal echocardiography (TEE) and TTE monitoring. Since January 2008, a total of 67 patients underwent on-site TTE alone to guide the procedure. Among the 82 adult patients who underwent a transcutaneous closure of the secundum-type ASD procedure, all had successful closure of the defects, and no periprocedural adverse complications occurred. No statistical significance was observed in the successful complete shunt closure rate between the TEE plus TTE and TTE groups during sequential follow-up (postprocedure 24 hour [87% vs. 92%],1 month [93% vs. 95%], 3 month [93% vs. 97%], and 12 month [93% vs. 97%], P > 0.05, respectively) nor was a significant difference observed between the two groups, including decreased right ventricular dimension (29.5 ± 3.3 vs. 32.0 ± 4.9 mm, 26.5 ± 3.0 vs. 28.7 ± 4.6 mm, 26.2 ± 3.1 vs. 28.2 ± 4.8 mm, and 25.6 ± 2.8 vs. 27.7 ± 4.7 mm, P > 0.05, respectively) or increased left ventricular end-diastolic dimension (41.1 ± 2.0 vs. 42.6 ± 3.0 mm, 44.3 ± 2.7 vs. 45.5 ± 3.1 mm, 44.2 ± 2.8 vs. 45.4 ± 3.1 mm, 44.9 ± 2.7 vs. 45.8 ± 2.6 mm, P > 0.05, respectively) before the procedure, and at the 3-, 6-, and 12-month follow-up evaluations. This study showed that TTE guidance alone may be considered efficacious and safe as TEE during a transcutaneous ASD occlusion procedure in select adults. © 2015, Wiley Periodicals, Inc.

Prospective evaluation of the feasibility, safety, and efficacy of Cocoon Duct Occluder for transcatheter closure of large patent ductus arteriosus: A single-center study with short- and medium-term follow-up results

PubMed Central

Sinha, Santosh Kumar; Razi, Mahmadula; Pandey, Rama Niwas; Kumar, Prakash; Krishna, Vinay; Jha, Mukesh Jitendra; Mishra, Vikas; Asif, Mohammad; Abdali, Nasar; Tewari, Pradyot; Thakur, Ramesh; Pandey, Umeshwar; Varma, Chandra Mohan

2017-01-01

Objective: To evaluate the feasibility, safety, and efficacy of a novel Cocoon Duct Occluder device for the transcatheter closure (TCC) of large patent ductus arteriosus (PDA). Methods: In this prospective, non-randomized study, consecutive patients with large PDA (narrowest diameter: ≥3.5/4.0 mm in symptomatic/asymptomatic patients, respectively), who underwent TCC with Cocoon Duct Occluder at our institute between November, 2012 and June, 2016 were examined. TCC was performed using the standard technique, and devices were antegradely delivered via 6–10F delivery sheaths. Device embolization, residual shunt, hemolysis, left pulmonary artery (LPA) stenosis, procedural and fluoroscopy time, and mortality were assessed. Patients were followed-up by transthoracic echocardiography with color Doppler imaging at 24 h (D1), 1 month (D30), and 6 months (D180) after implantation. Results: A total of 57 patients (age: 11.7±2.8 years; weight: 22.3±3.5 kg) were enrolled. The mean narrowest diameter was 7.4±0.7 mm. The PDA closure was successfully performed in each patient. Fluoroscopy and procedural time was 6.7±3.2 min and 23.9±2.7 min, respectively. Postprocedural angiography revealed that 49 (85.9%) patients had immediate and complete closure, whereas 8 (14.1%) had residual shunt. Color Doppler imaging at D1 revealed complete closure in 52 (91.3%) patients. At D30, complete closure was reported in all patients and was maintained at D180. Hemolysis, embolization, obstruction of LPA or descending aorta, and death were not reported till D180. Conclusion: TCC using Cocoon Duct Occluder is feasible, safe, and effective in the management of patients with large PDA, with excellent results on short- and medium-term follow-up. PMID:29145233

Safety and efficacy of transcatheter closure of large patent ductus arteriosus in adults with a self-expandable occluder.

PubMed

Yu, Man-Li; Huang, Xin-Miao; Wang, Jia-Feng; Qin, Yong-Wen; Zhao, Xian-Xian; Zheng, Xing

2009-11-01

Most occurrences of large patent ductus arteriosus (PDAs) of > or =10 mm have been surgically closed, and transcatheter closure of these large PDAs was only reported in a few case reports. The present study reviewed our experience in transcatheter closure of such large PDAs with a Chinese self-expandable occluder, which is similar to but much cheaper than the Amplatzer occluder. From July 2000 to January 2008, 23 patients underwent transcatheter closure of large PDA > or =10 mm with this kind of occluder. The mean (SD) age of the patients was 38.0 (15.6) years (range 18-75 years). Radiographs of the chest, electrocardiograms, and echocardiograms were used for follow-up evaluation of the treatment within 1 day, 1 month, 6 months, and then every year after successful closure. The mean (SD) angiographic PDA diameter was 12.8 (2.6) mm (range 10-18 mm) and the mean occluder diameter was 18.0 (2.9) mm (range 16-22 mm). The occluders were delivered successfully and closed the PDA completely in 19 out of the 23 patients. Pulmonary arterial pressures decreased significantly after occlusion in patients with successful treatment: 67.3 (24.7) mmHg (range 29-122 mmHg) before occlusion and 42.3 (22.0) mmHg (range 19-98 mmHg) immediately after the procedure. Radiographs of the chest and echocardiograms showed that the diameters of the left atrium, left ventricle, and the main pulmonary artery decreased, and the ejection fraction (EF) increased at a mean (SD) follow-up of 36.3 (18.7) months (range 6-72 months). No severe complication occurred. The immediate and long-term outcomes suggested that transcatheter closure of PDAs with the native PDA occluder is a safe and effective treatment for adults with large PDA > or =10 mm.

Achieving Effective Risk Management Reduction Throughout Decommissioning at the Columbus Closure Project

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

Anderson, K.D.

2006-07-01

Nuclear facility decontamination, dismantlement, and demolition activities provide a myriad of challenges along the path to reaching a safe, effective, and compliant decommissioning. Among the challenges faced during decommissioning, is the constant management and technical effort to eliminate, mitigate, or minimize the potential of risks of radiation exposures and other hazards to the worker, the surrounding community, and the environment. Management strategies to eliminate, mitigate, or minimize risks include incorporating strong safety and As Low As Reasonably Achievable (ALARA) principles into an integrated work planning process. Technical and operational strategies may include utilizing predictive risk analysis tools to establish contaminationmore » limits for demolition and using remote handling equipment to reduce occupational and radiation exposures to workers. ECC and E2 Closure Services, LLC (Closure Services) have effectively utilized these management and technical tools to eliminate, mitigate, and reduce radiation exposures under contract to the U.S. Department of Energy (DOE) for the decontamination and decommissioning Columbus Closure Project (CCP). In particular, Closure Services achieved significant dose reduction during the dismantling, decontamination, and demolition activities for Building JN-1. Management strategies during the interior dismantlement, decontamination, and demolition of the facility demanded an integrated work planning processes that involved project disciplines. Integrated planning processes identified multiple opportunities to incorporate the use of remote handling equipment during the interior dismantling and demolition activities within areas of high radiation. Technical strategies employed predictive risk analysis tools to set upper bounding contamination limits, allowed for the radiological demolition of the building without exceeding administrative dose limits to the worker, general public, and the environment. Adhering to management and technical strategies during the dismantlement, decontamination, and demolition of Building JN-1 enabled Closure Services to achieve strong ALARA performance, maintain absolute compliance under the regulatory requirements and meeting licensing conditions for decommissioning. (authors)« less

[Hybrid repair of postoperative ventral hernia].

PubMed

Gogiya, B Sh; Alyautdinov, R R; Karmazanovsky, G G; Chekmareva, I A; Kopyltsov, A A

2018-01-01

To develop new technique of abdominal wall repair for postoperative ventral hernia without disadvantages which are intrinsic for open and laparoscopic surgery. Combined open and laparoscopic hernia repair was used in 18 patients with postoperative ventral hernia. Open stage provided safe dissection of abdominal adhesions and defect closure by autoplasty, laparoscopic procedure consisted of prosthesis deployment without separation of abdominal wall layers. Two types of composite endoprostheses with anti-adhesive coating were used for abdominal wall repair. There were no cases of recurrence or infectious complications in long-term period (from 3 to 106 months). Hybrid repair of postoperative ventral hernia is safe and effective procedure. Further studies are necessary to assess cost-effectiveness ratio of this method in view of expensive composite endoprostheses and laparoscopic supplies.

Fat-plug myringoplasty of ear lobule vs abdominal donor sites.

PubMed

Acar, Mustafa; Yazıcı, Demet; San, Turhan; Muluk, Nuray Bayar; Cingi, Cemal

2015-04-01

The purpose of this study is to compare the success rates of fat-graft myringoplasties harvesting adipose grafts from different donor sites (ear lobule vs abdomen). The clinical records of 61 patients (24 males and 37 females) who underwent fat-plug myringoplasty (FPM) were reviewed retrospectively. Fat from ear lobule (FEL) and abdominal fat were used as graft materials. The impact of age, gender, systemic diseases, topography of the perforation, utilization of fat graft materials of different origin on the tympanic membrane closure rate and the effect of FPM on hearing gain was analyzed. Our tympanic membrane (TM) closure rate was 82 %. No statistical significant difference was observed regarding age, gender, comorbidities (septal deviation, hypertension and diabetes mellitus) or habits (smoking). Posterior TM perforations had significantly lower healing rate. The change in TM closure rate considering different adipose tissue donor sites was not statistically significant. The hearing gain of the patients was mostly below 20 dB. Fat-plug myringoplasty (FPM) is a safe, cost-effective and easy operation for selected patients. Abdominal fat graft is as effective as ear lobe fat graft on tympanic membrane healing, has cosmetic advantages and should be taken into consideration when planning fat as the graft source.

Paracetamol in Patent Ductus Arteriosus Treatment: Efficacious and Safe?

PubMed Central

Bardanzellu, Flaminia; Neroni, Paola; Fanos, Vassilios

2017-01-01

In preterm infants, failure or delay in spontaneous closure of Ductus Arteriosus (DA), resulting in the condition of Patent Ductus Arteriosus (PDA), represents a significant issue. A prolonged situation of PDA can be associated with several short- and long-term complications. Despite years of researches and clinical experience on PDA management, unresolved questions about the treatment and heterogeneity of clinical practices in different centers still remain, in particular regarding timing and modality of intervention. Nowadays, the most reasonable strategy seems to be reserving the treatment only to hemodynamically significant PDA. The first-line therapy is medical, and ibuprofen, related to several side effects especially in terms of nephrotoxicity, is the drug of choice. Administration of oral or intravenous paracetamol (acetaminophen) recently gained attention, appearing effective as traditional nonsteroidal anti-inflammatory drugs (NSAIDs) in PDA closure, with lower toxicity. The results of the studies analyzed in this review mostly support paracetamol efficacy in ductal closure, with inconstant low and transient elevation of liver enzymes as reported side effect. However, more studies are needed to confirm if this therapy shows a real safety profile and to evaluate its long-term outcomes, before considering paracetamol as first-choice drug in PDA treatment. PMID:28828381

Post-Closure Inspection Report for the Tonopah Test Range, Nevada: For Calendar Year 2017, Revision 0

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

Alvarado, Juan; Matthews, Patrick

This report provides the results of the annual post-closure inspections conducted at the closed corrective action units (CAUs) located on the Tonopah Test Range (TTR) and the Nevada Test and Training Range (NTTR). This report covers calendar year 2017 and includes visual inspection and repair activities completed at the following CAUs: CAU 400: Bomblet Pit and Five Points Landfill (TTR) CAU 407: Roller Coaster RadSafe Area (TTR) CAU 424: Area 3 Landfill Complexes (TTR) CAU 453: Area 9 UXO Landfill (TTR) CAU 487: Thunderwell Site (TTR) Visual inspections were conducted according to the post-closure plans in the approved closure reportsmore » and subsequent correspondence with the Nevada Division of Environmental Protection. The annual post-closure inspections were conducted on May 23, 2017. No maintenance or repair issues were noted at CAU 400 and CAU 487. Maintenance items and subsequent repairs include the following: CAU 407: A large animal burrow was observed in the southeast corner of the cover during the inspection. Two additional animal burrows were discovered during repair actions. All cover defects were repaired on January 9, 2018. CAU 424: CAS 03-08-002-A304 (Landfill Cell A3-4): A new monument was installed and the subsidence area was repaired on January 9, 2018. CAU 424: CAS 03-08-002-A308 (Landfill Cell A3-8): Lava rock, used to mark the two eastern monument locations, was noted as missing during the inspection. The lava rock was replaced on January 9, 2018. CAU 453: Five large animal burrows, located near the east–central portion of cover, was noted during the inspection. Eight additional animal burrows were discovered during repair actions. All cover defects were repaired on January 9, 2018.« less

Cost effectiveness of left atrial appendage closure with the Watchman device for atrial fibrillation patients with absolute contraindications to warfarin

PubMed Central

Reddy, Vivek Y.; Akehurst, Ronald L.; Armstrong, Shannon O.; Amorosi, Stacey L.; Brereton, Nic; Hertz, Deanna S.; Holmes, David R.

2016-01-01

Abstract Aims Atrial fibrillation (AF) patients with contraindications to oral anticoagulation have had few options for stroke prevention. Recently, a novel oral anticoagulant, apixaban, and percutaneous left atrial appendage closure (LAAC) have emerged as safe and effective therapies for stroke risk reduction in these patients. This analysis assessed the cost effectiveness of LAAC with the Watchman device relative to apixaban and aspirin therapy in patients with non-valvular AF and contraindications to warfarin therapy. Methods and results A cost-effectiveness model was constructed using data from three studies on stroke prevention in patients with contraindications: the ASAP study evaluating the Watchman device, the ACTIVE A trial of aspirin and clopidogrel, and the AVERROES trial evaluating apixaban. The cost-effectiveness analysis was conducted from a German healthcare payer perspective over a 20-year time horizon. Left atrial appendage closure yielded more quality-adjusted life years (QALYs) than aspirin and apixaban by 2 and 4 years, respectively. At 5 years, LAAC was cost effective compared with aspirin with an incremental cost-effectiveness ratio (ICER) of €16 971. Left atrial appendage closure was cost effective compared with apixaban at 7 years with an ICER of €9040. Left atrial appendage closure was cost saving and more effective than aspirin and apixaban at 8 years and remained so throughout the 20-year time horizon. Conclusions This analysis demonstrates that LAAC with the Watchman device is a cost-effective and cost-saving solution for stroke risk reduction in patients with non-valvular AF who are at risk for stroke but have contraindications to warfarin. PMID:26838691

Short-Term Safety and Efficacy of Femoral Vascular Closure after Percutaneous Coronary Intervention with Combination of the Boomerang(TM) Device and Intravenous Protamine Sulfate.

PubMed

Chen, Ching-Pei; Huang, Huang-Kai; Hsia, Chien-Hsun; Chang, Yung-Ming; Lin, Lee-Shin; Lee, Cheng-Liang

2013-11-01

The Cardiva Boomerang(TM) is a device used to perform femoral vascular closure. It facilitates passive hemostasis at the arteriotomy site, leaving no residual foreign body. We performed a controlled, randomized study of 60 patients undergoing percutaneous coronary intervention. Patients were randomized into two groups (30 per group) to undergo vascular closure with the Boomerang(TM) or the Perclose(TM) suture-based device after the intravenous administration of protamine sulfate. We compared overall success rates, patient-reported pain, length of time to achieve hemostasis and mobilization of the patient, and the frequency of complications in the two groups. Overall success rates using the Boomerang(TM) and Perclose(TM) devices were similarly high, at 93% and 97%, respectively. The Boomerang(TM) was significantly quicker to deploy than the PercloseTM, device deployment time, median (Q1-Q3), [2.00 (1.33-2.75) vs. 3.84 (2.75-4.38) mins, p < 0.001)]. The pain score was significantly lower in the Boomerang(TM) group (1.1 ± 1.7 vs. 6.4 ± 2.9, p < 0.001). The time the device remained in the artery and manual compression time were significantly longer with the Boomerang(TM) (p < 0.001), as well as the time taken to achieve hemostasis and time to ambulation. There were no major complications in either group and no significant differences between the groups in the frequency of minor complications. We conclude that when used in combination with intravenous protamine sulfate, the Boomerang(TM) device is as safe and effective as the Perclose(TM) device for femoral vascular closure, but quicker to deploy and less painful to patients. Boomerang; Percutaneous intervention; Vascular closure device.

Choledochorraphy (primary repair) versus t-tube drainage after open choledochotomy.

PubMed

Saeed, Nadia; Nasir, Muhammad Tauqeer; Khan, Muhammad Iqbal; Channa, Ghulam Asghar

2012-01-01

T-tube drainage used to be standard practice after surgical choledochotomy, but there is now a tendency in some canters to close the common bile duct primarily. This study was designed to compare the clinical results of primary closure with T-tube drainage after open choledocotomy and assess the safety of primary closure for future application. This study was conducted at surgical Unit-3, ward 26 Jinnah Postgraduate Medical Centre Karachi, from January 2007 to January 2008. Forty patients were included in this study out of which 20 underwent primary closure and 20 T-tube placements. It was Quasi-experimental, non-probability, purposive sampling. Main outcome measures were operating time, duration of hospital stay, and postoperative complications. SPSS-10 was used for data analysis. The age of patients in the study ranged from 29-83 years. There were 3 male while 37 female patients. Group-1 consisted of 20 patients underwent primary closure after choledocotomy, while Group-2 also consisted of 20 patients underwent T-tube drainage after duct exploration. Mean hospital stay in Group-1 patients was 7.63 days while in group 2 it was 13.6 days. Overall complication rate in group 1 was 15%, biliary leakage in 1 (5%), jaundice in 1 (5%), wound infection in 1 (5%). No re-exploration was required in Group-1. In Group-2 overall complication rate was 30%, biliary leakage in 2 (2%), jaundice in 1 (5%), dislodgement of T-tube in 1 (5%), wound infection in 1 (5%), and sepsis in 1 (5%) patients. Re-exploration was done in one patient. Primary closure of Common Bile Duct (CBD) is a safe and cost-effective alternative procedure to routine T-tube drainage after open choledocotomy.

Traction-assisted Internal Negative Pressure Wound Therapy With Bridging Retention Sutures to Facilitate Staged Closure of High-risk Wounds Under Tension.

PubMed

DeFazio, Michael V; Economides, James M; Anghel, Ersilia L; Mathis, Ryan K; Barbour, John R; Attinger, Christopher E

2017-10-01

Loss of domain often complicates attempts at delayed wound closure in regions of high tension. Wound temporization with traction-assisted internal negative pressure wound therapy (NPWT), using bridging retention sutures, can minimize the effects of edema and elastic recoil that contribute to progressive tissue retraction over time. The investigators evaluated the safety and efficacy of this technique for complex wound closure. Between May 2015 and November 2015, 18 consecutive patients underwent staged reconstruction of complex and/or contaminated soft tissue defects utilizing either conventional NPWT or modified NPWT with instillation and continuous dermatotraction via bridging retention sutures. Instillation of antimicrobial solution was reserved for wounds containing infected/exposed hardware or prosthetic devices. Demographic data, wound characteristics, reconstructive outcomes, and complications were reviewed retrospectively. Eighteen wounds were treated with traction-assisted internal NPWT using the conventional (n = 11) or modified instillation (n = 7) technique. Defects involved the lower extremity (n = 14), trunk (n = 3), and proximal upper extremity (n = 1), with positive cultures identified in 12 wounds (67%). Therapy continued for 3 to 8 days (mean, 4.3 days), resulting in an average wound surface area reduction of 78% (149 cm² vs. 33 cm²) at definitive closure. Seventeen wounds (94%) were closed directly, whereas the remaining defect required coverage with a local muscle flap and skin graft. At final follow-up (mean, 12 months), 89% of wounds remained closed. In 2 patients with delayed, recurrent periprosthetic infection (mean, 7.5 weeks), serial debridement/hardware removal mandated free tissue transfer for composite defect reconstruction. Traction-assisted internal NPWT provides a safe and effective alternative to reduce wound burden and facilitate definitive closure in cases where delayed reconstruction of high-tension wounds is planned.

Is the new Occlutech duct occluder an appropriate device for transcatheter closure of patent ductus arteriosus?

PubMed

Godart, François; Houeijeh, Ali; Domanski, Olivia; Guillaume, Marie-Paule; Brard, Mélanie; Lucron, Hugues

2018-06-15

To describe our initial experience with the Occlutech Duct Occluder (ODO) for percutaneous closure of patent ductus arteriosus (PDA). Retrospective review of patients undergoing transcatheter PDA closure with the ODO in 2 academic centers. From April 2013 to September 2017, 42 patients underwent PDA closure. Median age at implantation was 34 months (range 4 months-68 years) and median weight was 12 kg (range 4.1-57 kg). Ducts were Krichenko type A duct (n = 34), type E (n = 6), and type C (n = 2). The mean duct diameter was 3.76 mm (range 1.69 to 9.95 mm, median 3.1 mm). Implantation succeeded in all. There was neither device embolization nor hemolysis. At device release, immediate angiogram showed a small residual shunt in 54.7%. During follow-up, Doppler echocardiography demonstrated 71% of full occlusion at day one, rising to 95% at one month and 100% at one year and half after implantation. The mean maximal systolic pressure gradient in left pulmonary artery was 4.2 ± 4.3 mm and across the distal aortic arch 5.4 ± 4.7 mm Hg. No patient had any significant stenosis with clinical relevance. ODO is safe and effective in transcatheter closure of PDA including relatively large sized ducts. The results are satisfactory with a high level of full occlusion and a low rate of complications. Further evaluation with larger studies and longer follow-up will be required to confirm these preliminary good results. Copyright © 2018. Published by Elsevier B.V.

[Percutaneous closure of the patent ductus arteriosus in children with the Amplatzer Duct Occluder II].

PubMed

Parra-Bravo, José Rafael; Osuna-Izaguirre, Manuel Alfredo; Beirana-Palencia, Luisa; Gálvez-Cancino, Franco; Martínez-Monterrosas, Christian; Lazo-Cárdenas, César; Reyes-Vargas, César

2014-01-01

In the last decades, several devices have been used for the percutaneous closure of patent ductus arteriosus, with its own limitations and risks. The Amplatzer Duct Occluder II has been designed to overcome those limitations and reduce risks. We described our initial series of patients who underwent percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder II, emphasis on the technical aspects of the procedure. We reviewed the clinical records of 9 patients with patent ductus arteriosus who underwent percutaneous closure with the Amplatzer Duct Occluder II. Median age was 24 months (range 8-51 months) and the median weight was 10.7kg (range 6-16.3kg). The minimal ductus arteriosus diameter was 2.7mm (1-5mm). Implantation was successful in all cases. The devices most commonly used (33.3%) were the dimensions 4-4mm (3 patients), in 2 patients were used 3-4mm and in the rest of the patients were employed occluder other sizes. Four cases showed slight residual flow immediately after implantation. Total closure was achieved in 24h in 8 of 9 patients (89%). There was no embolization of the occluder or deaths during the procedure and we only observed one minor complication. The Amplatzer Duct Occluder II in this series was effective in 89% of the patients at 24hs after the procedure and 100% follow-up. The implantation was safe and no major complications were observed. The occlusion rate is comparable to those reported for the Amplatzer Duct Occluder I. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Long-Term Results of Transcatheter Closure of Patent Ductus Arteriosus in Infants Using Amplatzer Duct Occluder

PubMed Central

Behjati-Ardakani, Mostafa; Behjati-Ardakani, Mohammad-Amin; Hosseini, Seyed-Habibolla; Noori, Noormohammad

2013-01-01

Objective Patent ductus arteriosus (PDA) is one of the most frequently seen congenital heart diseases. Its closure is recommended because of the risk of infective endocardis, as well as morbidity and mortality in the long. The aim of this study was to assess the long term results of the transcatheter closure of PDA in infants using amplatzer duct occlude (ADO). Methods From May 2004 to September 2011, forty eight infants underwent transcatheter closure of PDA. A lateral or right anterior oblique view aortogram was done to locate PDA and to measure its size. Before discharge, repeat aortogram was performed to evaluate eventual residual shunt and to confirm the appropriate deployment of the ADO. Follow up evaluations were done with transthoracic echocardiography at discharge, 1 month, 6 months, 12 months and yearly thereafter. Findings The mean age of patients at procedure was 9.18±2.32 (range 3 to 12) months, mean weight 6.73±1.16 (range 4.5 to 10.1) kg. The PDA occluded completely in 20 out of the 48 patients. Twenty four patients had trivial or mild shunt and two patients had moderate residual shunt which disappeared in one patient within 24 hours and other patient with moderate shunt in 1 month. One patient (age 8 months) had mild LPA stenosis. The device emobolization occurred in two patients, immediately after the procedure in one and during night in the other patient Conclusion The long term results suggested that transcatheter closure of PDA using Amplatzer duct occluder is a safe and effective treatment in infants less than 1 year of age with minimal complications. PMID:24427494

Percutaneous closure of the left atrial appendage in patients with diabetes mellitus.

PubMed

Azizy, Obayda; Rammos, Christos; Lehmann, Nils; Rassaf, Tienush; Kälsch, Hagen

2017-09-01

Left atrial appendage closure is a preventive treatment of atrial fibrillation-related thrombo-embolism. Patients with diabetes mellitus have increased risk for a negative outcome in percutaneous cardiac interventions. We assessed whether percutaneous left atrial appendage closure is safe and effective in patients with diabetes mellitus. We included 78 patients (mean age of 74.4 ± 8.3 years) with indication for left atrial appendage closure in an open-label observational single-centre study. Patients with diabetes mellitus ( n = 31) were at higher thrombo-embolic and bleeding risk (CHA 2 DS 2 -VASc: 4.5 ± 0.9, HAS-BLED: 4.7 ± 0.7) compared to patients without diabetes mellitus ( n = 47, CHA 2 DS 2 -VASc: 3.5 ± 1.0, HAS-BLED: 4.1 ± 0.8; p < 0.001 for both). Pre- and periprocedural risk was elevated in patients with diabetes mellitus (Euro II-Score: 6.6 ± 3.7 vs 3.9 ± 1.9, p < 0.01; Society of Thoracic Surgeons (STS)-Score: 4.0 ± 2.5 vs 2.6 ± 1.2, p < 0.01). Procedural success was similar. Periprocedural major adverse cardiac and cerebrovascular events occurred in one patient from the control group (2.1%), whereas patients with diabetes mellitus had no events ( p = 0.672). Follow-up of 6 months revealed no bleeding complication in both groups. No stroke occurred in follow-up, and left atrial appendage flow velocity reduction (55.6 ± 38.6 vs 51.4 ± 19.1 cm/s, p = 0.474) and rate of postinterventional leakage in the left atrial appendage were comparable (0% vs 2.1%, p = 0.672). Despite patients with diabetes mellitus are high-risk patients, the outcome of percutaneous left atrial appendage closure is similar to patients without diabetes mellitus.

Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults: immediate and two-year follow-up results.

PubMed

Zhang, Cao-Jin; Huang, Yi-Gao; Huang, Xin-Sheng; Huang, Tao; Huang, Wen-Hui; Xia, Chun-Li; Mo, Yu-Jing

2012-11-01

Transcatheter closure of patent ductus arteriosus (PDA) is a well established procedure and an accepted treatment modality for small to moderate-sized PDA. This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension (PAH) in adults. After a complete hemodynamic evaluation differentiating from the reversibility of severe PAH, transcatheter closure of PDA was performed. Patients were followed up clinically and echocardiographically at 24 hours, 1 month, 3 months, 6 months, 12 months and 24 months after occlusion. Twenty-nine patients had successful occlusion, pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF) and fractional shortening (FS) significantly decreased immediately after occlusion ((106 ± 25) mmHg vs. (50 ± 14) mmHg, P < 0.01; (63.7 ± 7.2)% vs. (51.4 ± 10.1)%, P < 0.01 and (36.9 ± 8.2)% vs. (28.9 ± 8.6)%, P < 0.05, respectively). At 1 month after PDA closure, the signs and symptoms improved markedly in all 29 patients, and PDAs were completely closed and remained closed during the follow-up. Eighteen patients having different degrees of dyspnea were treated with angiotensin converting enzyme inhibitor (ACEI) and/or digoxin after occlusion. Nine patients whose pulmonary vascular resistence (PVR) > 6 Wood units accepted targeted PAH therapy. After 1 to 3 months of peroral drug therapy, their exercise tolerance improved from New York Heart Association (NYHA) class III-IV to NYHA class I. During follow-up, no latent arrhythmias were found, the left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular mass index (LVMI) and pulmonary artery systolic pressure (PASP) decreased significantly (P < 0.05), and FS and LVEF recovered compared to the immediate postclosure state. However, FS and LVEF remained low compared to the preclosure state. Transcatheter closure of large PDA with severe PAH is feasible, effective, and safe in adults. Significant left ventricular systolic changes may occur after closure of large PDA, and left ventricular function usually recovers within a few months.

Magnetic resonance imaging study of eye congenital birth defects in mouse model

PubMed Central

Tucker, Zachary; Mongan, Maureen; Meng, Qinghang; Xia, Ying

2017-01-01

Purpose Embryonic eyelid closure is a well-documented morphogenetic episode in mammalian eye development. Detection of eyelid closure defect in humans is a major challenge because eyelid closure and reopen occur entirely in utero. As a consequence, congenital eye defects that are associated with failure of embryonic eyelid closure remain unknown. To fill the gap, we developed a mouse model of defective eyelid closure. This preliminary work demonstrates that the magnetic resonance imaging (MRI) approach can be used for the detection of extraocular muscle abnormalities in the mouse model. Methods Mice with either normal (Map3k1+/−) or defective (Map3k1−/−) embryonic eyelid closure were used in this study. Images of the extraocular muscles were obtained with a 9.4 T high resolution microimaging MRI system. The extraocular muscles were identified, segmented, and measured in each imaging slice using an in-house program. Results In agreement with histological findings, the imaging data show that mice with defective embryonic eyelid closure develop less extraocular muscle than normal mice. In addition, the size of the eyeballs was noticeably reduced in mice with defective embryonic eyelid closure. Conclusions We demonstrated that MRI can potentially be used for the study of extraocular muscle in the mouse model of the eye open-at-birth defect, despite the lack of specificity of muscle group provided by the current imaging resolution. PMID:28848319

Left atrial appendage closure with the Watchman device in patients with a contraindication for oral anticoagulation: the ASAP study (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology).

PubMed

Reddy, Vivek Y; Möbius-Winkler, Sven; Miller, Marc A; Neuzil, Petr; Schuler, Gerhard; Wiebe, Jens; Sick, Peter; Sievert, Horst

2013-06-25

The purpose of this study was to assess the safety and efficacy of left atrial appendage (LAA) closure in nonvalvular atrial fibrillation (AF) patients ineligible for warfarin therapy. The PROTECT AF (Watchman Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that LAA closure with the Watchman device (Boston Scientific, Natick, Massachusetts) was noninferior to warfarin therapy. However, the PROTECT AF trial only included patients who were candidates for warfarin, and even patients randomly assigned to the LAA closure arm received concomitant warfarin for 6 weeks after Watchman implantation. A multicenter, prospective, nonrandomized study was conducted of LAA closure with the Watchman device in 150 patients with nonvalvular AF and CHADS₂ (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, and prior stroke or transient ischemic attack) score ≥1, who were considered ineligible for warfarin. The primary efficacy endpoint was the combined events of ischemic stroke, hemorrhagic stroke, systemic embolism, and cardiovascular/unexplained death. The mean CHADS₂ score and CHA₂DS₂-VASc (CHADS₂ score plus 2 points for age ≥75 years and 1 point for vascular disease, age 65 to 74 years, or female sex) score were 2.8 ± 1.2 and 4.4 ± 1.7, respectively. History of hemorrhagic/bleeding tendencies (93%) was the most common reason for warfarin ineligibility. Mean duration of follow-up was 14.4 ± 8.6 months. Serious procedure- or device-related safety events occurred in 8.7% of patients (13 of 150 patients). All-cause stroke or systemic embolism occurred in 4 patients (2.3% per year): ischemic stroke in 3 patients (1.7% per year) and hemorrhagic stroke in 1 patient (0.6% per year). This ischemic stroke rate was less than that expected (7.3% per year) based on the CHADS₂ scores of the patient cohort. LAA closure with the Watchman device can be safely performed without a warfarin transition, and is a reasonable alternative to consider for patients at high risk for stroke but with contraindications to systemic oral anticoagulation. (ASA Plavix Feasibility Study With Watchman Left Atrial Appendage Closure Technology [ASAP]; NCT00851578). Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Installation restoration program. Closure assessment report for UST removals at sites 4 and 5 - petroleum, oils, and lubricants facility. Virginia Air National Guard, 192nd Fighter Group, Richmond International Airport, Sandston, Virginia. Final report

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

NONE

The objectives of the closure assessment were to determine the extent of contaminated soil adjacent to the USTs requiring excavation, to provide documentation of soil and groundwater conditions following excavation, and to document closure activities in accordance with applicable VADEQ regulations. During closure activities, ASI provided technical support to the Base to ensure that the UST removal contractor (E K, Inc.) hereinafter referred to as the Contractor was in compliance with the technical requirements (as specified in the Plans and Specifications for Removal of Abandoned Underground Storage Tanks, Virginia Air National Guard, Richmond International Airport, Sandston, VA., dated July 1991more » and revised April 1992, and Addendum Numbers 1 through 7) of the contract. ASI was also responsible for collecting soil and/or groundwater closure samples from the excavations, and providing off-site fixed based laboratory analysis to verify clean conditions within the excavations.« less

The Impact of Public Hospital Closure on Medical and Residency Education: Implications and Recommendations

PubMed Central

Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2010-01-01

Background Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. Objective To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Method Retrospective cohort study of medical students’ and residents’ and clinical placement into safety-net experiences after the closure of the primary teaching hospital. Results The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. Conclusion While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location. PMID:19110905

The impact of public hospital closure on medical and residency education: implications and recommendations.

PubMed

Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

2008-12-01

Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Retrospective cohort study of medical students' and residents' and clinical placement into safety-net experiences after the closure of the primary teaching hospital. The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location.

Transarterial venous sinus occlusion of dural arteriovenous fistulas using ONYX.

PubMed

Torok, Collin M; Nogueira, Raul G; Yoo, Albert J; Leslie-Mazwi, Thabele M; Hirsch, Joshua A; Stapleton, Christopher J; Patel, Aman B; Rabinov, James D

2016-12-01

The purpose of this article is to present a case series of transarterial venous sinus occlusion for dural arteriovenous fistulas (DAVFs) of the transverse and sigmoid sinuses. From 2006 to 2012, 11 patients with DAVF of the transverse and sigmoid sinuses were treated with transarterial closure of the affected venous sinus using ethylene vinyl alcohol copolymer (ONYX). The consecutive retrospective cohort included six female and five male patients with an age range of 30-79. Patients presented with stroke, intracranial hemorrhage, seizure, headache, focal neurologic deficit or cognitive change. Lesions were categorized as Cognard II a + b (n = 5) or Cognard II b (n = 6). Four of this latter group consisted of isolated sinus segments. Selection criteria for dural sinus occlusion included direct multi-hole fistulas involving a broad surface in length or circumference of the sinus wall. External carotid artery (ECA) branches were directly embolized when considered safe. High-risk arterial supply from ICA, PICA, AICA or ECA cranial nerve branches were closed via retrograde approach during sinus occlusion. DAVF closure was accomplished in all 11 patients with a total of 17 embolization procedures using ONYX. High-risk arterial collaterals were closed via artery-artery or artery-sinus-artery embolization. The vein of Labbe was spared in the four cases with initial antegrade flow. No neurologic complications occurred, and DAVF closures were durable on three-month angiography. Transarterial closure of the transverse and sigmoid sinuses. © The Author(s) 2016.

Transcatheter closure of atrial septal defects type 2 in children under 3 years of age.

PubMed

Knop, Mateusz T; Białkowski, Jacek; Szkutnik, Małgorzata; Fiszer, Roland; Smerdziński, Sebastian; Gałeczka, Michał; Litwin, Linda

2018-06-04

Atrial septal defect type II (ASD), according to current standards, is closed percutaneously usually after the child has reached the age of 4-5 years. There are limited data regarding such treatment in smaller infants. To evaluate feasibility, safety and efficacy of percutaneous ASD closure in children under 3 years of age. Overall group of 149 children < 3 years with hemodynamically significant ASD, who underwent effective transcatheter ASD closure in one tertiary center between 1999 and 2014 were included. Mean procedural age of treated children was 2,2 years and weight 12,5 kg. In all nitinol wire mesh devices were applied (mostly Amplatzer Septal Occluders). ASD was closed by standard technique (except few cases when left disc of implant was inserted initially into right pulmonary vein to prevent oblique position of the device). Complications related to the procedure were divided into major and minor ones. There were 97 children with a single ASD and 52 with double/multiple ASD. No death, no implant embolization, and one major complications occurred during procedure and in follow-up. ASD was completely closed in all but 8 patients with double/multiple ASD. Right ventricle diameter normalization occurred in all during 1 year follow-up. In majority of the patients in follow-up an acceleration of physical development and resolution of accompanying morbidity was observed. Percutaneous ASD device closure can be performer safely in children below 3 years of age with low risk of complication during and after the procedure.

Impact of social characteristics on the treatment of patients with ischaemic events and patent foramen ovale.

PubMed

Schurter, David; Braun, Julia; Jenni, Rolf; Van Der Loo, Bernd

2012-02-01

Percutaneous closure of a patent foramen ovale (PFO) is a technically simple and safe procedure. PFO is a common finding present in up to one third of the population. Although several conditions such as stroke, migraine, and sleep apnoea have been associated with a PFO, as underlined by observational studies, no causal relationship has been documented so far. As this setting may potentially leave more space for the involved physicians for the choice of treatment, we hypothesized that social characteristics of the patient with a PFO might play a role. We retrospectively analysed the data of 153 patients with a cerebrovascular and/or peripheral ischaemic event with the diagnosis of a PFO as documented in echocardiography from 2000 until 2005 at the University Hospital in Zurich, Switzerland. Forty-four patients (= 23%) underwent catheter-based PFO closure. There was no significant difference with respect to age (<40 years: P = 0.094, ns; 40-59 years: P = 0.923, ns; > or =60 years: P= 0.234, ns), gender (P = 0.356, ns) and insurance status (<40 years: P= 0.15, ns; 40-59 years: P= 0.37, ns; 60 years: P = 0.26, ns) between those who underwent percutaneous PFO closure and those who did not. We conclude from this single-centre experience that social characteristics of patients only have a marginal impact on the indication of percutaneous closure of a PFO, if at all.

On-orbit demonstration of automated closure and capture using ESA-developed proximity operations technologies and an existing, serviceable NASA Explorer Platform spacecraft

NASA Technical Reports Server (NTRS)

Hohwiesner, Bill; Claudinon, Bernard

1991-01-01

The European Space Agency (ESA) has been working to develop an autonomous rendezvous and docking capability since 1984 to enable Hermes to automatically dock with Columbus. As a result, ESA with Matra, MBB, and other space companies have developed technologies that are also directly supportive of the current NASA initiative for Automated Rendezvous and Capture. Fairchild and Matra would like to discuss the results of the applicable ESA/Matra rendezvous and capture developments, and suggest how these capabilities could be used, together with an existing NASA Explorer Platform satellite, to minimize new development and accomplish a cost effective automatic closure and capture demonstration program. Several RV sensors have been developed at breadboard level for the Hermes/Columbus program by Matra, MBB, and SAAB. Detailed algorithms for automatic rendezvous, closure, and capture have been developed by ESA and CNES for application with Hermes to Columbus rendezvous and docking, and they currently are being verified with closed-loop software simulation. The algorithms have multiple closed-loop control modes and phases starting at long range using GPS navigation. Differential navigation is used for coast/continuous thrust homing, holdpoint acquisition, V-bar hopping, and station point acquisition. The proximity operation sensor is used for final closure and capture. A subset of these algorithms, comprising the proximity operations algorithms, could easily be extracted and tailored to a limited objective closure and capture flight demonstration.

Collective Protection (COLPRO) Novel Closures Testing

DTIC Science & Technology

2013-03-28

science and technology programs for future ColPro systems may include interfaces such as novel designs using zippers, hook-and-pile closures, and...necessitate new testing procedures. Additionally, stand- ards of performance must be adjusted as technologies advance. Test procedures and parameters...listed in this TOP may require updating to accommodate new technologies in test items or in test instrumentation. Any variation to the TOP procedures

Automated method for determining Instron Residual Seal Force of glass vial/rubber closure systems.

PubMed

Ludwig, J D; Nolan, P D; Davis, C W

1993-01-01

Instron Residual Seal Force (IRSF) of glass vial/rubber closure systems was determined using an Instron 4501 Materials Testing System. Computer programs were written to process raw data and calculate IRSF values. Preliminary experiments indicated both the appearance of the stress-deformation curves and precision of the derived IRSF values were dependent on the internal dimensions and top surface geometry of the cap anvil. Therefore, a series of five cap anvils varying in shape and dimensions were machined to optimize performance and precision. Vials capped with West 4416/50 PURCOAT button closures or Helvoet compound 6207 lyophilization closures were tested with each cap anvil. Cap anvils with spherical top surfaces and narrow internal dimensions produced more precise results and more uniform stress-deformation curves than cap anvils with flat top surfaces and wider internal dimensions.

National CPS Certification | A Program of Safe Kids Worldwide

Science.gov Websites

the Tech! ABOUT THE PROGRAM National CPS Certification Training is a program of Safe Kids Worldwide ; E-Vouchers FAQS/HELP FAQs Fees Forms Policies & Procedures Who We Are NHTSA Safe Kids CPS-board State Farm Follow us on Facebook Copyright © 2017 by Safe Kids Worldwide - Child Passenger Safety

The Superfund Innovative Technology Evaluation Program SUMMARY AND CLOSURE REPORT

EPA Science Inventory

The Superfund Innovative Technology Evaluation (SITE) Program promoted the development, commercialization, and implementation of innovative hazardous waste treatment technologies for 20 years. SITE offered a mechanism for conducting joint technology demonstration and evaluation ...

Taking Closure to the Next Level - 13030

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

Feist, E.T.

2013-07-01

The River Corridor Closure Project (RCCP) is the Hanford Site's first closure project and when it is complete, in 2015, it will have cleaned up 220 mi{sup 2} of contaminated land adjacent to the Columbia River. Washington Closure Hanford (WCH) was selected by the DOE to manage the removal and cleanup of Hanford's nuclear legacy along the River Corridor. Work began in 2005 and is now more than 85% complete with more than 2 years left in the contract. A Closure Team was commissioned in December 2009 and has since issued a closure strategy and a disciplined three-phase approach tomore » transition land parcels to DOE, Richland Operations Office (DOE-RL) as cleanup is completed. This process supports DOE-RL objectives for progressive footprint reduction based on the division of the River Corridor into geographical land parcels. It also allows for incremental area-by-area transition and turnover to the Long-Term Stewardship program. Several important milestones stand between now and the successful end of the RCCP. They include overall funding impacts, working with DOE-RL on new scope additions, meeting regulatory milestones, and maintaining a strong safety performance. (authors)« less

Bedside PDA ligation in premature infants less than 28 weeks and 1000 grams.

PubMed

Avsar, Mustafa Kemal; Demir, Tolga; Celiksular, Cem; Zeybek, Cenap

2016-10-04

PDA(Patent ductus arteriosus) is a common and clinically important condition which is presented with a number of hemodynamic and respiratory problems such as intraventricular hemorrhage, pulmonary hemorrhage and necrotizing enterocolitis due to increased pulmonary blood flow and stealing from systemic circulation. The incidence of PDA among the infants that were born before the 28th gestational week is as high as 70 %; and spontaneous closure rates in very-low-birth-weight premature neonates(VLBWPN) is around 34 %. The onset, duration, and repeat number of consecutive courses of the prostaglandin synthesis inhibitor medication for PDA closure are still issues of debate. Bed-side PDA closure is a safe surgical procedure in both mature and premature babies. Here we aim to retrospectively present our 26 cases which were less than 28 weeks and 1000 grams that underwent bed-side PDA ligation. This retrospective study included 26 VLBWPN with PDA that underwent bed-side ligation between 2012 and 2015. Babies were born before the 28th gestational week (23-27 weeks) and less than 1000 grams (489-970 gr). Of the 26, 15 were female and 11 were male. Indomethacin was administered to all of the cases as the medical closing agent. The medication was stopped due to unwanted effects in 6 cases. All of the patients took medical treatment before surgery. No surgical mortality occurred during our study. One case of pneumothorax was recorded as late surgical complication. Five of the 26 patients were lost, and the most common cause of mortality was sepsis (in 3 cases). The remaining 21 cases were discharged on days 86-238. The follow-up periods of the patients were 2 moths - 3 years. The most frequent problems encountered after discharge was chronic lung problems. Bed side PDA ligation surgery in the ICU is a safe method for VLBWPN with clinically significant PDA.

Defense Base Realignment and Closure Budget Data for MCGuire Air Force Base, New Jersey

DTIC Science & Technology

1995-08-04

The overall audit objective was to determine the accuracy of Defense base realignment and closure military construction budget data. This report provides the results of the audit of two projects, valued at $22.4 miilion, for the realignment of McGuire Air Force Base, New Jersey. The audit also assessed the adequacy of the management control program as it applied to the overall audit objective.

Chemoembolic Hepatopulmonary Shunt Reduction to Allow Safe Yttrium-90 Radioembolization Lobectomy of Hepatocellular Carcinoma

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

Gaba, Ron C., E-mail: rgaba@uic.edu; VanMiddlesworth, Kyle A.

2012-12-15

Yttrium-90 ({sup 90}Y) radioembolization represents an emerging transcatheter treatment option for the management of hepatocellular carcinoma (HCC). Elevation of the hepatopulmonary shunt fraction risks nontarget radiation to the lungs and may limit the use of {sup 90}Y therapy in patients with locally advanced disease with vascular invasion, who often demonstrate increased shunting. We present two cases in which patients with HCC and portal vein invasion resulting in elevated hepatopulmonary shunt fractions underwent chemoembolic shunt closure to allow safe {sup 90}Y radioembolization. Both patients demonstrated excellent tumor response and patient survival. On this basis, we propose a role for chemoembolic reductionmore » of the lung shunt fraction before {sup 90}Y radioembolization in patients with extensive tumor-related hepatopulmonary shunting.« less

Evaluation of the safety benefits of legacy safe routes to school programs

DOT National Transportation Integrated Search

2008-08-01

This study first examined the feasibility of conducting a crash-based assessment of the safety effects of legacy Safe Routes to School : (SRTS) programs. These were SRTS programs operating before the passage of the Safe, Accountable, Flexible, Effici...

Implementation plan for safe routes to school program.

DOT National Transportation Integrated Search

2009-08-01

Section 1404 of the Safe, Accountable, Flexible, and Efficient Transportation Equity Act: A Legacy for Users (SAFETEA-LU, Public Law 109-59) establishes a national Safe Routes to School (SRTS) Program. The purpose of the program is to encourage K-8 s...

Sampling and monitoring for closure

USGS Publications Warehouse

McLemore, V.T.; Russell, C.C.; Smith, K.S.

2004-01-01

The Metals Mining Sector of the Acid Drainage Technology Initiative (ADTI-MMS) addresses technical drainage-quality issues related to metal mining and related metallurgical operations, for future and active mines, as well as, for historical mines and mining districts. One of the first projects of ADTI-MMS is to develop a handbook describing the best sampling, monitoring, predicting, mitigating, and modeling of drainage from metal mines, pit lakes and related metallurgical facilities based upon current scientific and engineering practices. One of the important aspects of planning a new mine in today's regulatory environment is the philosophy of designing a new or existing mine or expansion of operations for ultimate closure. The holistic philosophy taken in the ADTI-MMS handbook maintains that sampling and monitoring programs should be designed to take into account all aspects of the mine-life cycle. Data required for the closure of the operation are obtained throughout the mine-life cycle, from exploration through post-closure.

7 CFR 225.7 - Program monitoring and assistance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... school closures during the period from October through April (or at any time of the year in an area with... available all necessary Program materials in sufficient time to enable applicant sponsors to prepare adequately for the Program. (c) Food specifications and meal quality standards. With the assistance of the...

Successful transcatheter closure of a congenital high-flow portosystemic venous shunt with the Amplatzer vascular plug II.

PubMed

Guneyli, Serkan; Cinar, Celal; Bozkaya, Halil; Parildar, Mustafa; Oran, Ismail; Akin, Yigit

2012-12-01

Congenital portosystemic venous shunt is extremely rare and should be treated. Advances in treatment techniques allow for patients to be treated safely. We present a 9-year-old boy with a large congenital portosystemic venous shunt. The shunt was occluded interventionally with the Amplatzer vascular plug II. Our case was unique with its clinical manifestation, the use of a 22-mm Amplatzer vascular plug II, and the presence of the patient's 1-year follow-up.

Project Sedan Event, July 6, 1962

DTIC Science & Technology

1962-12-12

Queen City Summit over Highway 25 14 1532 358 68 300 32 miles NW of Queen City Summit over Highway 25 14 1534 357 69 300 36 miles NW of Queen City...Blast Propagation REECO 203F On-Site Rad-Safe AEC/ USBM 204F Structural Survey of Private Mining Opera- tions FAA 205F Airspace Closure SC 211F Close-In...Weather Bureau, Las Vegas, Nevada USBM U. S. Bureau of Mines, Washington, D. C. FAA Federal Aviation Agency, Salt Lake City, Utah REECO Reynolds

76 FR 12719 - Safe Schools/Healthy Students Program; Office of Safe and Drug-Free Schools; Safe Schools/Healthy...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-08

... official version of this document is the document published in the Federal Register. Free Internet access... DEPARTMENT OF EDUCATION Safe Schools/Healthy Students Program; Office of Safe and Drug- Free... telecommunications device for the deaf (TDD), call the Federal Relay Service (FRS), toll free, at 1-800-877-8339...

Status of Environmental Management Initiatives to Accelerate the Reduction of Environmental Risks and Challenges Posed by the Legacy of the Cold War

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

None

2009-01-01

Fifty years of nuclear weapons production and energy research in the United States during the Cold War generated large amounts of radioactive wastes, spent nuclear fuel (SNF), excess plutonium and uranium, thousands of contaminated facilities, and contaminated soil and groundwater. During most of that half century, the Nation did not have the environmental regulatory structure or nuclear waste cleanup technologies that exist today. The result was a legacy of nuclear waste that was stored and disposed of in ways now considered unacceptable. Cleaning up and ultimately disposing of these wastes is the responsibility of the U.S. Department of Energy (DOE).more » In 1989, DOE established the Office of Environmental Management (EM) to solve the large scale and technically challenging risks posed by the world's largest nuclear cleanup. This required EM to build a new nuclear cleanup infrastructure, assemble and train a technically specialized workforce, and develop the technologies and tools required to safely decontaminate, disassemble, stabilize, disposition, and remediate unique radiation hazards. The sites where nuclear activities produced legacy waste and contamination include the original Manhattan Project sites--Los Alamos, New Mexico; Hanford, Washington; and Oak Ridge, Tennessee--as well as major Cold War sites, such as Savannah River Site, South Carolina; the Idaho National Laboratory, Idaho; Rocky Flats Plant, Colorado; and Fernald, Ohio. Today EM has responsibility for nuclear cleanup activities at 21 sites covering more than two million acres in 13 states, and employs more than 30,000 Federal and contractor employees, including scientists, engineers and hazardous waste technicians. This cleanup poses unique, technically complex problems, which must be solved under the most hazardous of conditions, and which will require billions of dollars a year for several more decades. The EM program focus during its first 10 years was on managing the most urgent risks and maintaining safety at each site while negotiating state and Federal environmental compliance agreements. The program also concentrated on characterizing waste and nuclear materials and assessing the magnitude and extent of environmental contamination. By the late 1990s, EM had made significant progress in identifying and characterizing the extent of contamination and cleanup required and began transitioning from primarily a characterization and stabilization program to an active cleanup and closure program. During that time, EM formulated multi-year cleanup and closure plans, which contributed to cleanup progress; however, reducing the overall environmental risk associated with the cleanup program remained a challenge. In response, the Secretary of Energy directed a review of the EM program be undertaken. The resulting 'Top-to Bottom Review' re-directed the program focus from managing risks to accelerating the reduction of these risks.« less

Implications for patient safety in the use of safe patient handling equipment: a national survey.

PubMed

Elnitsky, Christine A; Lind, Jason D; Rugs, Deborah; Powell-Cope, Gail

2014-12-01

The prevalence of musculoskeletal injuries among nursing staff has been high due to patient handling and movement. Internationally, healthcare organizations are integrating technological equipment into patient handling and movement to improve safety. Although evidence shows that safe patient handling programs reduce work-related musculoskeletal injuries in nursing staff, it is not clear how safe these new programs are for patients. The objective of this study was to explore adverse patient events associated with safe patient handling programs and preventive approaches in US Veterans Affairs medical centers. The study surveyed a convenience sample of safe patient handling program managers from 51 US Department of Veterans Affairs medical centers to collect data on skin-related and fall-related adverse patient events. Both skin- and fall-related adverse patient events associated with safe patient handling occurred at VA Medical centers. Skin-related events included abrasions, contusions, pressure ulcers and lacerations. Fall-related events included sprains and strains, fractures, concussions and bleeding. Program managers described contextual factors in these adverse events and ways of preventing the events. The use of safe patient handling equipment can pose risks for patients. This study found that organizational factors, human factors and technology factors were associated with patient adverse events. The findings have implications for how nursing professionals can implement safe patient handling programs in ways that are safe for both staff and patients. Published by Elsevier Ltd.

Economic Impact of the Critical Access Hospital Program on Kentucky's Communities

ERIC Educational Resources Information Center

Ona, Lucia; Davis, Alison

2011-01-01

Context: In 1997, the Medicare Rural Hospital Flexibility Grant Program created the Critical Access Hospital (CAH) Program as a response to the financial distress of rural hospitals. It was believed that this program would reduce the rate of rural hospital closures and improve access to health care services in rural communities. Objective: The…

Monitoring Potential Transport of Radioactive Contaminants in Shallow Ephemeral Channels: FY2013 and FY2014 (revised)

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

Mizell, Steve A.; Miller, Julianne J.; McCurdy, Greg D.

The Desert Research Institute (DRI) is conducting a field assessment of the potential for contaminated soil to be transported from the Smoky Contamination Area (CA) as a result of storm runoff, which supports National Nuclear Security Administration (NNSA) efforts to complete regulatory closure of the Soils Corrective Action Unit (CAU) contamination areas. The work is intended to confirm the likely mechanism of transport and determine the meteorological conditions that might cause movement of contaminated soils, as well as determine the particle size fraction that is most closely associated with transported radionuclide-contaminated soils. These data will facilitate the appropriate closure designmore » and post-closure monitoring program.« less

Laser-assisted corneal welding in cataract surgery: retrospective study.

PubMed

Menabuoni, Luca; Pini, Roberto; Rossi, Francesca; Lenzetti, Ivo; Yoo, Sonia H; Parel, Jean-Marie

2007-09-01

To evaluate the efficacy of laser welding to close corneal wounds in cataract surgery. Department of Ophthalmology, Hospital of Misericordia e Dolce, Prato, Italy. This retrospective nonrandomized interventional case series included 20 eyes of 20 patients. All eyes had cataract with visual acuity worse than 20/200. Ten patients had phacoemulsification surgery, and 10 had extracapsular cataract extraction (ECCE). Surgeries were followed by laser-assisted closure of the corneal wounds by diode laser welding of the stroma using a technique established in animal models. Preoperative and postoperative (1, 3, 7, 30, and 90 days) astigmatism, level of inflammation, Seidel testing, and endothelial cell counts were obtained. There were minor differences in preoperative and postoperative astigmatism except in 1 eye in the ECCE group. The Seidel test showed no wound leakage during the follow-up examinations, and endothelial cell loss was similar to that published for standard surgical cataract procedures. No collateral effects of the laser welding were detected, nor was postoperative inflammation. Astigmatism was slightly affected by the use of laser welding for corneal wound closure after phacoemulsification and ECCE. The laser-assisted corneal sealing procedure was rapid and safe and could serve as an alternative to corneal suturing, with significant potential applications for the closure of longer incisions, such as those used in penetrating keratoplasty.

Use of a fibrin adhesive for conjunctival closure in trabeculectomy.

PubMed

Martinez-de-la-Casa, José M; Rayward, Omar; Saenz-Frances, Federico; Mendez, Carmen; Bueso, Enrique Santos; Garcia-Feijoo, Julián

2013-08-01

To assess the safety and efficacy of a fibrin tissue adhesive (Tissucol Duo(®) ) used to close the conjunctiva in trabeculectomy. A nonrandomized prospective study including 57 patients with chronic simple glaucoma who underwent trabeculectomy surgery. All the trabeculectomies were conducted by the same surgeon using the same surgical technique with the exception that conjunctival closure was achieved by either running Nylon 10/0 suture (n = 29) or using the fibrin glue (n = 28). Preoperative and postoperative data were obtained on intraocular pressure (IOP), number of hypotensive medications used, self-reported discomfort and complications arising during and after surgery. No differences were detected between the two patient groups regarding the intraocular pressure reduction achieved during follow-up. In the first 2 weeks of follow-up, reported discomfort assessed using a visual analogue scale was significantly lower in the Tissucol Duo(®) group. Two patients in the Tissucol Duo(®) group suffered conjunctival dehiscence and suturing was required at 24 hours postsurgery. Remaining complications were similar in the two groups. The use of Tissucol Duo(®) seems to be a safe and efficient option for conjunctival closure in trabeculectomy that simplifies the surgical procedure and reduces patient discomfort in the immediate postoperative period. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Low-Dose Intravenous Paracetamol for Patent Ductus Arteriosus in Indomethacin-Resistant or Contraindicated Preterm Infants: Three Cases Reports.

PubMed

Matsumura, Shun; Oshima, Ayumi; Fujinuma, Sumie; Tanaka, Kosuke; Nagano, Nobuhiko; Miyake, Fuyu; Masutani, Satoshi; Tamura, Masanori; Ueda, Keiko; Namba, Fumihiko

2017-10-01

Background  Although indomethacin (IND) is the standard treatment for hemodynamically significant patent ductus arteriosus (hsPDA) in Japan, it may be associated with renal impairment and gastrointestinal complications. The use of paracetamol for hsPDA closure has recently increased. Unlike IND, paracetamol does not have a peripheral vasoconstrictive effect and can be given to infants with contraindications to IND. Based on limited data available from randomized trials, paracetamol and IND seem to have similar effects. However, there have been no reports of the use of paracetamol for hsPDA in Japan. Cases  Our drug administration protocol was approved by the institutional ethics committee after purchasing a clinical trial insurance. In three premature infants in whom IND was contraindicated or ineffective, a 7.5 mg/kg of paracetamol was intravenously administered every 6 hour for 3 days after obtaining parental consents. A temporary hsPDA closure was observed in two of the three infants. However, all three infants eventually needed surgical closure. No side effects, such as hepatic and renal dysfunctions, and adverse events were reported. Conclusion  The intravenous administration of paracetamol was safe and feasible in premature infants with hsPDA. Future clinical trials with optimized dose and timing of administration are needed.

Validity of surveys to assess safe routes to school programs

USDA-ARS?s Scientific Manuscript database

Safe Routes to School programs are designed to make walking and bicycling to school safe and accessible for children. These programs promote children's physical activity and show promise for obesity prevention. However, there are few validated surveys to measure important outcomes such as student tr...

Right Ventricle before and after Atrial Septal Defect Device Closure.

PubMed

Akula, Vidya Sagar; Durgaprasad, Rajasekhar; Velam, Vanajakshamma; Kasala, Latheef; Rodda, Madhavi; Erathi, Harsha Vardhan

2016-09-01

Percutaneous atrial septal defect (ASD) device closure is a safe and effective means of reducing or eliminating interatrial shunting. The response of the right heart to device closure is incompletely understood. To evaluate the effects of transcatheter closure of secundum ASD on right ventricle size and function, that is, both systolic and diastolic by transthoracic echocardiography (TTE) over a 6-month period. Seventy-three patients had 73 device implantations. The patients were assessed with echocardiography before and at 1 and 6 months after procedure. Mean age was 26 ± 17 years. Mean ASD size indexed to body surface area (BSA) was 19.1 ± 8.6 mm/m(2) . The device size ranged from 12 to 42 mm. One month after closure, there were statistically significant decreases in right ventricular (RV) basal diameter (3.5 ± 0.7 cm vs. 4.2 ± 0.8 cm), RV/LV end-diastolic diameter ratio (0.9 ± 0.1 vs. 1.2 ± 0.2), left ventricular eccentricity index (LVEI) (1.0 ± 0.1 vs. 1.2 ± 0.2), right atrial (RA) major dimension (4.4 ± 0.8 cm vs. 4.8 ± 1.0 cm), RA end-systolic area (13.2 ± 4.6 cm(2) vs. 18.5 ± 6.7 cm(2) ), tricuspid annular plane systolic excursion (TAPSE) (2.2 ± 1.8 cm vs. 2.8 ± 0.5 cm), tricuspid annular systolic velocity (TASV or S') (13.1 ± 3.0 cm/sec vs. 16.0 ± 2.8 cm/sec), E/A (1.4 ± 0.3 vs. 1.7 ± 0.5), and E/e' (5.9 ± 5.0 vs. 7.2 ± 2.0) in comparison with baseline. Six months after closure, there were statistically significant decreases in RV major dimension (5.9 ± 1.1 cm vs. 6.3 ± 1.0 cm), RV/LV end-diastolic diameter ratio (0.8 ± 0.1 vs. 0.9 ± 0.1), RA major dimension (4.1 ± 0.8 cm vs. 4.4 ± 0.8 cm), and RA end-systolic area (11.4 ± 3.8 cm(2) vs. 13.2 ± 4.6 cm(2) ) in comparison with 1 month post-device closure. After 6 months, there was a statistically insignificant increase in both TASV (13.7 ± 2.8 cm/sec vs. 13.1 ± 3.0 cm/sec) and TAPSE (2.5 ± 1.6 cm/sec vs. 2.2 ± 1.8 cm/sec). There was no significant change in tissue Doppler MPI at baseline, 1 month, and 6 months after closure (0.38 ± 0.19 vs. 0.35 ± 0.15 vs. 0.38 ± 0.13). There was significant decrease in E/e' from baseline to 1 month and 1 month to 6 months after closure (7.2 ± 2.0 vs. 5.9 ± 5.0 vs. 4.7 ± 1.5). RV volumes decreased significantly in the first month after ASD device closure and continued up to 6 months. There was no change in global right ventricular systolic function but a high basal RV systolic function decreased after closure. Some patients had impaired diastolic function before closure of defect, which reversed to normal within 6 months after closure. Diastolic dysfunction in older age-group may be a cause for long duration taken by right heart chambers to regress and deserves further investigation. © 2016, Wiley Periodicals, Inc.

A comparison of 2-octyl cyanoacrylate with nylon for wound closure of knee arthroscopy portals.

PubMed

Imbuldeniya, A M; Rashid, A; Murphy, J P

2014-09-01

To compare the cosmetic results, complications and patient satisfaction of 2-octyl cyanoacrylate (Dermabond, Ethicon Inc. Somerville, NJ, USA), a liquid bonding agent, with 3-0 nylon sutures (Ethilon, Ethicon Inc) skin closure in two groups of patients undergoing elective knee arthroscopy at 6 weeks. The retrospective clinical audit recruited patients undergoing knee surgery for the first time between October 2010 and August 2011. The patients were either treated with the liquid bonding agent or nylon sutures. The patients in the bonding agent group were allowed to shower as normal on postoperative day one, while patients in the suture group kept their wounds dry for 2 weeks. Between the two groups (40 patients per group) there was no difference in the cosmetic outcome (p=0.285), patient satisfaction (p=0.29), pain scores (p=0.44) or wound complication rate (p<0.05). Patient satisfaction was high in both groups. Furthermore, 83.75% of all patients indicated they would prefer the liquid bonding closure over nylon sutures if undergoing the same procedure in the future as they could shower the next day and avoid suture removal. 2-octyl cyanoacrylate is safe to use in the short term in knee arthroscopy providing comparable results to nylon suture closure. Allowing patients to shower the next day appears to cause no adverse effects. The authors would like to state that they do not have any economic or social interest in any of the products used or mentioned. No grant or finance was received for this study, nor any input from other sources.

Development of a score and probability estimate for detecting angle closure based on anterior segment optical coherence tomography.

PubMed

Nongpiur, Monisha E; Haaland, Benjamin A; Perera, Shamira A; Friedman, David S; He, Mingguang; Sakata, Lisandro M; Baskaran, Mani; Aung, Tin

2014-01-01

To develop a score along with an estimated probability of disease for detecting angle closure based on anterior segment optical coherence tomography (AS OCT) imaging. Cross-sectional study. A total of 2047 subjects 50 years of age and older were recruited from a community polyclinic in Singapore. All subjects underwent standardized ocular examination including gonioscopy and imaging by AS OCT (Carl Zeiss Meditec). Customized software (Zhongshan Angle Assessment Program) was used to measure AS OCT parameters. Complete data were available for 1368 subjects. Data from the right eyes were used for analysis. A stepwise logistic regression model with Akaike information criterion was used to generate a score that then was converted to an estimated probability of the presence of gonioscopic angle closure, defined as the inability to visualize the posterior trabecular meshwork for at least 180 degrees on nonindentation gonioscopy. Of the 1368 subjects, 295 (21.6%) had gonioscopic angle closure. The angle closure score was calculated from the shifted linear combination of the AS OCT parameters. The score can be converted to an estimated probability of having angle closure using the relationship: estimated probability = e(score)/(1 + e(score)), where e is the natural exponential. The score performed well in a second independent sample of 178 angle-closure subjects and 301 normal controls, with an area under the receiver operating characteristic curve of 0.94. A score derived from a single AS OCT image, coupled with an estimated probability, provides an objective platform for detection of angle closure. Copyright © 2014 Elsevier Inc. All rights reserved.

The Flatstent versus the conventional umbrella devices in the percutaneous closure of patent foramen ovale.

PubMed

Aral, Mert; Mullen, Michael

2015-05-01

Patent foramen ovale (PFO) has been associated with paradoxical embolism leading to stroke/transient ischemic attack, migraine, and neurological decompression sickness. In search for the optimal device that would achieve effective clinical closure with minimal complications, a better device selection based on PFO anatomy and improvements in device design is needed. The Flatstent is a new device designed to treat the highly prevalent long-tunnel PFOs from within, minimizing the amount of material left behind in an attempt to reduce device-related complications. The objective is to compare the safety and efficacy of the novel Flatstent versus the conventional umbrella devices in the transcatheter closure of PFO in a nonrandomized, retrospective, single-center study. Between March 2010 and March 2013, 88 patients underwent PFO closure at The Heart Hospital, London with either the novel Flatstent or one of the four conventionally used umbrella devices (GORE Helex Septal Occluder, Occlutech Figulla Flex, Biostar Septal Occluder, and Amplatzer PFO Occluder) depending on their PFO anatomy. Patients were then evaluated with contrast transthoracic echocardiography (TTE) and/or transoesophageal echocardiography (TOE) at 6 weeks and 1 year after the procedure. The residual shunt and complication rates between the Flatstent and umbrella devices were compared. The Flatstent was used in 27 patients (30.7%), whereas 61 patients (69.3%) received one of the four umbrella devices. Primary efficacy point of clinical closure defined as grade 0 or grade 1; residual shunt was achieved in 81.3% in the Flatstent cohort and 80.3% in the umbrella device group at 6 weeks follow-up. At 1 year, the clinical closure rates reached 92.6 and 91.8%. There were two device embolizations, one in each cohort during the immediate postoperative period (<24 hrs), with successful retrieval. One patient in the umbrella device group developed transient atrial fibrillation, which was controlled medically. Event recurrence rate was 0% at 1 year. No difference was found in closure or complication rates between the Flatstent and the umbrella devices. With appropriate preassessment of the PFO anatomy, the Flatstent works as a safe and effective method of treating the PFO from within the tunnel, especially in those with long-tunnel PFOs. Longer follow-up is needed to establish superiority. © 2014 Wiley Periodicals, Inc.

16 CFR 312.11 - Safe harbor programs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 16 Commercial Practices 1 2014-01-01 2014-01-01 false Safe harbor programs. 312.11 Section 312.11 Commercial Practices FEDERAL TRADE COMMISSION REGULATIONS UNDER SPECIFIC ACTS OF CONGRESS CHILDREN'S ONLINE PRIVACY PROTECTION RULE § 312.11 Safe harbor programs. (a) In general. Industry groups or other persons...

Development of Numerical Extended Hydrodynamics for Transition-Regime Non-Equilibrium Flows Encountered in Semiconductor Manufacturing Processes

NASA Technical Reports Server (NTRS)

Groth, Clinton P. T.; Roe, Philip L.

1998-01-01

Six months of funding was received for the proposed three year research program (funding for the period from March 1, 1997 to August 31, 1997). Although the official starting date for the project was March 1, 1997, no funding for the project was received until July 1997. In the funded research period, considerable progress was made on Phase I of the proposed research program. The initial research efforts concentrated on applying the 10-, 20-, and 35-moment Gaussian-based closures to a series of standard two-dimensional non-reacting single species test flow problems, such as the flat plate, couette, channel, and rearward facing step flows, and to some other two-dimensional flows having geometries similar to those encountered in chemical-vapor deposition (CVD) reactors. Eigensystem analyses for these systems for the case of two spatial dimensions was carried out and efficient formulations of approximate Riemann solvers have been formulated using these eigenstructures. Formulations to include rotational non-equilibrium effects into the moment closure models for the treatment of polyatomic gases were explored, as the original formulations of the closure models were developed strictly for gases composed of monatomic molecules. The development of a software library and computer code for solving relaxing hyperbolic systems in two spatial dimensions of the type arising from the closure models was also initiated. The software makes use of high-resolution upwind finite-volumes schemes, multi-stage point implicit time stepping, and automatic adaptive mesh refinement (AMR) to solve the governing conservation equations for the moment closures. The initial phase of the code development was completed and a numerical investigation of the solutions of the 10-moment closure model for the simple two-dimensional test cases mentioned above was initiated. Predictions of the 10-moment model were compared to available theoretical solutions and the results of direct-simulation Monte Carlo (DSMC) calculations. The first results of this study were presented at a meeting last year.

78 FR 39730 - Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-02

..., Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical Insurance Program.... SUMMARY: This document corrects a typographical error that appeared in the notice published in the Federal... typographical error that is identified and corrected in the Correction of Errors section below. II. Summary of...

24 CFR 761.23 - Grantee performance requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Operation Safe Home, Operation Weed and Seed, and the Safe Neighborhoods Action Program operating in the... emanating from other anti-crime and anti-drug programs, such as Operation Safe Home, Operation Weed and Seed...

24 CFR 761.23 - Grantee performance requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Operation Safe Home, Operation Weed and Seed, and the Safe Neighborhoods Action Program operating in the... emanating from other anti-crime and anti-drug programs, such as Operation Safe Home, Operation Weed and Seed...

24 CFR 761.23 - Grantee performance requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Operation Safe Home, Operation Weed and Seed, and the Safe Neighborhoods Action Program operating in the... emanating from other anti-crime and anti-drug programs, such as Operation Safe Home, Operation Weed and Seed...

Design, Development, Pre-Testing and Preparation for Full Scale Cold Testing of a System for Field Remediation of Vertical Pipe Units at the Hanford Site 618-10 Burial Grounds -12495

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

Halliwell, Stephen

2012-07-01

At the Hanford site, in the 1950's and 60's, radioactive waste materials, including Transuranic (TRU) wastes from a number of laboratories were stored in vertical pipe units (VPUs) in what are now the 618-10 and 618-11 burial grounds. Although the current physical condition of the VPUs is unknown, initial R and D studies had shown that in-ground size reduction and stabilization of VPU contents was feasible. This paper describes the R and D work and testing activities to validate the concept of in-ground size reduction and stabilization of VPU contents, and the design and pre-testing of major plant items andmore » augering systems on full size simulated VPUs. The paper also describes the full size prototype equipment which will be used in full size cold testing of simulated VPUs off the Hanford site, to prove the equipment, develop operating procedures, and train operators prior to deployment on site. Safe and effective field remediation, removal and disposal of the VPUs in the 600 area are critical to the success of the River Corridor Closure Contract at the U.S. Department of Energy's Hanford Site. Safe and effective field remediation, removal and disposal of the VPUs in the 600 area are critical to the success of the River Corridor Closure Contract at the U.S. Department of Energy's Hanford Site. (authors)« less

Objects as closures: Abstract semantics of object oriented languages

NASA Technical Reports Server (NTRS)

Reddy, Uday S.

1989-01-01

We discuss denotational semantics of object-oriented languages, using the concept of closure widely used in (semi) functional programming to encapsulate side effects. It is shown that this denotational framework is adequate to explain classes, instantiation, and inheritance in the style of Simula as well as SMALLTALK-80. This framework is then compared with that of Kamin, in his recent denotational definition of SMALLTALK-80, and the implications of the differences between the two approaches are discussed.

Closure development for high-level nuclear waste containers for the tuff repository; Phase 1, Final report

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

Robitz, E.S. Jr.; McAninch, M.D. Jr.; Edmonds, D.P.

1990-09-01

This report summarizes Phase 1 activities for closure development of the high-level nuclear waste package task for the tuff repository. Work was conducted under U.S. Department of Energy (DOE) Contract 9172105, administered through the Lawrence Livermore National Laboratory (LLNL), as part of the Yucca Mountain Project (YMP), funded through the DOE Office of Civilian Radioactive Waste Management (OCRWM). The goal of this phase was to select five closure processes for further evaluation in later phases of the program. A decision tree methodology was utilized to perform an objective evaluation of 15 potential closure processes. Information was gathered via a literaturemore » survey, industrial contacts, and discussions with project team members, other experts in the field, and the LLNL waste package task staff. The five processes selected were friction welding, electron beam welding, laser beam welding, gas tungsten arc welding, and plasma arc welding. These are felt to represent the best combination of weldment material properties and process performance in a remote, radioactive environment. Conceptual designs have been generated for these processes to illustrate how they would be implemented in practice. Homopolar resistance welding was included in the Phase 1 analysis, and developments in this process will be monitored via literature in Phases 2 and 3. Work was conducted in accordance with the YMP Quality Assurance Program. 223 refs., 20 figs., 9 tabs.« less

Transcatheter Closure of Patent Foramen Ovale in Patients with Platypnea-Orthodeoxia: Results of a Multicentric French Registry

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

Guerin, P.; Lambert, V.; Godart, F.

Background. Dyspnea and the decrease in arterial saturation in the upright position in elderly subjects is described as platypnea-orthodeoxia syndrome (POS). POS is secondary to the occurrence of an atrial right-to-left shunt through a patent foramen ovale (PFO). Methods. This French multicentric study reports on 78 patients (mean age 67 {+-} 11.3 years) with POS who had transcatheter closure of the PFO; frequently associated diseases were pneumonectomy (n = 36) and an ascending aortic aneurysm (n = 11). In all patients, the diagnosis was confirmed by transthoracic or/and transesophageal echocardiography. Five different closure devices were used: Amplatz (n = 45),more » Cardioseal (n = 13), Sideris (n = 11), Das Angel Wings (n = 8) and Starflex (n = 1). Closure was successful in 76 patients (97%). Results. Oxygen saturation increased immediately after occlusion from 84.6 {+-} 10.7% to 95.1 {+-} 6.4% (p < 0.001) and dyspnea improved from grade 2.7 {+-} 0.7 to grade 1 {+-} 1 (p < 0.001). A small residual shunt was immediately observed in 5 patients (3 with the Cardioseal device, 1 with the Sideris and 1 with the Amplatz) leading to the implantation of a second device in one case (Cardioseal). Two early deaths occurred unrelated to the procedure (one due to sepsis probably related to pneumonectomy, another due to respiratory insufficiency). Other complications were: a small shunt between the aorta and the left atrium, two atrial fibrillations and a left-sided thrombus which disappeared with anticoagulant therapy. At a mean follow-up of 15 {+-} 12 months, there were 7 late deaths related to the underlying disease. Conclusion. Percutaneous occlusion of the foramen ovale is safe and gives excellent results thanks to continuing improvement in available devices. This technique enables some patients in an unstable condition to avoid a surgical closure.« less

Repeated Courses of Oral Ibuprofen in Premature Infants with Patent Ductus Arteriosus: Efficacy and Safety.

PubMed

Olgun, Haşim; Ceviz, Naci; Kartal, İbrahim; Caner, İbrahim; Karacan, Mehmet; Taştekin, Ayhan; Becit, Necip

2017-02-01

There are limited data about the results of repeated oral ibuprofen (OIBU) treatment. This study aimed to describe patent ductus arteriosus (PDA) closure rates and adverse events after repeated courses of OIBU in premature infants with PDA. Preterm infants with hemodynamically significant (hs)PDA were enrolled in the study. If the first course of OIBU treatment failed, a second and, if required, third course was administered. A total of 100 patients received OIBU. In six patients, treatment could not be completed due to death (n=3) and side effects (n=3). In three patients, adverse effects related to OIBU (thrombocytopenia and impairment of renal function) developed during the first course. During the second and third courses, no new adverse event occurred. After all courses, the PDA closure rate was determined as 88%. The rate was 71% after the first course, 40% after the second course, and 35% after the third course. Although the second course resulted in a significant increase in the closure rate (p<0.05), the rate did not increase significantly with the third course (p>0.05). The mean postnatal age at the start of the first dose of OIBU was not significantly different among the responders and non-responders to the first course (p>0.05). Clinical characteristics did not affect the closure rate significantly. The number of courses did not have a significant effect on death, when gestational age and birth weight were used as covariates [p=0.867, Exp(B)=0.901, 95% confidence interval=0.264-3.1]. A second course of OIBU seems effective and safe for use in preterm infants with hsPDA. Although a third course of OIBU results in PDA closure in some additional patients, the difference is not significant. Thus, surgical ligation should be considered after the second course, especially in patients with signs of severe heart failure. Copyright © 2016. Published by Elsevier B.V.

Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension: Short and intermediate term results.

PubMed

Bhalgat, Parag S; Pinto, Robin; Dalvi, Bharat V

2012-07-01

To assess the efficacy and safety of transcatheter closure (TCC) of patent ductus arteriosus (PDA) with severe pulmonary arterial hypertension (PHT). TCC of small and moderate-sized PDAs is well established. However, there is a paucity of data on TCC of large PDA with severe PHT. This is a retrospective observational study of 76 patients with large PDA and severe PHT who were referred for TCC. Multiple clinical and investigational parameters were evaluated to decide the reversibility of PHT. Following the TCC, patients were serially followed up to assess the efficacy and safety of closure and its impact on PHT. Of 76 patients, nine were found to have PDA with Eisenmenger's syndrome. Of remaining 67, two were thought to have irreversible PHT based on hemodynamic data obtained after balloon occlusion of the duct. Sixty five patients, who eventually underwent TCC of PDA, had a median age of 9.1 years (range 1 month to 40 years). The weight ranged between 2.5 to 62 kg (median 14 kg). The PDA size was 9.1 ± 4.6 mm. The mean systolic pulmonary artery pressure was 66.9 ± 15.3 mm Hg. Duct occluder was used in 63 and muscular ventricular septal defect closure device in 2. The follow up was available in 56 (86%) with a mean follow up period of 65 ± 34 months. All the patients had complete closure of the PDA at 6 months follow up. Mild obstruction of left pulmonary artery (n=3) and aortic isthmus flow (n=6) was noted at the time of discharge. During the follow up, partial or complete resolution of PHT was observed in all the patients in whom Doppler-derived right ventricular systolic pressure was recorded (available in 40 of 56 patients). TCC of large PDA with severe PHT and significant left to right shunt was found to be effective and safe in the short and intermediate term.

Clinically apparent long-term electric disturbances in the acute and very long-term of patent foramen ovale device-based closure.

PubMed

Rigatelli, Gianluca; Zuin, Marco; Pedon, Luigi; Zecchel, Roberto; Dell'Avvocata, Fabio; Carrozza, Antonio; Zennaro, Marco; Pastore, Gianni; Zanon, Francesco

2017-03-01

Incidence of electrical disturbances in patients submitted to transcatheter patent foramen ovale (PFO) closure has not been fully clarified in a large population. The aim of the study is to assess the incidence of atrial fibrillation, supraventricular tachi-arrhythmias, and atrio-ventricular block in the acute and very long-term follow-up. We reviewed the medical and instrumental data of 1000 consecutive patients (mean age 47.3±17.1years) prospectively enrolled in two centers over a 13-year period (February 1999 to February 2012) for right-to-left (R-to-L) shunt ICE-aided catheter-based closure using different devices. Successful transcatheter PFO closure was achieved in 99.8% of the patients. Implanted devices were: Amplatzer PFO Occluder in 463 patients (46.3%), Amplatzer ASD Cribriform Occluder in 420 patients (42.0%), Premere Occlusion System in 95 patients (9.5%), and Biostar Occluder in 22 patients (2.2%). Postprocedural electrical complications occurred in 5.9% of patients. The only independent predictors of electrophysiological complications were female gender (OR 2.3, 0.5-5.1 [95% CI], p<0.001) and device disk >30mm (OR 5.0, 1.2-7.2 [95% CI], p<0.001). On a mean follow-up of 12 .3±0.6years (minimum 4- maximum 17years), electrical complications occurred in 1.4% of patients including one only case of complete AVB and 5 cases of permanent AF. The only independent predictors were female gender (OR 2.3, 0.5-5.1 [95% CI], p<0.001) and device disk >30mm (OR 5.0, 1.2-7.2 [95% CI], p<0.001). Device-based closure of PFO using different devices, appeared very safe from an electrophysiological point of view with low incidence of electrical disturbances even in the very long-term follow-up. Copyright © 2016 Elsevier Inc. All rights reserved.

Resection of the metatarsal head for diabetic foot ulcers.

PubMed

Wieman, T J; Mercke, Y K; Cerrito, P B; Taber, S W

1998-11-01

Diabetic foot ulceration is a worldwide health problem. Approximately 15% of the 10 million diabetic patients in the United States will develop a foot ulceration at some time in their lives. The presence of a foot ulcer in this population is extremely debilitating and dramatically increases the risk of lower extremity amputation, accounting for approximately 67,000 lost limbs each year. Additionally, the costs associated with treating foot ulcers in diabetic patients is a major expense in the overall care of this patient group. An 11-year retrospective study was conducted to evaluate 101 consecutive patients with diabetic ulcers of the forefoot who were treated using resection of the metatarsal head as the primary means of obtaining wound closure. The results indicate that 88% of the ulcers were healed by using this technique, and relatively more rapidly than would be expected when compared with historical norms. Resection of the metatarsal head is a safe and relatively inexpensive procedure that facilitates closure of the lesion, helps to control infection, and prevents countless and costly amputations.

Nitinol Thermoreactive Clips for Secondary Sternal Closure in Cases of Noninfective Sternal Dehiscence

PubMed Central

Gucu, Arif; Toktas, Faruk; Eris, Cuneyt; Ata, Yusuf; Turk, Tamer

2012-01-01

Postoperative sternal dehiscence is a potentially catastrophic sequela to median sternotomy that can cause not only chest-wall discomfort and pulmonary dysfunction but infection, both superficial and mediastinal. Nitinol thermoreactive clips use a novel material in the treatment of sternal dehiscence. We sought to determine whether the use of these clips is an effective remedy for noninfective sternal dehiscence. From January 2008 through December 2011, we retrospectively studied the data on 10 patients whose sternums had been closed with nitinol thermoreactive clips after the development of noninfective sternal dehiscence. Diagnosis was made on the bases of clinical criteria, chest radiography, and microbiological investigation. There was no control group. No procedure-related sequelae occurred. There was no recurrent sternal instability and dehiscence, sternal-related hemorrhage, superficial wound infection, or mediastinal infection. We believe that the use of nitinol thermoreactive clips is a safe, easy, and efficient method of secondary sternal closure for noninfective sternal dehiscence. PMID:22949767

Clinical experience with a novel bovine collagen dura mater substitute

PubMed Central

Costa, Bruno Silva; Cavalcanti-Mendes, George de Albuquerque; de Abreu, Marcelo Sartori; de Sousa, Atos Alves

2010-01-01

Background: Dural substitutes are used to achieve a watertight closure in situations where adequate closure is not possible .This study was conducted to evaluate the efficacy and safety of use a new collagen matrix dural substitute ( Duradry, Tecnodry, Belo Horizonte MG) in repair or expansion of cranial and spinal dura-mater. Methods: 30 patients operated on between March and September 2008, were studied. Surgical logs were reviewed for sex, age, diagnosis, location of the graft, technique and presence of fistula or infection. The patients were followed-up for at least 3 months, and the presence of complications as cerebrospinal leakage, infection, aseptic meningitis, hydrocephalus, pseudomeningocele were analysed. Results: Only one patient presented with CSF fistula. No patients presented with wound infections, hydrocephalus, pseudomeningocele, meningitis, brain abscesses or signs of toxicity related to the material. Conclusions: The new dural substitute used in this study is effective and safe, and the initial results are similar to those of other dural substitutes reported in the literature. PMID:22028756

Comprehensive Review of Tissue Adhesives.

PubMed

Jenkins, Lauren E; Davis, Loretta S

2018-06-19

Cyanoacrylates, also known as tissue adhesives or skin glues, are commonly used as sealants for lacerations and incisions and have found utility in excisional and cosmetic surgeries in both outpatient and operating room settings. To review the surgical literature on the utilities, advantages, disadvantages, and special uses of cyanoacrylates applicable to dermatology. PubMed was reviewed for relevant articles related to cyanoacrylates and their use in skin closures. Articles unrelated to cutaneous closures were excluded. Tissue adhesives polymerize to a water resistant, pliable film after application to approximated wound edges and have antibacterial properties. Adhesives slowly slough off as the wound heals, typically after 5 days. Compared with 5-0 nonabsorbable suture, adhesives provide similar tensile strength and similar patient and surgeon satisfaction. Although slightly more expensive than sutures, tissue adhesives obviate the need for wound dressings and suture removal. They do not perform as well as sutures for wounds under higher tension or in the setting of moisture and inadequate hemostasis. Cyanoacrylates serve as a safe and effective suture alternative in appropriate dermatologic surgeries and procedures.

48 CFR 226.7102 - Policy.

Code of Federal Regulations, 2010 CFR

2010-10-01

... DEFENSE SOCIOECONOMIC PROGRAMS OTHER SOCIOECONOMIC PROGRAMS Preference for Local and Small Businesses 226.7102 Policy. Businesses located in the vicinity of a military installation that is being closed or realigned under a base closure law, including 10 U.S.C. 2687, and small and small disadvantaged businesses...

Safe mobility for older people notebook

DOT National Transportation Integrated Search

1999-04-01

The Safe Mobility for Older People Notebook is a research product of the "Model Driver Screening and Evaluation Program" project sponsored by NHTSA, and is intended as a resource to support program initiatives promoting the safe mobility of older per...

Defense Base Realignment and Closure Budget Data for Naval Air Technical Training Center, Naval Air Station Pensacola, Florida

DTIC Science & Technology

1994-06-07

023- S -94 Military Construction Projects Budgeted January 14, 1994 and Programmed for Bases Identified for Closure or Realignment 028-C-93...deferred to this analysis as the more accurate basis for design and construction costs, rather than the gross estimates in the 1391’ s submitted much...solutions( s ), it is imperative that design and construction costs, operation/maintenance costs, the specific health care needs of the population to

Objects as closures - Abstract semantics of object oriented languages

NASA Technical Reports Server (NTRS)

Reddy, Uday S.

1988-01-01

The denotational semantics of object-oriented languages is discussed using the concept of closure widely used in (semi) functional programming to encapsulate side effects. It is shown that this denotational framework is adequate to explain classes, instantiation, and inheritance in the style of Simula as well as SMALLTALK-80. This framework is then compared with that of Kamin (1988), in his recent denotational definition of SMALLTALK-80, and the implications of the differences between the two approaches are discussed.

Safe, Cost Effective Management of Inactive Facilities at the Savannah River Site

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

Austin, W. E.; Yannitell, D. M.; Freeman, D. W.

The Savannah River Site is part of the U.S. Department of Energy complex. It was constructed during the early 1950s to produce basic materials (such as plutonium-239 and tritium) used in the production of nuclear weapons. The 310-square-mile site is located in South Carolina, about 12 miles south of Aiken, South Carolina, and about 15 miles southeast of Augusta, Georgia. Savannah River Site (SRS) has approximately 200 facilities identified as inactive. These facilities range in size and complexity from large nuclear reactors to small storage buildings. These facilities are located throughout the site including three reactor areas, the heavy watermore » plant area, the manufacturing area, and other research and support areas. Unlike DOE Closure Sites such as Hanford and Rocky Flats, SRS is a Project Completion Site with continuing missions. As facilities complete their defined mission, they are shutdown and transferred from operations to the facility disposition program. At the SRS, Facilities Decontamination and Decommissioning (FDD) personnel manage the disposition phase of a inactive facility's life cycle in a manner that minimizes life cycle cost without compromising (1) the health or safety of workers and the public or (2) the quality of the environment. The disposition phase begins upon completion of operations shutdown and extends through establishing the final end-state. FDD has developed innovative programs to manage their responsibilities within a constrained budget.« less

Surgical closure of persistent arterial duct with minimal invasive anterior thoracotomy: an alternative technique.

PubMed

Fouilloux, Virginie; Gran, Célia; Kreitmann, Bernard

2014-10-01

Surgical approach for persistent ductus arteriosus ligation is typically a left lateral thoracotomy opening the pleural-space with left lung retraction. We describe an alternative approach, with a minimally invasive anterior parasternal incision. This is particularly adapted to preterm infants weighing less than 1.5 kg. This approach ensures a good exposure of vessels. We believe that it is safe, reliable and reproducible. The learning curve should not be an issue for surgeons used to manage low weight patients. Georg Thieme Verlag KG Stuttgart · New York.

Study of solid rocket motors for a space shuttle booster. Appendix C: Recovery and reuse 120-inch diameter solid rocket motor boosters

NASA Technical Reports Server (NTRS)

1972-01-01

A baseline for a space shuttle configuration utilizing four parallel-burn 120-in. diameter SRMS is presented. Topics discussed include parachute system sequence, recovery system development profile, parachute container, and segment and closure recovery operations. A cost analysis for recovery of the SRM stage is presented. It is concluded that from the standpoint of minimum cost and development, parachutes are the best means of achieving SRM recovery. Major SRM components can be reused safely.

Comparison of three patent foramen ovale closure devices in a randomized trial (Amplatzer versus CardioSEAL-STARflex versus Helex occluder).

PubMed

Taaffe, Margaret; Fischer, Evelyn; Baranowski, Andreas; Majunke, Nicolas; Heinisch, Corinna; Leetz, Michaela; Hein, Ralph; Bayard, Yves; Büscheck, Franziska; Reschke, Madlen; Hoffmann, Ilona; Wunderlich, Nina; Wilson, Neil; Sievert, Horst

2008-05-01

This randomized trial compared procedural complications and 30-day clinical outcomes of 3 patent foramen ovale (PFO) closure devices (Amplatzer, Helex, and CardioSEAL-STARflex). It examined 660 patients (361 men, 299 women, mean age 49.3+/-1.9 years), with 220 patients per group. All patients had a history of paradoxical embolism. All PFO closures were successful technically. Exchange of devices for others was most frequently required for the Helex occluder (7 of 220) and 2 of 220 in either of the other groups. Three device embolizations in the Helex group were retrieved and replaced successfully. One patient with a Helex occluder developed a transient ischemic attack and recovered without treatment. A hemopericardium in that group was punctured without affecting the device. One tamponade in the Amplatzer group required surgical device explantation. In 8 of 660 patients in the CardioSEAL-STARflex group, thrombi resolved after anticoagulation. Sixteen patients (11 in the CardioSEAL-STARflex group, 3 in the Amplatzer group, and 2 in the Helex group) had episodes of atrial fibrillation. PFOs were closed completely in 143 of 220 patients (65%) in the Amplatzer group, 116 of 220 patients (52.7%) in the Helex group, and 137 of 220 patients (62.3%) in the CardioSEAL-STARflex group at 30 days with significant differences between the Helex and Amplatzer occluders (p=0.0005) and the Helex and CardioSEAL-STARflex occluders (p=0.0003). PFO closure can be performed safely with each device. In conclusion, the Helex occluder embolized more frequently. Device thrombus formation and paroxysmal atrial fibrillation were more common with the CardioSEAL-STARflex occluder.

Platypnea-orthodeoxia syndrome in the elderly treated by percutaneous patent foramen ovale closure: a case series and literature review.

PubMed

Blanche, Coralie; Noble, Stéphane; Roffi, Marco; Testuz, Ariane; Müller, Hajo; Meyer, Philippe; Bonvini, John M; Bonvini, Robert F

2013-12-01

Platypnea-orthodeoxia syndrome (POS) is a rare clinical phenomenon, associating normal oxygen saturation in a supine position and arterial hypoxemia in an upright position. This pathology can be secondary to an intracardiac shunt, a pulmonary vascular shunt or a ventilation-perfusion mismatch. Cardiac POS occurs in the presence of a right-to-left cardiac shunt, most commonly through a patent foramen ovale (PFO). From our single-center prospective database of percutaneous PFO closure we identified five patients (4 females, mean age: 77 ± 11 years) out of 224 (2.2%) patients with a PFO who presented with a POS of cardiac origin. Transthoracic and transoesophageal echocardiographic examinations revealed the underlying mechanisms of POS and the diagnosis was confirmed by right-and-left cardiac catheterization (RLC) and by measuring serial blood oxygen saturation in the pulmonary veins and left atrium in supine and upright positions. PFO was associated with atrial septal aneurysm and a persistent prominent Eustachian valve in 3 patients. All patients underwent a successful percutaneous PFO closure without any immediate or subsequent complications (mean follow-up of 24 ± 18 months). Immediately after the procedure, mean arterial oxygen saturation improved from 83% ± 3 to 93% ± 2 in an upright position and symptoms disappeared. POS is a rare and under-diagnosed pathology that must be actively investigated in the presence of position-dependent hypoxemia. The diagnostic work-up must exclude other causes of hypoxemia and confirm the intracardiac shunt using either contrast echocardiography or RLC. For cardiac POS, percutaneous PFO closure is a safe and effective technique that immediately relieves orthodeoxia and patient symptoms. © 2013.

Laparoscopic common bile duct exploration with primary closure for management of choledocholithiasis: a retrospective analysis and comparison with conventional T-tube drainage.

PubMed

Zhang, Hong-Wei; Chen, Ya-Jin; Wu, Chang-Hao; Li, Wen-Da

2014-02-01

Laparoscopic common bile duct exploration (LCBDE) had become one of the main options for management of choledocholithiasis. This retrospective comparative study aimed to evaluate on the feasibility and advantages of primary closure versus conventional T-tube drainage of the common bile duct (CBD) after laparoscopic choledochotomy. In this retrospective analysis, 100 patients (47 men and 53 women) with choledocholithiasis who underwent primary closure of the CBD (without T-tube drainage) after LCBDE (Group A) were compared with 92 patients who underwent LCBDE with T-tube drainage (Group B). Both groups were evaluated with regard to biliary complications, hospital stay, and recurrence of stones. The mean operation time was 104.12 minutes for Group A and 108.92 minutes for Group B (P = 0.069). The hospital stay was significantly shorter in Group A than that in Group B (6.95 days and 12.05 days, respectively; P < 0.001). In Group A, bile leakage occurred in two patients on postoperative Day 2 and Day 3, respectively. In Group B, bile leakage noted in one patient after removal of the T-tube on Day 14 after operation (P = 1.000). With a median follow-up time of 40 months for both groups, stone recurrence was noted in two patients in Group A and three patients in Group B (P = 0.672). Primary closure of the CBD is safe and feasible in selected patients after laparoscopic choledochotomy. It results in shorter duration of hospital stay without the need for carrying/care of a T-tube in the postoperative period and similar stone recurrence as that of the conventional method.

Feasibility study from a randomized controlled trial of standard closure of a stoma site vs biological mesh reinforcement.

PubMed

2016-09-01

Hernia formation occurs at closed stoma sites in up to 30% of patients. The Reinforcement of Closure of Stoma Site (ROCSS) randomized controlled trial is evaluating whether placement of biological mesh during stoma closure safely reduces hernia rates compared with closure without mesh, without increasing surgical or wound complications. This paper aims to report recruitment, deliverability and safety from the internal feasibility study. A multicentre, patient and assessor blinded, randomized controlled trial, delivered through surgical trainee research networks. A 90-patient internal feasibility study assessed recruitment, randomization, deliverability and early (30 day) safety of the novel surgical technique (ClinicalTrials.gov registration number NCT02238964). The feasibility study recruited 90 patients from the 104 considered for entry (45 to mesh, 45 to no mesh). Seven of eight participating centres randomized patients within 30 days of opening. Overall, 41% of stomas were created for malignant disease and 73% were ileostomies. No mesh-specific complications occurred. Thirty-one postoperative adverse events were experienced by 31 patients, including surgical site infection (9%) and postoperative ileus (6%). One mesh was removed for re-access to the abdominal cavity, for reasons unrelated to the mesh. Independent review by the Data Monitoring and Ethics Committee of adverse event data by treatment allocation found no safety concerns. Multicentre randomization to this trial of biological mesh is feasible, with no early safety concerns. Progression to the full Phase III trial has continued. ROCSS shows that trainee research networks can efficiently develop and deliver complex interventional surgical trials. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

[Vacuum-assisted therapy for various wound types including diabetic foot ulcer].

PubMed

Farah, Raymond; Gantus, Maher; Kogan, Leonid

2011-03-01

Vacuum is a noninvasive system that creates a localized controlled negative pressure environment. In this study, vacuum was provided by the V.A.C. Therapy system, which promotes wound healing by delayed primary or secondary intention through creating a moist wound environment, preparing the wound bed for closure, reducing edema, and promoting formation and perfusion of granulation tissue. Vacuum-assisted closure therapy is indicated for use in all care settings and for a variety of wound types including diabetic foot ulcers. The purpose of this study was to evaluate safety and clinical efficacy of negative pressure wound therapy (NPWT) compared with advanced moist wound therapy and standard treatment to treat foot ulcers in diabetic patients. This trial enrolled 43 patients; most of them were diabetic patients at any age with various skin ulcers and diabetic foot. These patients were divided into two groups, 17 patients were treated with vacuum and the 26 patients in the control group were treated with standard therapy including debridement. A greater proportion of foot and skin ulcers achieved complete ulcer closure with vacuum-assisted therapy p<0.001 compared with the standard therapy. Vacuum therapy significantly decreased the duration and frequency of admission p=0.032 and decreased the rate of amputation p<0.001. Results of our trial support other studies and demonstrate that vacuum is as safe as and more efficacious than standard therapy in the treatment of diabetic foot ulcers. A significantly greater number of patients achieved complete ulcer closure and granulation tissue formation with this therapy. The study group showed a significant reduction in the median time needed to heal ulcers, reduction of the number of admissions and amputation frequency.

Results of coil closure of patent ductus arteriosus using a tapered tip catheter for enhanced control.

PubMed

Devanagondi, Rajiv; Latson, Larry; Bradley-Skelton, Sharon; Prieto, Lourdes

2016-08-01

This article describes the efficacy and embolization rates of coil delivery via modified vertebral catheter (MVC) for patent ductus arteriosus (PDA) closure. Various techniques have been devised to enhance coil control and prevent embolization during PDA closure. Since 1995, they have delivered coils via tapered vertebral catheters for improved coil control. Catheterization reports, angiograms, and echocardiograms were reviewed for patients with PDA occlusion via MVC from 2001 to 2014. Residual shunting was determined by angiography and echocardiogram within 24 hr post-procedure. Procedural success was defined as ≤ trivial angiographic and echocardiographic shunt, and no aortic nor LPA obstruction, after final coil delivery. About 125 coil occlusions were attempted in 103 patients. Minimal PDA diameter was 2 (0.6-6) mm. Four coils were removed with a snare/bioptome due to aortic/LPA obstruction following release. Seven were malpositioned while still held by the MVC of which three embolized while attempting withdrawal. Five embolized after full release from the MVC. The embolization rate was 6.4%. Embolizations were more likely in PDAs ≥ 2.5 mm (P < 0.05). Ultimately, 98/103 PDAs were occluded using the MVC. No patient had greater trivial residual shunt or aortic/LPA obstruction for an overall success rate of 95%. For PDAs < 2.5 mm the success rate was 97%. Coil delivery via MVC was safe and effective for small PDAs. While fully controlled release and retrieval devices are now available for PDA closure with lower embolization rates, coil occlusion by MVC should still be considered for small PDAs, especially in resource limited regions. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Transcatheter closure of patent ductus arteriosus using the AMPLATZER™ duct occluder II (ADO II).

PubMed

Gruenstein, Daniel H; Ebeid, Makram; Radtke, Wolfgang; Moore, Phillip; Holzer, Ralf; Justino, Henri

2017-05-01

The study purpose is to evaluate the safety and efficacy of the ADO II device for closure of patent ductus arteriosus (PDA) in children. Transcatheter treatment of PDA has been evolving for 40+ years and is the treatment of choice. The AMPLATZER™ Duct Occluder (ADO) device was developed for larger diameter ducts and is not ideal in all PDAs. ADO II was developed for small to moderate-sized ducts. This is a single-arm, multicenter study evaluating safety and efficacy of the ADO II device. Patients <18 years were screened for a PDA ≤5.5 mm in diameter and 3-12 mm in length. Right and left heart catheterization was performed, and hemodynamic data were obtained at the time of implant. The diameter of the left pulmonary artery (LPA) and descending aorta, and the presence of any pre-existing pressure gradients across the LPA or aortic arch were assessed at baseline and 6 months post-implant. A total of 192 patients were enrolled. The median implant time was 74 min. Median fluoroscopy time was 12 min. A retrograde (aortic) approach was used in 33% of procedures and demonstrated a statistically significant reduction in fluoroscopy time (P value = 0.0018) compared to an antegrade approach. The device was successfully implanted in 93% of patients, with complete closure in 98% of successful implantations. In this prospective study, the ADO II was safe and effective for closure of small to moderate PDAs. Implantation is simple and the ability for retrograde aortic delivery reduces procedure-related radiation exposure. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Stapedotomy in osteogenesis imperfecta: a prospective study of 32 consecutive cases.

PubMed

Vincent, Robert; Wegner, Inge; Stegeman, Inge; Grolman, Wilko

2014-12-01

To prospectively evaluate hearing outcomes in patients with osteogenesis imperfecta undergoing primary stapes surgery and to isolate prognostic factors for success. A nonrandomized, open, prospective case series. A tertiary referral center. Twenty-five consecutive patients who underwent 32 primary stapedotomies for osteogenesis imperfecta with evidence of stapes fixation and available postoperative pure-tone audiometry. Primary stapedotomy with vein graft interposition and reconstruction with a regular Teflon piston or bucket handle-type piston. Preoperative and postoperative audiometric evaluation using conventional 4-frequency (0.5, 1, 2, and 4 kHz) audiometry. Air-conduction thresholds, bone-conduction thresholds, and air-bone gap were measured. The overall audiometric results as well as the results of audiometric evaluation at 3 months and at least 1 year after surgery were used. Overall, postoperative air-bone gap closure to within 10 dB was achieved in 88% of cases. Mean (standard deviation) gain in air-conduction threshold was 22 (9.4) dB for the entire case series, and mean (standard deviation) air-bone gap closure was 22 (9.0) dB. Backward multivariate logistic regression showed that a model with preoperative air-bone gap closure and intraoperatively established incus length accurately predicts success after primary stapes surgery. Stapes surgery is a feasible and safe treatment option in patients with osteogenesis imperfecta. Success is associated with preoperative air-bone gap and intraoperatively established incus length.

Pancreatoenteral anastomosis or direct closure of the pancreatic remnant after a distal pancreatectomy: a single-centre experience

PubMed Central

Klein, Fritz; Glanemann, Matthias; Faber, Wladimir; Gül, Safak; Neuhaus, Peter; Bahra, Marcus

2012-01-01

Background A major complication of a distal pancreatectomy (DP) is the formation of a post-operative pancreatic fistula (POPF). In spite of the utilization of numerous surgical techniques no consensus on an appropriate technique for closure of the pancreatic remnant after DP has been established yet. The aim of this study was to analyse the impact of pancreatoenteral anastomosis (PE) vs. direct closure (DC) of the pancreatic remnant on POPF. Methods A total of 198 consecutive patients who underwent a distal pancreatectomy between 2002 and 2010 at our institution were retrospectively analysed for post-operative morbidity and mortality. Results One hundred and fifty-one patients (76.3%) received DC whereas PE was performed in 47 patients (23.7%). The incidence of POPF was higher in the DC group (22% vs. 11%), whereas the rate of post-operative haemorrhage was higher in the PE group (11% vs. 7%). However, these differences were not significant. Additionally, there were no significant differences in overall post-operative morbidity and mortality between the groups. Conclusions The performance of PE instead of DC may be considered as a safe alternative in individual patients, but it does not significantly lead to a general improvement in post-operative outcome after DP. An interdisciplinary collaboration in the prevention and treatment of POPF therefore remains essential. PMID:23134180

The design of multirate digital control systems

NASA Technical Reports Server (NTRS)

Berg, M. C.

1986-01-01

The successive loop closures synthesis method is the only method for multirate (MR) synthesis in common use. A new method for MR synthesis is introduced which requires a gradient-search solution to a constrained optimization problem. Some advantages of this method are that the control laws for all control loops are synthesized simultaneously, taking full advantage of all cross-coupling effects, and that simple, low-order compensator structures are easily accomodated. The algorithm and associated computer program for solving the constrained optimization problem are described. The successive loop closures , optimal control, and constrained optimization synthesis methods are applied to two example design problems. A series of compensator pairs are synthesized for each example problem. The succesive loop closure, optimal control, and constrained optimization synthesis methods are compared, in the context of the two design problems.

The measurement of mangrove characteristics in southwest Florida using SPOT multispectral data

NASA Technical Reports Server (NTRS)

Jensen, John R.; Lin, Hongyue; Yang, Xinghe; Ramsey, Elijah, III; Davis, Bruce A.; Thoemke, Chris W.

1991-01-01

An intensive in situ sampling program near Marco Island, Florida during 19-23 October 1988 collected information on mangrove type, maximum canopy height, and percent canopy closure. These data were correlated with selected vegetation index information derived from analysis of SPOT multispectral (XS) data obtained on 21 October 1988. The Normalized Difference (ND) vegetation index information was the most highly correlated index with percent canopy closure (r = 0.91). Percent canopy closure information can be used as a surrogate for mangrove density which is of great value when predicting which parts of the mangrove ecosystem are at greatest risk after an oil spill occurs. Such information is very valuable when constructing oil spill Environmental Sensitivity Index (ESI) Maps for tropical regions of the world.

SURBAL: computerized metes and bounds surveying

Treesearch

Roger N. Baughman; James H. Patric

1970-01-01

A computer program has been developed at West Virginia University for use in metes and bounds surveying. Stations, slope distances, slope angles, and bearings are primary information needed for this program. Other information needed may include magnetic deviation, acceptable closure error, desired map scale, and title designation. SURBAL prints out latitudes and...

Decision Rules Used in Academic Program Closure: Where the Rubber Meets the Road.

ERIC Educational Resources Information Center

Eckel, Peter D.

2002-01-01

Adopted a decision/action rationality framework to explore the criteria used to close academic programs at four universities. Findings suggested that decisions are based upon criteria other than those usually stated (e.g., cost, quality, and centrality), and that process leads to criteria generation. (EV)

Defunct Grants-Special Considerations for Termination Effectiveness.

ERIC Educational Resources Information Center

Whittington, Ronaele R.; Brand, Chrystal R.

1980-01-01

Charts the phases of denial, anger, bargaining, depression, acceptance, and hope in a rural work-study program for disadvantaged youth that lost its funding. An overview of national studies and reports on client terminations and program terminations is outlined. Closure-oriented tasks for the practitioner and implications for program…

Integrated Research/Education University Aircraft Design Program Development

DTIC Science & Technology

2017-04-06

iterations and loop shaping compared to MIMO control methods. Despite the drawbacks, loop closure and classical methods are the design methods most commonly...AFRL-AFOSR-VA-TR-2017-0077 Integrated Research/Education University Aircraft Design Program Development Eli Livne UNIVERSITY OF WASHINGTON 4333...SUBTITLE Integrated Research/Education University Aircraft Design Program Development 5a.  CONTRACT NUMBER 5b.  GRANT NUMBER FA9550-14-1-0027 5c.  PROGRAM

Cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of post-procedure compression: Initial outcomes of a post-market evaluation of the VenaSeal System (the WAVES Study).

PubMed

Gibson, Kathleen; Ferris, Brian

2017-04-01

Purpose Cyanoacrylate closure of the great saphenous vein with the VenaSeal™ Closure System is a relatively new modality. Studies have been limited to moderate-sized great saphenous veins and some have mandated postoperative compression stockings. We report the results of a prospective study of cyanoacrylate closure for the treatment of great saphenous vein, small saphenous veins, and/or accessory saphenous veins up to 20 mm in diameter. Methods Fifty subjects with symptomatic great saphenous vein, small saphenous veins, and/or accessory saphenous veins incompetence were each treated at a single session. Compression stockings were not used post-procedure. Subjects returned to clinic at week 1 and again at one month. Post-procedure evaluations were performed at seven days and one month and included numerical pain rating score, revised venous clinical severity score, the Aberdeen Varicose Vein Questionnaire score, and time to return to work and normal activities. Duplex ultrasound was performed at each visit. Findings Procedural pain was mild (numerical pain rating scale 2.2 ± 1.8). All treated veins (48 great saphenous vein, 14 accessory saphenous veins, and 8 small saphenous veins) had complete closure by duplex ultrasound at seven days and one month. Mean time to return to work and normal activities was 0.2 ± 1.1 and 2.4 ± 4.1 days, respectively. The revised venous clinical severity score was improved to 1.8 ± 1.4 ( p < .001) and Aberdeen Varicose Vein Questionnaire score to 8.9 ± 6.6 ( p < .001) at one month. Phlebitis in the treatment area or side branches occurred in 10 subjects (20%) and completely resolved in all but one subject (2%) by one month; 98% of subjects were "completely" or "somewhat" satisfied, and 2% "unsatisfied" with the procedure at one month, despite the protocol disallowance of concomitant side branch treatment. Conclusions Cyanoacrylate closure is safe and effective for the treatment of one or more incompetent saphenous or accessory saphenous veins. Closure rates were high even in the absence of the use of compression stockings or side branch treatment. Time back to work or normal activities was short and improvements in venous severity scores and QOL were significant, comparing favorably with alternative treatment methods.

Safe Patient Handling and Mobility: Development and Implementation of a Large-Scale Education Program.

PubMed

Lee, Corinne; Knight, Suzanne W; Smith, Sharon L; Nagle, Dorothy J; DeVries, Lori

This article addresses the development, implementation, and evaluation of an education program for safe patient handling and mobility at a large academic medical center. The ultimate goal of the program was to increase safety during patient mobility/transfer and reduce nursing staff injury from lifting/pulling. This comprehensive program was designed on the basis of the principles of prework, application, and support at the point of care. A combination of online learning, demonstration, skill evaluation, and coaching at the point of care was used to achieve the goal. Specific roles and responsibilities were developed to facilitate implementation. It took 17 master trainers, 88 certified trainers, 176 unit-based trainers, and 98 coaches to put 3706 nurses and nursing assistants through the program. Evaluations indicated both an increase in knowledge about safe patient handling and an increased ability to safely mobilize patients. The challenge now is sustainability of safe patient-handling practices and the growth and development of trainers and coaches.

School-Based Practices and Programs That Promote Safe and Drug-Free Schools. CASE/CCBD Mini-Library Series on Safe, Drug-Free, and Effective Schools.

ERIC Educational Resources Information Center

Guthrie, Patricia M.

This monograph focuses on school-based practices and programs that promote safe and drug-free schools. It begins with a description of the key characteristics of schools with effective programs and provides a model for school-wide support. Necessary steps for developing an effective system of universal prevention are listed and include: (1)…

Pulmonary artery closure in combination with patch technique for treating congenital heart disease combined with large patent ductus arteriosus: A clinical study of 9 cases

PubMed Central

Wen, Bing; Yang, Junya; Liu, Huiruo; Jiao, Zhouyang; Zhao, Wenzeng

2016-01-01

Objective: To document clinical experience of treating congenital heart disease combined with large patent ductus arteriosus with pulmonary artery closure in combination with patch technique. Methods: Thirty-six patients (8 males and 28 females) who suffered from congenital heart disease and underwent hybrid surgery in the First Affiliated Hospital of Zhengzhou University from October 2010 to February 2014 were selected for this study. They aged 14 to 39 years and weighed 32.20 to 61.50 kg. Diameter of arterial duct was between 10 mm and 13 mm; 28 cases were tube type, 4 cases were funnel type and four cases were window type. All patients had moderate or severe pulmonary arterial hypertension; besides, there were 28 cases of ventricular septal defect, 16 cases of atrial septal defect, eight cases of aortic insufficiency, four cases of mitral stenosis and insufficiency and four cases of infectious endocarditis. Cardz Pulmonary Bypass (CPB) was established after chest was opened along the middle line. With the help of Transesophageal echocardiography, large patent ductus arteriosus was blocked off through pulmonary artery. Pulmonary artery was cut apart after blocking of heart. Large patent ductus arteriosus on the side of pulmonary artery was strengthened with autologous pericardial patch. Results: Of 36 patients, 32 patients had patent ductus arteriosus closure device and four patients had atrial septal defect closure device. Pulmonary arteries of 36 cases were all successfully closed. Systolic pressure declined after closure ((54.86±19.23) mmHg vs (96.05±23.07) mmHg, p<0.05); average pulmonary arterial pressure also declined after closure ((39.15±14.83) mmHg vs (72.88±15.76) mmHg, p<0.05). The patients were followed up for one to fifty one months (average 11.5 months). Compared to before surgery, left atrial diameter, left ventricular diameter and pulmonary artery diameter all narrowed after surgery. Besides, clinical symptoms were relieved and cardiac function of the patients also improved. Conclusion: Hybrid surgery is feasible and safe in treating patients with large patent ductus arteriosus and congenital heart disease, which decreases surgical problems, shortens surgical time and lowers the incidence of complications. PMID:27375685

Pulmonary artery closure in combination with patch technique for treating congenital heart disease combined with large patent ductus arteriosus: A clinical study of 9 cases.

PubMed

Wen, Bing; Yang, Junya; Liu, Huiruo; Jiao, Zhouyang; Zhao, Wenzeng

2016-01-01

To document clinical experience of treating congenital heart disease combined with large patent ductus arteriosus with pulmonary artery closure in combination with patch technique. Thirty-six patients (8 males and 28 females) who suffered from congenital heart disease and underwent hybrid surgery in the First Affiliated Hospital of Zhengzhou University from October 2010 to February 2014 were selected for this study. They aged 14 to 39 years and weighed 32.20 to 61.50 kg. Diameter of arterial duct was between 10 mm and 13 mm; 28 cases were tube type, 4 cases were funnel type and four cases were window type. All patients had moderate or severe pulmonary arterial hypertension; besides, there were 28 cases of ventricular septal defect, 16 cases of atrial septal defect, eight cases of aortic insufficiency, four cases of mitral stenosis and insufficiency and four cases of infectious endocarditis. Cardz Pulmonary Bypass (CPB) was established after chest was opened along the middle line. With the help of Transesophageal echocardiography, large patent ductus arteriosus was blocked off through pulmonary artery. Pulmonary artery was cut apart after blocking of heart. Large patent ductus arteriosus on the side of pulmonary artery was strengthened with autologous pericardial patch. Of 36 patients, 32 patients had patent ductus arteriosus closure device and four patients had atrial septal defect closure device. Pulmonary arteries of 36 cases were all successfully closed. Systolic pressure declined after closure ((54.86±19.23) mmHg vs (96.05±23.07) mmHg, p<0.05); average pulmonary arterial pressure also declined after closure ((39.15±14.83) mmHg vs (72.88±15.76) mmHg, p<0.05). The patients were followed up for one to fifty one months (average 11.5 months). Compared to before surgery, left atrial diameter, left ventricular diameter and pulmonary artery diameter all narrowed after surgery. Besides, clinical symptoms were relieved and cardiac function of the patients also improved. Hybrid surgery is feasible and safe in treating patients with large patent ductus arteriosus and congenital heart disease, which decreases surgical problems, shortens surgical time and lowers the incidence of complications.

So many choices, so many ways to choose : how five state departments of transportation select safe routes to school for funding.

DOT National Transportation Integrated Search

2011-06-01

Safe Routes to School (SRTS) programs support children safely walking and biking to and from school. Each state Department of Transportation (DOT) awards federal grant money to proposal applications made by local SRTS programs. Because demand for fed...

78 FR 57319 - Children's Online Privacy Protection Rule Safe Harbor Proposed Self-Regulatory Guidelines...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-18

...-AB20 Children's Online Privacy Protection Rule Safe Harbor Proposed Self-Regulatory Guidelines; kidSAFE... proposed self-regulatory guidelines submitted by the kidSAFE Seal Program (``kidSAFE''), owned and operated... part of the SUPPLEMENTARY INFORMATION section below. Write ``kidSAFE Application for Safe Harbor...

High-performance space shuttle auxiliary propellant valve system

NASA Technical Reports Server (NTRS)

Smith, G. M.

1973-01-01

Several potential valve closures for the space shuttle auxiliary propulsion system (SS/APS) were investigated analytically and experimentally in a modeling program. The most promising of these were analyzed and experimentally evaluated in a full-size functional valve test fixture of novel design. The engineering investigations conducted for both model and scale evaluations of the SS/APS valve closures and functional valve fixture are described. Preliminary designs, laboratory tests, and overall valve test fixture designs are presented, and a final recommended flightweight SS/APS valve design is presented.

Base Realignment and Closure Environmental Evaluation (BRAC EE) Fort Devens, Massachusetts

DTIC Science & Technology

1995-09-01

Not Sampled ......... 6 2.3.2 Transformer Sites Sampled ........................ 7 2.4 Soil Sampling Protocol and Analytical Program ...Evaluation (AREE) 66. The study included evaluating the current PCB Transformer Management Program administered by the Fort Devens Environmental Management...Office (EMO), the Fort Devens Spill Contingency Plan, and the ongoing transformer inspection program . Personnel in both the Fort Devens EMO and the Fort

Retraining Programs for Displaced Workers in the Post-Industrial Era: An Exploration of Government Policies and Programs in Canada and England.

ERIC Educational Resources Information Center

White, Melissa

2003-01-01

Introduces the problem of widespread worker displacement. Argues the problem is more severe in regions where the employment base centers on a single industry or resource. Considers two government programs developed to address the need resulting from closure of the Canadian northern cod fishery and decline of the mining industry in England. (CAJ)

Enhanced Preliminary Assessment Fort Devens, Massachusetts

DTIC Science & Technology

1992-04-30

remedial programs and RCRA corrective actions at Fort Devens . The areas regulated under RCRA will require closure when no longer in...under which the work in the MEP has been developed requires full integration of CERCLA remedial programs and RCRA corrective actions at Fort Devens ...AREEs 65 and 67, asbestos and radon, respectively. Fort Devens has ongoing programs that deal with these concerns. Any remedial action or disturbance

34 CFR 361.88 - Reporting requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... RSA-911 data: (1) The number of individuals who exited the VR program in each closure category as specified in the definition of “Exit the VR program” under § 361.81. (2) The number of individuals who exited the VR program in competitive, self-, or BEP employment with earnings at or above the minimum wage...

34 CFR 361.88 - Reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... RSA-911 data: (1) The number of individuals who exited the VR program in each closure category as specified in the definition of “Exit the VR program” under § 361.81. (2) The number of individuals who exited the VR program in competitive, self-, or BEP employment with earnings at or above the minimum wage...

34 CFR 361.88 - Reporting requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... RSA-911 data: (1) The number of individuals who exited the VR program in each closure category as specified in the definition of “Exit the VR program” under § 361.81. (2) The number of individuals who exited the VR program in competitive, self-, or BEP employment with earnings at or above the minimum wage...

34 CFR 361.88 - Reporting requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... RSA-911 data: (1) The number of individuals who exited the VR program in each closure category as specified in the definition of “Exit the VR program” under § 361.81. (2) The number of individuals who exited the VR program in competitive, self-, or BEP employment with earnings at or above the minimum wage...

34 CFR 361.88 - Reporting requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... RSA-911 data: (1) The number of individuals who exited the VR program in each closure category as specified in the definition of “Exit the VR program” under § 361.81. (2) The number of individuals who exited the VR program in competitive, self-, or BEP employment with earnings at or above the minimum wage...

Good Teaching Matters, Teachers Matter, and Teacher Education Matters

ERIC Educational Resources Information Center

Gordon, Lynn Melby

2012-01-01

This paper was the keynote address at the June 6, 2012 Occidental College completion ceremony for new teachers completing their teacher credential program. This occasion was momentous because it was the final new teacher graduation that Occidental College would hold, due to the previously announced closure of the teacher preparation program by the…

A Research Based Sport Management Curricular Model: Undergraduate and Graduate Programs.

ERIC Educational Resources Information Center

Kelley, Dennie R.; And Others

This paper brings to closure a series of evaluation/action research studies on needs assessment by: (1) sport management personnel in sport business/agencies; (2) faculty in charge of curriculum in all known undergraduate and graduate sport management programs in higher education; and (3) undergraduate and graduate majors in sport management from…

Federal Agency Program Realignment and Closure Act

THOMAS, 111th Congress

Rep. Sullivan, John [R-OK-1

2009-02-12

House - 05/04/2009 Referred to the Subcommittee on Government Management, Organization, and Procurement. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Evaluation of safe routes to school programs : qualitative and quantitative analysis of parental decision-making.

DOT National Transportation Integrated Search

2011-08-01

In the United States, walking to school declined from 42% of 5-18 year olds in 1969 to 16% in 20011. The US : Department of Transportation has responded to this dramatic decrease by funding the Safe Routes to School program : for $612 million in SAFE...

Patent foramen ovale closure with GORE HELEX or CARDIOFORM Septal Occluder vs. antiplatelet therapy for reduction of recurrent stroke or new brain infarct in patients with prior cryptogenic stroke: Design of the randomized Gore REDUCE Clinical Study.

PubMed

Kasner, Scott E; Thomassen, Lars; Søndergaard, Lars; Rhodes, John F; Larsen, Coby C; Jacobson, Joth

2017-12-01

Rationale The utility of patent foramen ovale (PFO) closure for secondary prevention in patients with prior cryptogenic stroke is uncertain despite multiple randomized trials completed to date. Aims The Gore REDUCE Clinical Study (REDUCE) aims to establish superiority of patent foramen ovale closure in conjunction with antiplatelet therapy over antiplatelet therapy alone in reducing the risk of recurrent clinical ischemic stroke or new silent brain infarct in patients who have had a cryptogenic stroke. Methods and design This controlled, open-label trial randomized 664 subjects with cryptogenic stroke at 63 multinational sites in a 2:1 ratio to either antiplatelet therapy plus patent foramen ovale closure (with GORE® HELEX® Septal Occluder or GORE® CARDIOFORM Septal Occluder) or antiplatelet therapy alone. Subjects will be prospectively followed for up to five years. Neuroimaging is required for all subjects at baseline and at two years or study exit. Study outcomes The two co-primary endpoints for the study are freedom from recurrent clinical ischemic stroke through at least 24 months post-randomization and incidence of new brain infarct (defined as clinical ischemic stroke or silent brain infarct) through 24 months. The primary analyses are an unadjusted log-rank test and a binomial test of subject-based proportions, respectively, both on the intent-to-treat population, with adjustment for testing multiplicity. Discussion The REDUCE trial aims to target a patient population with truly cryptogenic strokes. Medical therapy is limited to antiplatelet agents in both arms thereby reducing confounding. The trial should determine whether patent foramen ovale closure with the Gore septal occluders is safe and more effective than medical therapy alone for the prevention of recurrent clinical ischemic stroke or new silent brain infarct; the neuroimaging data will provide an opportunity to further support the proof of concept. The main results are anticipated in 2017. Registration Clinical trial registration-URL: http://clinicaltrials.gov/show/NCT00738894.

The Safe and Drug-Free Schools Program

ERIC Educational Resources Information Center

Sherman, Lawrence W.

2000-01-01

In this paper, the author analyzes the Safe and Drug-Free Schools and Communities program and reveals the inherent flaws of what he calls "symbolic pork." The program is popular because it addresses subjects about which the public is deeply concerned: school safety and substance abuse. He notes that since 1986 the program has received…

Handbook: Collecting Groundwater Samples from Monitoring Wells in Frenchman Flat, CAU 98

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

Chapman, Jenny; Lyles, Brad; Cooper, Clay

Frenchman Flat basin on the Nevada National Security Site (NNSS) contains Corrective Action Unit (CAU) 98, which is comprised of ten underground nuclear test locations. Environmental management of these test locations is part of the Underground Test Area (UGTA) Activity conducted by the U.S. Department of Energy (DOE) under the Federal Facility Agreement and Consent Order (FFACO) (1996, as amended) with the U.S. Department of Defense (DOD) and the State of Nevada. A Corrective Action Decision Document (CADD)/Corrective Action Plan (CAP) has been approved for CAU 98 (DOE, 2011). The CADD/CAP reports on the Corrective Action Investigation that was conductedmore » for the CAU, which included characterization and modeling. It also presents the recommended corrective actions to address the objective of protecting human health and the environment. The recommended corrective action alternative is “Closure in Place with Modeling, Monitoring, and Institutional Controls.” The role of monitoring is to verify that Contaminants of Concern (COCs) have not exceeded the Safe Drinking Water Act (SDWA) limits (Code of Federal Regulations, 2014) at the regulatory boundary, to ensure that institutional controls are adequate, and to monitor for changed conditions that could affect the closure conditions. The long-term closure monitoring program will be planned and implemented as part of the Closure Report stage after activities specified in the CADD/CAP are complete. Groundwater at the NNSS has been monitored for decades through a variety of programs. Current activities were recently consolidated in an NNSS Integrated Sampling Plan (DOE, 2014). Although monitoring directed by the plan is not intended to meet the FFACO long-term monitoring requirements for a CAU (which will be defined in the Closure Report), the objective to ensure public health protection is similar. It is expected that data collected in accordance with the plan will support the transition to long-term monitoring at each CAU. The sampling plan is designed to ensure that monitoring activities occur in compliance with the UGTA Quality Assurance Plan (DOE, 2012). The sampling plan should be referenced for Quality Assurance (QA) elements and procedures governing sampling activities. The NNSS Integrated Sampling Plan specifies the groundwater monitoring that will occur in CAU 98 until the long-term monitoring program is approved in the Closure Report. The plan specifies the wells that must be monitored and categorizes them by their sampling objective with the associated analytical requirements and frequency. Possible sample collection methods and required standard operating procedures are also presented. The intent of this handbook is to augment the NNSS Integrated Sampling Plan by providing well-specific details for the sampling professional implementing the Sampling Plan in CAU 98, Frenchman Flat. This handbook includes each CAU 98 well designated for sampling in the NNSS Integrated Sampling Plan. The following information is provided in the individual well sections: 1. The purpose of sampling. 2. A physical description of the well. 3. The chemical characteristics of the formation water. 4. Recommended protocols for purging and sampling. The well-specific information has been gathered from numerous historical and current sources cited in each section, but two particularly valuable resources merit special mention. These are the USGS NNSS website (http://nevada.usgs.gov/doe_nv/ntsarea5.cfm) and the UGTA Field Operations website (https://ugta.nv.doe.gov/sites/Field%20Operations/default.aspx). 2 Land surface elevation and measuring point for water level measurements in Frenchman Flat were a focus during CAU investigations (see Appendix B, Attachment 1 in Navarro-Intera, 2014). Both websites listed above provide information on the accepted datum for each well. A summary is found on the home page for the well on the USGS website. Additional information is available through a link in the “Available Data” section to an “MP diagram” with a photo annotated with the datum information. On the UGTA Field Operations well page, the same information is in the “Wellhead Diagram” link. Well RNM-2s does not have an annotated photo at this time. All of the CAU 98 monitoring wells are located within Area 5 of Frenchman Flat, with the exception of ER-11-2 in Area 11 (Figure 1). The wells are clustered in two areas: the northern area (Figure 2) and the central area (Figure 3). Each well is discussed below in geographic order from north to south as follows: ER-11-2, ER-5-3 shallow piezometer, ER-5-3-2, ER-5-5, RNM-1, RNM-2s, and UE-5n.« less

Microelectromechanical safing and arming apparatus

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

Koehler, David R; Hoke, Darren A; Weichman, Louis S

2006-05-30

A two-stage acceleration sensing apparatus is disclosed which has applications for use in a fuze assembly for a projected munition. The apparatus, which can be formed by bulk micromachining or LIGA, can sense acceleration components along two orthogonal directions to enable movement of a shuttle from an "as-fabricated" position to a final position and locking of the shuttle in the final position. With the shuttle moved to the final position, the apparatus can perform one or more functions including completing an explosive train or an electrical switch closure, or allowing a light beam to be transmitted through the device.

Microelectromechanical safing and arming apparatus

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

Koehler, David R; Hoke, Darren A; Weichman, Louis S

2008-06-10

A two-stage acceleration sensing apparatus is disclosed which has applications for use in a fuze assembly for a projected munition. The apparatus, which can be formed by bulk micromachining or LIGA, can sense acceleration components along two orthogonal directions to enable movement of a shuttle from an "as-fabricated" position to a final position and locking of the shuttle in the final position. With the shuttle moved to the final position, the apparatus can perform one or more functions including completing an explosive train or an electrical switch closure, or allowing a light beam to be transmitted through the device.

The Milieu Manager: A Nursing Staffing Strategy to Reduce Observer Use in the Acute Psychiatric Inpatient Setting.

PubMed

Triplett, Patrick; Dearholt, Sandra; Cooper, Mary; Herzke, John; Johnson, Erin; Parks, Joyce; Sullivan, Patricia; Taylor, Karin F; Rohde, Judith

Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a "milieu manager" to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.

Piezosurgery for the repair of middle cranial fossa meningoencephaloceles.

PubMed

Acharya, Aanand N; Rajan, Gunesh P

2015-03-01

To describe the use of a piezosurgery medical device to perform a craniotomy and produce a split calvarial graft for the repair of middle cranial fossa meningoencephaloceles. Retrospective case review. Tertiary referral hospital. Ten consecutive patients undergoing middle cranial fossa approach for the repair of meningoencephaloceles. Therapeutic. Intraoperative and postoperative complications, success rate as defined by the ability to fashion a split calvarial graft that achieves complete closure of the tegmen defect. As a secondary outcome measure, evidence of integration of the split calvarial bone graft with the adjacent skull base was assessed. There were no intraoperative or postoperative complications. An appropriately sized calvarial bone graft was produced, and complete closure of the tegmen defect was achieved in all 10 cases. Computed tomography demonstrated evidence of integration of the bone graft in eight cases between 4 and 9 months after surgery. The piezosurgery medical device provides a safe and effective means by which the middle fossa craniotomy and split calvarial bone graft can be produced to repair defects of the middle fossa tegmen, with integration of the bone graft in the majority of cases.

C-SAFE: A Computer-Delivered Sexual Health Promotion Program for Latinas.

PubMed

Klein, Charles H; Kuhn, Tamara; Altamirano, Midori; Lomonaco, Carmela

2017-07-01

This article describes the development and evaluation of C-SAFE (Sexual Awareness for Everyone), a computer-delivered sexual health promotion program for Latinas. We first describe the process of adapting an evidence-based, group-level intervention into an individually administered computer-delivered program. We then present the methods and results of a randomized control trial with 321 Latinas in California and Florida to test C-SAFE's preliminary efficacy in reducing sexual health risk. We found no statistically significant differences between the two conditions at a six-month follow-up in terms of sexual behaviors or attitudes toward sexually transmitted infections and condoms, although C-SAFE women reported fewer days in the past month when their mental health was not good (p = .02). C-SAFE condition women also reported more satisfaction than control condition women in their assessment of information presentation (on a scale of 1 = poor and 5 = excellent; C-SAFE = 4.45 vs. control = 4.25, p = .053) and having learned something new (C-SAFE = 95.1% vs. control = 79.3%, χ 2 < 0.001), with utility of content for Latinas approaching significance (C-SAFE = 4.50 vs. control = 4.31, p = .058). In conclusion we discuss the importance of teachable moments, matching of delivery modalities to implementation contexts, and possible directions for evidence-based sexual health promotion programs given the current sexual health landscape.

A second-order closure analysis of turbulent diffusion flames. [combustion physics

NASA Technical Reports Server (NTRS)

Varma, A. K.; Fishburne, E. S.; Beddini, R. A.

1977-01-01

A complete second-order closure computer program for the investigation of compressible, turbulent, reacting shear layers was developed. The equations for the means and the second order correlations were derived from the time-averaged Navier-Stokes equations and contain third order and higher order correlations, which have to be modeled in terms of the lower-order correlations to close the system of equations. In addition to fluid mechanical turbulence models and parameters used in previous studies of a variety of incompressible and compressible shear flows, a number of additional scalar correlations were modeled for chemically reacting flows, and a typical eddy model developed for the joint probability density function for all the scalars. The program which is capable of handling multi-species, multistep chemical reactions, was used to calculate nonreacting and reacting flows in a hydrogen-air diffusion flame.

Extension's Efforts to Help Kids Be SAFE: Evaluation of a Statewide Bullying Prevention Program

ERIC Educational Resources Information Center

Duke, Adrienne; Norton, Jessica

2017-01-01

The evaluation reported in this article examined the effectiveness of a statewide bullying prevention program, Be SAFE. Be SAFE involves use of a positive youth development approach to influence peer groups rather than individual bullies or victims. Through the use of pre- and postprogram questionnaires, we found increases in youths' knowledge of…

30 CFR 250.456 - What safe practices must the drilling fluid program follow?

Code of Federal Regulations, 2010 CFR

2010-07-01

... INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations Drilling Fluid Requirements § 250.456 What safe practices must the drilling fluid program follow... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What safe practices must the drilling fluid...

Iterations of the SafeCare Model: An Evidence-Based Child Maltreatment Prevention Program

ERIC Educational Resources Information Center

Edwards, Anna; Lutzker, John R.

2008-01-01

SafeCare is an evidenced-based parenting program for at-risk and maltreating parents that addresses the social and family ecology in which child maltreatment occurs. SafeCare home visitors focus on behavioral skills that are trained to predetermined performance criteria. Recent research has stressed the importance of successful dissemination and…

Injection laryngoplasty as miniinvasive office-based surgery in patients with unilateral vocal fold paralysis - voice quality outcomes.

PubMed

Sielska-Badurek, Ewelina M; Sobol, Maria; Jędra, Katarzyna; Rzepakowska, Anna; Osuch-Wójcikiewicz, Ewa; Niemczyk, Kazimierz

2017-09-01

Injection laryngoplasty (glottis augmentation) is the preferred method in surgical management of unilateral vocal fold paralysis (UVFP). Traditionally, these procedures are performed in the operating room. Nowadays, however, these procedures have moved into the office. To evaluate the voice quality after transoral injection laryngoplasty under local anaesthesia in patients with unilateral vocal fold paralysis. Fourteen subjects (5 women and 9 men) with unilateral vocal fold paresis (9 with right vocal fold paresis and 5 with left vocal fold paresis) were included in the study. The mean age of the group was 57.8 ±19.0 years (32-83 years). All of the injection laryngoplasties were performed transorally, under local anaesthesia. The injection material was calcium hydroxylapatite. Before and 1, 3 and 6 months after the procedure the following variables were evaluated: voice perception, videostroboscopy, acoustic analysis, aerodynamic evaluation, and the subjective rating of the voice quality by the patient. After injection laryngoplasty, complete glottal closure was achieved or there was a significant improvement in the glottal closure of each subject. We noted great improvement in the post-injection objective and subjective voice outcomes and patients reported improvement in the voice-related quality of life. The transoral approach for injection laryngoplasty under local anaesthesia is an effective and safe way to treat incomplete glottal closure in patients with UVFP. The transoral approach is an efficient alternative to other surgical techniques used for vocal fold injection.

Laryngeal complications after type 1 thyroplasty.

PubMed

Cotter, C S; Avidano, M A; Crary, M A; Cassisi, N J; Gorham, M M

1995-12-01

Type I thyroplasty has become a primary surgical choice for voice restoration in patients with glottal incompetence. This study examines factors associated with laryngeal complications after type I thyroplasty. Ten laryngoscopic variables were analyzed from preoperative, intraoperative, and postoperative videolaryngoscopies of 51 patients undergoing 58 medialization procedures. Ten patient and operative variables were examined by medical record review. Major complications were defined as wound hemorrhage, airway obstruction, or prosthesis extrusion. Minor complications were defined as vocal fold hematoma without airway obstruction or prosthesis movement. The major complication rate was 8.6%, and the minor complication rate was 29%. No delayed hemorrhage or airway obstruction occurred. Prosthesis extrusion occurred in five (8.6%) patients 1 week to 5 months after surgery. Extrusion was associated with suboptimal prosthesis placement in 80% of cases. Two patients retained excellent glottal closure despite extrusion. Vocal fold hematoma was identified in 14 (24%) cases and resolved within 1 week. Prosthesis movement occurred in three (5%) patients 1 week to 6 months after surgery and resulted in poor glottal closure. All patients with prosthesis extrusion or movement were female. Type I thyroplasty remains a safe outpatient procedure with few major complications. Prosthesis extrusion was associated with suboptimal prosthesis placement and may or may not result in poor glottal closure. Minor vocal fold hematomas were relatively frequent, resolved rapidly, and were not associated with airway obstruction. Female patients may be more prone to complications because of their small laryngeal size.

Imaging Techniques in Percutaneous Cardiac Structural Interventions: Atrial Septal Defect Closure and Left Atrial Appendage Occlusion.

PubMed

Rodríguez Fernández, Antonio; Bethencourt González, Armando

2016-08-01

Because of advances in cardiac structural interventional procedures, imaging techniques are playing an increasingly important role. Imaging studies show sufficient anatomic detail of the heart structure to achieve an excellent outcome in interventional procedures. Up to 98% of atrial septal defects at the ostium secundum can be closed successfully with a percutaneous procedure. Candidates for this type of procedure can be identified through a systematic assessment of atrial septum anatomy, locating and measuring the size and shape of all defects, their rims, and the degree and direction of shunting. Three dimensional echocardiography has significantly improved anatomic assessments and the end result itself. In the future, when combined with other imaging techniques such as cardiac computed tomography and fluoroscopy, 3-dimensional echocardiography will be particularly useful for procedure guidance. Percutaneous closure of the left atrial appendage offers an alternative for treating patients with atrial fibrillation and contraindication for oral anticoagulants. In the future, the clinical focus may well turn to stroke prevention in selected patients. Percutaneous closure is effective and safe; device implantation is successful in 94% to 99% of procedures. However, the procedure requires an experienced cardiac structural interventional team. At present, 3-dimensional echocardiography is the most appropriate imaging technique to assess anatomy suitability, select device type and size, guide the procedure alongside fluoroscopy, and to follow-up the patient afterwards. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Effect of Unshaven Hair with Absorbable Sutures and Early Postoperative Shampoo on Cranial Surgery Site Infection.

PubMed

Oh, Won-Oak; Yeom, Insun; Kim, Dong-Seok; Park, Eun-Kyung; Shim, Kyu-Won

2018-01-01

Cranial surgical site infection is a significant cause of morbidity and mortality in hospitals. Preoperative hair shaving for cranial neurosurgical procedures is performed traditionally in an attempt to protect patients against complications from infections at cranial surgical sites. However, preoperative shaving of surgical incision sites using traditional surgical blades without properly washing the head after surgery can cause infections at surgical sites. Therefore, a rapid protocol in which the scalp remains unshaven and absorbable sutures are used for scalp closure with early postoperative shampooing is examined in this study. A retrospective comparative study was conducted from January 2008 to December 2012. A total of 2,641 patients who underwent unshaven cranial surgery with absorbable sutures for scalp closure were enrolled in this study. Data of 1,882 patients who underwent surgery with the traditional protocol from January 2005 to December 2007 were also analyzed for comparison. Of 2,641 patients who underwent cranial surgery with the rapid protocol, all but 2 (0.07%) patients experienced satisfactory wound healing. Of 1,882 patients who underwent cranial surgery with the traditional protocol, 3 patients (0.15%) had infections. Each infection occurred at the superficial incisional surgical site. Unshaven cranial surgery using absorbable sutures for scalp closure with early postoperative shampooing is safe and effective in the cranial neurosurgery setting. This protocol has a positive psychological effect. It can help patients accept neurosurgical procedures and improve their self-image after the operation. © 2017 S. Karger AG, Basel.

A randomised placebo-controlled trial of early treatment of the patent ductus arteriosus.

PubMed

Kluckow, Martin; Jeffery, Michele; Gill, Andy; Evans, Nick

2014-03-01

Failure of closure of the patent ductus arteriosus (PDA) may be associated with harm. Early cardiac ultrasound-targeted treatment of a large PDA may result in a reduction in adverse outcomes and need for later PDA closure with no increase in adverse effects. Multicentre, double-blind, placebo-controlled randomised trial. Three neonatal intensive care units in Australia. Eligible infants born <29 weeks were screened for a large PDA and received indomethacin or placebo before age 12 h. Death or abnormal cranial ultrasound. The trial ceased enrolment early due to lack of availability of indomethacin. 164 eligible infants were screened before 12 h; of the 92 infants with a large PDA, 44 were randomised to indomethacin and 48 to placebo. There was no difference in the main outcome between groups. Infants receiving early indomethacin had significantly less early pulmonary haemorrhage (PH) (2% vs 21%), a trend towards less periventricular/intraventricular haemorrhage (PIVH) (4.5% vs 12.5%) and were less likely to receive later open-label treatment for a PDA (20% vs 40%). The 72 non-randomised infants with a small PDA were at low risk of pulmonary haemorrhage and had an 80% spontaneous PDA closure rate. Early cardiac ultrasound-targeted treatment of a large PDA is feasible and safe, resulted in a reduction in early pulmonary haemorrhage and later medical treatment but had no effect on the primary outcome of death or abnormal cranial ultrasound. Australian New Zealand Clinical Trials Registry (ACTRN12608000295347).

Two-port robotic hysterectomy: a novel approach.

PubMed

Moawad, Gaby N; Tyan, Paul; Khalil, Elias D Abi

2018-03-24

The objective of the study was to demonstrate a novel technique for two-port robotic hysterectomy with a particular focus on the challenging portions of the procedure. The study is designed as a technical video, showing step-by-step a two-port robotic hysterectomy approach (Canadian Task Force classification level III). IRB approval was not required for this study. The benefits of minimally invasive surgery for gynecological pathology have been clearly documented in multiple studies. Patients had fewer medical and surgical complications postoperatively, better cosmesis and quality of life. Most gynecological surgeons require 3-5 ports for the standard gynecological procedure. Even though the minimally invasive multiport system provides an excellent safety profile, multiple incisions are associated with a greater risk for morbidity including infection, pain, and hernia. In the past decade, various new methods have emerged to minimize the number of ports used in gynecological surgery. The interventions employed were a two-port robotic hysterectomy, using a camera port plus one robotic arm, with a focus on salpingectomy and cuff closure. We describe a transvaginal and a transabdominal approach for salpingectomy and a novel method for cuff closure. The transvaginal and transabdominal techniques for salpingectomy for two-port robotic-assisted hysterectomy provide excellent tension and exposure for a safe procedure without the need for an extra port. We also describe a transvaginal technique to place the vaginal cuff on tension during closure. With the necessary set of skills on a carefully chosen patient, two-port robotic-assisted total laparoscopic hysterectomy is a feasible procedure.

Injection laryngoplasty as miniinvasive office-based surgery in patients with unilateral vocal fold paralysis – voice quality outcomes

PubMed Central

Sielska-Badurek, Ewelina M.; Jędra, Katarzyna; Rzepakowska, Anna; Osuch-Wójcikiewicz, Ewa; Niemczyk, Kazimierz

2017-01-01

Introduction Injection laryngoplasty (glottis augmentation) is the preferred method in surgical management of unilateral vocal fold paralysis (UVFP). Traditionally, these procedures are performed in the operating room. Nowadays, however, these procedures have moved into the office. Aim To evaluate the voice quality after transoral injection laryngoplasty under local anaesthesia in patients with unilateral vocal fold paralysis. Material and methods Fourteen subjects (5 women and 9 men) with unilateral vocal fold paresis (9 with right vocal fold paresis and 5 with left vocal fold paresis) were included in the study. The mean age of the group was 57.8 ±19.0 years (32–83 years). All of the injection laryngoplasties were performed transorally, under local anaesthesia. The injection material was calcium hydroxylapatite. Before and 1, 3 and 6 months after the procedure the following variables were evaluated: voice perception, videostroboscopy, acoustic analysis, aerodynamic evaluation, and the subjective rating of the voice quality by the patient. Results After injection laryngoplasty, complete glottal closure was achieved or there was a significant improvement in the glottal closure of each subject. We noted great improvement in the post-injection objective and subjective voice outcomes and patients reported improvement in the voice-related quality of life. Conclusions The transoral approach for injection laryngoplasty under local anaesthesia is an effective and safe way to treat incomplete glottal closure in patients with UVFP. The transoral approach is an efficient alternative to other surgical techniques used for vocal fold injection. PMID:29062449

The role of cognitive and visual abilities as predictors in the Multifactorial Model of Driving Safety.

PubMed

Anstey, Kaarin J; Horswill, Mark S; Wood, Joanne M; Hatherly, Christopher

2012-03-01

The current study evaluated part of the Multifactorial Model of Driving Safety to elucidate the relative importance of cognitive function and a limited range of standard measures of visual function in relation to the Capacity to Drive Safely. Capacity to Drive Safely was operationalized using three validated screening measures for older drivers. These included an adaptation of the well validated Useful Field of View (UFOV) and two newer measures, namely a Hazard Perception Test (HPT), and a Hazard Change Detection Task (HCDT). Community dwelling drivers (n=297) aged 65-96 were assessed using a battery of measures of cognitive and visual function. Factor analysis of these predictor variables yielded factors including Executive/Speed, Vision (measured by visual acuity and contrast sensitivity), Spatial, Visual Closure, and Working Memory. Cognitive and Vision factors explained 83-95% of age-related variance in the Capacity to Drive Safely. Spatial and Working Memory were associated with UFOV, HPT and HCDT, Executive/Speed was associated with UFOV and HCDT and Vision was associated with HPT. The Capacity to Drive Safely declines with chronological age, and this decline is associated with age-related declines in several higher order cognitive abilities involving manipulation and storage of visuospatial information under speeded conditions. There are also age-independent effects of cognitive function and vision that determine driving safety. Copyright © 2011 Elsevier Ltd. All rights reserved.

Safe Affordable Fission Engine-(SAFE-) 100a Heat Exchanger Thermal and Structural Analysis

NASA Technical Reports Server (NTRS)

Steeve, B. E.

2005-01-01

A potential fission power system for in-space missions is a heat pipe-cooled reactor coupled to a Brayton cycle. In this system, a heat exchanger (HX) transfers the heat of the reactor core to the Brayton gas. The Safe Affordable Fission Engine- (SAFE-) 100a is a test program designed to thermally and hydraulically simulate a 95 Btu/s prototypic heat pipe-cooled reactor using electrical resistance heaters on the ground. This Technical Memorandum documents the thermal and structural assessment of the HX used in the SAFE-100a program.

Online Student Evaluation Improves Course Experience Questionnaire Results in a Physiotherapy Program

ERIC Educational Resources Information Center

Tucker, Beatrice; Jones, Sue; Straker, Leon

2008-01-01

This paper reports the use of an online student evaluation system, Course Experience on the Web (CEW), in a physiotherapy program to improve their Course Experience Questionnaire (CEQ) results. CEW comprises a course survey instrument modeled on the CEQ and a tailored unit survey instrument. Closure of the feedback loop is integral in the CEW…

Decision Rules Used in Academic Program Closure: Where the Rubber Meets the Road.

ERIC Educational Resources Information Center

Eckel, Peter D.

This study examines, from an organizational perspective, decision rules guiding program discontinuance, testing the framework of decision rule rationality versus action rationality. A multi-site case study method was used; interviews were conducted with 11-16 individuals at each of four research I or II universities that had discontinued at least…

Universal Prevention Program Outcomes: Safe Schools Healthy Students in a Rural, Multicultural Setting

ERIC Educational Resources Information Center

Harris, Elizabeth; McFarland, Joyce; Siebold, Wendi; Aguilar, Rafael; Sarmiento, Ana

2007-01-01

The Idaho Consortium for Safe Schools Healthy Students consists of three school districts in rural North Central Idaho and the Nez Perce Tribe's Students for Success Program. Universal prevention programs implemented in the elementary schools include Second Step and the middle schools implemented the Life Skills program. Each of the three…

ACT against Violence Parents Raising Safe Kids Program: Effects on Maltreatment-Related Parenting Behaviors and Beliefs

ERIC Educational Resources Information Center

Knox, Michele S.; Burkhart, Kimberly; Hunter, Kimberly E.

2011-01-01

The ACT Against Violence Parents Raising Safe Kids program (ACT-PRSK) is an interactive violence prevention program developed by the American Psychological Association for parents of young children. The program teaches and supports parents in the areas of child development, roots and consequences of violence, anger management for adults and…

A feasibility study to assess the effectiveness of safe dates for teen mothers.

PubMed

Herrman, Judith W; Waterhouse, Julie K

2014-01-01

To determine the effectiveness of the adapted Safe Dates curriculum as an intervention for pregnant and/or parenting teens to prevent teen dating violence (TDV). This pre-/posttest, single-sample study provided a means to assess the effectiveness of an adapted Safe Dates curriculum for teen mothers. The adapted Safe Dates curriculum was implemented in three schools designed for the unique needs of teens who are pregnant and/or parenting. The final sample of 41 teen participants, with a mean age of 16.27, completed 80% of the curriculum and two of the three assessments. Most of the teens were pregnant during participation in the curriculum, and six had infants between age 1 and 3 months. The teen mothers completed the pretest, participated in the 10-session adapted Safe Dates curriculum, and completed the posttest at the end of the program and 1 month after program completion. The pre/posttest was adapted from the Safe Dates curriculum-specific evaluation instrument. Senior, undergraduate nursing students were trained in and implemented the curriculum. Participation in the adapted Safe Dates program yielded significant differences in the areas of responses to anger, gender stereotyping, awareness of resources for perpetrators and victims, and psychological violence perpetration. This adapted program may be effective in changing selected outcomes. The implementation of a larger scale, experimental/control group study may demonstrate the program's efficacy at reducing the incidence of TDV among teen mothers. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

The effects of the evidence-based Safe Dates dating abuse prevention program on other youth violence outcomes.

PubMed

Foshee, Vangie A; Reyes, Luz McNaughton; Agnew-Brune, Christine B; Simon, Thomas R; Vagi, Kevin J; Lee, Rosalyn D; Suchindran, Chiravath

2014-12-01

In response to recent calls for programs that can prevent multiple types of youth violence, the current study examined whether Safe Dates, an evidence-based dating violence prevention program, was effective in preventing other forms of youth violence. Using data from the original Safe Dates randomized controlled trial, this study examined (1) the effectiveness of Safe Dates in preventing peer violence victimization and perpetration and school weapon carrying 1 year after the intervention phase was completed and (2) moderation of program effects by the sex or race/ethnicity of the adolescent. Ninety percent (n = 1,690) of the eighth and ninth graders who completed baseline questionnaires completed the 1-year follow-up assessment. The sample was 51 % female and 26 % minority (of whom 69 % was black and 31 % was of another minority race/ethnicity). There were no baseline treatment group differences in violence outcomes. Treatment condition was significantly associated with peer violence victimization and school weapon carrying at follow-up; there was 12 % less victimization and 31 % less weapon carrying among those exposed to Safe Dates than those among controls. Treatment condition was significantly associated with perpetration among the minority but not among white adolescents; there was 23 % less violence perpetration among minority adolescents exposed to Safe Dates than that among controls. The observed effect sizes were comparable with those of other universal school-based youth violence prevention programs. Implementing Safe Dates may be an efficient way of preventing multiple types of youth violence.

Active Living Logan Square: joining together to create opportunities for physical activity.

PubMed

Gomez-Feliciano, Lucy; McCreary, Linda L; Sadowsky, Rob; Peterson, Serena; Hernandez, Adolfo; McElmurry, Beverly J; Park, Chang Gi

2009-12-01

The Active Living Logan Square target audience is the community of the southwest corner of Logan Square, an urban Chicago community of 84,466 residents, mostly Latinos. Through the Active Living by Design (ALbD) initiative, the Logan Square Neighborhood Association leveraged its 48 years of existence in the neighborhood to create opportunities and build partnerships. Activities addressed three primary goals: (1) enhance school environments and practices to support physical activity before, during, and after the school day; (2) encourage individuals and families to enjoy outdoor activities in their own communities; and (3) create safe, inviting places for activity that connect to surrounding communities. The partnership's participatory approach involved a variety of community stakeholders in developing and implementing affordable, accessible, culturally acceptable, and sustainable physical activities for children and their families. The partnership successfully piloted Open Streets (temporary street closures) and advocated for development of the Bloomingdale Trail, an elevated rails-to-trails project. In schools, the partnership changed the culture at McAuliffe Elementary to support healthy behaviors through new policies, physical projects, and programs. Vital components of the project's success included a full-time coordinator with strong community ties; time to build healthy relationships within the partnership and community; the use of culturally relevant strategies; and flexibility to welcome complementary opportunities. The partnership intentionally did not produce a single community-recognized campaign; instead, it chose to use limited resources to promote tangible programs and projects that led to sustainable and replicable changes that promote physical activity.

Feasibility of Using Fluorescence Spectrophotometry to Develop a Sensitive Dye Immersion Method for Container Closure Integrity Testing of Prefilled Syringes.

PubMed

Lu, Xujin; Lloyd, David K; Klohr, Steven E

2016-01-01

A feasibility study was conducted for a sensitive and robust dye immersion method for the measurement of container closure integrity of unopened prefilled syringes using fluorescence spectrophotometry as the detection method. A Varian Cary Eclipse spectrofluorometer was used with a custom-made sample holder to position the intact syringe in the sample compartment for fluorescence measurements. Methylene blue solution was initially evaluated as the fluorophore in a syringe with excitation at 607 nm and emission at 682 nm, which generated a limit of detection of 0.05 μg/mL. Further studies were conducted using rhodamine 123, a dye with stronger fluorescence. Using 480 nm excitation and 525 nm emission, the dye in the syringe could be easily detected at levels as low as 0.001 μg/mL. The relative standard deviation for 10 measurements of a sample of 0.005 μg/mL (with repositioning of the syringe after each measurement) was less than 1.1%. A number of operational parameters were optimized, including the photomultiplier tube voltage, excitation, and emission slit widths. The specificity of the testing was challenged by using marketed drug products and a protein sample, which showed no interference to the rhodamine detection. Results obtained from this study demonstrated that using rhodamine 123 for container closure integrity testing with in-situ (in-syringe) fluorescence measurements significantly enhanced the sensitivity and robustness of the testing and effectively overcame limitations of the traditional methylene blue method with visual or UV-visible absorption detection. Ensuring container closure integrity of injectable pharmaceutical products is necessary to maintain quality throughout the shelf life of a sterile drug product. Container closure integrity testing has routinely been used to evaluate closure integrity during product development and production line qualification of prefilled syringes, vials, and devices. However, container closure integrity testing has recently gained industry attention due to increased regulatory agency scrutiny regarding the analytical rigor of container closure integrity testing methods and expectations to use container closure integrity testing in lieu of sterility tests in stability programs. Methylene blue dye is often used for dye ingress testing of container closure integrity, but we found it unsuitable for reliable detection of small breaches in prefilled syringes of drug product. This work describes the suitability and advantages of using a fluorescent dye and spectroscopic detection for a robust, sensitive, and quality control-friendly container closure integrity testing method for prefilled syringes. © PDA, Inc. 2016.

Development of explosively driven launcher for meteoroid studies

NASA Technical Reports Server (NTRS)

Baum, D. W.

1973-01-01

The results of a continuing program to develop an explosively driven 2-stage hypervelocity launcher capable of achieving velocities between 15 and 20 km/sec are described. Previous efforts had identified incomplete barrel collapse as a limiting factor in launcher performance. Correlation of experimental and computational results obtained in the present study indicate that boundary-layer gases within the barrel act to prevent complete closure. Simplified calculations suggest that in-contact explosives may have insufficient energy densities to collapse the barrel against a developed boundary layer. Higher energy densities, sufficient to produce complete closure, were obtained with the use of steel flyer plates accelerated by a phased explosive lens. However, when flat flyer plates were impacted on the barrel, the sides of the barrel were observed to rupture and leak gas prior to barrel closure. A promising solution to this problem (untested) is to produce a symmetrical collapse with a cylindrical tube around the barrel.

Annual Report, Fall 2016: Identifying Cost Effective Tank Waste Characterization Approaches

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

Reboul, S. H.; DiPrete, D. P.

2016-12-12

This report documents the activities that were performed during the second year of a project undertaken to improve the cost effectiveness and timeliness of SRNL’s tank closure characterization practices. The activities performed during the first year of the project were previously reported in SRNL-STI-2015-00144. The scope of the second year activities was divided into the following three primary tasks: 1) develop a technical basis and strategy for improving the cost effectiveness and schedule of SRNL’s tank closure characterization program; 2) initiate the design and assembly of a new waste removal system for improving the throughput and reducing the personnel dosemore » associated with extraction chromatography radiochemical separations; and 3) develop and perform feasibility testing of three alternative radiochemical separation protocols holding promise for improving high resource demand/time consuming tank closure sample analysis methods.« less

Gender dysphoria and the controversy over the Safe Schools program.

PubMed

Parkinson, Patrick

2017-10-01

The Safe Schools program has attracted great controversy. On one end of the spectrum, it is defended as an anti-bullying program for young people who identify themselves as gay or lesbian, or have issues concerning their gender identity. On the other end of the spectrum, it is regarded as social engineering. This article seeks to promote a discussion of the way in which gender identity issues are addressed in the Safe Schools program. It is argued that the information in this program to Principals, teachers and young people is inaccurate and misleading. The program, as presently designed, may actually cause harm to children and young people who experience gender identity issues because it promotes gender transitioning without expert medical advice. The Safe Schools materials do not acknowledge that the great majority of children resolve gender dysphoria issues around the time of puberty. It may be much more difficult for a child to accept his or her gender at puberty if he or she has already changed name and gender identity in primary school. These deficits need to be addressed if the program is to continue.

An evaluation of abdominal wall closure in general surgical and gynecological residents.

PubMed

Williams, Z; Williams, S; Easley, H A; Seita, H M; Hope, W W

2017-12-01

To evaluate abdominal wall closure knowledge base and technical skills in surgical and OB/GYN residents. Residents consented to participate in a skills laboratory and quiz. The skills portion involved closure of a 10-cm incision on a simulated abdominal wall. Participants were timed, filmed, and graded using a standardized grading system. Thirty surgical and OB/GYN residents participated. All residents reported closing the abdominal wall continuously, 97% preferred slowly absorbing sutures (28/29), 97% preferred taking 1-cm bites (29/30), and 93% spaced bites 1 cm apart (27/29). However, 77% (10/13) of surgery residents identified 4:1 as the ideal suture to wound length ratio; 47% (7/15) of OB/GYN residents believed it to be 2:1, and another 40% (6/15) indicated 3:1 (p < 0.0001). In the simulation, OB/GYN residents used significantly fewer stitches (p = 0.0028), significantly more distance between bites (p < 0.0001), and significantly larger bite size (p < 0.0001) than surgery residents. When graded, there was no significant difference between programs. Despite some knowledge regarding the principles of abdominal wall closure among surgical and OB/GYN residents, more instruction is needed. We identified some differences in knowledge base and techniques for abdominal wall closure among general surgery and OB/GYN residents, which are likely due to differences in educational curriculums.

Interactional Practices Used in the Teaching of Conflict Prevention and Resolution Skills in an Innovative Safe School Program at an Elementary School

ERIC Educational Resources Information Center

Shin, Annalise Grace

2010-01-01

Within the framework of language socialization, this dissertation uses conversation analytic and ethnographic methods to examine the interactional practices used by the adult safe school educator at a progressive elementary school to socialize students into beliefs and practices associated with the school's Cool Tools Safe School Program. Cool…

Manual for physical fitness

NASA Technical Reports Server (NTRS)

Coleman, A. E.

1981-01-01

Training manual used for preflight conditioning of NASA astronauts is written for audience with diverse backgrounds and interests. It suggests programs for various levels of fitness, including sample starter programs, safe progression schedules, and stretching exercises. Related information on equipment needs, environmental coonsiderations, and precautions can help readers design safe and effective running programs.

Dislocated Workers. Trade Adjustment Assistance Program Flawed. Statement of Linda G. Morra, Director of Education and Employment Issues, Human Resources Division. Testimony before the Subcommittee on Employment, Housing and Aviation, Committee on Government Operations, House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. Div. of Human Resources.

The Trade Adjustment Assistance (TAA) program is designed to help the more than 1 million workers per year who lose their jobs because of permanent layoffs or plant closures, due in part because of imports. Studies show, however, that the TAA program fails to meet the seven goals of a successful reemployment assistance program: (1) TAA benefits…

Securing the appendiceal stump with the Gea extracorporeal sliding knot during laparoscopic appendectomy is safe and economical.

PubMed

Arcovedo, R; Barrera, H; Reyes, H S

2007-10-01

Laparoscopic appendectomy (LA) has become very popular. One criticism of this approach is the high cost of the disposable equipment such as the linear stapler. An alternative would be suture ligation of the appendiceal base. To prove the safety of the Gea extracorporeal sliding knot (GESK) for closure of the stump after LA, a retrospective study was conducted. For this study, 63 LA procedures performed by one surgeon using the Gea knot (group A) were reviewed and compared with 63 LA procedures performed by two other surgeons (group B) using the linear stapler. The GESK is created with 0-prolene in the manner already described. The main variable was the presence or absence of blowout, leak, or fistula from the appendiceal stump. The secondary variables were abdominal abscess, wound infection, and need for readmission or reoperation. The results were analyzed using the appropriate statistical methods. Both groups were similar in terms of age, gender, and pathologic diagnosis. No patient in group A or B experienced a colonic fistula, stump blowout, or leak. In group A, one patient experienced interloop abscesses. There were two wound infections. In group B, one patient experienced a wound infection, and another patient had a wound dehiscence of the umbilical port, which required reoperation. No statistical differences were noted between the two groups. There are surgeons who routinely use sutures to secure the stump of the appendectomy. This study aimed to demonstrate that the GESK is as secure as the stapler for closure of the appendiceal stump. The GESK could be passed through a 5-mm trocar, potentially avoiding complications of a larger trocar site. The GESK seems to be an economic and safe alternative to the stapler.

Choosing a Safe and Successful Weight-Loss Program

MedlinePlus

... For Reporters Meetings & Workshops Follow Us Home Health Information Weight Management Choosing a Safe and Successful Weight-loss Program ... at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information ... Disease Urologic Diseases Endocrine Diseases Diet & Nutrition ...

Premature femoral neck physeal closure in Perthes' disease.

PubMed

Bowen, J R; Schreiber, F C; Foster, B K; Wein, B K

1982-01-01

One hundred premature femoral neck physeal closures in 430 hips with Perthes' disease have occurred in two patterns central and lateral. Abnormal physeal growth can be demonstrated early by a narrowed physeal plate with overlying avascular epiphysis and marked metaphyseal reaction below. Subsequently, a bony bridge forms between the metaphysis and epiphysis. If the physeal closure is central, the mature hip will have a short femoral neck, a relatively round femoral head, a trochanter that has overgrown the femoral head, a short leg, and a mildly deformed acetabulum. If the physeal closure is lateral, the mature hip will have a femoral head that is externally tilted as the medial neck lengthens and the lateral neck remains short, a trochanter that has overgrown the femoral head, an oval femoral head, a short leg, and a deformed acetabulum. A physeal arrest is a contraindication for a varus osteotomy because it accentuates the deformity, especially in the greater trochanter. The leg-length discrepancy may be treated by epiphysiodesis of the contralateral femur, when necessary, and the abductor muscle insufficiency may be treated by an exercise program or distal and lateral transfer of the greater trochanter.

Bounds on stochastic chemical kinetic systems at steady state

NASA Astrophysics Data System (ADS)

Dowdy, Garrett R.; Barton, Paul I.

2018-02-01

The method of moments has been proposed as a potential means to reduce the dimensionality of the chemical master equation (CME) appearing in stochastic chemical kinetics. However, attempts to apply the method of moments to the CME usually result in the so-called closure problem. Several authors have proposed moment closure schemes, which allow them to obtain approximations of quantities of interest, such as the mean molecular count for each species. However, these approximations have the dissatisfying feature that they come with no error bounds. This paper presents a fundamentally different approach to the closure problem in stochastic chemical kinetics. Instead of making an approximation to compute a single number for the quantity of interest, we calculate mathematically rigorous bounds on this quantity by solving semidefinite programs. These bounds provide a check on the validity of the moment closure approximations and are in some cases so tight that they effectively provide the desired quantity. In this paper, the bounded quantities of interest are the mean molecular count for each species, the variance in this count, and the probability that the count lies in an arbitrary interval. At present, we consider only steady-state probability distributions, intending to discuss the dynamic problem in a future publication.

Technical Review of Retrieval and Closure Plans for the INEEL INTEC Tank Farm Facility

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

Bamberger, Judith A; Burks, Barry L; Quigley, Keith D

2001-09-28

The purpose of this report is to document the conclusions of a technical review of retrieval and closure plans for the Idaho National Energy and Environmental Laboratory (INEEL) Idaho Nuclear Technology and Engineering Center (INTEC) Tank Farm Facility. In addition to reviewing retrieval and closure plans for these tanks, the review process served as an information exchange mechanism so that staff in the INEEL High Level Waste (HLW) Program could become more familiar with retrieval and closure approaches that have been completed or are planned for underground storage tanks at the Oak Ridge National Laboratory (ORNL) and Hanford sites. Thismore » review focused not only on evaluation of the technical feasibility and appropriateness of the approach selected by INEEL but also on technology gaps that could be addressed through utilization of technologies or performance data available at other DOE sites and in the private sector. The reviewers, Judith Bamberger of Pacific Northwest National Laboratory (PNNL) and Dr. Barry Burks of The Providence Group Applied Technology, have extensive experience in the development and application of tank waste retrieval technologies for nuclear waste remediation.« less

Mentoring staff members as patient safety leaders: the Clarian Safe Passage Program.

PubMed

Rapala, Kathryn

2005-06-01

This article describes a second element of the Synergy Model of Patient Care implemented by Clarian Health Partners of Indiana. The Clarian Safe Passage Program is a unique approach to the promotion of patient safety. In this program, frontline staff nurses are trained to serve as Safe Passage nurses, who are unit-based safety experts. These nurses mentor each other and their peers in acquiring patient safety expertise and promoting a free flow of information to avert actual and potential errors in health care delivery.

Summary Report on the Audit of Defense Base Realignment and Closure Budget Data

DTIC Science & Technology

1996-04-03

management control program as it applied to the audit objectives. This report summarizes the results of the specific objectives in Finding A and discusses the management control objective in Finding B.

40 CFR 63.961 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR SOURCE CATEGORIES (CONTINUED) National Emission... air emissions to the atmosphere by blocking an opening to the individual drain system. Closure devices...

Practical operational implementation of Teton Pass avalanche monitoring infrasound system.

DOT National Transportation Integrated Search

2008-12-01

Highway snow avalanche forecasting programs typically rely on weather and field observations to make road closure and hazard : evaluations. Recently, infrasonic avalanche monitoring technology has been developed for practical use near Teton Pass, WY ...

The Resident-Run Minor Surgery Clinic: A Pilot Study to Safely Increase Operative Autonomy.

PubMed

Wojcik, Brandon M; Fong, Zhi Ven; Patel, Madhukar S; Chang, David C; Petrusa, Emil; Mullen, John T; Phitayakorn, Roy

General surgery training has evolved to align with changes in work hour restrictions, supervision regulations, and reimbursement practices. This has culminated in a lack of operative autonomy, leaving residents feeling inadequately prepared to perform surgery independently when beginning fellowship or practice. A resident-run minor surgery clinic increases junior resident autonomy, but its effects on patient outcomes have not been formally established. This pilot study evaluated the safety of implementing a resident-run minor surgery clinic within a university-based general surgery training program. Single institution case-control pilot study of a resident-run minor surgery clinic from 9/2014 to 6/2015. Rotating third-year residents staffed the clinic once weekly. Residents performed operations independently in their own procedure room. A supervising attending surgeon staffed each case prior to residents performing the procedure and viewed the surgical site before wound closure. Postprocedure patient complications and admissions to the hospital because of a complication were analyzed and compared with an attending control cohort. Massachusetts General Hospital General in Boston, MA; an academic tertiary care general surgery residency program. Ten third-year general surgery residents. Overall, 341 patients underwent a total of 399 procedures (110 in the resident clinic vs. 289 in the attending clinic). Minor surgeries included soft tissue mass excision (n = 275), abscess incision and drainage (n = 66), skin lesion excision (n = 37), skin tag removal (n = 15), and lymph node excision (n = 6). There was no significant difference in the overall rate of patients developing a postprocedure complication within 30 days (3.6% resident vs. 2.8% attending; p = 0.65); which persisted on multivariate analysis. Similar findings were observed for the rate of hospital admission resulting from a complication. Resident evaluations overwhelmingly supported the rotation, citing increased operative autonomy as the greatest strength. Implementation of a resident-run minor surgery clinic is a safe and effective method to increase trainee operative autonomy. The rotation is well suited for mid-level residents, as it provides an opportunity for realistic self-evaluation and focused learning that may enhance their operative experience during senior level rotations. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

CELSS Transportation Analysis

NASA Technical Reports Server (NTRS)

Olson, R. L.; Gustan, E. A.; Vinopal, T. J.

1985-01-01

Regenerative life support systems based on the use of biological material was considered for inclusion in manned spacecraft. Biological life support systems are developed in the controlled ecological life support system (CELSS) program. Because of the progress achieved in the CELSS program, it is determined which space missions may profit from use of the developing technology. Potential transportation cost savings by using CELSS technology for selected future manned space missions was evaluated. Six representative missions were selected which ranged from a low Earth orbit mission to those associated with asteroids and a Mars sortie. The crew sizes considered varied from four persons to five thousand. Other study parameters included mission duration and life support closure percentages, with the latter ranging from complete resupply of consumable life support materials to 97% closure of the life support system. The analytical study approach and the missions and systems considered, together with the benefits derived from CELSS when applicable are described.

Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: a single-center experience.

PubMed

Faustino, Ana; Paiva, Luís; Providência, Rui; Trigo, Joana; Botelho, Ana; Costa, Marco; Leitão-Marques, António

2013-06-01

In non-valvular atrial fibrillation 90% of thrombi originate in the left atrial appendage (LAA). Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism. To evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed. Patients with non-valvular atrial fibrillation and CHADS2 score ≥2 in whom oral anticoagulation was impractical or contraindicated or had failed underwent percutaneous LAA closure according to the standard technique. After the procedure, dual antiplatelet therapy was maintained for one month, followed by single antiplatelet therapy indefinitely. Patients were followed by clinical assessment and transthoracic and transesophageal echocardiography. The procedure was performed in 22 of the 23 selected patients (95.7%), mean age 70±9 years, CHADS2 score 3.2±0.9 and CHA2DS2-VASC score 4.7±1.4. Intraprocedural device replacement was necessary only in the first patient, due to oversizing. The following periprocedural complications were observed: one femoral pseudoaneurysm, three femoral hematomas and two minor oropharyngeal bleeds, resolved by local hemostatic measures. During a 12±8 month follow-up a mild peri-device flow and a thrombus adhering to the device, resolved under with enoxaparin therapy, were identified. The rate of transient ischemic attack (TIA)/stroke was lower than expected according to the CHADS2 score (0 vs. 6.7±2.2%). In our initial experience, this procedure proved to be a feasible, safe and effective alternative for atrial fibrillation patients in whom oral anticoagulation is not an option. Only relatively minor complications were observed, with a lower than expected TIA/stroke rate. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

[Outcome of transcatheter closure of perimembranous ventricular septal defect with modified double-disk occluder device].

PubMed

Liu, Jing; You, Xiao-hua; Zhao, Xian-xian; Hu, Jian-qiang; Cao, Jiang; Xu, Rong-liang; Wu, Hong; Chen, Shao-ping; Zhang, Jian-liang; Zheng, Xing; Qin, Yong-wen

2010-04-01

To evaluate the efficacy and adverse effects of transcatheter closure of perimembranous ventricular septal defect (pmVSD) with modified double-disk occluder device (MDVO). Clinical data including clinical examination, electrocardiography daily after the procedure for a week, chest-X-rays and TTE before discharge and at 3-5 days after the procedure were analyzed from 604 patients underwent percutaneous closure of a pmVSD with MDVO at our department between December 2001 and December 2008. Procedure was successful in 576 out of 604 patients (95.4%) and 583 VSD occluders were placed. Endocarditis, thromboembolism, or deaths were not observed after procedure. Conduction block occurred in 81 patients (56 RBBB, 14 LBBB) and transient nonparoxysmal ventricular tachycardia in 31 patients after the procedure. Complete heart block occurred in 11 patients, 9 of them recovered in 3 weeks, permanent pacemaker was implanted in 2 patients (one had transient III degrees AVB before the procedure, the other underwent simultaneous closure of ventricular septal defect and atrial septal defect). Trivial/small residual shunts were found in 69 patients (12.0%). The residual shunts disappeared in 31 patients and remained unchanged in 38 patients (6.6%) 7 days after procedures. Aortic regurgitation developed in 5 patients (2 trivial/small, 3 small/moderate), and tricuspid regurgitation was present in 35 patients (32 trivial/small, 3 moderate). Five patients developed haemolysis (device retrieved via catheter in 1 patient due to persistent haemolysis, the other 4 patients recovered 3-14 days post procedure). Pseudoaneurysm of femoral artery occurred in 1 patient, and disappeared by pressure dressing. Device was successfully replaced in 2 patients with either device embolization (n = 1) or device misplacement (n = 1) after device retrieval by catheter. It is safe and effective to close congenital perimembranous ventricular septal defect with domestic-made occluder device.

Initial experience with the 3.3 Fr Mongoose® pigtail catheter for aortic angiography during patent ductus arteriosus closure in small patients.

PubMed

Hena, Zachary; Sutton, Nicole J; Gates, Gregory J; Taragin, Benjamin H; Pass, Robert H

2017-01-01

Smaller femoral arterial sheaths may be associated with fewer vascular complications. The 3.3 Fr Mongoose ® Pediavascular pigtail catheter is a catheter that allows higher flow rates, potentially resulting in improved angiographic quality. We reviewed our experience with this small catheter during patent ductus arteriosus (PDA) closure. Review of patients ≤20 kg in whom the Mongoose ® catheter was used during PDA closure from 12/13 to 4/15. Angiographic efficacy and procedural details were compared to ten 4 Fr catheter cases. Comparisons were performed using Mann-Whitney U-test; P < 0.05 was statistically significant. Twelve (9 female) patients were catheterized with a 3.3 Fr Mongoose ® . Median weight 10.5 kg (range 6.4-18.2), height 81 cm (range 37-111), and body surface area (BSA) 0.47 m 2 (range 0.33-0.75) were similar to ten patients (3 females) in the 4 Fr control group ( P = NS); median weight 9.9 kg (range 6-16.8), height 80 cm (range 64-102), and BSA 0.46 m2 (range 0.31-0.74). Angiographic quality was subjectively adequate with both with no difference in the median pixel density between the two techniques (3.3 Fr: 76.7 [range 33.5-90] and 4 Fr: [70; 38-102]; P = NS). Contrast used was similar between the groups (3.3 Fr: median 4.2 ml/kg and 4 Fr: 4.9 ml/kg; P = NS). Median radiation dose was similar in the two groups (3.3 Fr: 28.1 mGy [range 17.2-38] and 4 Fr: 38 mGy [range 20.4-58.5]; P = NS). All ducts were closed at latest follow-up ( P = NS). No complications were encountered. The 3.3 Fr Mongoose ® allowed similar angiography to the 4 Fr pigtail catheter, allowing safe and effective transcatheter PDA closure in small children.

Chest closure without drainage after open patent ductus arteriosus ligation in Ugandan children: A non blinded randomized controlled trial.

PubMed

Kebba, Naomi; Mwambu, Tom; Oketcho, Michael; Izudi, Jonathan; Obuku, Ekwaro A

2016-09-29

There is clinical equipoise regarding post-operative management of patients with patent ductus arteriosus (PDA) without insertion of a chest drain. This study evaluated post operative outcomes of chest closure with or without a drain following Patent Ductus Arteriosus ligation among childen at Uganda Heart Instritute (UHI). This was an open label randomized controlled trial of 62 children 12 years of age and below diagnosed with patent ductus arteriosus at Mulago National Teaching and Referral Hospital, Uganda. Participants were randomized in the ratio of 1:1 with surgical ligation of patent ductus arteriosus to either thoracotomy closure with a chest tube or without a chest tube. All participants received standard care and were monitored hourly for 24 hours then until hospital discharge. The combined primary endpoint consisted of significant pleural space accumulation of fluid or air, higher oxygen need or infection of the surgical site. Analysis was conducted by multivariable logistic regression analysis at 5 % significance level. We enrolled 62 participants, 46 (74 %) of whom were females. Their median age was 12 months (IQR: 8-36). Participants in the no-drain arm significantly had less post-operative complications compared to the drain arm (Unadjusted odds ratio [uOR]: 0.21, 95 % CI: 0.06-0.73, p = 0.015). This "protective effect" remained without statistical significance in the multivariable regression model (Adjusted odds ratio [aOR]: 0.07, 95 % CI: 0.00-2.50, p = 0.144). Children aged below 6 years with patent ductus arterious can safely and effectively have thoracotomy closure without using a drain in uncomplicated surgical ligation of the PDA. Chest drain was associated with post-operative complications. The trial was registered in the Pan African Clinical Trials registry on 1st/July/2012, retrospectively registered. Identifier number PACTR201207000395469 .

Percutaneous closure of patent ductus arteriosus in children using amplatzer duct occluder II: relationship between PDA type and risk of device protrusion into the descending aorta.

PubMed

Masri, Samer; El Rassi, Issam; Arabi, Mariam; Tabbakh, Anas; Bitar, Fadi

2015-08-01

To compare the efficacy and safety of Amplatzer Duct Occluder II (ADOII) among the various patent ductus arteriosus (PDA) types, and to assess the association between development of aortic obstruction and the PDA type in terms of measurable parameters as the device angulation and distance of upper end protrusion into the aortic lumen. Retrospective cohort study involving 50 consecutive subjects who underwent ADO II device closure of PDA. The median age and weight at intervention were 13 months (5.5 months to 18 years) and 11 (6-67) kg respectively. The median smallest ductal diameter by angiography was 3.2 (1.9-5.4) mm. Thirty two patients had type A PDA, 5 had type C, 5 had type D, and 8 had type E. Residual shunt was seen in only 1 patient who had a tubular PDA and resolved within 2 months of the procedure. No device embolization or pulmonary side protrusion were noted. There was a 16% aortic protrusion rate. The median distance of protrusion of the upper end of the device into the aortic lumen was 3.1 (0-9) mm and the median angle formed between the aortic end of the device and the PDA take-off was 10.4 (0-80.6) degrees. These latter parameters of aortic obstruction were significantly higher in the non-conical PDA group as compared to the conical PDA. Nevertheless, there was no significant coarctation due to aortic retention disc protrusion. Device closure of PDA using the ADO II is a safe procedure for chosen types of PDA. We demonstrated a novel technique for objective assessment of device protrusion into the descending aorta based on measurable parameters. ADOII device closure of non-conical PDAs warrants closer follow ups. © 2015 Wiley Periodicals, Inc.

COVER: A user's guide to the CANOPY and SHRUBS extension of the Stand Prognosis Model

Treesearch

Melinda Moeur

1985-01-01

The COVER model predicts vertical and horizontal tree canopy closure, tree foliage biomass, and the probability of occurrence, height, and cover of shrubs in forest stands. This paper documents use of the COVER program, an adjunct to the Stand Prognosis Model. Preparation of input, interpretation of output, program control, model characteristics, and example...

When Stakeholders Rebel: Lessons from a Safe Schools Program

ERIC Educational Resources Information Center

Gastic, Billie; Irby, Decoteau J.; Zdanis, Maureen

2008-01-01

In this essay, we describe our experiences working with a rebellious primary stakeholder, Sylvia, as evaluators of a district-wide safe schools program. Given the breadth of the program and its multiple target constituencies, we were confronted with the challenges of managing a large number of stakeholders, or those individuals and groups that…

40 CFR 35.101 - Environmental programs covered by the subpart.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) of the Safe Drinking Water Act). (5) Underground water source protection (section 1443(b) of the Safe... 104(b)(3) of the Clean Water Act). (17) Wetlands development grants program (section 104(b)(3) of the... 40 Protection of Environment 1 2013-07-01 2013-07-01 false Environmental programs covered by the...

40 CFR 35.101 - Environmental programs covered by the subpart.

Code of Federal Regulations, 2014 CFR

2014-07-01

...) of the Safe Drinking Water Act). (5) Underground water source protection (section 1443(b) of the Safe... 104(b)(3) of the Clean Water Act). (17) Wetlands development grants program (section 104(b)(3) of the... 40 Protection of Environment 1 2014-07-01 2014-07-01 false Environmental programs covered by the...

40 CFR 35.101 - Environmental programs covered by the subpart.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) of the Safe Drinking Water Act). (5) Underground water source protection (section 1443(b) of the Safe... 104(b)(3) of the Clean Water Act). (17) Wetlands development grants program (section 104(b)(3) of the... 40 Protection of Environment 1 2012-07-01 2012-07-01 false Environmental programs covered by the...

75 FR 47818 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-09

... violence in one rural North Carolina school district, but appropriateness of the program with urban, high...). Background and Brief Description Safe Dates, a dating violence prevention curriculum for 8th and 9th grade... schools who delivered the Safe Dates program and students at one school who received the program...

Albuquerque police department's Safe Streets program

DOT National Transportation Integrated Search

2001-06-01

The origins and results of the Albuquerque Police Department;s "Safe Streets" program are discussed. Influenced by the "broken windows" theory espoused by criminologist George Kelling and spurred to action over public outcry over several cases of fat...

Mass extraction container closure integrity physical testing method development for parenteral container closure systems.

PubMed

Yoon, Seung-Yil; Sagi, Hemi; Goldhammer, Craig; Li, Lei

2012-01-01

Container closure integrity (CCI) is a critical factor to ensure that product sterility is maintained over its entire shelf life. Assuring the CCI during container closure (C/C) system qualification, routine manufacturing and stability is important. FDA guidance also encourages industry to develop a CCI physical testing method in lieu of sterility testing in a stability program. A mass extraction system has been developed to check CCI for a variety of container closure systems such as vials, syringes, and cartridges. Various types of defects (e.g., glass micropipette, laser drill, wire) were created and used to demonstrate a detection limit. Leakage, detected as mass flow in this study, changes as a function of defect length and diameter. Therefore, the morphology of defects has been examined in detail with fluid theories. This study demonstrated that a mass extraction system was able to distinguish between intact samples and samples with 2 μm defects reliably when the defect was exposed to air, water, placebo, or drug product (3 mg/mL concentration) solution. Also, it has been verified that the method was robust, and capable of determining the acceptance limit using 3σ for syringes and 6σ for vials. Sterile products must maintain their sterility over their entire shelf life. Container closure systems such as those found in syringes and vials provide a seal between rubber and glass containers. This seal must be ensured to maintain product sterility. A mass extraction system has been developed to check container closure integrity for a variety of container closure systems such as vials, syringes, and cartridges. In order to demonstrate the method's capability, various types of defects (e.g., glass micropipette, laser drill, wire) were created in syringes and vials and were tested. This study demonstrated that a mass extraction system was able to distinguish between intact samples and samples with 2 μm defects reliably when the defect was exposed to air, water, placebo, or drug product (3 mg/mL concentration) solution. Also, it was verified that the method showed consistent results, and was able to determine the acceptance limit using 3σ for syringes and 6σ for vials.

Steering teens safe: a randomized trial of a parent-based intervention to improve safe teen driving.

PubMed

Peek-Asa, Corinne; Cavanaugh, Joseph E; Yang, Jingzhen; Chande, Vidya; Young, Tracy; Ramirez, Marizen

2014-07-31

Crashes are the leading cause of death for teens, and parent-based interventions are a promising approach. We assess the effectiveness of Steering Teens Safe, a parent-focused program to increase safe teen driving. Steering Teens Safe aimed to improve parental communication with teens about safe driving using motivational interviewing techniques in conjunction with 19 safe driving lessons. A randomized controlled trial involved 145 parent-teen dyads (70 intervention and 75 control). Intervention parents received a 45-minute session to learn the program with four follow-up phone sessions, a DVD, and a workbook. Control parents received a standard brochure about safe driving. Scores were developed to measure teen-reported quantity and quality of parental communication about safe driving. The main outcome measure was a previously validated Risky Driving Score reported by teens. Because the Score was highly skewed, a generalized linear model based on a gamma distribution was used for analysis. Intervention teens ranked their parent's success in talking about driving safety higher than control teens (p = 0.035) and reported that their parents talked about more topics (non-significant difference). The Risky Driving Score was 21% lower in intervention compared to control teens (85% CI = 0.60, 1.00). Interaction between communication quantity and the intervention was examined. Intervention teens who reported more successful communication had a 42% lower Risky Driving Score (95% CI = 0.37, 0.94) than control parents with less successful communication. This program had a positive although not strong effect, and it may hold the most promise in partnership with other programs, such as Driver's Education or Graduated Driver's License policies. ClinicalTrials.gov NCT01014923. Registered Nov. 16, 2009.

A crisis of protection and safe passage: violence experienced by migrants/refugees travelling along the Western Balkan corridor to Northern Europe.

PubMed

Arsenijević, Jovana; Schillberg, Erin; Ponthieu, Aurelie; Malvisi, Lucio; Ahmed, Waeil A Elrahman; Argenziano, Stefano; Zamatto, Federica; Burroughs, Simon; Severy, Natalie; Hebting, Christophe; de Vingne, Brice; Harries, Anthony D; Zachariah, Rony

2017-01-01

Pushed by ongoing conflicts and pulled by the desire for a better life, over one million migrants/refugees transited Balkan countries and arrived in Europe during 2015 and early 2016. To curb this influx, European countries instituted restrictive migration policies often characterized by building of razor-wire border fences and border closures. Among migrants/refugees who received mental health care in Serbia while travelling through Balkan countries to Northern Europe, we assessed the prevalence and patterns of violent events experienced including physical trauma. A mixed methods study among migrants/refugees attending mobile mental health clinics run by Médecins sans Frontières (MSF) between July 2015 and June 2016, in Serbia - a main transit hub to European countries. Clinics were conducted according to MSF guidelines by experienced psychologists who were supported by cultural mediators. The main outcome measures were violent events and associated physical trauma. Of 992 migrants/refugees attending MSF mental health clinics, the majority (72%) were from Syria and Afghanistan and included vulnerable groups (14%) such as unaccompanied minors and pregnant women. The most frequent mental health symptoms/signs were anxiety (29%) and adjustment reactions (26%). Of the 992 migrants/refugees, 270 (27%) had experienced violent events during their journey. Signs of physical trauma due to acts of violence were seen in 223(22%) of the 992 individuals, 144 (65%) being perpetrated by State authorities and involving women (11%) and children (13%). Border closures along the Balkan route were associated with a dramatic decrease in registered migrants/refugee arrivals in Serbia. Conversely, among those that made it across the borders, an increasing linear trend in reported violent events was observed at MSF mental health clinics ( X 2 for linear trend, P <0 · 001). Qualitative evidence corroborated with quantitative findings. Nearly one-in-three migrants/refugees seen in MSF clinics experienced violent events including physical trauma along their journey. State authorities, including those in European countries were the perpetrators in over half of such events which were associated with border closures. There is "a crisis of protection and safe passage" which needs to change towards one of respect for the principles of international human rights and refugee law.

Unintended costs and consequences of school closures implemented in preparation for Hurricane Isaac in Harrison County School District, Mississippi, August-September 2012

PubMed Central

Zheteyeva, Yenlik; Rainey, Jeanette J.; Gao, Hongjiang; Jacobson, Evin U.; Adhikari, Bishwa B.; Shi, Jianrong; Mpofu, Jonetta J.; Bhavnani, Darlene; Dobbs, Thomas; Uzicanin, Amra

2017-01-01

Introduction School closures, while an effective measure against the spread of disease during a pandemic, may carry unintended social and economic consequences for students and families. We evaluated these costs and consequences following a 4-day school closure in Mississippi’s Harrison County School District (HCSD). Methods In a survey of all households with students enrolled in HCSD, we collected information on difficulties related to the school closure, including interruption of employment and pay, loss of access to subsidized school meals, and arrangement of alternative childcare. We analyzed this information in the context of certain demographic characteristics of the survey respondents and households, such as race, level of education, and income. We also estimated the average number of lost work days and documented the childcare alternatives chosen by households affected by the school closure. Results We received 2,229 (28.4%) completed surveys from an estimated 7,851 households eligible to participate. About half (1,082 [48.5%]) of the households experienced at least some difficulty during the closure, primarily in three areas: uncertainty about duration of the closure, lost income, and the effort of arranging alternate childcare. Adults working outside the home, particularly the major wage earner in the household, were more likely to suffer lost income while schools were closed, an effect mitigated by paid leave benefits. Difficulty arranging childcare was reported most frequently by respondents with lower levels of education and households with younger children. Beyond the top three concerns expressed by households in HCSD, the survey also shed light on the issue of food insecurity when subsidized school meals are not available. Reported by 17.9% of households participating in the subsidized school lunch program, difficulty providing meals during the closure was associated with higher numbers of dependent children, selection of “other” as the race of the household respondent, and lower levels of education. Conclusion To help prevent undue financial hardship in families of school children, public health authorities and school administrators should provide recommendations for childcare alternatives and paid leave or remote work options during prolonged school closures, particularly to households in which all adults work outside of the home. PMID:29091717

Translation of an Evidence-Based Tailored Childhood Injury Prevention Program

PubMed Central

Weaver, Nancy L.; Williams, Janice; Jacobsen, Heather A.; Botello-Harbaum, Maria; Glasheen, Cristie; Noelcke, Elizabeth; Nansel, Tonja R.

2008-01-01

This article describes the process of translating Safe n’ Sound, a computer-based program for parents of young children, for a general clinic environment. Safe n’ Sound is designed to reduce the risk of unintentional childhood injuries, the leading cause of death among children older than 1 year in the United States. The evidence-based program produces tailored information for parents and their healthcare provider about burns, falls, poisoning, drowning, suffocations, choking prevention, and car safety. To offer Safe n’ Sound to a broader audience, we translated the program from the form used for efficacy testing to a stand-alone application. Notable steps in this translation included (1) conducting an organizational assessment to determine the needs of the clinic staff and feasibility of implementation, (2) modifying the program to reduce length, prioritize risk areas, and update content, (3) repackaging the program to minimize cost and space requirements, and (4) developing promotional and instructional materials. Factors contributing to the success of this effort include strong collaborative partnerships, the relative advantage of Safe n’ Sound over traditional materials, the modifiable design of the program, and the support of the clinic staff and providers. Challenges and areas for future work are discussed. PMID:18287925

Safe and Sound: An Educational Leader's Guide to Evidence-Based Social and Emotional Learning (SEL) Programs. Illinois Edition

ERIC Educational Resources Information Center

Collaborative for Academic, Social, and Emotional Learning (NJ1), 2005

2005-01-01

Based on a three-year study funded by the Office of Safe and Drug-Free Schools (OSDFS) in the U.S. Department of Education, "Safe and Sound" is a comprehensive and inclusive guide for social and emotional learning (SEL) programming. The guide provides a road map for schools and districts that are launching or adding social, emotional,…

Right atrial isolation associated with atrial septal closure in patients with atrial septal defect and chronic atrial fibrillation.

PubMed

Minzioni, G; Graffigna, A; Pagani, F; Vigano, M

1993-12-01

To restore sinus rhythm in the remaining heart chambers of six adult patients with atrial septal defect and chronic or paroxysmal atrial fibrillation, electrical, right atrial isolation associated with surgical correction of the defect was performed. All but one patient was free from atrial fibrillation without medication 2-25 months after operation. The isolated right atrial appendages showed intrinsic rhythmical activity in five patients and no electrical activity in one. Right atrial isolation is a safe and effective procedure that abolishes atrial fibrillation in patients with arrhythmia after surgical correction of atrial septal defect.

Laryngeal videostroboscopy in the dog model: a simplified technique and applications

NASA Astrophysics Data System (ADS)

Coleman, John R., Jr.; Reinisch, Lou; Smith, Shane; Deriso, Walter; Ossoff, Jacob; Huang, Shan; Garrett, C. Gaelyn

1998-07-01

Laryngeal videostroboscopy (LVS) allows the physician to examine the vibratory free edge of the vocal fold providing direct visualization of the vocal fold surface and indirect visualization of the substance of the vocal fold. Previously in dog LVS, electrical stimulation of the superior and recurrent laryngeal nerves or painful stimuli in the lightly anesthetized animal provided the impetus for glottic closure. In this paper we present a new technique for LVS in the dog model that involves mechanical traction on arytenoid adduction sutures to achieve vocal fold adduction. This method is safe, effective, and reproducible, and the potential applications are numerous.

Measuring User Compliance and Cost Effectiveness of Safe Drinking Water Programs: A Cluster-Randomized Study of Household Ultraviolet Disinfection in Rural Mexico.

PubMed

Reygadas, Fermín; Gruber, Joshua S; Dreizler, Lindsay; Nelson, Kara L; Ray, Isha

2018-03-01

Low adoption and compliance levels for household water treatment and safe storage (HWTS) technologies have made it challenging for these systems to achieve measurable health benefits in the developing world. User compliance remains an inconsistently defined and poorly understood feature of HWTS programs. In this article, we develop a comprehensive approach to understanding HWTS compliance. First, our Safe Drinking Water Compliance Framework disaggregates and measures the components of compliance from initial adoption of the HWTS to exclusive consumption of treated water. We apply this framework to an ultraviolet (UV)-based safe water system in a cluster-randomized controlled trial in rural Mexico. Second, we evaluate a no-frills (or "Basic") variant of the program as well as an improved (or "Enhanced") variant, to test if subtle changes in the user interface of HWTS programs could improve compliance. Finally, we perform a full-cost analysis of both variants to assess their cost effectiveness (CE) in achieving compliance. We define "compliance" strictly as the habit of consuming safe water. We find that compliance was significantly higher in the groups where the UV program variants were rolled out than in the control groups. The Enhanced variant performed better immediately postintervention than the Basic, but compliance (and thus CE) degraded with time such that no effective difference remained between the two versions of the program.

Biosphere 2 test module experimentation program

NASA Technical Reports Server (NTRS)

Alling, Abigail; Leigh, Linda S.; Maccallum, Taber; Alvarez-Romo, Norberto

1990-01-01

The Biosphere 2 Test Module is a facility which has the capability to do either short or long term closures: five month closures with plants were conducted. Also conducted were investigations of specific problems, such as trace gas purification by bioregenerative systems by in-putting a fixed concentration of a gas and observing its uptake over time. In other Test Module experiments, the concentration of one gas was changed to observe what effects this has on other gases present or on the system. The science of biospherics which encompasses the study of closed biological systems provides an opening into the future in space as well as in the Earth's biosphere.

300 Area process trench sediment analysis report

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

Zimmerman, M.G.; Kossik, C.D.

1987-12-01

This report describes the results of a sampling program for the sediments underlying the Process Trenches serving the 300 Area on the Hanford reservation. These Process Trenches were the subject of a Closure Plan submitted to the Washington State Department of Ecology and to the US Environmental Protection Agency in lieu of a Part B permit application on November 8, 1985. The closure plan described a proposed sampling plan for the underlying sediments and potential remedial actions to be determined by the sample analyses results. The results and proposed remedial action plan are presented and discussed in this report. 50more » refs., 6 figs., 8 tabs.« less

Severe Accident Sequence Analysis Program: Anticipated transient without scram simulations for Browns Ferry Nuclear Plant Unit 1

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

Dallman, R J; Gottula, R C; Holcomb, E E

1987-05-01

An analysis of five anticipated transients without scram (ATWS) was conducted at the Idaho National Engineering Laboratory (INEL). The five detailed deterministic simulations of postulated ATWS sequences were initiated from a main steamline isolation valve (MSIV) closure. The subject of the analysis was the Browns Ferry Nuclear Plant Unit 1, a boiling water reactor (BWR) of the BWR/4 product line with a Mark I containment. The simulations yielded insights to the possible consequences resulting from a MSIV closure ATWS. An evaluation of the effects of plant safety systems and operator actions on accident progression and mitigation is presented.

Temporary Abdominal Closure Combined With an Irrigating System Utilizing Hypochlorous Acid Solution to Decrease Abdominal Mucopurulence

PubMed Central

Matthews, Marc R.; Quan, Asia N.; Weir, Alexandra S.; Foster, Kevin N.; Caruso, Daniel M.

2018-01-01

Introduction: Leaving the abdominal cavity open is a well-described and frequently utilized technique in the treatment of severe intra-abdominal sepsis. Irrigation through a negative pressure wound therapy device is a technique employed to assist in the closure of wounds as well as the reduction of bacterial contamination. Furthermore, hypochlorous acid has been found to be safe and effective in microorganismal elimination from extremity wounds. There is no literature regarding the infusion of hypochlorous solution into the abdominal cavity for intra-abdominal sepsis or mucopurulent abscesses or biofilm. Objectives: A 47-year-old man with granulomatosis polyangiitis was started on weekly rituximab. After 4 infusions, skin sloughing, ultimately diagnosed as toxic epidermal necrolysis, developed. During the hospital course, he developed sepsis and bowel perforation necessitating an exploratory laparotomy. The abdomen was left open with a temporary abdominal closure using the Abthera open abdomen negative wound therapy device; however, the abdomen remained infected with visually diffuse, thickening mucopurulence despite multiple washouts. Therefore, a VAC Vera-Flo irrigation device was combined with the Abthera open abdomen negative wound therapy device and cyclical irrigation of hypochlorous acid. After 72 hours, the purulence visually was improved and no adverse events were recorded with the placement of intra-abdominal hypochlorous acid. Conclusions: The combination of two medical devices for the intra-abdominal instillation of irrigation is considered “off-label use” from the manufacturer's recommendations. In addition, the repeated instillation of hypochlorous acid solution has not been described but was noted to have visually decreased the contaminated effluent within the intra-abdominal fluid. PMID:29527250

The Magnetic Levator Prosthesis for Temporary Management of Severe Blepharoptosis: Initial Safety and Efficacy

PubMed Central

Houston, Kevin E.; Tomasi, Matteo; Amaral, Christina; Finch, Nicole; Yoon, Michael K.; Lee, Hang; Paschalis, Eleftherios I.

2018-01-01

Purpose We further optimized and evaluated the safety of the magnetic levator prosthesis (MLP) for temporary management of severe blepharoptosis, and compared efficacy and comfort against the ptosis crutch. Methods The interpalpebral fissure (IPF) of participants (n = 12) with ptosis was measured during attempted eyelid opening, volitional closing, and spontaneous closing with no device, ptosis crutch, or the MLP. A 10-point scale documented comfort. Additionally, a 20 minute and then 1 week trial of the MLP was offered. Safety measures were skin erythema rating, change in visual acuity, and change in corneal staining. Results The MLP and crutch opened the eye (IPF 11.2 and 9.3 mm), but the MLP allowed better volitional closure (IPF 1.0 vs. 4.9 mm, P = 0.009), but was no better in allowing spontaneous blink (IPF 7.5 vs. 7.7 mm, P = 0.722). Both devices were equally comfortable (both median 8/10 comfort, P = 0.46). With extended use, opening with the MLP showed IPF 9.24 mm at 20 minutes and 9.46 mm at 1 week, and volitional closure was IPF 0.95 and 0.52 mm, respectively. Closure on spontaneous blink improved with extended wear to IPF 5.14 and 5.18 mm, respectively (P = 0.002). Two participants exhibited moderate skin erythema and one had increased corneal staining without change in acuity. Conclusions The MLP is safe and feasible for temporary correction of severe ptosis. Translational Relevance First group data in patients showing successful reanimation of the eyelid with magnetic force. PMID:29367892

Integration of silver nanoparticle-impregnated polyelectrolyte multilayers into murine splinted cutaneous wound beds

PubMed Central

Guthrie, Kathleen M.; Agarwal, Ankit; Teixeira, Leandro B. C.; Dubielzig, Richard R.; Abbott, Nicholas L.; Murphy, Christopher J.; Singh, Harpreet; McAnulty, Jonathan F.; Schurr, Michael J.

2013-01-01

Silver is a commonly used topical antimicrobial. However, technologies to immobilize silver at the wound surface are lacking, while currently available silver-containing wound dressings release excess silver that can be cytotoxic and impair wound healing. We have shown that precise concentrations of silver at lower levels can be immobilized into a wound bed using a polyelectrolyte multilayer (PEM) attachment technology. These silver nanoparticle-impregnated PEMs are non-cytotoxic yet bactericidal in vitro, but their effect on wound healing in vivo was previously unknown. Objective The purpose of this study was to determine the effect on wound healing of integrating silver nanoparticle/PEMs into the wound bed. Methods A full-thickness, splinted, excisional murine wound healing model was employed in both phenotypically normal mice and spontaneously diabetic mice (healing impaired model). Results Gross image measurements showed an initial small lag in healing in the silver-treated wounds in diabetic mice, but no difference in time to complete wound closure in either normal or diabetic mice. Histological analysis showed modest differences between silver-treated and control groups on day 9, but no difference between groups at the time of wound closure. Conclusions We conclude that silver nanoparticle/PEMs can be safely integrated into the wound beds of both normal and diabetic mice without delaying wound closure, and with transient histological effects. The results of this study suggest the feasibility of this technology for use as a platform to effect nanoscale wound engineering approaches to microbial prophylaxis or to augment wound healing. PMID:23511285

303-K Storage Facility closure plan. Revision 2

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

Not Available

1993-12-15

Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 303-K Storage Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 303-K Storage Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Codemore » (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 303-K Storage Facility, the history of materials and waste managed, and the procedures that will be followed to close the 303-K Storage Facility. The 303-K Storage Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5.« less

Surgical debridement, vacuum therapy and pectoralis plasty in poststernotomy mediastinitis.

PubMed

Ennker, I C; Pietrowski, D; Vöhringer, L; Kojcici, B; Albert, A; Vogt, P M; Ennker, J

2009-11-01

In cardiac surgery poststernotomy mediastinitis continues to be a serious cause of morbidity and mortality. We report our experience with vacuum-assisted closure (VAC) therapy followed by reconstruction with M. pectoralis muscle flaps as treatment for deep sternal wound infections. Our group performed a retrospective analysis of 3630 consecutive cardiac surgical patients using median sternotomy from 11/2004 to 11/2007. After removing sternal wires, necrotic debris and potentially infective material, restabilisation of the sternum was performed and VAC therapy was employed. Wound closure and subsequent reconstruction were performed using a bilateral pectoralis muscle plasty. Of the analysed patients 16 female and 29 male patients suffered from deep sternal wound infections and were treated with VAC. The most common risk factors were diabetes mellitus odds ratio (OR 3.5), chronic obstructive pulmonary disease (COPD) (OR 2.9), use of bilateral mammarian artery (OR 2.0) and obesity (1.8). The median age of patients with deep sternal infections was similar to control patients. Staphylococcus epidermis was the most common pathogen (37.8%) followed by Enterococcus faecilis (22.2%) and Staphylococcus aureus (17.8). In 22.2% no pathogen could be detected. The 30 day mortality was 0%, the in-hospital mortality was 15.6%. The results of our studies demonstrate that vacuum therapy in conjunction with early and aggressive debridement is an effective strategy for treating poststernotomy mediastinitis. We consider pectoralis major muscle flap reconstruction as a safe technique and regard it as the primary choice for wound closure in poststernotomy mediastinitis. (c) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Study of a fail-safe abort system for an actively cooled hypersonic aircraft: Computer program documentation

NASA Technical Reports Server (NTRS)

Haas, L. A., Sr.

1976-01-01

The Fail-Safe Abort System TEMPerature Analysis Program, (FASTEMP), user's manual is presented. This program was used to analyze fail-safe abort systems for an actively cooled hypersonic aircraft. FASTEMP analyzes the steady state or transient temperature response of a thermal model defined in rectangular, cylindrical, conical and/or spherical coordinate system. FASTEMP provides the user with a large selection of subroutines for heat transfer calculations. The various modes of heat transfer available from these subroutines are: heat storage, conduction, radiation, heat addition or generation, convection, and fluid flow.

Base Realignment and Closure (BRAC) Environmental Restoration Program Management Plan

DTIC Science & Technology

1999-04-01

ENVIRONMENTAL PROGRAM 5 4.1 Environmental Restoration (Cleanup, Compliance and Unexploded Ordnance) 6 4.2 National Environmental Policy Act (NEPA...Realignment Act) to create a process to close bases and realign the force infrastructure. The law addressed National Environmental Policy Act (NEPA...primarily through provisions contained in the National Defense Authorization Acts for Fiscal Years 1992 through 1997. Appendix A of the BRAC Reuse

Virtual and Traditional Slides for Teaching Cellular Morphology to Medical Laboratory Science Undergraduates: A Comparative Study of Performance Outcomes, Retention, and Self-Efficacy Beliefs

ERIC Educational Resources Information Center

Solberg, Brooke L.

2011-01-01

As a result of massive retirement and educational program expense and closure, the field of Medical Laboratory Science (MLS) is facing a critical workforce shortage. Combatting this issue by increasing undergraduate class size is a difficult proposition due to the intense psychomotor curricular requirements of MLS programs. Technological advances…

Tank waste remediation system nuclear criticality safety program management review

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

BRADY RAAP, M.C.

1999-06-24

This document provides the results of an internal management review of the Tank Waste Remediation System (TWRS) criticality safety program, performed in advance of the DOE/RL assessment for closure of the TWRS Nuclear Criticality Safety Issue, March 1994. Resolution of the safety issue was identified as Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) Milestone M-40-12, due September 1999.

Making a Comeback in the New Century.

ERIC Educational Resources Information Center

Sturgeon, Julie

2001-01-01

Reveals how Ohio's Central State University avoided state closure with a bold mission to rebuild both the academic programs and the facilities. What the new century holds for maintenance, software, card systems, contract services, and security and online purchasing are discussed. (GR)

9 CFR 318.301 - Containers and closures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY... container integrity. Such an examination should be based upon a statistical sampling plan. (2) All empty... the establishment and the container plant records are made available to Program employees. Additional...

9 CFR 318.301 - Containers and closures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY... container integrity. Such an examination should be based upon a statistical sampling plan. (2) All empty... the establishment and the container plant records are made available to Program employees. Additional...

9 CFR 318.301 - Containers and closures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY... container integrity. Such an examination should be based upon a statistical sampling plan. (2) All empty... the establishment and the container plant records are made available to Program employees. Additional...

9 CFR 318.301 - Containers and closures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... AGENCY ORGANIZATION AND TERMINOLOGY; MANDATORY MEAT AND POULTRY PRODUCTS INSPECTION AND VOLUNTARY... container integrity. Such an examination should be based upon a statistical sampling plan. (2) All empty... the establishment and the container plant records are made available to Program employees. Additional...

13 CFR 120.380 - Program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Special Purpose Loans Defense... loans to help eligible small businesses transition from defense to civilian markets, or eligible individuals adversely impacted by base closures or defense cutbacks to acquire or open and operate a small...

13 CFR 120.380 - Program.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Special Purpose Loans Defense... loans to help eligible small businesses transition from defense to civilian markets, or eligible individuals adversely impacted by base closures or defense cutbacks to acquire or open and operate a small...

13 CFR 120.380 - Program.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Special Purpose Loans Defense... loans to help eligible small businesses transition from defense to civilian markets, or eligible individuals adversely impacted by base closures or defense cutbacks to acquire or open and operate a small...

13 CFR 120.380 - Program.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Special Purpose Loans Defense... loans to help eligible small businesses transition from defense to civilian markets, or eligible individuals adversely impacted by base closures or defense cutbacks to acquire or open and operate a small...

13 CFR 120.380 - Program.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Special Purpose Loans Defense... loans to help eligible small businesses transition from defense to civilian markets, or eligible individuals adversely impacted by base closures or defense cutbacks to acquire or open and operate a small...

Staying Healthy and Safe at Work

MedlinePlus

... The Prematurity Campaign About us Annual report Our work Community impact Global programs Research Need help? Frequently ... safe at work Staying healthy and safe at work E-mail to a friend Please fill in ...

Endoscopic treatment of Roux-en-Y gastric bypass-related gastrocutaneous fistulas using a novel biomaterial.

PubMed

Maluf-Filho, Fauze; Hondo, Fabio; Halwan, Bhawna; de Lima, Marcelo Simas; Giordano-Nappi, José Humberto; Sakai, Paulo

2009-07-01

Roux-en-Y gastric bypass (RYGB) is amongst the commonest surgical intervention for weight loss in obese patients. Gastrocutaneous fistula, which usually occurs along the vertical staple line of the pouch, is amongst its most alarming complications. Medical management comprised of wound drainage, nutritional support, acid suppression, and antibiotics may be ineffective in as many as a third of patients with this complication. We present outcomes after endoscopic application of SurgiSIS, which is a novel biomaterial for the treatment of this complication. A case series of 25 patients. Twenty-five patients who had failed conservative medical management of gastrocutaneous fistula after RYGB underwent endoscopic application of SurgiSIS--an acellular fibrogenic matrix biomaterial to help fistula healing. Fistula closure as assessed by upper gastrointestinal imaging and endoscopic examination. In patients who had failed medical management lasting 4-25 (median, 7) weeks, closure of the fistulous tract was successful after one application in six patients (30%), two applications in 11 patients (55%), and three applications in three patients (15%). There were no procedure-related complications. Endoscopic application of SurgiSIS-an acellular fibrogenic matrix--is safe and effective for the treatment of gastrocutaneous fistula after RYGB.

ReSure Sealant for Pars Plana Vitrectomy Wound Closure.

PubMed

Ho, Vincent Y; Shah, Gaurav K; Liu, Enchun M

2015-01-01

ReSure Sealant (Ocular Therapeutix, Bedford, MA) is an ocular sealant that demonstrated both safety and effectiveness in a prospective, randomized clinical trial for sealing clear corneal incisions following cataract surgery and intraocular lens placement in adults.1 PATIENTS AND METHODS: This is the first literature report of ReSure Sealant used for the closure of 23-gauge (G) pars plana vitrectomy (PPV) sclerotomies. A 70-year-old pseudophakic female with a history of epiretinal membrane and branch retinal vein occlusion of the right eye underwent 23-G PPV, membrane peel, and air-fluid exchange and was found to have leaking subconjunctival air at the end of the case. A linear conjunctival incision was performed to access the sclerotomy site. The incisions were then carefully dried before the sealant was applied to seal both the sclera and conjunctiva. After polymerization, the sealant formed a polyethylene glycol (PEG) hydrogel that was 89% water and 9.44% PEG. PEG is a synthetic material that is non-toxic and inert and, thus, suitable for use in medical products. ReSure Sealant may be a safe, quick method to close sclerotomy wounds in select cases. [ Copyright 2015, SLACK Incorporated.

Natural orifice translumenal endoscopic surgery: Progress in humans since white paper

PubMed Central

Santos, Byron F; Hungness, Eric S

2011-01-01

Since the first description of the concept of natural orifice translumenal endoscopic surgery (NOTES), a substantial number of clinical NOTES reports have appeared in the literature. This editorial reviews the available human data addressing research questions originally proposed by the white paper, including determining the optimal method of access for NOTES, developing safe methods of lumenal closure, suturing and anastomotic devices, advanced multitasking platforms, addressing the risk of infection, managing complications, addressing challenges with visualization, and training for NOTES procedures. An analysis of the literature reveals that so far transvaginal access and closure appear to be the most feasible techniques for NOTES, with a limited, but growing transgastric, transrectal, and transesophageal NOTES experience in humans. The theoretically increased risk of infection as a result of NOTES procedures has not been substantiated in transvaginal and transgastric procedures so far. Development of suturing and anastomotic devices and advanced platforms for NOTES has progressed slowly, with limited clinical data on their use so far. Data on the optimal management and incidence of intraoperative complications remain sparse, although possible factors contributing to complications are discussed. Finally, this editorial discusses the likely direction of future NOTES development and its possible role in clinical practice. PMID:21483624

Outcomes of De Vega versus biodegradable ring annuloplasty in the surgical treatment of tricuspid regurgitation (mid-term results).

PubMed

Basel, Halil; Aydin, Unal; Kutlu, Hakan; Dostbil, Aysenur; Karadag, Melike; Odabasi, Dolunay; Aydin, Cemalettin

2010-08-01

The aim of this study was to compare De Vega semicircular annuloplasty and a new biodegradable ring annuloplasty technique in patients requiring surgical intervention for tricuspid valve disease with concomitant disease of the mitral valve. Between January 2004 and May 2008, 129 consecutive patients underwent annuloplasty procedures to correct tricuspid valve regurgitation during a concomitant mitral valve operation requiring replacement. Additionally, 24 patients underwent aortic valve replacement (AVR), 11 underwent coronary artery bypass grafting (CABG), 5 underwent AVR plus CABG, 3 underwent mitral valve replacement plus atrial septal defect (ASD) closure, and 2 underwent ASD closure. The patients in this study were assigned to 2 groups: Kalangos ring annuloplasty was performed in 67 patients (group 1), and De Vega semicircular annuloplasty was performed in the remaining 62 patients (group 2). Both tricuspid valve repair techniques produced a low rate of complications; however, the number of patients who developed residual tricuspid regurgitation was significantly lower in group 1. The biodegradable ring annuloplasty technique may be used easily and safely in moderate and severe cases of tricuspid regurgitation; however, larger clinical series are necessary to confirm our promising results.

Use of the 5-mm Endoscopic Stapler for Ligation of Fistula in Laparoscopic-Assisted Repair of Anorectal Malformation.

PubMed

Slater, Bethany J; Kay, Saundra; Rothenberg, Steven S

2018-02-15

Laparoscopic anorectoplasty (LARRP) for the treatment of select anorectal malformations has gained popularity due to enhanced visualization of the fistula and the ability to place the rectum within the sphincter complex while minimizing division of muscles and the perineal incision. However, given the technical challenges and reported complications of ligation, a number of techniques have been described, including using clips, suture ligation, endoloops, or division without closure. We aimed to evaluate fistula closure and division for high imperforate anus using a 5-mm stapler (JustRight Surgical, Boulder, CO). A retrospective chart review was performed on patients who underwent LAARP for imperforate anus between March 2015 and December 2016. Four patients underwent LAARP with division of the fistula using the 5-mm stapler. The average age was 3.2 months and average weight was 4.5 kg. The location of the fistula was rectoprostatic in 3 cases and rectobladder neck in 1 case. There were no complications. Division of a fistula at or above the level of the prostate can safely and effectively be performed with the 5-mm stapler. The stapler allows for division flush with the urethra or bladder ergonomically and quickly.

The Use of Interventional Radiology Techniques in the Treatment of Pancreatic Fistula.

PubMed

Miłek, Tomasz; Baranowski, Krzysztof; Petryka, Robert; Ciostek, Piotr

2016-12-01

One of the complications of pancreatic disease is the formation of pancreatic fistulae. The presence of fistula leads to body wasting and cachexia. The standard treatment is intubation of the Wirsung duct and in cases where there are no improvements the next proposed form of treatment is surgery. The aim of the study was to evaluate the efficacy of pancreatic fistula closure using interventional radiology techniques. In 2009 to 2014, 46 patients diagnosed with pancreatic fistula were treated with interventional radiology techniques. Treatment consisted of vascular coil implanted at the entry of the fistula and then sealed with tissue glue adhesive during endoscopic procedure. Technical success of vascular coil implantation and the use of tissue glue adhesive were reported in all patients. Pancreatic fistula recurred in 7 patients (15.2%). The latter group of patients underwent statistical analysis to determine what the risk factors in recurring pancreatic fistulas were. The results indicate a significant relationship between etiology of the fistula and treatment effect. (1) the use of interventional radiology methods in the closure of pancreatic fistula is an effective and safe procedure; and (2) the recurrence of fistula is dependent on the etiology and often occurs after surgery or trauma.

Ostomy creation in neonates with acute abdominal disease: friend or foe?

PubMed

van Zoonen, Anne G J F; Schurink, Maarten; Bos, Arend F; Heineman, Erik; Hulscher, Jan B F

2012-08-01

An ostomy seems a safe alternative in neonates with an acute abdomen when immediate restoration of bowel continuity is deemed undesirable. Faced with several complications in our center, and the feeling we are not the only center with these complications, we decided to assess the rate and type of complications after both ostomy creation and closure. All data regarding neonates (<30 days of age) who underwent a laparotomy for a suspected abdominal emergency in the period 2000 to 2010 were retrospectively analyzed. These data included demographics such as gender, gestational age, and birth weight. Disease etiology was defined and various features of the enterostomy were analyzed. These features included type, location, time to ostomy take down, and complications and mortality directly related to both creation and closure of the ostomy. A total of 155 patients who underwent a laparotomy for suspect acute abdomen were identified. Median gestational age was 33 weeks (range 25 to 40) and median birth weight was 1926 g (range 560 to 4380). Median age at laparotomy was 8 days (range 0 to 30). Indications for surgery were necrotizing enterocolitis (n = 38), spontaneous intestinal perforation (n = 11), intestinal atresia (n = 9) or obstruction (n = 5), and volvulus (n = 4). An ostomy was created in 67 patients (67/155: 43%): 38 boys and 29 girls. There were 8 jejuno-, 49 ileo-, and 10 colostomies created. In almost all cases (94%), a mucous fistula was also constructed.In 23 patients (23/67: 34%) ostomy-related complications occurred. Most frequent were high output ostomy (n = 10) and necrosis of the enterostomy (n = 7). Due to either one of the complications, nine patients (9/67: 13%) needed a reoperation.In this study, 11 patients died before ostomy closure could occur. In 53 patients, the ostomy was closed after a median of 107 days (range 4 to 299).After ostomy closure, complications occurred in 13 cases (13/53: 25%). Seven patients (7/53: 13%) needed another reoperation because of anastomotic leakage (n = 4), adhesions (n = 2), or incisional hernia (n = 1). There was no closure-related mortality. Although creating a temporary ostomy in newborns is preferable in certain situations, there is a considerable occurrence of complications and reoperations. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effectiveness of the HomeSafe Pilot Program in reducing injury rates among residential construction workers, 1994-1998.

PubMed

Darragh, Amy Rowntree; Stallones, Lorann; Bigelow, Phillip L; Keefe, Thomas J

2004-02-01

The construction industry typically has one of the highest fatal and non-fatal injury rates compared with other industries. Residential construction workers are at particular risk of injury (work is in remote sites with small crews, there are often many subcontractors, and they have limited access to safety programs). Difficulty accessing information specific to this group has made research more challenging, therefore, there are few studies. This study evaluated the effectiveness of the HomeSafe Pilot Program, a safety education and training program designed to reduce injuries among residential construction workers. Researchers evaluated whether overall and severe injury incidence rates declined during the intervention period. Data were analyzed using incidence rates and Poisson regression to control for the effect of antecedent secular trend. Injury incidence rates declined significantly following HomeSafe; however, this effect was not statistically significant once temporal variation was controlled. The decline in injury rates following HomeSafe cannot be attributed solely to HomeSafe, however, programmatic and methodologic limitations contributed to the inconclusive results. Further research into the hazards faced by residential construction workers is needed. Am. J. Ind. Med. 45:210-217, 2004. Copyright 2004 Wiley-Liss, Inc.

Fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy: A retrospective study at a single center

PubMed Central

Zhang, Wen-Gang; Linghu, En-Qiang; Li, Hui-Kai

2017-01-01

AIM To assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia during peroral endoscopic myotomy (POEM). METHODS Twenty-four patients who underwent POEM and experienced mucosal injury of the cardia during the procedure were retrospectively identified. Of the 24 patients, 21 had mucosal penetration and 3 had only slight mucosal damage without penetration. The 21 patients with mucosal penetration received fibrin sealant for closure at the site of penetration. Penetration-related characteristics, treatment, and recovery were reviewed for all 21 patients to assess the efficacy and safety of fibrin sealant for closure of mucosal penetration at the cardia. Clinical data, including general characteristics, procedure-related parameters, Eckardt scores, lower esophageal sphincter pressures (LESP), and esophagogastroduodenoscopy (EGD) results, were analyzed to determine their influence on treatment success after mucosal penetration during POEM. RESULTS All 21 patients had a solitary mucosal penetration in the cardia (12 in esophageal region of the cardia, 9 in the stomach region of the cardia, and 1 in both the esophageal and stomach regions). Twelve had a hole-like penetration and 9 had a linear penetration. For those with a hole-like penetration, the mean size was 0.14 cm2 (0.02-0.32 cm2). For those with a linear penetration, the median size was 0.37 cm (0.10-1.00 cm). Closure of the mucosal penetration using fibrin sealant was performed successfully in all 21 patients (two patients required 5 mL fibrin sealant, and the remaining 19 patients required 2.5 mL). Two patients had a nasogastric tube placed for five days after POEM; the remaining 19 patients were kept fasting for 3 d. All 21 patients were discharged after a median of 5 d (range: 5-7 d) postoperatively. During a median 42 mo (range: 9-62 mo) follow-up, all 21 patients with a mucosal penetration successfully healed without the occurrence of infection, ulcer, or esophagitis. Furthermore, the median LESP decreased from 31.9 mmHg (range: 21.9-67.1 mmHg) preoperatively to 20.3 mmHg (range: 6.0-41.0 mmHg) postoperatively (P < 0.05). The median preoperative and postoperative Eckardt scores were 5.0 (range; 4-10) and 1.0 (range: 0-4), respectively (P < 0.05). Of the 21 patients with mucosal penetration, symptom remission, which is defined as a postoperative Eckardt score ≤ 3, was achieved in 20 patients (95.2%) indicating that mucosal penetration did not influence the success of POEM treatment if closed successfully using fibrin sealant. CONCLUSION Fibrin sealant is safe and effective for closure of mucosal penetration during POEM. Mucosal penetrations do not appear to influence the treatment success of POEM if closed successfully using fibrin sealant. Additional studies regarding the feasibility, efficacy, and safety of fibrin sealant for closure of larger mucosal penetrations is warranted. PMID:28321165

Saving our backs: safe patient handling and mobility for home care.

PubMed

Beauvais, Audrey; Frost, Lenore

2014-01-01

Predicted work-related injuries for nurses and home healthcare workers are on the rise given the many risk factors in the home environment and the escalating demands for home healthcare workers in the United States. Fortunately, safe patient handling and mobility programs can dramatically decrease injuries. Despite strides being made to promote safe patient handling and mobility programs in acute care, more can be done to establish such initiatives in the home care setting.

Safe Schools, Safe Students. Proceedings of the National Education Goals Panel/National Alliance of Pupil Services Organizations Conference on "Safe Schools, Safe Students: A Collaborative Approach to Achieving Safe, Disciplined, and Drug-free Schools Conducive to Learning" (Washington, D.C., October 28-29, 1994).

ERIC Educational Resources Information Center

Talley, Ronda C., Ed.; Walz, Garry R., Ed.

The "Safe Schools, Safe Students" conference brought together leading researchers and practitioners in order to share knowledge about innovative safety strategies being used in America's schools. The papers here represent the thinking of scientific experts and school-based pupil service providers who are implementing programs to prevent…

10 CFR 60.140 - General requirements.

Code of Federal Regulations, 2012 CFR

2012-01-01

... and it will continue until permanent closure. (c) The program shall include in situ monitoring, laboratory and field testing, and in situ experiments, as may be appropriate to accomplish the objective as... REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES...

10 CFR 60.140 - General requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... and it will continue until permanent closure. (c) The program shall include in situ monitoring, laboratory and field testing, and in situ experiments, as may be appropriate to accomplish the objective as... REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES...

10 CFR 60.140 - General requirements.

Code of Federal Regulations, 2014 CFR

2014-01-01

... and it will continue until permanent closure. (c) The program shall include in situ monitoring, laboratory and field testing, and in situ experiments, as may be appropriate to accomplish the objective as... REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES...

10 CFR 60.140 - General requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... and it will continue until permanent closure. (c) The program shall include in situ monitoring, laboratory and field testing, and in situ experiments, as may be appropriate to accomplish the objective as... REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES...

10 CFR 60.140 - General requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... and it will continue until permanent closure. (c) The program shall include in situ monitoring, laboratory and field testing, and in situ experiments, as may be appropriate to accomplish the objective as... REGULATORY COMMISSION (CONTINUED) DISPOSAL OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES...

Promoting safe walking and biking to school: the Marin County success story.

PubMed

Staunton, Catherine E; Hubsmith, Deb; Kallins, Wendi

2003-09-01

Walking and biking to school can be an important part of a healthy lifestyle, yet most US children do not start their day with these activities. The Safe Routes to School Program in Marin County, California, is working to promote walking and biking to school. Using a multipronged approach, the program identifies and creates safe routes to schools and invites communitywide involvement. By its second year, the program was serving 4665 students in 15 schools. Participating public schools reported an increase in school trips made by walking (64%), biking (114%), and carpooling (91%) and a decrease in trips by private vehicles carrying only one student (39%).

Lessons Learned from Safe Kids/Safe Streets. Juvenile Justice Bulletin

ERIC Educational Resources Information Center

Cronin, Roberta; Gragg, Frances; Schultz, Dana; Eisen, Karla

2006-01-01

This bulletin reports results from an evaluation of six sites of the Safe Kids/Safe Streets (SK/SS) program, which applies a comprehensive, collaborative approach to the child maltreatment field. The bulletin provides insights into collaboration building, systems reform, service options, and other strategies. Among the findings were that the SK/SS…

Predicting Financial Distress and Closure in Rural Hospitals.

PubMed

Holmes, George M; Kaufman, Brystana G; Pink, George H

2017-06-01

Annual rates of rural hospital closure have been increasing since 2010, and hospitals that close have poor financial performance relative to those that remain open. This study develops and validates a latent index of financial distress to forecast the probability of financial distress and closure within 2 years for rural hospitals. Hospital and community characteristics are used to predict the risk of financial distress 2 years in the future. Financial and community data were drawn for 2,466 rural hospitals from 2000 through 2013. We tested and validated a model predicting a latent index of financial distress (FDI), measured by unprofitability, equity decline, insolvency, and closure. Using the predicted FDI score, hospitals are assigned to high, medium-high, medium-low, and low risk of financial distress for use by practitioners. The FDI forecasts 8.01% of rural hospitals to be at high risk of financial distress in 2015, 16.3% as mid-high, 46.8% as mid-low, and 28.9% as low risk. The rate of closure for hospitals in the high-risk category is 4 times the rate in the mid-high category and 28 times that in the mid-low category. The ability of the FDI to discriminate hospitals experiencing financial distress is supported by a c-statistic of .74 in a validation sample. This methodology offers improved specificity and predictive power relative to existing measures of financial distress applied to rural hospitals. This risk assessment tool may inform programs at the federal, state, and local levels that provide funding or support to rural hospitals. © 2016 National Rural Health Association.

RCRA, superfund and EPCRA hotline training module. Introduction to: Closure/post-closure (40 cfr parts 264/265, subpart g) updated July 1996

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

NONE

1996-07-01

The module explains the difference between closure and post-closure. It lists the types of facilities that are subject to closure/post-closures and defines the difference between partial and final closure. It specifies who submits a closure plan and when a closure plan must be submitted, lists the steps in the process, and states the time frame for submittal. It identifies when and how a closure must be amended. It explains the time frame for notification of closure and the deadlines for beginning and completing closure. It specifies which facilities need contingent post-closure plans and lists and the elements of post-closure andmore » cites the requirements. It specifies the conditions and timing for amending a post-closure plan and states who must certify closure/post-closure.« less

Role of Groundwater Monitoring for Closure of Underground Nuclear Tests on the Nevada Test Site

NASA Astrophysics Data System (ADS)

Chapman, J. B.; Pohlmann, K.; Pohll, G.; Russell, C.

2009-12-01

Over 800 underground nuclear tests were conducted at the Nevada Test Site in a variety of hydrogeologic environments. As of the 1996 Environmental Impact Statement for the site, more than 100 million curies of radioactivity remained in the subsurface from these tests, much of it near or below the water table. The U.S. Department of Energy Environmental Management program is implementing a closure strategy for these sites that anticipates closure-in-place, natural attenuation, and institutional controls. Groundwater monitoring is a key component of this strategy, but its role is significantly evolved from that of a detection- or compliance-based monitoring concept. Indeed, monitoring is part of the integrated closure process itself, not an activity confined to a static post-closure period. The reasons for this evolution derive from the complex hydrogeologic conditions, the long time-frames of concern, and recognition that a significant degree of uncertainty is irreducible. The hundreds of test locations are grouped into Corrective Action Units that measure over 100 km2 in area and extend to depths in excess of 1000 m. Despite concerted data collection efforts, the technical basis for closure of these large regions relies heavily on complex numerical models of flow and transport. The inherent uncertainties in these models present challenges for reaching regulatory acceptance of closure, and challenges for confidently locating monitoring wells. The solution now being pursued for the NTS is to integrate model evaluation and monitoring. In addition to standard goals of contaminant detection and protection of human health, an explicit monitoring objective is to increase confidence in model results by assessing the reliability of model forecasts. The initial monitoring network is expected to eventually transition to a long-term closure design, with less emphasis on confidence-building as uncertainty in forecasts is reduced. The methodology for this iterative process of monitoring and model refinement will incorporate expert-judgment and Bayesian updating of model input parameters to provide a cost-beneficial monitoring network that is expected to reduce model prediction uncertainty. This approach to monitoring for these large and complex contaminant areas is consistent with the underlying reliance on model predictions and will ensure that water quality samples are collected in a manner and location that is consistent with the current understanding of contaminant flowpaths.

Monitoring Potential Transport of Radioactive Contaminants in Shallow Ephemeral Channels: FY2015 and FY2016

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

Mizell, Steve A; Miller, Julianne J; McCurdy, Greg

The Desert Research Institute (DRI) is conducting a field assessment of the potential for contaminated soil to be transported from the Smoky Contamination Area (CA) as a result of storm runoff. This activity supports Nevada Nuclear Security Administration (NNSA) efforts to complete regulatory closure of the Soils Corrective Action Unit (CAU) contamination areas. The work is intended to confirm the likely mechanism of transport and determine the meteorological conditions that might cause movement of contaminated soils, as well as determine the particle size fraction that is most closely associated with transported radionuclide-contaminated soils. These data will facilitate the appropriate closuremore » design and post-closure monitoring program.« less

School Counseling Programs as Spiritual and Religious Safe Zones

ERIC Educational Resources Information Center

Stloukal, Merit E.; Wickman, Scott A.

2011-01-01

The authors present a model for creating spiritual and religious safe zones in school counseling programs that implements the Association for Spiritual, Ethical and Religious Values in Counseling's (ASERVIC; 2009) "Competencies for Addressing Spiritual and Religious Issues in Counseling" in a school setting. The authors frame the model within the…

Bike Skills Training in PE Is Fun, Keeps Kids Safe

ERIC Educational Resources Information Center

Wallace, Judi Lawson; Sutton, Nancy P.

2015-01-01

Incorporating bike skills into the elementary- and middle-school physical education curriculum encourages students to be physically active in a fun way while also learning bike safety skills. Winston-Salem's (NC) Safe Routes to School program demonstrates how collaboration with the public schools' health and physical education program can…

Exercising for Two. What's Safe for the Active Pregnant Woman?

ERIC Educational Resources Information Center

White, Jacqueline

1992-01-01

Clinical experience and recent research challenge the current standards of exercise duration and intensity for pregnant women. By carefully assessing patients' self-monitoring techniques, physicians can work with active women to create safe exercise programs during pregnancy. Safety guidelines for developing home exercise programs are included.…

An Introduction to the Safe Schools/Healthy Students Initiative

ERIC Educational Resources Information Center

Modzeleski, William; Mathews-Younes, Anne; Arroyo, Carmen G.; Mannix, Danyelle; Wells, Michael E.; Hill, Gary; Yu, Ping; Murray, Stephen

2012-01-01

The Safe Schools/Healthy Students (SS/HS) Initiative offers a unique opportunity to conduct large-scale, multisite, multilevel program evaluation in the context of a federal environment that places many requirements and constraints on how the grants are conducted and managed. Federal programs stress performance-based outcomes, valid and reliable…

Planning and Designing Safe Facilities

ERIC Educational Resources Information Center

Seidler, Todd

2006-01-01

Those who manage physical education, athletic, and recreation programs have a number of legal duties that they are expected to carry out. Among these are an obligation to take reasonable precautions to ensure safe programs and facilities for all participants, spectators, and staff. Physical education and sports facilities that are poorly planned,…

Predicting Employment Outcomes of Consumers of State-Operated Comprehensive Rehabilitation Centers

ERIC Educational Resources Information Center

Beach, David Thomas

2009-01-01

This study used records from a state-operated comprehensive rehabilitation center to investigate possible predictive factors related to completing comprehensive rehabilitation center programs and successful vocational rehabilitation (VR) case closure. An analysis of demographic data of randomly selected comprehensive rehabilitation center…

78 FR 2284 - Methodology for Selecting Job Corps Centers for Closure; Comments Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-10

... (GED), and career technical training credentials, including industry-recognized credentials, state... align existing career technical training programs to technical standards established by industries or... technical training. Both PIPs and CAPs are used for continued monitoring and implemented for USDA and...

40 CFR 146.72 - Post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

....72 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED... endanger a USDW. (3) Submit a survey plat to the local zoning authority designated by the Director. The... as the address of the Regional Environmental Protection Agency Office to which it was submitted; (3...

40 CFR 146.72 - Post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

....72 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED... endanger a USDW. (3) Submit a survey plat to the local zoning authority designated by the Director. The... as the address of the Regional Environmental Protection Agency Office to which it was submitted; (3...

45 CFR 303.11 - Case closure criteria.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Public Welfare Regulations Relating to Public Welfare OFFICE OF CHILD SUPPORT ENFORCEMENT (CHILD SUPPORT ENFORCEMENT PROGRAM), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... child is at least 18 years old and action to establish paternity is barred by a statute of limitations...

ANALYTICAL METHODS FOR ASSESSING THE MAGNITUDE OF HUMAN INGESTION OF RECREATIONAL WATER DURING SWIMMING ACTIVITY

EPA Science Inventory

The EPA's Beaches Environmental Assessment, Closure, and Health (BEACH) Program is a multi-year, multifaceted strategy for reducing human exposure to certain risks from infectious pathogenic organisms associated with human behavior, and activities related to hygienic practices, o...

Specifics of MS training in the area of nuclear materials safe management for new-comers in nuclear power

NASA Astrophysics Data System (ADS)

Geraskin, N. I.; Glebov, V. B.

2017-01-01

The issues of specialists training in the field of nuclear materials safe management for the countries, who have taken a way of nuclear power development are analyzed. Arguments in justification of a need of these specialists training for the new-comers are adduced. The general characteristic of the reference MS program “Nuclear materials safe management” is considered. The peculiar features of the program, which is important for graduates from the new-comers have been analyzed. The best practices got as a result of implementation of the program in recent years for the students from Kazakhstan, Belarus, Azerbaijan, Tajikistan, Iran, Turkey and other countries are presented. Finally, the directions of international cooperation in further improvement and development of the program are considered.

The role of Aboriginal family workers in delivering a child safety focused home visiting program for Aboriginal families in an urban region of NSW.

PubMed

Clapham, Kathleen; Bennett-Brook, Keziah; Hunter, Kate

2018-05-09

Aboriginal Australian children experience higher rates of injury than other Australian children. However few culturally acceptable programs have been developed or evaluated. The Illawarra Aboriginal Medical Service (IAMS) developed the Safe Homes Safe Kids program as an injury prevention program targeting disadvantaged Aboriginal families with children aged 0-5 in an urban region of NSW. Delivered by Aboriginal Family Workers the program aims to reduce childhood injury by raising awareness of safety in the home. A program evaluation was conducted to determine the effectiveness of the home visiting model as an injury prevention program. This paper reports on the qualitative interviews which explored the ways in which clients, IAMS staff, and external service providers experienced the program and assessed its delivery by the Aboriginal Family Workers. A qualitative program evaluation was conducted between January 2014 and June 2015. We report here on the semi-structured interviews undertaken with 34 individuals. The results show increased client engagement in the program; improved child safety knowledge and skills; increased access to services; improved attitudes to home and community safety; and changes in the home safety environment. Safe Homes Safe Kids provides a culturally appropriate child safety program delivered by Aboriginal Family Workers to vulnerable families. Clients, IAMS staff, and external service were satisfied with the family workers' delivery of the program and the holistic model of service provision. SO WHAT?: This promising program could be replicated in other Aboriginal health services to address unintentional injury to vulnerable Aboriginal children. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Closure of a giant saphenous vein graft aneurysm with embolization coil.

PubMed

Kumar, Ashwani; Santana, Dixon; Jenkins, Leigh Ann

2009-01-01

Aneurysms of saphenous vein grafts (SVGs) to coronary arteries are rare, usually asymptomatic and found incidentally. We report a case of an 84-year-old female who was found to have 8.1 x 8.4 cm aneurysm of an SVG to obtuse marginal (OM) artery. The aneurysm was prior to the distal anastamosis but no flow into the OM artery was noted. Cook Tornado Embolization Coils were used successfully to occlude the SVG proximal to the aneurysm. No complications occurred. The use of embolization coils is an effective and safe method for aneurysm occlusion when the anatomy is suitable and especially when patient is high risk for repeat surgical intervention.

Closure of a Giant Saphenous Vein Graft Aneurysm with Embolization Coil

PubMed Central

Kumar, Ashwani; Santana, Dixon; Jenkins, Leigh Ann

2009-01-01

Aneurysms of saphenous vein grafts (SVGs) to coronary arteries are rare, usually asymptomatic and found incidentally. We report a case of an 84-year-old female who was found to have 8.1 × 8.4 cm aneurysm of an SVG to obtuse marginal (OM) artery. The aneurysm was prior to the distal anastamosis but no flow into the OM artery was noted. Cook Tornado Embolization Coils were used successfully to occlude the SVG proximal to the aneurysm. No complications occurred. The use of embolization coils is an effective and safe method for aneurysm occlusion when the anatomy is suitable and especially when patient is high risk for repeat surgical intervention. PMID:19946632

Hospital infection prevention and control issues relevant to extensive floods.

PubMed

Apisarnthanarak, Anucha; Mundy, Linda M; Khawcharoenporn, Thana; Glen Mayhall, C

2013-02-01

The devastating clinical and economic implications of floods exemplify the need for effective global infection prevention and control (IPC) strategies for natural disasters. Reopening of hospitals after excessive flooding requires a balance between meeting the medical needs of the surrounding communities and restoration of a safe hospital environment. Postflood hospital preparedness plans are a key issue for infection control epidemiologists, healthcare providers, patients, and hospital administrators. We provide recent IPC experiences related to reopening of a hospital after extensive black-water floods necessitated hospital closures in Thailand and the United States. These experiences provide a foundation for the future design, execution, and analysis of black-water flood preparedness plans by IPC stakeholders.

Successful embolization of iatrogenic ruptured coronary artery using Onyx: a new technique.

PubMed

Asouhidou, I; Katsaridis, V

2014-12-01

Iatrogenic perforation of coronary artery is rare during percutaneous coronary intervention (PCI); however the complications are life-threatening. Patients in this clinical setting may be treated either by stent placement, closure of the perforation with fibrin glue or coils, or with emergency bypass surgery. Onyx, a new material that has been used successfully in cerebral arteries, represents a new and safe alternative. The advantage of Onyx is that it is easily injected through a microcatheter and it allows for a longer injection time having also the ability to reach difficult anatomical locations. We present the first case of successful embolization of a right coronary artery perforation during coronary angiography using Onyx.

The Tompkins County Solid Waste Annual Fee: Background and overview

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

Penniman, P.W.

1995-05-01

This report outlines the development by Tompkins County of a new revenue source for solid waste programs -- The Solid Waste Annual Fee. Over the past two decades in New York State, regulatory demands and the decline in available landfill space have combined to cause a rapid escalation in the cost of solid waste disposal. While the New York State Department of Environmental Conservation (NYSDEC) has implemented tighter regulations for the siting of solid waste landfills, they have also mandated the permitting or closure of all existing landfills in the state. The result is that all communities have been requiredmore » to invest millions of dollars in landfill siting, closure and solid waste processing facilities. In addition, programs for reducing and recycling solid wastes have been mandated to reduce the outflow to landfills. Until recent years, solid waste services in most New York counties have been funded almost entirely through a collection of property taxes. During the past six years, fiscal stress has stimulated a movement toward funding solid waste programs by other means. Alternatives to the property tax include: (1) special assessment taxes or fees; (2) user charges (including tipping fees); and (3) intergovernment grants.« less

40 CFR 265.310 - Closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 27 2013-07-01 2013-07-01 false Closure and post-closure care. 265.310... DISPOSAL FACILITIES Landfills § 265.310 Closure and post-closure care. (a) At final closure of the landfill... subsoils present. (b) After final closure, the owner or operator must comply with all post-closure...

40 CFR 265.310 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Closure and post-closure care. 265.310... DISPOSAL FACILITIES Landfills § 265.310 Closure and post-closure care. (a) At final closure of the landfill... subsoils present. (b) After final closure, the owner or operator must comply with all post-closure...

40 CFR 265.310 - Closure and post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 26 2014-07-01 2014-07-01 false Closure and post-closure care. 265.310... DISPOSAL FACILITIES Landfills § 265.310 Closure and post-closure care. (a) At final closure of the landfill... subsoils present. (b) After final closure, the owner or operator must comply with all post-closure...

SCOPE of Pain: An Evaluation of an Opioid Risk Evaluation and Mitigation Strategy Continuing Education Program

PubMed Central

Zisblatt, Lara; Ng, Pamela; Hayes, Sean M.; Peloquin, Sophie; Hardesty, Ilana; White, Julie L.

2016-01-01

Objective. Due to the high prevalence of prescription opioid misuse, the US Food and Drug Administration (FDA) mandated a Risk Evaluation and Mitigation Strategy (REMS) requiring manufacturers of extended-release/long-acting (ER/LA) opioid analgesics to fund continuing education based on a FDA Blueprint. This article describes the Safe and Competent Opioid Prescribing Education (SCOPE of Pain) program, an ER/LA opioid analgesic REMS program, and its impact on clinician knowledge, confidence, attitudes, and self-reported clinical practice. Method. Participants of the 3-h SCOPE of Pain training completed pre-, immediate post- and 2-month post-assessments. Subjects. The primary target group (n = 2,850), and a subset (n = 476) who completed a 2-month post-assessment, consisted of clinicians licensed to prescribe ER/LA opioid analgesics, who care for patients with chronic pain and who completed the 3-h training between February 28, 2013 and June 13, 2014. Results. Immediately post-program, there was a significant increase in correct responses to knowledge questions (60% to 84%, P ≤ 0.02) and 87% of participants planned to make practice changes. At 2-months post-program, there continued to be a significant increase in correct responses to knowledge questions (60% to 69%, P ≤ 0.03) and 67% reported increased confidence in applying safe opioid prescribing care and 86% reported implementing practice changes. There was also an improvement in alignment of desired attitudes toward safe opioid prescribing. Conclusions. The SCOPE of Pain program improved knowledge, attitudes, confidence, and self-reported clinical practice in safe opioid prescribing. This national REMS program holds potential to improve the safe use of opioids for the treatment of chronic pain. PMID:26304703

A Technology-Mediated Approach to the Implementation of an Evidence-Based Child Maltreatment Prevention Program.

PubMed

Self-Brown, Shannon R; C Osborne, Melissa; Rostad, Whitney; Feil, Ed

2017-11-01

Implementation of evidence-based parenting programs is critical for parents at-risk for child maltreatment perpetration; however, widespread use of effective programs is limited in both child welfare and prevention settings. This exploratory study sought to examine whether a technology-mediated approach to SafeCare ® delivery can feasibly assist newly trained providers in achieving successful implementation outcomes. Thirty-one providers working in child welfare or high-risk prevention settings were randomized to either SafeCare Implementation with Technology-Assistance (SC-TA) or SafeCare Implementation as Usual (SC-IU). SC-TA providers used a web-based program during session that provided video-based psychoeducation and modeling directly to parents and overall session guidance to providers. Implementation outcome data were collected from providers for six months. Data strongly supported the feasibility of SC-TA. Further, data indicated that SC-TA providers spent significantly less time on several activities in preparation, during, and in follow-up to SafeCare sessions compared to SC-IU providers. No differences were found between the groups with regard to SafeCare fidelity and certification status. Findings suggest that technology can augment implementation by reducing the time and training burden associated with implementing new evidence-based practices for at-risk families.

The combination of two training approaches to improve older adults' driving safety.

PubMed

Bédard, Michel; Porter, Michelle M; Marshall, Shawn; Isherwood, Ivy; Riendeau, Julie; Weaver, Bruce; Tuokko, Holly; Molnar, Frank; Miller-Polgar, Jan

2008-03-01

An increasing number of older adults rely on the automobile for transportation. Educational approaches based on the specific needs of older drivers may help to optimize safe driving. We examined if the combination of an in-class education program with on-road education would lead to improvements in older drivers' knowledge of safe driving practices and on-road driving evaluations. We used a multisite, randomized controlled trial approach. Participants in the intervention group received the in-class and on-road education; those in the control group waited and were offered the education afterwards. We measured knowledge of safe driving practices before and after the in-class component of the program and on-road driving skills before and after the whole program. Participants' knowledge improved from 61% of correct answers before the in-class education component to 81% after (p < .001). The on-road evaluation results suggested improvements on some aspects of safe driving (e.g., moving in roadway, p < .05) but not on others. The results of this study demonstrate that education programs focused on the needs of older drivers may help improve their knowledge of safe driving practices and actual driving performance. Further research is required to determine if these changes will affect other variables such as driver confidence and crash rates.

Systems Analysis of NASA Aviation Safety Program: Final Report

NASA Technical Reports Server (NTRS)

Jones, Sharon M.; Reveley, Mary S.; Withrow, Colleen A.; Evans, Joni K.; Barr, Lawrence; Leone, Karen

2013-01-01

A three-month study (February to April 2010) of the NASA Aviation Safety (AvSafe) program was conducted. This study comprised three components: (1) a statistical analysis of currently available civilian subsonic aircraft data from the National Transportation Safety Board (NTSB), the Federal Aviation Administration (FAA), and the Aviation Safety Information Analysis and Sharing (ASIAS) system to identify any significant or overlooked aviation safety issues; (2) a high-level qualitative identification of future safety risks, with an assessment of the potential impact of the NASA AvSafe research on the National Airspace System (NAS) based on these risks; and (3) a detailed, top-down analysis of the NASA AvSafe program using an established and peer-reviewed systems analysis methodology. The statistical analysis identified the top aviation "tall poles" based on NTSB accident and FAA incident data from 1997 to 2006. A separate examination of medical helicopter accidents in the United States was also conducted. Multiple external sources were used to develop a compilation of ten "tall poles" in future safety issues/risks. The top-down analysis of the AvSafe was conducted by using a modification of the Gibson methodology. Of the 17 challenging safety issues that were identified, 11 were directly addressed by the AvSafe program research portfolio.

An evaluation of the Adults and Children Together (ACT) Against Violence Parents Raising Safe Kids program.

PubMed

Portwood, Sharon G; Lambert, Richard G; Abrams, Lyndon P; Nelson, Ellissa Brooks

2011-08-01

This study evaluated the effectiveness of the Adults and Children Together (ACT) Against Violence Parents Raising Safe Kids program, developed by the American Psychological Association in collaboration with the National Association for the Education of Young Children, as an economical primary prevention intervention for child maltreatment. Using an experimental design with random assignment to groups, program impact on participating parents' knowledge, behavior, and attitudes compared to those of a comparison group of parents receiving standard community-based support services was examined. As hypothesized, the ACT Parents Raising Safe Kids program achieved positive results in several areas related to effective parenting, including a reduction in the use of harsh verbal and physical discipline and an increase in nurturing behavior. Positive results were observable both at the conclusion of the ACT program and at three-month follow-up. Results further indicated a positive impact on parent expectations and social support for those parents with the greatest need in these areas. Qualitative data collected through focus groups demonstrated that parents themselves perceived numerous benefits to the ACT program, including assistance in controlling their anger, learning and implementing better parenting and discipline strategies, and recognizing when their child's behavior is developmentally appropriate. Overall, findings suggest that the ACT Parents Raising Safe Kids program is a promising primary prevention strategy that can be implemented across diverse community settings.

Fault detection and initial state verification by linear programming for a class of Petri nets

NASA Technical Reports Server (NTRS)

Rachell, Traxon; Meyer, David G.

1992-01-01

The authors present an algorithmic approach to determining when the marking of a LSMG (live safe marked graph) or a LSFC (live safe free choice) net is in the set of live safe markings M. Hence, once the marking of a net is determined to be in M, then if at some time thereafter the marking of this net is determined not to be in M, this indicates a fault. It is shown how linear programming can be used to determine if m is an element of M. The worst-case computational complexity of each algorithm is bounded by the number of linear programs necessary to compute.

Promoting Safe Walking and Biking to School: The Marin County Success Story

PubMed Central

Staunton, Catherine E.; Hubsmith, Deb; Kallins, Wendi

2003-01-01

Walking and biking to school can be an important part of a healthy lifestyle, yet most US children do not start their day with these activities. The Safe Routes to School Program in Marin County, California, is working to promote walking and biking to school. Using a multipronged approach, the program identifies and creates safe routes to schools and invites communitywide involvement. By its second year, the program was serving 4665 students in 15 schools. Participating public schools reported an increase in school trips made by walking (64%), biking (114%), and carpooling (91%) and a decrease in trips by private vehicles carrying only one student (39%). PMID:12948957

Primary and Secondary Stroke Prevention Using Left Atrial Appendage Closure with Watchman Devices in Atrial Fibrillation Patients: A Single Center Experience from Mainland China.

PubMed

Chen, Yanhong; Zhang, Yonghua; Huang, Weiping; Huang, Keqiang; Xu, Bei; Su, X I

2017-06-01

Atrial fibrillation (AF) is associated with increased stroke risk resulting from cardiac embolism of the left atrial appendage (LAA). Stroke tends to recur in NVAF patients. Yet safety and feasibility of secondary stroke preventions with LAA closure (LAAC) have not been assessed in detail. This retrospective study was designed to compare the feasibility and safety of LAAC in primary and secondary stroke preventions, in a real-world setting of Chinese patients. From 2014 to 2015, non-valvular AF patients with CHA2DS2-VASc ≥1 were selected for percutaneous LAAC operations. Outcome observations of primary and secondary stroke preventions with Watchman devices were analyzed and compared. Overall, 122 patients were included. LAAC with Watchman devices were attempted in 115 patients, of whom 68 were for primary stroke prevention and 47 were for secondary prevention. Both the CHA2DS2-VASc score and the HASBLED score were significantly higher in the secondary prevention group (4.09 ± 1.06 vs. 1.93 ± 1.09 for CHA2DS2-VASc and 1.83 ± 1.03 vs. 1.26 ± 0.87 for HASBLED, P < 0.01). In both groups LAAC were achieved with high successful rate (98.53% in the primary prevention group and 100% in the secondary prevention group, P > 0.05) and low complication rates. The stroke rates were at a low level in both groups (1.47% in primary prevention group vs. 2.13% in secondary prevention group, P > 0.05). In our initial single-center experience, percutaneous LAA closure was a feasible and safe procedure for both primary and secondary stroke preventions in Chinese patients with nonvalvular AF. © 2017 Wiley Periodicals, Inc.

State Environmental Policy Act (SEPA) environmental checklist forms for 304 Concretion Facility Closure Plan. Revision 2

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

Not Available

The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 304 Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Facility is now undergoing closure asmore » defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 304 Facility, the history of materials and waste managed, and the procedures that will be followed to close the 304 Facility. The 304 Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5.« less

Outcomes of primary repair and primary anastomosis in war-related colon injuries.

PubMed

Vertrees, Amy; Wakefield, Matthew; Pickett, Chris; Greer, Lauren; Wilson, Abralena; Gillern, Sue; Nelson, Jeffery; Aydelotte, Jayson; Stojadinovic, Alexander; Shriver, Craig

2009-05-01

The role of primary repair (PR) of modern day war-related colon injuries remains controversial. Retrospective review of medical records of combat-wounded soldiers with colon injuries sustained during March 2003 to August 2006 was conducted. Injuries were analyzed according to location: right (n = 30), transverse (n = 13), and left (n = 24) sided colon injuries. Two-tailed Fisher's Exact or chi tests were used for statistical analysis. Seventy-seven soldiers returned to Walter Reed Army Medical Center with colon injuries suffered during Operations Enduring Freedom and Iraqi Freedom. Twelve patients with minor colon injuries were excluded. The remaining 65 patients (mean age, 28 +/- 7 years) sustained 67 colon injuries from secondary blast (n = 38); gunshot (n = 27); motor vehicle crash (n = 1) and crush injury (n = 1). Patients arrived at Walter Reed Army Medical Center 5 days (range, 2-16 days) after injury and damage control operations (n = 27, 42%), and were hospitalized for a median of 22 days (range, 1-306 days). Follow-up averaged 311 days (median, 198 days). PR was attempted in right (n = 18, 60%), transverse (n = 11, 85%), and left (n = 9, 38%) sided colon injuries. Delayed definitive treatment of colon injuries occurred in 42% of patients. Failure of repair occurred in 16% of patients and was more likely with concomitant pancreatic, stomach, splenic, diaphragm, and renal injuries. Overall morbidity for ostomy closure after primary ostomy formation was 30%, but increased to 75% for ostomy closure after primary anastomotic or repair failure. PR of war-related colon injuries can be performed safely in selected circumstances in the absence of concomitant organ injury. Delayed anastomosis can often be performed after damage control operations once the patient stabilizes. Ostomy closure complications are more likely after anastomotic failure.

Large-for-size liver transplant: a single-center experience.

PubMed

Akdur, Aydincan; Kirnap, Mahir; Ozcay, Figen; Sezgin, Atilla; Ayvazoglu Soy, Hatice Ebru; Karakayali Yarbug, Feza; Yildirim, Sedat; Moray, Gokhan; Arslan, Gulnaz; Haberal, Mehmet

2015-04-01

The ideal ratio between liver transplant graft mass and recipient body weight is unknown, but the graft probably must weigh 0.8% to 2.0% recipient weight. When this ratio > 4%, there may be problems due to large-for-size transplant, especially in recipients < 10 kg. This condition is caused by discrepancy between the small abdominal cavity and large graft and is characterized by decreased blood supply to the liver graft and graft dysfunction. We evaluated our experience with large-for-size grafts. We retrospectively evaluated 377 orthotopic liver transplants that were performed from 2001-2014 in our center. We included 188 pediatric transplants in our study. There were 58 patients < 10 kg who had living-donor living transplant with graft-to-bodyweight ratio > 4%. In 2 patients, the abdomen was closed with a Bogota bag. In 5 patients, reoperation was performed due to vascular problems and abdominal hypertension, and the abdomen was closed with a Bogota bag. All Bogota bags were closed in 2 weeks. After closing the fascia, 10 patients had vascular problems that were diagnosed in the operating room by Doppler ultrasonography, and only the skin was closed without fascia closure. No graft loss occurred due to large-for-size transplant. There were 8 patients who died early after transplant (sepsis, 6 patients; brain death, 2 patients). There was no major donor morbidity or donor mortality. Large-for-size graft may cause abdominal compartment syndrome due to the small size of the recipient abdominal cavity, size discrepancies in vascular caliber, insufficient portal circulation, and disturbance of tissue oxygenation. Abdominal closure with a Bogota bag in these patients is safe and effective to avoid abdominal compartment syndrome. Early diagnosis by ultrasonography in the operating room after fascia closure and repeated ultrasonography at the clinic may help avoid graft loss.

Transcatheter Closure of Patent Ductus Arteriosus in Extremely Premature Newborns: Early Results and Midterm Follow-Up.

PubMed

Zahn, Evan M; Peck, Daniel; Phillips, Alistair; Nevin, Phillip; Basaker, Kaylan; Simmons, Charles; McRae, Marion E; Early, Tracy; Garg, Ruchira

2016-12-12

The goal of this study was to describe early and midterm outcomes of extremely premature newborns (EPNs) who underwent transcatheter echocardiographically guided patent ductus arteriosus (PDA) closure. Surgical ligation of PDA in EPNs confers significant risk for procedural morbidity and adverse long-term outcomes. The Amplatzer Vascular Plug II was used in all cases. Post-ligation syndrome was defined using previously published parameters. Patients were followed at pre-specified intervals, and prospectively collected data were reviewed. Transcatheter closure was attempted in 24 EPNs (mean procedural age 30 days [range 5 to 80 days], mean procedural weight 1,249 g [range 755 to 2,380 g]) and was successful in 88%. The 3 procedural failures were related to the development of left pulmonary artery (LPA) stenosis caused by the device, and all devices were removed uneventfully. Complications included 2 instances of device malposition, resolved with device repositioning, and 1 instance of LPA stenosis, requiring an LPA stent. There were no procedural deaths, cases of post-ligation syndrome, residual PDA, or device embolization. Survival to discharge was 96% (23 of 24), with a single late death unrelated to the procedure. After a median follow-up period of 11.1 months, all patients were alive and well, with no residual PDA or evidence of LPA or aortic coarctation. This newly described technique can be performed safely with a high success rate and minimal procedural morbidity in EPNs. Early and midterm follow-up is encouraging. Future efforts should be directed toward developing specific devices for this unique application. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Transcatheter closure of ventricular septal defects with nitinol wire occluders of type patent ductus arteriosus.

PubMed

Wierzyk, Arkadiusz; Szkutnik, Małgorzata; Fiszer, Roland; Banaszak, Paweł; Pawlak, Szymon; Białkowski, Jacek

2014-01-01

Ventricular septal defects closure (VSD) depending on the anatomy and clinical setting can be performed surgically or by a hybrid and transcatheter approach. Two cases of children with VSD will be presented. Patients' defects were closed with various types of occluders made of nitinol wire mesh occluder, patent ductus arteriosus (PDA) type. The first case was a 2.5-year-old boy after cardiosurgical correction of tetralogy of Fallot (TOF). After the procedure, a significant haemodynamic residual VSD was observed, which was not successfully closed during the subsequent reoperation. Despite pharmacological treatment, symptoms of heart failure were observed in this patient. In echocardiographic images the residual VSD was presented as a tunnel-like dissection of the ventricular septum (length 6 mm and diameter 3.4 mm). The defect was closed via arterial access with an Amplatzer Duct Occluder II (ADO II). The procedure was successfully performed without any medical complications. In this child, a significant shunt reduction and a noticeable improvement in the patient's clinical status and diminished symptoms of heart failure were noticed. The second patient was a 4-year-old girl suffering from a multi-perforated perimembranous VSD accompanied by a ventricular septal defect with aneurysm. The defect was closed by a venous approach with a PDA Cardio-O-Fix occluder (very similar to ADO I). No short-term or long-term complications were visible during or after the procedure. Only a mild residual shunt through the VSD was observed 6 months afterwards. Transcatheter VSD closure with a proper morphology, with occluders of type Amplatzer Duct Occluder ADO I or ADO II, constitutes a safe and effective therapeutic alternative.

Percutaneous closure of hypertensive ductus arteriosus.

PubMed

Zabal, Carlos; García-Montes, José Antonio; Buendía-Hernández, Alfonso; Calderón-Colmenero, Juan; Patiño-Bahena, Emilia; Juanico-Enriquez, Antonio; Attie, Fause

2010-04-01

The Amplatzer duct occluder (ADO) has been used with success to close large patent ductus arteriosus (PDA), but some problems exist especially with hypertensive PDAs, such as incomplete closure, haemolysis, left pulmonary artery stenosis, obstruction of the descending aorta and progressive pulmonary vascular disease. We analysed a group of 168 patients with isolated PDA and pulmonary artery systolic pressure (PSAP) > or =50 mm Hg. Mean age was 10.3 +/- 14.3 years (median 3.9), PDA diameter was 6.4 +/- 2.9 mm (median 5.9), PASP was 63.5 +/- 16.2 mm Hg (median 60), Qp/Qs was 2.7 +/- 1.2 (median 2.5), total pulmonary resistance index (PRI) was 3.69 +/- 2.15 (median 3.35) and vascular PRI was 2.73 +/- 1.72 (median 2.37). We used ADOs in 145 (86.3%) cases, Amplatzer muscular ventricular septal defect occluders (AMVSDO) in 18 (10.7%), Amplatzer septal occluders (ASO) in three (1.8%) and the Gianturco-Grifka device in two (1.2%) cases. Device diameter was 106.3% +/- 51% higher than PDA diameter. PASP decreased after occlusion to 42.5 +/- 13.3 mm Hg (p<0.00001). Immediately after closure, no or trivial shunt was present in 123 (74.5%) cases. Immediate complications were device embolisation in five (3%) cases and descending aortic obstruction in one case. The overall success rate was 98.2%. Follow-up in 145 (86.3%) cases for 37.1 +/- 24 months (median 34.1) showed further decrease of the PASP to 30.1 +/- 7.7 mm Hg (p<0.0001). Percutaneous treatment of hypertensive PDA is safe and effective. ADO works well for most cases, but sometimes other devices (MVSDO or ASO) have to be used. When cases are selected adequately, pulmonary pressures decrease immediately and continue to fall with time.

Laser-assisted fixation of a nitinol stapes prosthesis.

PubMed

Schrötzlmair, Florian; Suchan, Fabian; Pongratz, Thomas; Krause, Eike; Müller, Joachim; Sroka, Ronald

2018-02-01

Otosclerosis is an inner ear bone disease characterized by fixation of the stapes and consequently progressive hearing loss. One treatment option is the surgical replacement of the stapes by a prosthesis. When so called "smart materials" like nitinol are used, prosthesis fixation can be performed using a laser without manual crimping on the incus. However, specific laser-prosthesis interactions have not been described yet. The aim of the present study was to elucidate the thermo-mechanical properties of the NiTiBOND® prosthesis as a basis for handling instructions for laser-assisted prosthesis fixation. Closure of the NiTiBOND® prosthesis was induced ex vivo by either a diode laser emitting at λ = 940 nm or a CO 2 laser (λ = 10,600 nm). Total energy for closure was determined. Suitable laser parameters (pulse duration, power per pulse, distance between tip of the laser fiber and prosthesis) were assessed. Specific laser-prosthesis interactions were recorded. Especially the diode laser was found to be an appropriate energy source. A total energy deposit of 60 mJ by pulses in near contact application was found to be sufficient for prosthesis closure ex vivo. Energy should be transmitted through a laser fiber equipollent to the prosthesis band diameter. Specific deformation characteristics due to the zonal prosthesis composition have to be taken into account. NiTiBOND® stapes prosthesis can be closed by very little energy when appropriate energy sources like diode lasers are used, suggesting a relatively safe application in vivo. Lasers Surg. Med. 50:153-157, 2018. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

40 CFR 264.228 - Closure and post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure and post-closure care. 264.228... Surface Impoundments § 264.228 Closure and post-closure care. (a) At closure, the owner or operator must... materials are left in place at final closure, the owner or operator must comply with all post-closure...

40 CFR 264.228 - Closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 27 2013-07-01 2013-07-01 false Closure and post-closure care. 264.228... Surface Impoundments § 264.228 Closure and post-closure care. (a) At closure, the owner or operator must... materials are left in place at final closure, the owner or operator must comply with all post-closure...

40 CFR 264.228 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Closure and post-closure care. 264.228... Surface Impoundments § 264.228 Closure and post-closure care. (a) At closure, the owner or operator must... materials are left in place at final closure, the owner or operator must comply with all post-closure...

40 CFR 264.228 - Closure and post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Closure and post-closure care. 264.228... Surface Impoundments § 264.228 Closure and post-closure care. (a) At closure, the owner or operator must... materials are left in place at final closure, the owner or operator must comply with all post-closure...

40 CFR 264.228 - Closure and post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 26 2014-07-01 2014-07-01 false Closure and post-closure care. 264.228... Surface Impoundments § 264.228 Closure and post-closure care. (a) At closure, the owner or operator must... materials are left in place at final closure, the owner or operator must comply with all post-closure...

Factors Impacting School Closure and Configuration

ERIC Educational Resources Information Center

Corrales, Antonio

2017-01-01

Newly implemented state policy dealing with school finance created several consequences in a school district to include school configuration and restructuring of educational programs. This case describes how a new school finance law changes the entire dynamic of a school district and its newly appointed superintendent. The superintendent…

An Overview of the Tropospheric Aerosol Radiative Forcing Observational Experiment

NASA Technical Reports Server (NTRS)

Russell, P. B.; Chan, K. Roland (Technical Monitor)

1997-01-01

Aerosol effects on atmospheric radiation are a leading source of uncertainty in predicting future climate. As a result, the International Global Atmospheric Chemistry Program has established a Focus on Atmospheric Aerosols (IGAC/FAA) and endorsed a series of aerosol field campaigns. TARFOX, the second in the IGAC/FAA series, was designed to reduce this uncertainty by measuring aerosol properties and effects in the US eastern seaboard, where one of the world's major plumes of industrial haze moves from the continent over the Atlantic Ocean. TARFOX's objectives are to: 1. Make simultaneous measurements of: (a) aerosol effects on radiation fields, and (b) the chemical, physical, and optical properties of the aerosols causing those effects. 2. Perform a variety of closure studies by using overdetermined data sets to test the mutual consistency of measurements and calculations of a wide range of aerosol properties and effects. 3. Use the results of the closure studies to assess and reduce uncertainties in estimates of aerosol radiative forcing, as well as to guide future field programs. An important subset of the closure studies is tests and improvements of algorithms used to derive aerosol properties and radiative effects from satellite measurements. The TARFOX Intensive Field Period (IFP) was conducted July 10-31, 1996. It included coordinated measurements from four satellites (GOES-8, NOAA-14, ERS-2, LANDSAT), four aircraft (ER-2, C-130, C-131, and a modified Cessna), land sites, and ships. A variety of aerosol conditions was sampled, ranging from relatively clean behind frontal passages to moderately polluted with aerosol optical depths exceeding 0.5 at mid-visible wavelengths. The latter conditions included separate incidents of enhancements caused primarily by anthropogenic sources and another incident of enhancement apparently influenced by recent fog processing. Spatial gradients of aerosol optical thickness were sampled to aid in isolating aerosol effects from other radiative effects and to more tightly constrain closure tests, including those of satellite retrievals. This talk gives an overview of TARFOX goals, rationale, methods, and initial key findings.

Using Interactive Multimedia to Teach Pedestrian Safety: An Exploratory Study

ERIC Educational Resources Information Center

Glang, Ann; Noell, John; Ary, Dennis; Swartz, Lynne

2005-01-01

Objectives: To evaluate an interactive multimedia (IMM) program that teaches young children safe pedestrian skills. Methods: The program uses IMM (animation and video) to teach children critical skills for crossing streets safely. A computer-delivered video assessment and a real-life street simulation were used to measure the effectiveness of the…

Rural Midwestern Public College Safe Ride Program Case Study

ERIC Educational Resources Information Center

Mohfeld, Kathy I.

2017-01-01

The central phenomenon researched in this case study was higher education administrators' decisions to institutionalize a safe ride program at a small, rural college. The purpose of this single/within-site case study was to describe the changes that happened at a rural public institution of higher education and the surrounding community in the…

Doorways II: Community Counselor Reference Materials. On School-Related Gender-Based Violence Prevention and Response

ERIC Educational Resources Information Center

US Agency for International Development, 2009

2009-01-01

The Doorways training program was designed by the U.S. Agency for International Development (USAID)-funded Safe Schools Program (Safe Schools) to enable teachers, community members and students to prevent and respond to school-related gender-based violence (SRGBV). This booklet, "Doorways II: Community Counselor Reference Materials on…

Doorways III: Teacher Reference Materials. On School-Related Gender-Based Violence Prevention and Response

ERIC Educational Resources Information Center

US Agency for International Development, 2009

2009-01-01

The Doorways training program was designed by the U.S. Agency for International Development (USAID)-funded Safe Schools Program (Safe Schools) to enable teachers, community members and students to prevent and respond to school-related gender-based violence (SRGBV). This booklet, "Doorways III: Teacher Reference Materials on School-Related…

75 FR 6006 - Office of Safe and Drug-Free Schools; Cooperative Civic Education and Economic Education Exchange...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-05

... DEPARTMENT OF EDUCATION Office of Safe and Drug-Free Schools; Cooperative Civic Education and Economic Education Exchange Program Catalog of Federal Domestic Assistance (CFDA) Number: 84.304A. ACTION... the Cooperative Civic Education and Economic Education Exchange Program. The notice stated that a list...

LogSafe and Smart: Minnesota OSHA's LogSafe Program Takes Root.

ERIC Educational Resources Information Center

Honerman, James

1999-01-01

Logging is now the most dangerous U.S. occupation. The Occupational Safety and Health Administration (OSHA) developed specialized safety training for the logging industry but has been challenged to reach small operators. An OSHA-approved state program in Minnesota provides annual safety seminars to about two-thirds of the state's full-time…

33 CFR 150.623 - What are the requirements for protecting personnel from hazards associated with confined spaces?

Code of Federal Regulations, 2011 CFR

2011-07-01

... associated with entering the port's confined spaces, and develop a confined space safe entry program that... implement the confined space safe entry program, the deepwater port operator must determine the education... protecting personnel from hazards associated with confined spaces? 150.623 Section 150.623 Navigation and...

Creating Safe Schools: Roles and Challenges, a Federal Perspective.

ERIC Educational Resources Information Center

Modzeleski, William

1996-01-01

Presents an overview of the Safe and Drug-Free Schools and Communities Act, a key federal program that provides funding directly to states and local educational agencies to facilitate drug and violence prevention programs. The Gun-Free Schools Act is also examined, and the major challenges communities face in correcting school safety problems are…

Safe Routes to School at Maybury Elementary School in Detroit

ERIC Educational Resources Information Center

Robert Wood Johnson Foundation, 2012

2012-01-01

In 2005, Congress passed legislation establishing the Safe Routes to School Program (SRTS). Since then, nearly all states and the District of Columbia have announced local or statewide SRTS activities, and thousands of schools have participated in the program. SRTS enables and encourages children to walk and bike to school by helping communities…

An Evaluation of the Adults and Children Together (ACT) against Violence Parents Raising Safe Kids Program

ERIC Educational Resources Information Center

Portwood, Sharon G.; Lambert, Richard G.; Abrams, Lyndon P.; Nelson, Ellissa Brooks

2011-01-01

This study evaluated the effectiveness of the Adults and Children Together (ACT) Against Violence Parents Raising Safe Kids program, developed by the American Psychological Association in collaboration with the National Association for the Education of Young Children, as an economical primary prevention intervention for child maltreatment. Using…

Audit Report. Quick-Reaction Report on the Review of Defense Base Closure and Realignment Budget Data for Carswell, Barksdale, Dyess, Minot, and Tinker Air Force Bases

DTIC Science & Technology

1992-11-27

for 10 construction pr~n’jcts for realigning Carswell AFB was not adeauately documented as required by Air Force Regulation (AFR) 86-1, " Programming ...Engineering Programming , Standard Facility Requirements." paragraph 24-70, allows for a total of 25,200 square feet of space for tne warehouse and...cantonment area, and replaced an existing capability. The fact that a replacement wash rack was previously programmed does not alter this requirement

Initial experience with the 3.3 Fr Mongoose® pigtail catheter for aortic angiography during patent ductus arteriosus closure in small patients

PubMed Central

Hena, Zachary; Sutton, Nicole J; Gates, Gregory J; Taragin, Benjamin H; Pass, Robert H

2017-01-01

Background: Smaller femoral arterial sheaths may be associated with fewer vascular complications. The 3.3 Fr Mongoose® Pediavascular pigtail catheter is a catheter that allows higher flow rates, potentially resulting in improved angiographic quality. We reviewed our experience with this small catheter during patent ductus arteriosus (PDA) closure. Materials and Methods: Review of patients ≤20 kg in whom the Mongoose® catheter was used during PDA closure from 12/13 to 4/15. Angiographic efficacy and procedural details were compared to ten 4 Fr catheter cases. Comparisons were performed using Mann–Whitney U-test; P < 0.05 was statistically significant. Results: Twelve (9 female) patients were catheterized with a 3.3 Fr Mongoose®. Median weight 10.5 kg (range 6.4–18.2), height 81 cm (range 37–111), and body surface area (BSA) 0.47 m2 (range 0.33–0.75) were similar to ten patients (3 females) in the 4 Fr control group (P = NS); median weight 9.9 kg (range 6–16.8), height 80 cm (range 64–102), and BSA 0.46 m2 (range 0.31–0.74). Angiographic quality was subjectively adequate with both with no difference in the median pixel density between the two techniques (3.3 Fr: 76.7 [range 33.5–90] and 4 Fr: [70; 38–102]; P = NS). Contrast used was similar between the groups (3.3 Fr: median 4.2 ml/kg and 4 Fr: 4.9 ml/kg; P = NS). Median radiation dose was similar in the two groups (3.3 Fr: 28.1 mGy [range 17.2–38] and 4 Fr: 38 mGy [range 20.4–58.5]; P = NS). All ducts were closed at latest follow-up (P = NS). No complications were encountered. Conclusions: The 3.3 Fr Mongoose® allowed similar angiography to the 4 Fr pigtail catheter, allowing safe and effective transcatheter PDA closure in small children. PMID:28928609

[Robot-assisted atrial septal defect closure in adults: first experience in Russia].

PubMed

Arkhipov, A N; Bogachev-Prokofiev, A V; Zubritskiy, A V; Khapaev, T S; Gorbatykh, Yu N; Pavlushin, P M; Karaskov, A M

To analyze immediate results of minimally invasive robot-assisted atrial septal defect (ASD) closure in adults. For the period from March 2012 to November 2016 sixty patients with contraindications to endovascular procedure have undergone robot-assisted atrial septal defect closure at Meshalkin Siberian Federal Biomedical Research Center. Mean age was 34.5±11.3 years, body mass index - 24.6±4.0 kg/m 2 . 48 (80%) patients had NYHA class II before surgery. In 37 (61.7%) patients isolated ASD with deficiency or absence of one edge was diagnosed, isolated ASD with primary septum aneurysm - in 16 (26.7%) cases, 7 (11.6%) patients had reticulate ASD. 5 (8.3%) patients had concomitant tricuspid valve insufficiency required surgical repair (suture annuloplasty). All operations were performed under cardiopulmonary bypass with peripheral cannulation. Right-sided anterolateral mini-thoracotomy was used in the first 43 patients. Following 17 patients underwent completely endoscopic procedure. Depending on the shape, size and anatomical features of the defect we performed suturing (14 patients, 23.3%) or repair with xenopericardial patch (46%, 76.6%). Mean CPB and aortic cross-clamping time was 89.1±28.7 and 24.8±9.5 min, respectively. Postoperative variables: mechanical ventilation 3.3±1.5 hours, ICU-stay - 18.2±3.7 hours, postoperative hospital-stay - 13.4±5.7 days. There were no mortality and any life-threatening intra- and postoperative complications. Cases of conversion to thoraco-/sternotomy and postoperative bleeding followed by redo surgery were also absent. 23 patients were followed-up within 1 year, 6 patients - within 2 years, 3 patients - within 3 years. All patients were in NYHA class I-II with 100% freedom from ASD recanalization and redo surgery. According to echocardiography data there were decreased right heart, pulmonary artery pressure and preserved left ventricular function in early postoperative period and 1 year after surgery. In view of favorable course of postoperative period, no significant specific complications and encouraging immediate results we can talk about endoscopic robot-assisted ASD closure in adults as a safe and effective alternative to surgical treatment.

Biological life support systems for martian missions: some problems and prospects

NASA Astrophysics Data System (ADS)

Tikhomirov, A. A.; Ushakova, S. A.; Kovaleva, N. P.; Lasseur, C.

Taking into account the experience of scientific researches obtained during experiments in the BIOS - 3 of the Institute of Biophysics of Siberian Branch of Russian Academy of Science (IBP SB RAS) and the MELISSA program (ESA), approaches in creation biological life support systems for a flight period and a fixed-site base of Martian mission are considered. Various alternate variants of designing of elements of BLSS based on use of Chlorella and/or Spirulina, and also greenhouses with higher plants for the flight period of Martian mission are analyzed. For this purpose construction of BLSS ensuring full closure of matter turnover according to gas exchange and water and partial closure on the human's exometabolites is supposed. For the fixed site Martian station BLSS based on use of higher plants with a various degree of closure of internal mass exchange are suggested. Various versions of BLSS configuration and degree of closure of mass exchange depending on duration of Martian mission, the diet type of a crew and some other conditions are considered. Special attention is given to problems of reliability and tolerance of matter turnover processes in BLSS which maintenance is connected, in particular, with additional oxygen reproduction inside a system. Technologies for realization of BLSS of various configurations are offered and justified. The auxiliary role of the physicochemical methods in BLSS functioning both for the flight period and for the crew stay on Mars is justified.

40 CFR 265.228 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Closure and post-closure care. 265.228... DISPOSAL FACILITIES Surface Impoundments § 265.228 Closure and post-closure care. (a) At closure, the owner... impoundment and provide post-closure care for a landfill under subpart G and § 265.310, including the...

40 CFR 265.228 - Closure and post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Closure and post-closure care. 265.228... DISPOSAL FACILITIES Surface Impoundments § 265.228 Closure and post-closure care. (a) At closure, the owner... impoundment and provide post-closure care for a landfill under subpart G and § 265.310, including the...

Full Life Cycle Research at the Ketzin Pilot Site, Germany - From Safe and Successful CO2 Injection Operation to Post-Injection Monitoring and Site Closure

NASA Astrophysics Data System (ADS)

Liebscher, A. H.

2016-12-01

The Ketzin pilot site near Berlin, Germany, was initiated in 2004 as the first European onshore storage project for research and development on geological CO2 storage. The operational CO2 injection period started in June 2008 and ended in August 2013 when the site entered the post-injection closure period. During these five years, a total amount of 67 kt of CO2 was safely injected into a saline aquifer (Upper Triassic sandstone) at a depth of 630 m - 650 m. In fall 2013, the first observation well was partially plugged in the reservoir section; full abandonment of this well finished in 2015 after roughly 2 years of well closure monitoring. Abandonment of the remaining 4 wells will be finished by 2017 and hand-over of liability to the competent authority is planned for end of 2017. The CO2 injected was mainly of food grade quality (purity > 99.9%). In addition, 1.5 kt of CO2 from the pilot capture facility "Schwarze Pumpe" (oxyfuel power plant CO2 with purity > 99.7%) was injected in 2011. The injection period terminated with a CO2-N2 co-injection experiment of 650 t of a 95% CO2/5% N2 mixture in summer 2013 to study the effects of impurities in the CO2 stream on the injection operation. During regular operation, the CO2 was pre-heated on-site to 40 - 45°C prior to injection to ensure a single-phase injection process and avoid any phase transition or transient states within the injection facility or the reservoir. Between March and July 2013, just prior to the CO2-N2 co-injection experiment, the injection temperature was stepwise decreased down to 10°C within a "cold-injection" experiment to study the effects of two-phase injection conditions. During injection operation, the combination of different geochemical and geophysical monitoring methods enabled detection and mapping of the spatial and temporal in-reservoir behaviour of the injected CO2 even for small quantities. After the cessation of CO2 injection, post-injection monitoring continued and two additional field experiments have been performed. A CO2 back-production experiment was run in autumn 2014 to study the physicochemical properties of the back-produced CO2 as well as the pressure response of the reservoir. In October 2015 to January 2016, a brine injection experiment studied the imbibition process and residual gas saturation.

Supporting Displaced Workers for Successful Retraining.

ERIC Educational Resources Information Center

Bugler, Helen; Newhook, Brenda

In response to the closure and down-sizing of fish plants in Newfoundland, Cabot College (CC) established a Student Support Services Unit (SSSU) to offer special counseling and advising services to the more than 100 students expected to undertake vocational retraining at CC under the province's Fisheries Adjustment Program. The SSSU hired two…

Cyanobacteria: State Monitoring Programs, Beach Closures, and Potential Human Health Risks

EPA Science Inventory

New England is rich in freshwater lakes and ponds, many of which are subject to cyanobacteria (blue-green algae) blooms that can limit recreational use and cause health problems. This study was conducted to better understand the health risks to human and animal populations that a...

7 CFR 225.14 - Requirements for sponsor participation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... an unanticipated school closure during the period from October through April (or at any time of the..., from submitting a new application if they have participated in the program at any time during the... and have the capability and the facilities to provide the meal service planned for the number of...

7 CFR 225.14 - Requirements for sponsor participation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... an unanticipated school closure during the period from October through April (or at any time of the..., from submitting a new application if they have participated in the program at any time during the... and have the capability and the facilities to provide the meal service planned for the number of...

45 CFR 261.41 - How will we determine the caseload reduction credit?

Code of Federal Regulations, 2010 CFR

2010-10-01

... ASSISTANCE (ASSISTANCE PROGRAMS), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN..., or other administrative data sources and analyses. (2) We will accept the information and estimates... closures, or other administrative data sources to validate the accuracy of the State estimates. (b) In...

Small Schools Task Force. Final Report.

ERIC Educational Resources Information Center

Eugene School District 4J, OR.

In the spring of 1975 the Eugene (Oregon) school board appointed a task force to make a comprehensive study related to all aspects of possible closure of small schools. Consideration was given to population and enrollment trends; economics; building condition; school size; school design; neighborhood and community implications; program capacity;…

34 CFR 685.214 - Closed school discharge.

Code of Federal Regulations, 2014 CFR

2014-07-01

... closure date is the date that the school ceases to provide educational instruction in all programs, as... 34 Education 4 2014-07-01 2014-07-01 false Closed school discharge. 685.214 Section 685.214... Provisions § 685.214 Closed school discharge. (a) General. (1) The Secretary discharges the borrower's (and...

Retrenchment in Education: Hierarchical Decision Models for Instructional Program Termination, District Consolidations and School Closures.

ERIC Educational Resources Information Center

Wholeben, Brent Edward

A number of key issues facing elementary, secondary, and postsecondary educational administrators during retrenchment require a hierarchical decision-modeling approach. This paper identifies and discusses the use of a hierarchical multiple-alternatives modeling formulation (computer-based) that compares and evaluates a group of solution…

Compression in the Superintendent Ranks

ERIC Educational Resources Information Center

Saron, Bradford G.; Birchbauer, Louis J.

2011-01-01

Sadly, the fiscal condition of school systems now not only is troublesome, but in some cases has surpassed all expectations for the worst-case scenario. Among the states, one common response is to drop funding for public education to inadequate levels, leading to permanent program cuts, school closures, staff layoffs, district dissolutions and…

75 FR 12746 - Difenzoquat; Registration Review Case Closure; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-17

... on human health or the environment. Through this program, EPA is ensuring that each pesticide's registration is based on current scientific and other knowledge, including its effects on human health and the..., human health, farm worker, and agricultural advocates; the chemical industry; pesticide users; and...

75 FR 57782 - Clofencet; Registration Review Case Closure; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-22

... on human health or the environment. Through this program, EPA is ensuring that each pesticide's registration is based on current scientific and other knowledge, including its effects on human health and the..., human health, farm worker, and agricultural advocates; the chemical industry; pesticide users; and...

23 CFR 511.309 - Provisions for traffic and travel conditions reporting.

Code of Federal Regulations, 2012 CFR

2012-04-01

... requirements for traffic and travel conditions made available by real-time information programs are: (1... or less from the time the hazardous conditions, blockage, or closure is observed. (4) Travel time information. The timeliness for the availability of travel time information along limited access roadway...

78 FR 22529 - Information on Surplus Land at a Military Installation Designated for Disposal: Naval Air Station...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-16

... Installation Designated for Disposal: Naval Air Station Alameda, Alameda, California AGENCY: Department of the... at Naval Air Station Alameda, Alameda, California. FOR FURTHER INFORMATION CONTACT: Ms. Laura Duchnak, Director, Naval Facilities Engineering Command, Base Realignment and Closure Program Management Office...

Laparoscopic CBD Exploration.

PubMed

Savita, K S; Bhartia, Vishnu K

2010-10-01

Laparoscopic CBD exploration (LCBDE) is a cost effective, efficient and minimally invasive method of treating choledocholithiasis. Laparoscopic Surgery for common bile duct stones (CBDS) was first described in 1991, Petelin (Surg Endosc 17:1705-1715, 2003). The surgical technique has evolved since then and several studies have concluded that Laparoscopic common bile duct exploration(LCBDE) procedures are superior to sequential endolaparoscopic treatment in terms of both clinical and economical outcomes, Cuschieri et al. (Surg Endosc 13:952-957, 1999), Rhodes et al. (Lancet 351:159-161, 1998). We started doing LCBDE in 1998.Our experience with LCBDE from 1998 to 2004 has been published, Gupta and Bhartia (Indian J Surg 67:94-99, 2005). Here we present our series from January 2005 to March 2009. In a retrospective study from January 2005 to March 2009, we performed 3060 laparoscopic cholecystectomies, out of which 342 patients underwent intraoperative cholangiogram and 158 patients eventually had CBD exploration. 6 patients were converted to open due to presence of multiple stones and 2 patients were converted because of difficulty in defining Calots triangle; 42 patients underwent transcystic clearance, 106 patients had choledochotomy, 20 patients had primary closure of CBD whereas in 86 patients CBD was closed over T-tube; 2 patients had incomplete stone clearance and underwent postoperative ERCP. Choledochoduodenosotomy was done in 2 patients. Patients were followed regularly at six monthly intervals with a range of six months to three years of follow-up. There were no major complications like bile leak or pancreatitis. 8 patients had port-site minor infection which settled with conservative treatment. There were no cases of retained stones or intraabdominal infection. The mean length of hospital stay was 3 days (range 2-8 days). LCBDE remains an efficient, safe, cost-effective method of treating CBDS. Primary closure of choledochotomy in select patients is a viable & safe option with shorter operative time and length of stay. LCBDE can be performed successfully with minimal morbidity & mortality.