The importance of localizing pulmonary veins in atrial septal defect closure!

PubMed Central

2011-01-01

An 8-year-old girl was admitted for a simple closure of echocardiographically diagnosed Atrial Septal Defect (ASD). During the operation the right pulmonary veins orifices were not detected in the left atrium and attempt to localize them led to the discovery of three additional anomalies, namely Interrupted Inferior Vena Cava (IIVC), Scimitar syndrome, and systemic arterial supply of the lung. Postoperatively these finding were confirmed by CT angiography. This case report emphasizes the need for adequate preoperative diagnosis and presents a very rare constellation of four congenital anomalies that to the best of our knowledge is not reported before. PMID:21450090

High-resolution subject-specific mitral valve imaging and modeling: experimental and computational methods.

PubMed

Toma, Milan; Bloodworth, Charles H; Einstein, Daniel R; Pierce, Eric L; Cochran, Richard P; Yoganathan, Ajit P; Kunzelman, Karyn S

2016-12-01

The diversity of mitral valve (MV) geometries and multitude of surgical options for correction of MV diseases necessitates the use of computational modeling. Numerical simulations of the MV would allow surgeons and engineers to evaluate repairs, devices, procedures, and concepts before performing them and before moving on to more costly testing modalities. Constructing, tuning, and validating these models rely upon extensive in vitro characterization of valve structure, function, and response to change due to diseases. Micro-computed tomography ([Formula: see text]CT) allows for unmatched spatial resolution for soft tissue imaging. However, it is still technically challenging to obtain an accurate geometry of the diastolic MV. We discuss here the development of a novel technique for treating MV specimens with glutaraldehyde fixative in order to minimize geometric distortions in preparation for [Formula: see text]CT scanning. The technique provides a resulting MV geometry which is significantly more detailed in chordal structure, accurate in leaflet shape, and closer to its physiological diastolic geometry. In this paper, computational fluid-structure interaction (FSI) simulations are used to show the importance of more detailed subject-specific MV geometry with 3D chordal structure to simulate a proper closure validated against [Formula: see text]CT images of the closed valve. Two computational models, before and after use of the aforementioned technique, are used to simulate closure of the MV.

In vitro effects of 3% hypertonic saline and 20% mannitol on canine whole blood coagulation and platelet function.

PubMed

Adamik, Katja-Nicole; Butty, Emmanuelle; Howard, Judith

2015-09-24

Hyperosmolar therapy, using either mannitol or hypertonic saline (HTS), is considered the treatment of choice for intracranial hypertension. However, hyperosmolar agents may impair coagulation and platelet function, limiting their use in patients at risk for hemorrhage. Despite this, studies evaluating the effects of mannitol compared to other hyperosmolar agents in dogs are largely lacking. The aim of this study was to compare the in vitro effects on global hemostasis and platelet function of 20% mannitol and 3% HTS on canine blood. Citrated whole blood from 15 healthy dogs was diluted with 0.9% saline, 20% mannitol and 3% HTS in ratios of 1:16 and 1:8. Rotational thromboelastometry (ROTEM) was used to assess clotting time (CT), clot formation time (CFT) and maximal clot firmness (MCF) following extrinsic activation (Ex-tem) and after platelet inhibition (Fib-tem). A platelet function analyzer (PFA-100) was used to assess closure time (Ct(PFA)). No significant differences were observed between untreated whole blood and samples diluted with saline. Samples diluted with both mannitol and HTS were hypocoagulable compared to untreated whole blood samples. At a dilution of 1:16, no significant differences were found between any measured parameter in samples diluted with saline compared to mannitol or HTS. At a 1:8 dilution, Ct(PFA) was prolonged in samples diluted with mannitol and HTS compared to saline, and Ct(PFA) was prolonged more with mannitol than HTS. Ex-tem CT was increased at a 1:8 dilution with mannitol compared to HTS. Ex-tem CFT was prolonged at a 1:8 dilution with both agents compared to saline, and was prolonged more with mannitol than HTS. Ex-tem MCF was reduced at a 1:8 dilution with both agents compared to saline. Data in this study indicate that both mannitol and HTS affect canine platelet function and whole blood coagulation in vitro in a dose-dependent fashion. The most pronounced effects were observed after high dilutions with mannitol, which impaired platelet aggregation, clot formation time, clot strength, and fibrin formation significantly more than HTS. Further in vivo studies are necessary before recommendations can be made.

50 CFR 660.360 - Recreational fishery-management measures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... authorized for recreational fishing are hook-and-line and spear. Spears may be propelled by hand or by... when the closure is in effect. The closure is not in effect at this time. This closure may be imposed... when the closure is in effect. The closure is not in effect at this time. This closure may be imposed...

50 CFR 660.360 - Recreational fishery-management measures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... authorized for recreational fishing are hook-and-line and spear. Spears may be propelled by hand or by... when the closure is in effect. The closure is not in effect at this time. This closure may be imposed... when the closure is in effect. The closure is not in effect at this time. This closure may be imposed...

Management of hidradenitis suppurativa wounds with an internal vacuum-assisted closure device.

PubMed

Chen, Y Erin; Gerstle, Theodore; Verma, Kapil; Treiser, Matthew D; Kimball, Alexandra B; Orgill, Dennis P

2014-03-01

Hidradenitis suppurativa is a chronic, debilitating disease that is difficult to treat. Once medical management fails, wide local excision offers the best chance for cure. However, the resultant wound often proves too large or contaminated for immediate closure. The authors performed a retrospective chart review of hidradenitis cases managed surgically between 2005 and 2010. Data collected included patient characteristics, management method, and outcomes. Approximately half of the patients received internal vacuum-assisted closure therapy using the vacuum-assisted closure system and delayed closure and half of the patients received immediate primary closure at the time of their excision. Delayed closure consisted of closing the majority of the wound in a linear fashion following internal vacuum-assisted closure while accepting healing by means of secondary intention for small wound areas. Patients managed with internal vacuum-assisted closure had wounds on average four times larger in area than patients managed without internal vacuum-assisted closure. In both groups, all wounds were eventually closed primarily. Healing times averaged 2.2 months with internal vacuum-assisted closure and 2.7 months without. At an average follow-up time of 2.3 months, all patients with internal vacuum-assisted closure had no recurrence of their local disease. Severe hidradenitis presents a treatment challenge, as surgical excisions are often complicated by difficult closures and unsatisfactory recurrence rates. This study demonstrates that wide local excision with reasonable outcomes can be achieved using accelerated delayed primary closure. This method uses internal vacuum-assisted closure as a bridge between excision and delayed primary closure, facilitating closure without recurrence in large, heavily contaminated wounds. Therapeutic, III.

CO2 flux determination by closed-chamber methods can be seriously biased by inappropriate application of linear regression

NASA Astrophysics Data System (ADS)

Kutzbach, L.; Schneider, J.; Sachs, T.; Giebels, M.; Nykänen, H.; Shurpali, N. J.; Martikainen, P. J.; Alm, J.; Wilmking, M.

2007-11-01

Closed (non-steady state) chambers are widely used for quantifying carbon dioxide (CO2) fluxes between soils or low-stature canopies and the atmosphere. It is well recognised that covering a soil or vegetation by a closed chamber inherently disturbs the natural CO2 fluxes by altering the concentration gradients between the soil, the vegetation and the overlying air. Thus, the driving factors of CO2 fluxes are not constant during the closed chamber experiment, and no linear increase or decrease of CO2 concentration over time within the chamber headspace can be expected. Nevertheless, linear regression has been applied for calculating CO2 fluxes in many recent, partly influential, studies. This approach has been justified by keeping the closure time short and assuming the concentration change over time to be in the linear range. Here, we test if the application of linear regression is really appropriate for estimating CO2 fluxes using closed chambers over short closure times and if the application of nonlinear regression is necessary. We developed a nonlinear exponential regression model from diffusion and photosynthesis theory. This exponential model was tested with four different datasets of CO2 flux measurements (total number: 1764) conducted at three peatlands sites in Finland and a tundra site in Siberia. Thorough analyses of residuals demonstrated that linear regression was frequently not appropriate for the determination of CO2 fluxes by closed-chamber methods, even if closure times were kept short. The developed exponential model was well suited for nonlinear regression of the concentration over time c(t) evolution in the chamber headspace and estimation of the initial CO2 fluxes at closure time for the majority of experiments. However, a rather large percentage of the exponential regression functions showed curvatures not consistent with the theoretical model which is considered to be caused by violations of the underlying model assumptions. Especially the effects of turbulence and pressure disturbances by the chamber deployment are suspected to have caused unexplainable curvatures. CO2 flux estimates by linear regression can be as low as 40% of the flux estimates of exponential regression for closure times of only two minutes. The degree of underestimation increased with increasing CO2 flux strength and was dependent on soil and vegetation conditions which can disturb not only the quantitative but also the qualitative evaluation of CO2 flux dynamics. The underestimation effect by linear regression was observed to be different for CO2 uptake and release situations which can lead to stronger bias in the daily, seasonal and annual CO2 balances than in the individual fluxes. To avoid serious bias of CO2 flux estimates based on closed chamber experiments, we suggest further tests using published datasets and recommend the use of nonlinear regression models for future closed chamber studies.

Wound healing effects of noni (Morinda citrifolia L.) leaves: a mechanism involving its PDGF/A2A receptor ligand binding and promotion of wound closure.

PubMed

Palu, Afa; Su, Chen; Zhou, Bing-Nan; West, Brett; Jensen, Jarakae

2010-10-01

Morinda citrifolia L. (Rubiaceae) commonly known as noni, has been used in Polynesia by traditional healers for the treatment of cuts, bruises and wounds. Our objective was to investigate the wound-healing mechanisms of the noni leaf. The investigations of its wound-healing mechanisms were carried out using fresh noni leaf juice (NLJ), noni leaf ethanol extract (NLEE) and its methanol (MFEE) and hexane (HFEE) fractions on the PDGF and A(2A) receptors in vitro and topically in mice. Fresh noni leaf juice showed significant affinity to PDGF receptors, and displayed 166% binding inhibition of the ligand binding to its receptors, while at the same concentration, it only had 7% inhibition of the ligand binding to the A(2A) receptors. NLEE, HFEE and MFEE showed significant affinity to A(2A) receptors, concentration dependently, with IC(50) values of 34.1, 42.9 and 86.7 μg/mL, respectively. However, MFEE significantly increased wound closure and reduced the half closure time in mice with a CT(50) of 5.4 ± 0.2 days compared with control (p < 0.05). These results suggest that noni leaf significantly accelerated wound healing in mice via its ligand binding to the PDGF and A(2A) receptors as its probable mechanisms of wound-healing and also support its traditional usage for wound-healing in Polynesia. Copyright © 2010 John Wiley & Sons, Ltd.

Temporal Dermoid Cyst with Unusual Imaging Appearance: Case Report.

PubMed

Abderrahmen, Khansa; Bouhoula, Asma; Aouidj, Lasaad; Jemel, Hafedh

2016-01-01

Intracranial dermoid cysts are benign, slow growing tumors derived from ectopic inclusions of epithelial cells during closure of neural tube. These lesions, accounting for less than 1% of intracranial tumors, have characteristic computed tomography (CT) and magnetic resonance imaging (MRI) appearances that generally permits preoperative diagnosis. However, the radiologic features are uncommon and the cyst can be easily misdiagnosed with other tumors in rare cases. Herein, we report a case of a left temporoparietal dermoid cyst in a 48-year-old woman that was peroperatively and histopathologically proven but not advocated on CT and MRI. Clinical, radiological and histopathological features of a dermoid cyst are reviewed.

Effect of Resorbable Collagen Plug on Bone Regeneration in Rat Critical-Size Defect Model.

PubMed

Liu, Weiqing; Kang, Ning; Dong, Yuliang; Guo, Yuchen; Zhao, Dan; Zhang, Shiwen; Zhou, Liyan; Seriwatanachai, Dutmanee; Liang, Xing; Yuan, Quan

2016-04-01

The purpose of this investigation was to examine the effect of resorbable collagen plug (RCP) on bone regeneration in rat calvarial critical-size defects. About 5-mm-diameter calvarial defects were created in forty 12-week-old male Sprague-Dawley rats and implanted with or without RCP. Animals were killed at 1, 2, 4, and 8 weeks postoperatively. After being killed, specimens were collected and subjected to micro-computed tomography (μCT) and histological analysis. The μCT showed a significant increase of newly formed bone volume/tissue volume in RCP-implanted defect compared with controls at all designated time points. After 8 weeks, the defects implanted with RCP displayed almost complete closure. Hematoxylin and eosin staining of the decalcified sections confirmed these observations and evidenced active bone regeneration in the RCP group. In addition, Masson's trichrome staining demonstrated that RCP implantation accelerated the process of collagen maturation. The RCP enhances bone regeneration in rat critical-size cranial defects, which suggest it might be a desired material for bone defect repair.

Von Willebrand factor antigen predicts response to double dose of aspirin and clopidogrel by PFA-100 in patients undergoing primary angioplasty for ST elevation myocardial infarction.

PubMed

Gianetti, Jacopo; Parri, Maria Serena; Della Pina, Francesca; Marchi, Federica; Koni, Endrin; De Caterina, Alberto; Maffei, Stefano; Berti, Sergio

2013-01-01

Von Willebrand factor (VWF) is an emerging risk factor in acute coronary syndromes. Platelet Function Analyzer (PFA-100) with Collagen/Epinephrine (CEPI) is sensitive to functional alterations of VWF and also identifies patients with high on-treatment platelet reactivity (HPR). The objective of this study was to verify the effect of double dose (DD) of aspirin and clopidogrel on HPR detected by PFA-100 and its relation to VWF and to its regulatory metalloprotease ADAMTS-13. Between 2009 and 2011 we enrolled 116 consecutive patients with ST elevation myocardial infarction undergoing primary PCI with HPR at day 5 after PCI. Patients recruited were then randomized between a standard dose (SD, n = 58) or DD of aspirin and clopidogrel (DD, n = 58), maintained for 6 months follow-up. Blood samples for PFA-100, light transmittance aggregometry, and VWF/ADAMTS-13 analysis were collected after 5, 30, and 180 days (Times 0, 1, and 2). At Times 1 and 2 we observed a significantly higher CEPI closure times (CT) in DD as compared to SD (P < 0.001). Delta of CEPI-CT (T1 - T0) was significantly related to VWF (P < 0.001) and inversely related to ADAMTS-13 (0.01). Responders had a significantly higher level of VWF at T0. Finally, in a multivariate model analysis, VWF and ADAMTS-13 in resulted significant predictors of CEPI-CT response (P = 0.02). HRP detected by PFA-100 in acute myocardial infarction is reversible by DD of aspirin and clopidogrel; the response is predicted by basal levels of VWF and ADAMTS-13. PFA-100 may be a useful tool to risk stratification in acute coronary syndromes given its sensitivity to VWF.

One-stop shop assessment for atrial septal defect closure using 256-slice coronary CT angiography.

PubMed

Yamasaki, Yuzo; Nagao, Michinobu; Kawanami, Satoshi; Kamitani, Takeshi; Sagiyama, Koji; Yamanouchi, Torahiko; Sakamoto, Ichiro; Yamamura, Kenichiro; Yabuuchi, Hidetake; Honda, Hiroshi

2017-02-01

To investigate the feasibility and accuracy of measurement of the pulmonary to systemic blood flow ratio (Qp/Qs) and defect and rim sizes in secundum atrial septal defects (ASDs) using 256-slice CT, compared to the reference transoesophageal echocardiography (TEE) and right heart catheterization (RHC) measurements. Twenty-three consecutive adult patients with secundum ASDs who underwent retrospective ECG-gated coronary CT angiography (CCTA), TEE and RHC were enrolled in this study. Right ventricular (RV) and left ventricular (LV) stroke volumes (SV) were calculated by biventricular volumetry of CCTA. Qp/Qs-CT was defined as RVSV/LVSV. The sizes of the defect and rim were measured by multi-planar reconstruction CT images. Correlations between Qp/Qs-CT and Qp/Qs-RHC and between the defect diameter obtained by CT and TEE were analyzed by Pearson's coefficient analysis. Rim sizes by CT and TEE were compared by paired t-test. Qp/Qs-CT was significantly correlated with Qp/Qs-RHC (r = 0.83, p < 0.0001), and the defect diameter by CT was significantly correlated with that by TEE (r = 0.95, p < 0.0001). There was no significant difference between CT and TEE in measurements of rim size. 256-slice CCTA allows measuring Qp/Qs and size of defects and rims in patients with secundum ASDs, accomplishing pretreatment evaluation non-invasively and comprehensively. • Quantification of left-to-right shunting can be performed reliably and accurately by CT. • The sizes of defects and rims can be measured accurately using 256-slice CT. • 256-slice CT permits pretreatment evaluation of ASD non-invasively and comprehensively.

Comparison of the effects of a balanced crystalloid-based and a saline-based tetrastarch solution on canine whole blood coagulation and platelet function.

PubMed

Reuteler, Annina; Axiak-Flammer, Shannon; Howard, Judith; Adamik, Katja-Nicole

2017-01-01

To evaluate the effects of a 6% hydroxyethyl starch (130/0.42) solution in either a buffered, electrolyte-balanced (HES-BAL), or a saline (HES-SAL) carrier solution on canine platelet function and whole blood coagulation. Prospective, randomized study. University teaching hospital. Thirty-seven client-owned dogs undergoing general anesthesia for arthroscopy or imaging studies. Dogs received a 15 mL/kg intravenous bolus of HES-SAL (n = 13), HES-BAL (n = 14), or a modified Ringer's solution (n = 10) over 30-40 minutes. Coagulation was analyzed using a Platelet Function Analyzer-100 (closure time [Ct PFA ]), and whole blood thromboelastometry (ROTEM) with extrinsically (ex-tem and fib-tem) and intrinsically (in-tem) activated assays, which assessed clotting time (CT), clot formation time (CFT), maximal clot firmness (MCF), and lysis index (LI). Coagulation samples were assayed prior to fluid administration (T0), and 5 minutes (T1), and 3 hours (T2) following fluid bolus administration, respectively. Both HES solutions resulted in impaired platelet function as indicated by a significant prolongation of Ct PFA at T1 as compared to T0, but which resolved by T2. An IV bolus of Ringer's solution did not alter platelet function. In both HES groups, whole blood coagulation was significantly impaired at T1 as indicated by a significant increase in in-tem CFT, and a significant decrease in ex-tem, in-tem, and fib-tem MCF compared to T0. Furthermore, a significant increase in ex-tem CFT at T1 compared to T0 was found in the HES-SAL group. With the exception of in-tem MCF after HES-BAL, these effects were not present at T2. No significant differences were found in Ct PFA or any ROTEM variable at any time point between HES-SAL and HES-BAL. Administration of a single bolus of 15 mL/kg 6% HES 130/0.42 results in significant but short-lived impairment of canine platelet function and whole blood coagulation, regardless of carrier solution. © Veterinary Emergency and Critical Care Society 2016.

Keyhole Fracture of the Skull

DTIC Science & Technology

2008-12-01

unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 Keyhole Fracture of the Skull irrigation and drainage of the penetrating...skull injury without craniotomy , and repair of the laceration via advancement flap Fig. 3. Diagram of forces involved in creation of keyhole...midline shift was noted. Helical CT scan performed the following day after debridement, irrigation, drainage , and closure of the gunshot wound showed

The timing of ostomy closure in infants with necrotizing enterocolitis: a systematic review.

PubMed

Struijs, Marie-Chantal; Sloots, Cornelius E J; Hop, Wim C J; Tibboel, Dick; Wijnen, Rene M H

2012-07-01

The optimal timing of ostomy closure is a matter of debate. We performed a systematic review of outcomes of early ostomy closure (EC, within 8 weeks) and late ostomy closure (LC, after 8 weeks) in infants with necrotizing enterocolitis. PubMed, EMbase, Web-of-Science, and Cinahl were searched for studies that detailed time to ostomy closure, and time to full enteral nutrition (FEN) or complications after ostomy closure. Patients with Hirschsprung's disease or anorectal malformations were excluded. Analysis was performed using SPSS 17 and RevMan 5. Of 778 retrieved articles, 5 met the inclusion criteria. The median score for study quality was 9 [range 8-14 on a scale of 0 to 32 points (Downs and Black, J Epidemiol Community Health 52:377-384, 1998)]. One study described mean time to FEN: 19.1 days after EC (n = 13) versus 7.2 days after LC (n = 24; P = 0.027). Four studies reported complication rates after ostomy closure, complications occurred in 27% of the EC group versus 23% of the LC group. The combined odds ratio (LC vs. EC) was 1.1 [95% CI 0.5, 2.5]. Evidence that supports early or late closure is scarce and the published articles are of poor quality. There is no significant difference between EC versus LC in the complication rate. This systematic review supports neither early nor late ostomy closure.

40 CFR 265.142 - Cost estimate for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... must equal the cost of final closure at the point in the facility's active life when the extent and... at all times over the life of the facility. (3) The closure cost estimate may not incorporate any... facility at the time of partial or final closure. (4) The owner or operator may not incorporate a zero cost...

40 CFR 265.142 - Cost estimate for closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... must equal the cost of final closure at the point in the facility's active life when the extent and... at all times over the life of the facility. (3) The closure cost estimate may not incorporate any... facility at the time of partial or final closure. (4) The owner or operator may not incorporate a zero cost...

Making the diagnosis: metopic ridge versus metopic craniosynostosis.

PubMed

Birgfeld, Craig B; Saltzman, Babette S; Hing, Anne V; Heike, Carrie L; Khanna, Paritosh C; Gruss, Joseph S; Hopper, Richard A

2013-01-01

The metopic suture is the only calvarial suture which normally closes during infancy. Upon closure, a palpable and visible ridge often forms which can be confused with metopic craniosynostosis. Metopic ridging (MR) is treated nonsurgically while metopic craniosynostosis (MCS) is treated surgically. Differentiating between the two is paramount; however, consensus is lacking about where a clear diagnostic threshold lies. The goal of this study is to describe the physical examination and CT scan characteristics which may help to differentiate between physiological closure of the metopic suture with ridging (MR) and MCS. A retrospective chart review of all patients seen at Seattle Children's Hospital between 2004 and 2009 with the diagnosis of either MCS or MR (n = 282) was performed. Physical examination characteristics described by diagnosing practitioners were analyzed. Clinical photos were assessed by 3 expert raters to determine the importance of these characteristics. CT scan findings were abstracted and compared between the two diagnoses. The "classic" triad of narrow forehead, biparietal widening, and hypotelorism was present in only 14% of patients with MCS. Ninety-eight percent of patients in both groups had a palpable metopic ridge. The photographic finding of narrow forehead and pterional constriction was present in all patients with MCS, but only in 11.2% and 2.8% of patients with MR. On CT scan, the presence of 3 or more MCS findings was diagnostic of MCS in 96% of patients. Patients with MCS were more likely to present before 6 months of age (66% vs. 32%). Patients with MCS tend to present earlier than those with MR. Upon physical examination, the relationship between the lateral frontal bone and the lateral orbit is important in distinguishing between the two diagnoses. A CT scan can be helpful in making the diagnosis not to confirm a closed suture but to identify 3 or more MCS characteristics.

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.

Variability of non-response to aspirin in patients with peripheral arterial occlusive disease during long-term follow-up.

PubMed

Linnemann, Birgit; Prochnow, Stephanie; Mani, Helen; Schwonberg, Jan; Lindhoff-Last, Edelgard

2009-10-01

Non-responsiveness to aspirin as detected by laboratory tests may identify patients at high risk for future vascular events. The aim of this prospective study was to evaluate whether non-responsiveness to aspirin is stable over time. Ninety-eight patients with stable peripheral arterial occlusive disease (PAOD) treated with 100 mg/d aspirin were followed over a median timeframe of 17 months. Platelet function tests were performed initially and at follow-up using arachidonic acid-induced light transmittance aggregometry (LTA) in native platelet-rich plasma with the Behring Coagulation Timer and by measuring the collagen-epinephrine closure time (CT) on a Platelet Function Analyzer (PFA-100). When determining platelet function using LTA, four patients (4.1%) had residual platelet function (i.e., MaxAggr > or =78%) despite aspirin treatment, whereas, according to the PFA-100 results, 12 patients (12.2%) were identified as non-responders (i.e., CT <192 s). Fifty-seven patients who were still under treatment with 100 mg/d aspirin at the time of follow-up provided a second blood sample. Further platelet function tests with the PFA-100 system identified a persistent non-responsiveness to aspirin over time in three patients (5.3%) whereas four (7.0%) and 15 (26.3%) patients had changes in response status when platelet function was assessed by LTA and on the PFA-100(R), respectively. We conclude that true non-responsiveness to aspirin is a rare phenomenon in stable PAOD patients. Furthermore, we conclude that in a number of patients, aspirin non-responsiveness is not stable over time.

Comparison of the in vitro effects of saline, hypertonic hydroxyethyl starch, hypertonic saline, and two forms of hydroxyethyl starch on whole blood coagulation and platelet function in dogs.

PubMed

Wurlod, Virginie A; Howard, Judith; Francey, Thierry; Schweighauser, Ariane; Adamik, Katja N

2015-01-01

To compare the in vitro effects of hypertonic solutions and colloids to saline on coagulation in dogs. In vitro experimental study. Veterinary teaching hospital. Twenty-one adult dogs. Blood samples were diluted with saline, 7.2% hypertonic saline solution with 6% hydroxyethylstarch with an average molecular weight of 200 kDa and a molar substitution of 0.4 (HH), 7.2% hypertonic saline (HTS), hydroxyethyl starch (HES) 130/0.4 or hydroxyethyl starch 600/0.75 at ratios of 1:22 and 1:9, and with saline and HES at a ratio of 1:3. Whole blood coagulation was analyzed using rotational thromboelastometry (extrinsic thromboelastometry-cloting time (ExTEM-CT), maximal clot firmness (MCF) and clot formation time (CFT) and fibrinogen function TEM-CT (FibTEM-CT) and MCF) and platelet function was analyzed using a platelet function analyzer (closure time, CTPFA ). All parameters measured were impaired by saline dilution. The CTPFA was prolonged by 7.2% hypertonic saline solution with 6% hydroxyethylstarch with an average molecular weight of 200 kDa and a molar substitution of 0.4 (HH) and HTS but not by HES solutions. At clinical dilutions equivalent to those generally administered for shock (saline 1:3, HES 1:9, and hypertonic solutions 1:22), CTPFA was more prolonged by HH and HTS than other solutions but more by saline than HES. No difference was found between the HES solutions or the hypertonic solutions. ExTEM-CFT and MCF were impaired by HH and HTS but only mildly by HES solutions. At clinically relevant dilutions, no difference was found in ExTEM-CFT between HTS and saline or in ExTEM-MCF between HH and saline. No consistent difference was found between the 2 HES solutions but HH impaired ExTEM-CFT and MCF more than HTS. At high dilutions, FibTEM-CT and -MCF and ExTEM-CT were impaired by HES. Hypertonic solutions affect platelet function and whole blood coagulation to a greater extent than saline and HES. At clinically relevant dilutions, only CTPFA was markedly more affected by hypertonic solutions than by saline. At high dilutions, HES significantly affects coagulation but to no greater extent than saline at clinically relevant dilutions. © Veterinary Emergency and Critical Care Society 2015.

Lessons from a large norovirus outbreak: impact of viral load, patient age and ward design on duration of symptoms and shedding and likelihood of transmission.

PubMed

Partridge, D G; Evans, C M; Raza, M; Kudesia, G; Parsons, H K

2012-05-01

Hospital norovirus outbreaks cause significant financial and operational disruption which should be minimised by optimal handling of affected areas and use of isolation facilities. To identify factors associated with increased duration of symptoms and viral excretion and increased probability of transmission. Retrospective observational study of a large norovirus outbreak at a UK teaching hospital in the winter of 2009-2010 where patients were diagnosed using a real-time polymerase chain reaction (PCR) assay. Symptom duration was significantly associated with patient age (Spearman rank correlation coefficient: 0.197; P = 0.002) but not with PCR cycle threshold (C(T)) value. Duration of viral excretion was found to be longer in patients with higher viral loads. Transmission within a ward bay was not significantly associated either with age or with C(T) value but was more likely to occur in some ward blocks than others, which may relate to differences in ward design. Transfer of patients into isolation rooms or cohorted area within two days of symptom onset did not significantly influence probability of onward transmission (52% vs 47%; P = 0.67). The presented data suggest that C(T) value may guide timing of repeat sample collection if ongoing gastrointestinal symptoms may relate to other pathologies, and that patients developing symptoms of norovirus may remain in their current bay rather than being moved into isolation facilities. The bay or ward should be closed to new admissions but it should be anticipated that duration of symptoms and therefore closure will be longer when the outbreak involves elderly patients. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Closure of colostomy.

PubMed Central

Beck, P H; Conklin, H B

1975-01-01

We analyzed the records of 77 cases of loop colostomy closure in Vietnam War Casualties. All records were complete from the date of injury to discharge following colostomy closure. Simple of the loop colostomy was performed in 44 patients and resection of the stoma and reanastomosis of bowel segments was performed in 33 patients. Average operating time for simple closure of the loop was 70 minutes compared to 115 minutes for resection and anastomosis. Nasogastric suction was used less frequently and for a shorter time with simple loop closure. The total postoperative complication rate was 9% with simple loop closure as compared to 24% for resection and anastomosis. Simple closure of the loop described in this report is technically easier and as safe as resection of the stoma and reanastomosis. Images Fig. 1. PMID:1094967

Is size the only determinant of delayed abdominal closure in pediatric liver transplant?

PubMed

Khorsandi, Shirin Elizabeth; Day, Arthur William Raven; Cortes, Miriam; Deep, Akash; Dhawan, Anil; Vilca-Melendez, Hector; Heaton, Nigel

2017-03-01

The aim was to determine the factors associated with the use of delayed abdominal closure in pediatric liver transplantation (LT) and whether this affected outcome. From a prospectively maintained database, transplants performed in children (≤18 years) were identified (October 2010 to March 2015). Primary abdominal closure was defined as mass closure performed at time of transplant. Delayed abdominal closure was defined as mass closure not initially performed at the same time as transplant; 230 children underwent LT. Of these, 176 (76.5%) had primary closure. Age was similar between the primary and delayed groups (5.0 ± 4.9 versus 3.9 ± 5.0 years; P = 0.13). There was no difference in the graft-to-recipient weight ratio (GRWR) in the primary and delayed groups (3.4 ± 2.8 versus 4.1 ± 2.1; P = 0.12). Children with acute liver failure (ALF) were more likely to experience delayed closure then those with chronic liver disease (CLD; P < 0.001). GRWR was similar between the ALF and CLD (3.4 ± 2.4 versus 3.6 ± 2.7; P = 0.68). Primary closure children had a shorter hospital stay (P < 0.001), spent fewer days in pediatric intensive care unit (PICU; P = 0.001), and required a shorter duration of ventilation (P < 0.001). Vascular complications (arterial and venous) were similar (primary 8.2% versus delayed 5.6%; P = 0.52). Graft (P = 0.42) and child survival (P = 0.65) in the primary and delayed groups were similar. Considering timing of mass closure after transplant, patients in the early delayed closure group (<6 weeks) were found to experience a shorter time of ventilation (P = 0.03) and in PICU (P = 0.003). In conclusion, ALF was the main determinant of delayed abdominal closure rather than GRWR. The optimal time for delayed closure is within 6 weeks. The use of delayed abdominal closure does not adversely affect graft/child survival. Liver Transplantation 23 352-360 2017 AASLD. © 2016 by the American Association for the Study of Liver Diseases.

Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection.

PubMed

Camacho-Mauries, Daniel; Rodriguez-Díaz, José Luis; Salgado-Nesme, Noel; González, Quintín H; Vergara-Fernández, Omar

2013-02-01

The use of temporary stomas has been demonstrated to reduce septic complications, especially in high-risk anastomosis; therefore, it is necessary to reduce the number of complications secondary to ostomy takedowns, namely wound infection, anastomotic leaks, and intestinal obstruction. To compare the rates of superficial wound infection and patient satisfaction after pursestring closure of ostomy wound vs conventional linear closure. Patients undergoing colostomy or ileostomy closure between January 2010 and February 2011 were randomly assigned to linear closure (n = 30) or pursestring closure (n = 31) of their ostomy wound. Wound infection within 30 days of surgery was defined as the presence of purulent discharge, pain, erythema, warmth, or positive culture for bacteria. Patient satisfaction, healing time, difficulty managing the wound, and limitation of activities were analyzed with the Likert questionnaire. The infection rate for the control group was 36.6% (n = 11) vs 0% in the pursestring closure group (p < 0.0001). Healing time was 5.9 weeks in the linear closure group and 3.8 weeks in the pursestring group (p = 0.0002). Seventy percent of the patients with pursestring closure were very satisfied in comparison with 20% in the other group (p = 0.0001). This study was limited by the heterogeneity in the type of stoma in both groups. The pursestring method resulted in the absence of infection after ostomy wound closure (shorter healing time and improved patient satisfaction).

Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury.

PubMed

Eliya-Masamba, Martha C; Banda, Grace W

2013-10-22

Acute traumatic wounds are one of the common reasons why people present to the emergency department. Primary closure has traditionally been reserved for traumatic wounds presenting within six hours of injury and considered 'clean' by the attending surgeon, with the rest undergoing delayed primary closure as a means of controlling wound infection. Primary closure has the potential benefit of rapid wound healing but poses the potential threat of increased wound infection. There is currently no evidence to guide clinical decision-making on the best timing for closure of traumatic wounds. To determine the effect on time to healing of primary closure versus delayed closure for non bite traumatic wounds presenting within 24 hours post injury. To explore the adverse effects of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours post injury. In May 2013, for this first update we searched the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. Randomised controlled trials comparing primary closure with delayed closure of non bite traumatic wounds. Two review authors independently evaluated the results of the searches against the inclusion criteria. No studies met the inclusion criteria for this review. Since no studies met the inclusion criteria, neither a meta-analysis nor a narrative description of studies was possible. There is currently no systematic evidence to guide clinical decision-making regarding the timing for closure of traumatic wounds. There is a need for robust research to investigate the effect of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours of injury.

Ramipril and Losartan Exert a Similar Long-Term Effect upon Markers of Heart Failure, Endogenous Fibrinolysis, and Platelet Aggregation in Survivors of ST-Elevation Myocardial Infarction: A Single Centre Randomized Trial.

PubMed

Marinšek, Martin; Sinkovič, Andreja

2016-01-01

Blocking the renin-angiotensin-aldosterone system in ST-elevation myocardial infarction (STEMI) patients prevents heart failure and recurrent thrombosis. Our aim was to compare the effects of ramipril and losartan upon the markers of heart failure, endogenous fibrinolysis, and platelet aggregation in STEMI patients over the long term. After primary percutaneous coronary intervention (PPCI), 28 STEMI patients were randomly assigned ramipril and 27 losartan, receiving therapy for six months with dual antiplatelet therapy (DAPT). We measured N-terminal proBNP (NT-proBNP), ejection fraction (EF), plasminogen-activator-inhibitor type 1 (PAI-1), and platelet aggregation by closure times (CT) at the baseline and after six months. Baseline NT-proBNP ≥ 200 pmol/mL was observed in 48.1% of the patients, EF < 55% in 49.1%, and PAI-1 ≥ 3.5 U/mL in 32.7%. Six-month treatment with ramipril or losartan resulted in a similar effect upon PAI-1, NT-proBNP, EF, and CT levels in survivors of STEMI, but in comparison to control group, receiving DAPT alone, ramipril or losartan treatment with DAPT significantly increased mean CT (226.7 ± 80.3 sec versus 158.1 ± 80.3 sec, p < 0.05). Ramipril and losartan exert a similar effect upon markers of heart failure and endogenous fibrinolysis, and, with DAPT, a more efficient antiplatelet effect in long term than DAPT alone.

Allegation of ethnic minorities from 1993-2008: an Equal Employment Opportunity Commission (EEOC) study.

PubMed

Arango-Lasprilla, Juan Carlos; Ketchum, Jessica M; Hurley, Jessica; Getachew, Almaz M; Gary, Kelli Williams

2014-01-01

Approximately 25% of working-aged Americans with disabilities work full or part time, yet still face discrimination despite the passing of the American's with Disabilities Act (ADA) over 20 years ago. To determine if the proportion of allegations of ADA Title I workplace discrimination with merit closed at any year between 1993 and 2008 differs among Whites, African Americans, Hispanics, and Asians; to determine if there was a change over time from 1993 to 2008 in merit closure rate within each race/ethnicity group; and to determine whether changes over time between 1993 and 2008 in the merit closure rate differ among the race/ethnicity groups. Logistic regression was used for this cross-sectional panel study to model the merit closure rate for each ethnic group from 1993 to 2008 using 318,587 charging parties from the EEOC database. All ethnic groups exhibited significant changes over time in the merit closure rate. There were significant differences in the closure rates among the race/ethnicity groups specifically at closure years 1995-2000, 2002, 2003, and 2006. Finally, there was evidence that the trends in merit closure rates over time differed significantly among the race/ethnicity groups. There was significant evidence that the proportion of claims closed with merit was significantly different among the racial/ethnicity groups.

Metalloproteinase Expression is Associated with Traumatic Wound Failure

DTIC Science & Technology

2010-04-01

Traumatic amputation- no.(%) 15 Size of wound (cm3 )* Associated vascular injury- no.(%) 7 Wound closure method no.(%) Suture 29 Skin graft 9 Number...definitive closure or coverage with skin graft . Im- paired wound healing included delayed wound closure or wound dehiscence after closure or coverage...closure time period of 10 d. Dehiscence was defined as spontaneous partial or com- plete wound disruption after primary closure or > 90% skin graft loss

Robotic laser tissue welding of sclera using chitosan films.

PubMed

Garcia, Pablo; Mines, Michael J; Bower, Kraig S; Hill, J; Menon, J; Tremblay, Eric; Smith, Benjamin

2009-01-01

To demonstrate the feasibility of scleral wound closure using a novel adhesive made of chitosan film. Five-millimeter scleral lacerations were created in enucleated pig eyes. Casted chitosan films were sized to 7x7 mm patches. Lacerations were sealed with chitosan film alone (7 eyes) or chitosan film followed by laser irradiation using a near infrared laser (1,455 nm) at 350 mW for 6 minutes (7 eyes). Seven eyes were closed with 9-0 nylon suture for comparison (7 eyes). Outcome measures included watertight closure, closure time, and leak pressure. Leak pressure was measured with a pressure transducer attached to tubing continuously monitored intraocular pressure during saline infusion. Watertight closure testing was performed immediately following closure (n = 3 per group) and after 24 hours (n = 3 per group). One eye in each group was fixed in formalin for histology. All wounds were watertight for each closure method. Mean closure time with unlasered chitosan film was 2.24 minutes (range 1.80-3.26, 7 eyes) with a mean leak pressure of 303 mm Hg (range 217-364, 3 eyes). Mean closure time with lasered chitosan was 12.47 minutes (range 11.45-14.15, 7 eyes) with a mean leak pressure of 454.7 mm Hg (range 152-721, 3 eyes). Suture closure required a mean of 4.83 minutes (range 4.03-7.30, 7 eyes) and resulted in a mean leak pressure of 570.3 mm Hg (range 460-646, 3 eyes). Both lasered and unlasered chitosan eyes remained watertight after 24 hours. Histology revealed minimal laser tissue damage in lasered eyes. In this preliminary study chitosan film successfully closed scleral lacerations with and without the application of laser energy. While laser appears to strengthen the closure, it significantly increases the closure time. Chitosan based adhesives hold promise as a scleral wound closure technique.

[Feasibility of device closure for multiple atrial septal defects using 3D printing and ultrasound-guided intervention technique].

PubMed

Qiu, X; Lü, B; Xu, N; Yan, C W; Ouyang, W B; Liu, Y; Zhang, F W; Yue, Z Q; Pang, K J; Pan, X B

2017-04-25

Objective: To investigate the feasibility of trans-catheter closure of multiple atrial septal defects (ASD) monitored by trans-thoracic echocardiography (TTE) under the guidance of 3D printing heart model. Methods: Between April and August 2016, a total of 21 patients (8 male and 13 female) with multiple ASD in Fuwai Hospital of Chinese Academy of Medical Sciences underwent CT scan and 3-dimensional echocardiography for heart disease model produced by 3D printing technique. The best occlusion program was determined through the simulation test on the model. Percutaneous device closure of multiple ASD was performed follow the predetermined program guided by TTE. Clinical follow-up including electrocardiogram and TTE was arranged at 1 month after the procedure. Results: The trans-catheter procedure was successful in all 21 patients using a single atrial septal occluder. Mild residual shunt was found in 5 patient in the immediate postoperative period, 3 of them were disappeared during postoperative follow-up. There was no death, vascular damage, arrhythmia, device migration, thromboembolism, valvular dysfunction during the follow-up period. Conclusion: The use of 3D printing heart model provides a useful reference for transcatheter device closure of multiple ASD achieving through ultrasound-guided intervention technique, which appears to be safe and feasible with good outcomes of short-term follow-up.

[Epidemiologic and economic effectiveness of school closure during influenza epidemics and pandemics].

PubMed

Gendon, Iu Z; Vasil'ev, Iu M

2012-01-01

Epidemiologic and economic effectiveness of school closure during influenza epidemics and pandemics is discussed. Optimal effect of school closure is observed when this measure is taken at the start of the epidemic or pandemic and for a sufficiently long time. School closure during high morbidity among schoolchildren, in the middle (at the peak) and by the end of epidemic or pandemic does not influence significantly the spread of influenza or morbidity. Significant economic losses and other negative consequences of school closure are noted. School closure may be the most appropriate during the emergence of influenza pandemic when the pandemic vaccine is not yet available, however timely mass immunization of schoolchildren against influenza may be a more appropriate measure than school closure for the reduction of influenza morbidity and spread during seasonal influenza epidemics.

Substantial Impact of School Closure on the Transmission Dynamics during the Pandemic Flu H1N1-2009 in Oita, Japan

PubMed Central

2015-01-01

Background School closure is considered as an effective measure to prevent pandemic influenza. Although Japan has implemented many class, grade, and whole school closures during the early stage of the pandemic 2009, the effectiveness of such a school closure has not been analysed appropriately. In addition, analysis based on evidence or data from a large population has yet to be performed. We evaluated the preventive effect of school closure against the pandemic (H1N1) 2009 and examined efficient strategies of reactive school closure. Materials and Methods Data included daily reports of reactive school closures and the number of infected students in the pandemic in Oita City, Japan. We used a regression model that incorporated a time delay to analyse the daily data of school closure based on a time continuous susceptible-exposed-infected-removed model of infectious disease spread. The delay was due to the time-lag from transmission to case reporting. We simulated the number of students infected daily with and without school closure and evaluated the effectiveness. Results The model with a 3-day delay from transmission to reporting yielded the best fit using R 2 (the coefficient of determination). This result suggests that the recommended period of school closure is more than 4 days. Moreover, the effect of school closure in the simulation of school closure showed the following: the number of infected students decreased by about 24% at its peak, and the number of cumulative infected students decreased by about 8.0%. Conclusions School closure was an effective intervention for mitigating the spread of influenza and should be implemented for more than 4 days. School closure has a remarkable impact on decreasing the number of infected students at the peak, but it does not substantially decrease the total number of infected students. PMID:26669757

A novel one-shot circular stapler closure for atrial septal defect in a beating-heart porcine model.

PubMed

Tarui, Tatsuya; Tomita, Shigeyuki; Ishikawa, Norihiko; Ohtake, Hiroshi; Watanabe, Go

2015-02-01

In surgical atrial septal defect (ASD) closure, there are no techniques or devices that can close the ASD accurately in a short time under a beating heart. We have developed a simple and automatic ASD closure technique using a circular stapler. This study assessed the feasibility and efficacy of a new circular stapler closure for ASD. Under a continuous beating heart, hand-sewn patch plasty ASD closure was performed in 6 pigs (group A) and circular stapler ASD closure was performed in 6 pigs (group B). The time to close the ASD and the effectiveness of the closure were compared. Closure was significantly faster in group B (10.5 ± 1.0 seconds) than in group A (664 ± 10 seconds; p < 0.05). There was no leakage at the closure site, and sufficient tolerance was confirmed. A circular stapler can be used to treat ASD faster than hand-sewn patch plasty, with sufficient pressure tolerance in a beating heart porcine model. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Computed-tomography modeled polyether ether ketone (PEEK) implants in revision cranioplasty.

PubMed

O'Reilly, Eamon B; Barnett, Sam; Madden, Christopher; Welch, Babu; Mickey, Bruce; Rozen, Shai

2015-03-01

Traditional cranioplasty methods focus on pre-operative or intraoperative hand molding. Recently, CT-guided polyether ether ketone (PEEK) plate reconstruction enables precise, time-saving reconstruction. This case series aims to show a single institution experience with use of PEEK cranioplasty as an effective, safe, precise, reusable, and time-saving cranioplasty technique in large, complex cranial defects. We performed a 6-year retrospective review of cranioplasty procedures performed at our affiliated hospitals using PEEK implants. A total of nineteen patients underwent twenty-two cranioplasty procedures. Pre-operative, intra-operative, and post-operative data was collected. Nineteen patients underwent twenty-two procedures. Time interval from injury to loss of primary cranioplasty averaged 57.7 months (0-336 mo); 4.0 months (n=10, range 0-19) in cases of trauma. Time interval from primary cranioplasty loss to PEEK cranioplasty was 11.8 months for infection (n=11, range 6-25 mo), 12.2 months for trauma (n=5, range 2-27 mo), and 0.3 months for cosmetic or functional reconstructions (n=3, range 0-1). Similar surgical techniques were used in all patients. Drains were placed in 11/22 procedures. Varying techniques were used in skin closure, including adjacent tissue transfer (4/22) and free tissue transfer (1/22). The PEEK plate required modification in four procedures. Three patients had reoperation following PEEK plate reconstruction. Cranioplasty utilizing CT-guided PEEK plate allows easy inset, anatomic accuracy, mirror image aesthetics, simplification of complex 3D defects, and potential time savings. Additionally, it's easily manipulated in the operating room, and can be easily re-utilized in cases of intraoperative course changes or infection. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant.

PubMed

Avalos-González, Jorge; Portilla-deBuen, Eliseo; Leal-Cortés, Caridad Aurea; Orozco-Mosqueda, Abel; Estrada-Aguilar, María del Carmen; Velázquez-Ramírez, Gabriela Abigail; Ambriz-González, Gabriela; Fuentes-Orozco, Clotilde; Guzmán-Gurrola, Aldo Emmerson; González-Ojeda, Alejandro

2010-06-14

To assess whether the use of fibrin sealant shortens the closure time of postoperative enterocutaneous fistulas (ECFs). The prospective case-control study included 70 patients with postoperative ECFs with an output of < 500 mL/d, a fistulous tract of > 2 cm and without any local complication. They were divided into study (n = 23) and control groups (n = 47). Esophageal, gastric and colocutaneous fistulas were monitored under endoscopic visualization, which also allowed fibrin glue application directly through the external hole. Outcome variables included closure time, time to resume oral feeding and morbidity related to nutritional support. There were no differences in mean age, fistula output, and follow-up. Closure-time for all patients of the study group was 12.5 +/- 14.2 d and 32.5 +/- 17.9 d for the control group (P < 0.001), and morbidity related to nutritional support was 8.6% and 42.5%, respectively (P < 0.01). In patients with colonic fistulas, complete closure occurred 23.5 +/- 19.5 d after the first application of fibrin glue, and spontaneous closure was observed after 36.2 +/- 22.8 d in the control group (P = 0.36). Recurrences were observed in 2 patients because of residual disease. One patient of each group died during follow-up as a consequence of septic complications related to parenteral nutrition. Closure time was significantly reduced with the use of fibrin sealant, and oral feeding was resumed faster. We suggest the use of fibrin sealant for the management of stable enterocutaneous fistulas.

40 CFR 265.117 - Post-closure care and use of property.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... 265.117 Section 265.117 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID.... (a)(1) Post-closure care for each hazardous waste management unit subject to the requirements of... this part. (2) Any time preceding closure of a hazardous waste management unit subject to post-closure...

Occupancy estimation and the closure assumption

USGS Publications Warehouse

Rota, Christopher T.; Fletcher, Robert J.; Dorazio, Robert M.; Betts, Matthew G.

2009-01-01

1. Recent advances in occupancy estimation that adjust for imperfect detection have provided substantial improvements over traditional approaches and are receiving considerable use in applied ecology. To estimate and adjust for detectability, occupancy modelling requires multiple surveys at a site and requires the assumption of 'closure' between surveys, i.e. no changes in occupancy between surveys. Violations of this assumption could bias parameter estimates; however, little work has assessed model sensitivity to violations of this assumption or how commonly such violations occur in nature. 2. We apply a modelling procedure that can test for closure to two avian point-count data sets in Montana and New Hampshire, USA, that exemplify time-scales at which closure is often assumed. These data sets illustrate different sampling designs that allow testing for closure but are currently rarely employed in field investigations. Using a simulation study, we then evaluate the sensitivity of parameter estimates to changes in site occupancy and evaluate a power analysis developed for sampling designs that is aimed at limiting the likelihood of closure. 3. Application of our approach to point-count data indicates that habitats may frequently be open to changes in site occupancy at time-scales typical of many occupancy investigations, with 71% and 100% of species investigated in Montana and New Hampshire respectively, showing violation of closure across time periods of 3 weeks and 8 days respectively. 4. Simulations suggest that models assuming closure are sensitive to changes in occupancy. Power analyses further suggest that the modelling procedure we apply can effectively test for closure. 5. Synthesis and applications. Our demonstration that sites may be open to changes in site occupancy over time-scales typical of many occupancy investigations, combined with the sensitivity of models to violations of the closure assumption, highlights the importance of properly addressing the closure assumption in both sampling designs and analysis. Furthermore, inappropriately applying closed models could have negative consequences when monitoring rare or declining species for conservation and management decisions, because violations of closure typically lead to overestimates of the probability of occurrence.

Evaluation of radiography as a screening method for detection and characterisation of congenital vertebral malformations in dogs.

PubMed

Brocal, Josep; De Decker, Steven; José-López, Roberto; Guevar, Julien; Ortega, Maria; Parkin, Tim; Ter Haar, Gert; Gutierrez-Quintana, Rodrigo

2018-05-19

Congenital vertebral malformations (CVM) are common in brachycephalic 'screw-tailed' dogs; they can be associated with neurological deficits and a genetic predisposition has been suggested. The purpose of this study was to evaluate radiography as a screening method for congenital thoracic vertebral malformations in brachycephalic 'screw-tailed' dogs by comparing it with CT. Forty-nine dogs that had both radiographic and CT evaluations of the thoracic vertebral column were included. Three observers retrospectively reviewed the images independently to detect CVMs. When identified, they were classified according to a previously published radiographic classification scheme. A CT consensus was then reached. All observers identified significantly more affected vertebrae when evaluating orthogonal radiographic views compared with lateral views alone; and more affected vertebrae with the CT consensus compared with orthogonal radiographic views. Given the high number of CVMs per dog, the number of dogs classified as being CVM free was not significantly different between CT and radiography. Significantly more midline closure defects were also identified with CT compared with radiography. Malformations classified as symmetrical or ventral hypoplasias on radiography were frequently classified as ventral and medial aplasias on CT images. Our results support that CT is better than radiography for the classification of CVMs and this will be important when further evidence of which are the most clinically relevant CVMs is identified. These findings are of particular importance for designing screening schemes of CVMs that could help selective breeding programmes based on phenotype and future studies. © British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

A closure test for time-specific capture-recapture data

USGS Publications Warehouse

Stanley, T.R.; Burnham, K.P.

1999-01-01

The assumption of demographic closure in the analysis of capture-recapture data under closed-population models is of fundamental importance. Yet, little progress has been made in the development of omnibus tests of the closure assumption. We present a closure test for time-specific data that, in principle, tests the null hypothesis of closed-population model M(t) against the open-population Jolly-Seber model as a specific alternative. This test is chi-square, and can be decomposed into informative components that can be interpreted to determine the nature of closure violations. The test is most sensitive to permanent emigration and least sensitive to temporary emigration, and is of intermediate sensitivity to permanent or temporary immigration. This test is a versatile tool for testing the assumption of demographic closure in the analysis of capture-recapture data.

CT based 3D printing is superior to transesophageal echocardiography for pre-procedure planning in left atrial appendage device closure.

PubMed

Obasare, Edinrin; Mainigi, Sumeet K; Morris, D Lynn; Slipczuk, Leandro; Goykhman, Igor; Friend, Evan; Ziccardi, Mary Rodriguez; Pressman, Gregg S

2018-05-01

Accurate assessment of the left atrial appendage (LAA) is important for pre-procedure planning when utilizing device closure for stroke reduction. Sizing is traditionally done with transesophageal echocardiography (TEE) but this is not always precise. Three-dimensional (3D) printing of the LAA may be more accurate. 24 patients underwent Watchman device (WD) implantation (71 ± 11 years, 42% female). All had complete 2-dimensional TEE. Fourteen also had cardiac computed tomography (CCT) with 3D printing to produce a latex model of the LAA for pre-procedure planning. Device implantation was unsuccessful in 2 cases (one with and one without a 3D model). The model correlated perfectly with implanted device size (R 2  = 1; p < 0.001), while TEE-predicted size showed inferior correlation (R 2  = 0.34; 95% CI 0.23-0.98, p = 0.03). Fisher's exact test showed the model better predicted final WD size than TEE (100 vs. 60%, p = 0.02). Use of the model was associated with reduced procedure time (70 ± 20 vs. 107 ± 53 min, p = 0.03), anesthesia time (134 ± 31 vs. 182 ± 61 min, p = 0.03), and fluoroscopy time (11 ± 4 vs. 20 ± 13 min, p = 0.02). Absence of peri-device leak was also more likely when the model was used (92 vs. 56%, p = 0.04). There were trends towards reduced trans-septal puncture to catheter removal time (50 ± 20 vs. 73 ± 36 min, p = 0.07), number of device deployments (1.3 ± 0.5 vs. 2.0 ± 1.2, p = 0.08), and number of devices used (1.3 ± 0.5 vs. 1.9 ± 0.9, p = 0.07). Patient specific models of the LAA improve precision in closure device sizing. Use of the printed model allowed rapid and intuitive location of the best landing zone for the device.

Reduction of the closure time of postoperative enterocutaneous fistulas with fibrin sealant

PubMed Central

Avalos-González, Jorge; Portilla-deBuen, Eliseo; Leal-Cortés, Caridad Aurea; Orozco-Mosqueda, Abel; del Carmen Estrada-Aguilar, María; Velázquez-Ramírez, Gabriela Abigail; Ambriz-González, Gabriela; Fuentes-Orozco, Clotilde; Guzmán-Gurrola, Aldo Emmerson; González-Ojeda, Alejandro

2010-01-01

AIM: To assess whether the use of fibrin sealant shortens the closure time of postoperative enterocutaneous fistulas (ECFs). METHODS: The prospective case-control study included 70 patients with postoperative ECFs with an output of < 500 mL/d, a fistulous tract of > 2 cm and without any local complication. They were divided into study (n = 23) and control groups (n = 47). Esophageal, gastric and colocutaneous fistulas were monitored under endoscopic visualization, which also allowed fibrin glue application directly through the external hole. Outcome variables included closure time, time to resume oral feeding and morbidity related to nutritional support. RESULTS: There were no differences in mean age, fistula output, and follow-up. Closure-time for all patients of the study group was 12.5 ± 14.2 d and 32.5 ± 17.9 d for the control group (P < 0.001), and morbidity related to nutritional support was 8.6% and 42.5%, respectively (P < 0.01). In patients with colonic fistulas, complete closure occurred 23.5 ± 19.5 d after the first application of fibrin glue, and spontaneous closure was observed after 36.2 ± 22.8 d in the control group (P = 0.36). Recurrences were observed in 2 patients because of residual disease. One patient of each group died during follow-up as a consequence of septic complications related to parenteral nutrition. CONCLUSION: Closure time was significantly reduced with the use of fibrin sealant, and oral feeding was resumed faster. We suggest the use of fibrin sealant for the management of stable enterocutaneous fistulas. PMID:20533600

Direct percutaneous transaortic approach for treatment of aortic pseudoaneurysms.

PubMed

Pirelli, Luigi; Kliger, Chad; Fontana, Gregory P; Ruiz, Carlos E

2015-05-01

Aortic pseudoaneurysms (APAs) can develop months or years after aortic and cardiac surgery. If not treated appropriately, APAs can lead to fatal complications and ultimately death. We describe a case of a 61-year old patient with a diagnosed large pseudoaneurysm 5 years after his aortic valve surgery, who was treated with a novel transcatheter direct transaortic approach. The patient had dilated cardiomyopathy with an APA adjacent to the lower sternal plate. An Amplatzer septal occlusion device followed by coils was delivered transcutaneously through the APA to close its neck and fill the false aneurysm, respectively. Triple fusion multimodality imaging was used to guide the placement of the occlusion devices. The merging of computed tomography (CT) and echocardiography with real-time fluoroscopy was fundamental in procedural planning and guidance. Post-procedural transoesophageal echocardiogram (TOE) and CT angiography showed complete exclusion of the APA. A direct transaortic approach is a valid option for closure of an APA if the surgical risk is prohibitive, and the use of triple fusion technology is an essential tool in the hands of interventionalists and surgeons for preoperative planning and conduction of these procedures. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Effects of the internal friction and the solvent quality on the dynamics of a polymer chain closure.

PubMed

Yu, Wancheng; Luo, Kaifu

2015-03-28

Using 3D Langevin dynamics simulations, we investigate the effects of the internal friction and the solvent quality on the dynamics of a polymer chain closure. We show that the chain closure in good solvents is a purely diffusive process. By extrapolation to zero solvent viscosity, we find that the internal friction of a chain plays a non-ignorable role in the dynamics of the chain closure. When the solvent quality changes from good to poor, the mean closure time τc decreases by about 1 order of magnitude for the chain length 20 ≤ N ≤ 100. Furthermore, τc has a minimum as a function of the solvent quality. With increasing the chain length N, the minimum of τc occurs at a better solvent. Finally, the single exponential distributions of the closure time in poor solvents suggest that the negative excluded volume of segments does not alter the nearly Poisson statistical characteristics of the process of the chain closure.

Transcatheter Closure of Bilateral Multiple Huge Pulmonary Arteriovenous Malformations with Homemade Double-Umbrella Occluders

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

Zhong Hongshan, E-mail: zhonghongshan@hotmail.com; Xu Ke; Shao Haibo

2008-07-15

A 28-year-old man underwent successful transcatheter occlusion of three huge pulmonary arteriovenous malformations (PAVMs) using homemade double-umbrella occluders and stainless steel coils. Thoracic CT with three-dimensional reconstruction and pulmonary angiography were used for treatment planning and follow-up. The diameters of the feeding vessels were 11 mm, 13 mm, and 14 mm, respectively. This report demonstrates the novel design and utility of the double-umbrella occluder, an alternative tool for treatment of large PAVMs.

Life Prediction Methodologies for Aerospace Materials

DTIC Science & Technology

2000-08-01

stress in Ti-6Al-4V generated by laser shock peening have been investigated. 15. SUBJECT TERMS Titanium aluminides, gamma, orthorhombic, titanium...effects of stress ratio on FCG in an Al-alloy in the absence of closure and prediction of residual stress in Ti-6Al-4V generated by laser shock... keyhole ) C(T) specimens. Two temperatures, 540 °C and 760 °C, and two notch radii, 5.1 and 1.5 mm (0.2 and 0.06 in) are being considered for a gamma

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).

Suitable closure for post-duodenal endoscopic resection taking medical costs into consideration

PubMed Central

Mori, Hirohito; Ayaki, Maki; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Matsunaga, Tae; Yachida, Tatsuo; Masaki, Tsutomu

2015-01-01

AIM: To compare closure methods, closure times and medical costs between two groups of patients who had post-endoscopic resection (ER) artificial ulcer floor closures. METHODS: Nineteen patients with duodenal adenoma, early duodenal cancer, and subepithelial tumors that received ER between September 2009 and September 2014 at Kagawa University Hospital and Ehime Rosai Hospital, an affiliated hospital of Kagawa University, were included in the study. We retrospectively compared two groups of patients who received post-ER artificial ulcer floor closure: the conventional clip group vs the over-the-scope clip (OTSC) group. Delayed bleeding, procedure time of closure, delayed perforation, total number of conventional clips and OTSCs and medical costs were analyzed. RESULTS: Although we observed delayed bleeding in three patients in the conventional clip group, we observed no delayed bleeding in the OTSC group (P = 0.049). We did not observe perforation in either group. The mean procedure times for ulcer closure were 33.26 ± 12.57 min and 9.71 ± 2.92 min, respectively (P = 0.0001). The resection diameters were 18.8 ± 1.30 mm and 22.9 ± 1.21 mm for the conventional clip group and the OTSC group, respectively, with significant difference (P = 0.039). As for medical costs, the costs of all conventional clips were USD $1257 and the costs of OTSCs were $7850 (P = 0.005). If the post-ER ulcer is under 20 mm in diameter, a conventional clip closure may be more suitable with regard to the prevention of delayed perforation and to medical costs. CONCLUSION: If the post-ER ulcer is over 20 mm, the OTSC closure should be selected with regard to safety and reliable closure even if there are high medical costs. PMID:25954101

Suitable closure for post-duodenal endoscopic resection taking medical costs into consideration.

PubMed

Mori, Hirohito; Ayaki, Maki; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Matsunaga, Tae; Yachida, Tatsuo; Masaki, Tsutomu

2015-05-07

To compare closure methods, closure times and medical costs between two groups of patients who had post-endoscopic resection (ER) artificial ulcer floor closures. Nineteen patients with duodenal adenoma, early duodenal cancer, and subepithelial tumors that received ER between September 2009 and September 2014 at Kagawa University Hospital and Ehime Rosai Hospital, an affiliated hospital of Kagawa University, were included in the study. We retrospectively compared two groups of patients who received post-ER artificial ulcer floor closure: the conventional clip group vs the over-the-scope clip (OTSC) group. Delayed bleeding, procedure time of closure, delayed perforation, total number of conventional clips and OTSCs and medical costs were analyzed. Although we observed delayed bleeding in three patients in the conventional clip group, we observed no delayed bleeding in the OTSC group (P = 0.049). We did not observe perforation in either group. The mean procedure times for ulcer closure were 33.26 ± 12.57 min and 9.71 ± 2.92 min, respectively (P = 0.0001). The resection diameters were 18.8 ± 1.30 mm and 22.9 ± 1.21 mm for the conventional clip group and the OTSC group, respectively, with significant difference (P = 0.039). As for medical costs, the costs of all conventional clips were USD $1257 and the costs of OTSCs were $7850 (P = 0.005). If the post-ER ulcer is under 20 mm in diameter, a conventional clip closure may be more suitable with regard to the prevention of delayed perforation and to medical costs. If the post-ER ulcer is over 20 mm, the OTSC closure should be selected with regard to safety and reliable closure even if there are high medical costs.

Method of well testing

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

Ringgenberg, P.D.; Burris, W.J.

1988-06-28

A method is described of flow testing a formation in a wellbore, comprising: providing a testing string including at least one annulus pressure responsive tool bore closure valve; providing a packer and setting the packer in the wellbore to seal thereacross; running the testing string into the wellbore with the tool bore closure valve in an open position; stinging into the set packer with the bottom of the testing string; increasing pressure a first time in the wellbore annulus around the testing string and above the set packer without cycling the tool bore closure valve; reducing pressure in the wellboremore » annulus; closing the tool bore closure valve responsive to the pressure reduction; increasing pressure a second time in the wellbore annulus; reopening the tool bore closure valve responsive to the second increase; and flowing fluids from the formation through the reopened tool bore closure valve.« less

Linearly exact parallel closures for slab geometry

NASA Astrophysics Data System (ADS)

Ji, Jeong-Young; Held, Eric D.; Jhang, Hogun

2013-08-01

Parallel closures are obtained by solving a linearized kinetic equation with a model collision operator using the Fourier transform method. The closures expressed in wave number space are exact for time-dependent linear problems to within the limits of the model collision operator. In the adiabatic, collisionless limit, an inverse Fourier transform is performed to obtain integral (nonlocal) parallel closures in real space; parallel heat flow and viscosity closures for density, temperature, and flow velocity equations replace Braginskii's parallel closure relations, and parallel flow velocity and heat flow closures for density and temperature equations replace Spitzer's parallel transport relations. It is verified that the closures reproduce the exact linear response function of Hammett and Perkins [Phys. Rev. Lett. 64, 3019 (1990)] for Landau damping given a temperature gradient. In contrast to their approximate closures where the vanishing viscosity coefficient numerically gives an exact response, our closures relate the heat flow and nonvanishing viscosity to temperature and flow velocity (gradients).

50 CFR 622.34 - Gulf EEZ seasonal and/or area closures.

Code of Federal Regulations, 2010 CFR

2010-10-01

...′47″ S 28°30′51″ 82°52′55″ T 28°27′46″ 82°55′09″ U 28°30′51″ 82°52′09″ 1 Crystal River Entrance Light... (l) will begin on the same date and time as the Texas closure unless circumstances dictate otherwise.... the following day. All times are eastern standard time. During these closures, a person aboard a...

50 CFR 622.34 - Gulf EEZ seasonal and/or area closures.

Code of Federal Regulations, 2011 CFR

2011-10-01

...′47″ S 28°30′51″ 82°52′55″ T 28°27′46″ 82°55′09″ U 28°30′51″ 82°52′09″ 1 Crystal River Entrance Light... (l) will begin on the same date and time as the Texas closure unless circumstances dictate otherwise... day. All times are eastern standard time. During these closures, a person aboard a vessel using or...

50 CFR 622.34 - Gulf EEZ seasonal and/or area closures.

Code of Federal Regulations, 2012 CFR

2012-10-01

...′47″ S 28°30′51″ 82°52′55″ T 28°27′46″ 82°55′09″ U 28°30′51″ 82°52′09″ 1 Crystal River Entrance Light... same date and time as the Texas closure unless circumstances dictate otherwise. (2) Eastern zone. The... to 6:00 a.m. the following day. All times are eastern standard time. During these closures, a person...

Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections

PubMed Central

Shaikh, Faraz; Weintrob, Amy C.; Rodriguez, Carlos J.; Murray, Clinton K.; Lloyd, Bradley A.; Ganesan, Anuradha; Aggarwal, Deepak; Carson, M. Leigh; Tribble, David R.

2015-01-01

Combat trauma wounds with invasive fungal infections (IFIs) are often polymicrobial with fungal and bacterial growth, but the impact of the wound microbiology on clinical outcomes is uncertain. Our objectives were to compare the microbiological features between IFI and non-IFI wounds and evaluate whether clinical outcomes differed among IFI wounds based upon mold type. Data from U.S. military personnel injured in Afghanistan with IFI wounds were examined. Controls were matched by the pattern/severity of injury, including blood transfusion requirements. Wound closure timing was compared between IFI and non-IFI control wounds (with/without bacterial infections). IFI wound closure was also assessed according to mold species isolation. Eighty-two IFI wounds and 136 non-IFI wounds (63 with skin and soft tissue infections [SSTIs] and 73 without) were examined. The time to wound closure was longer for the IFI wounds (median, 16 days) than for the non-IFI controls with/without SSTIs (medians, 12 and 9 days, respectively; P < 0.001). The growth of multidrug-resistant Gram-negative rods was reported among 35% and 41% of the IFI and non-IFI wounds with SSTIs, respectively. Among the IFI wounds, times to wound closure were significantly longer for wounds with Mucorales growth than for wounds with non-Mucorales growth (median, 17 days versus 13 days; P < 0.01). When wounds with Mucorales and Aspergillus spp. growth were compared, there was no significant difference in wound closure timing. Trauma wounds with SSTIs were often polymicrobial, yet the presence of invasive molds (predominant types: order Mucorales, Aspergillus spp., and Fusarium spp.) significantly prolonged the time to wound closure. Overall, the times to wound closure were longest for the IFI wounds with Mucorales growth. PMID:25972413

Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections.

PubMed

Warkentien, Tyler E; Shaikh, Faraz; Weintrob, Amy C; Rodriguez, Carlos J; Murray, Clinton K; Lloyd, Bradley A; Ganesan, Anuradha; Aggarwal, Deepak; Carson, M Leigh; Tribble, David R

2015-07-01

Combat trauma wounds with invasive fungal infections (IFIs) are often polymicrobial with fungal and bacterial growth, but the impact of the wound microbiology on clinical outcomes is uncertain. Our objectives were to compare the microbiological features between IFI and non-IFI wounds and evaluate whether clinical outcomes differed among IFI wounds based upon mold type. Data from U.S. military personnel injured in Afghanistan with IFI wounds were examined. Controls were matched by the pattern/severity of injury, including blood transfusion requirements. Wound closure timing was compared between IFI and non-IFI control wounds (with/without bacterial infections). IFI wound closure was also assessed according to mold species isolation. Eighty-two IFI wounds and 136 non-IFI wounds (63 with skin and soft tissue infections [SSTIs] and 73 without) were examined. The time to wound closure was longer for the IFI wounds (median, 16 days) than for the non-IFI controls with/without SSTIs (medians, 12 and 9 days, respectively; P < 0.001). The growth of multidrug-resistant Gram-negative rods was reported among 35% and 41% of the IFI and non-IFI wounds with SSTIs, respectively. Among the IFI wounds, times to wound closure were significantly longer for wounds with Mucorales growth than for wounds with non-Mucorales growth (median, 17 days versus 13 days; P < 0.01). When wounds with Mucorales and Aspergillus spp. growth were compared, there was no significant difference in wound closure timing. Trauma wounds with SSTIs were often polymicrobial, yet the presence of invasive molds (predominant types: order Mucorales, Aspergillus spp., and Fusarium spp.) significantly prolonged the time to wound closure. Overall, the times to wound closure were longest for the IFI wounds with Mucorales growth. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Dynamic ocean management increases the efficiency and efficacy of fisheries management.

PubMed

Dunn, Daniel C; Maxwell, Sara M; Boustany, Andre M; Halpin, Patrick N

2016-01-19

In response to the inherent dynamic nature of the oceans and continuing difficulty in managing ecosystem impacts of fisheries, interest in the concept of dynamic ocean management, or real-time management of ocean resources, has accelerated in the last several years. However, scientists have yet to quantitatively assess the efficiency of dynamic management over static management. Of particular interest is how scale influences effectiveness, both in terms of how it reflects underlying ecological processes and how this relates to potential efficiency gains. Here, we address the empirical evidence gap and further the ecological theory underpinning dynamic management. We illustrate, through the simulation of closures across a range of spatiotemporal scales, that dynamic ocean management can address previously intractable problems at scales associated with coactive and social patterns (e.g., competition, predation, niche partitioning, parasitism, and social aggregations). Furthermore, it can significantly improve the efficiency of management: as the resolution of the closures used increases (i.e., as the closures become more targeted), the percentage of target catch forgone or displaced decreases, the reduction ratio (bycatch/catch) increases, and the total time-area required to achieve the desired bycatch reduction decreases. In the scenario examined, coarser scale management measures (annual time-area closures and monthly full-fishery closures) would displace up to four to five times the target catch and require 100-200 times more square kilometer-days of closure than dynamic measures (grid-based closures and move-on rules). To achieve similar reductions in juvenile bycatch, the fishery would forgo or displace between USD 15-52 million in landings using a static approach over a dynamic management approach.

Toward a Theory of Coexistence in Shared Social-Ecological Systems: The Case of Cook Inlet Salmon Fisheries.

PubMed

Loring, Philip A

Coexistence theory (CT) in community ecology provides a functional perspective on how multiple competing species coexist. Here, I explore CT's usefulness for understanding conflict and coexistence among human groups with diverse livelihood interests in shared resources such as fisheries. I add three concepts from social science research on coexistence: adaptability, pluralism, and equity and apply this expanded theoretical framework to the case of salmon fisheries in Alaska's Cook Inlet, synthesizing catch records with anthropological research. The analysis addresses issues of inequity, such as who bears the costs of conservation measures, a lack of pluralism, in that people have come to devalue their neighbors, and a decline in resilience for some sectors, all of which undermine the likelihood of these groups continuing coexistence. I discuss policy options for addressing escalating conflict in the region, such as improving equity in management and the resilience of some fishing groups to temporary closures. Finally, I discuss points of engagement for CT with other areas of sustainability science such as resilience thinking.

Stress-induced, time-dependent fracture closure at hydrothermal conditions

USGS Publications Warehouse

Beeler, N.M.; Hickman, S.H.

2004-01-01

Time-dependent closure of fractures in quartz was measured in situ at 22-530??C temperature and 0.1-150 MPa water pressure. Unlike previous crack healing and rock permeability studies, in this study, fracture aperture is monitored directly and continuously using a windowed pressure vessel, a long-working-distance microscope, and reflected-light interferometry. Thus the fracture volume and geometry can be measured as a function of time, temperature, and water pressure. Relatively uniform closure occurs rapidly at temperatures and pressures where quartz becomes significantly soluble in water. During closure the aperture is reduced by as much as 80% in a few hours. We infer that this closure results from the dissolution of small particles or asperities that prop the fracture open. The driving force for closure via dissolution of the prop is the sum of three chemical potential terms: (1) the dissolution potential, proportional to the logarithm of the degree of undersaturation of the solution; (2) the coarsening potential, proportional to the radius of curvature of the prop; and (3) the pressure solution potential, proportional to the effective normal stress at the contact between propping particles and the fracture wall. Our observations suggest that closure is controlled by a pressure solution-like process. The aperture of dilatant fractures and microcracks in the Earth that are similar to those in our experiments, such as ones generated from thermal stressing or brittle failure during earthquake rupture and slip, will decrease rapidly with time, especially if the macroscopic stress is nonhydrostatic.

Stress-induced, time-dependent fracture closure at hydrothermal conditions

NASA Astrophysics Data System (ADS)

Beeler, N. M.; Hickman, S. H.

2004-02-01

Time-dependent closure of fractures in quartz was measured in situ at 22-530°C temperature and 0.1-150 MPa water pressure. Unlike previous crack healing and rock permeability studies, in this study, fracture aperture is monitored directly and continuously using a windowed pressure vessel, a long-working-distance microscope, and reflected-light interferometry. Thus the fracture volume and geometry can be measured as a function of time, temperature, and water pressure. Relatively uniform closure occurs rapidly at temperatures and pressures where quartz becomes significantly soluble in water. During closure the aperture is reduced by as much as 80% in a few hours. We infer that this closure results from the dissolution of small particles or asperities that prop the fracture open. The driving force for closure via dissolution of the prop is the sum of three chemical potential terms: (1) the dissolution potential, proportional to the logarithm of the degree of undersaturation of the solution; (2) the coarsening potential, proportional to the radius of curvature of the prop; and (3) the pressure solution potential, proportional to the effective normal stress at the contact between propping particles and the fracture wall. Our observations suggest that closure is controlled by a pressure solution-like process. The aperture of dilatant fractures and microcracks in the Earth that are similar to those in our experiments, such as ones generated from thermal stressing or brittle failure during earthquake rupture and slip, will decrease rapidly with time, especially if the macroscopic stress is nonhydrostatic.

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.

Auditing SNOMED CT hierarchical relations based on lexical features of concepts in non-lattice subgraphs.

PubMed

Cui, Licong; Bodenreider, Olivier; Shi, Jay; Zhang, Guo-Qiang

2018-02-01

We introduce a structural-lexical approach for auditing SNOMED CT using a combination of non-lattice subgraphs of the underlying hierarchical relations and enriched lexical attributes of fully specified concept names. Our goal is to develop a scalable and effective approach that automatically identifies missing hierarchical IS-A relations. Our approach involves 3 stages. In stage 1, all non-lattice subgraphs of SNOMED CT's IS-A hierarchical relations are extracted. In stage 2, lexical attributes of fully-specified concept names in such non-lattice subgraphs are extracted. For each concept in a non-lattice subgraph, we enrich its set of attributes with attributes from its ancestor concepts within the non-lattice subgraph. In stage 3, subset inclusion relations between the lexical attribute sets of each pair of concepts in each non-lattice subgraph are compared to existing IS-A relations in SNOMED CT. For concept pairs within each non-lattice subgraph, if a subset relation is identified but an IS-A relation is not present in SNOMED CT IS-A transitive closure, then a missing IS-A relation is reported. The September 2017 release of SNOMED CT (US edition) was used in this investigation. A total of 14,380 non-lattice subgraphs were extracted, from which we suggested a total of 41,357 missing IS-A relations. For evaluation purposes, 200 non-lattice subgraphs were randomly selected from 996 smaller subgraphs (of size 4, 5, or 6) within the "Clinical Finding" and "Procedure" sub-hierarchies. Two domain experts confirmed 185 (among 223) suggested missing IS-A relations, a precision of 82.96%. Our results demonstrate that analyzing the lexical features of concepts in non-lattice subgraphs is an effective approach for auditing SNOMED CT. Copyright © 2017 Elsevier Inc. All rights reserved.

Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults

PubMed Central

Guedes, Renata; Azola, Alba; Macrae, Phoebe; Sunday, Kirstyn; Mejia, Veerley; Vose, Alicia; Humbert, Ianessa A.

2017-01-01

Swallowing maneuvers are routinely trained in dysphagia rehabilitation with the assumption that practiced behaviors transfer to functional swallowing, however transfer is rarely examined in the deglutition literature. The goal of this study was to train the volitional laryngeal vestibule closure (vLVC) maneuver, which is a swallowing maneuver that targets prolonged laryngeal vestibule closure (LVC). In two different training experiments, 69 healthy adults underwent Long-hold (hold vLVC as long as possible) or Short-hold vLVC training (hold vLVC for 2 seconds). Before and after vLVC training, natural swallows (swallowing without a therapeutic technique) were completed. The outcome variables included laryngeal vestibule closure reaction time and the duration of laryngeal vestibule closure. Results indicate that during both Long-hold and Short-hold vLVC trainings, vLVC swallows had faster laryngeal vestibule closure reaction times and longer durations of laryngeal vestibule closure than in pre-training 5ml liquid swallows. However, only faster laryngeal vestibule closure reaction times transferred to post-training 5ml liquid swallows (20–24% faster), but not prolonged durations of laryngeal vestibule closure. Our findings suggest that swallowing maneuver training has the potential to induce transfer of what was practiced to functional swallowing behavior, although not all practiced behaviors may generalize. These findings are significant for bolstering the effectiveness of dysphagia management medical settings and should be tested in individuals with dysphagia. PMID:28322908

Examination of swallowing maneuver training and transfer of practiced behaviors to laryngeal vestibule kinematics in functional swallowing of healthy adults.

PubMed

Guedes, Renata; Azola, Alba; Macrae, Phoebe; Sunday, Kirstyn; Mejia, Veerley; Vose, Alicia; Humbert, Ianessa A

2017-05-15

Swallowing maneuvers are routinely trained in dysphagia rehabilitation with the assumption that practiced behaviors transfer to functional swallowing, however transfer is rarely examined in the deglutition literature. The goal of this study was to train the volitional laryngeal vestibule closure (vLVC) maneuver, which is a swallowing maneuver that targets prolonged laryngeal vestibule closure (LVC). In two different training experiments, 69 healthy adults underwent Long-hold (hold vLVC as long as possible) or Short-hold vLVC training (hold vLVC for 2s). Before and after vLVC training, natural swallows (swallowing without a therapeutic technique) were completed. The outcome variables included laryngeal vestibule closure reaction time and the duration of laryngeal vestibule closure. Results indicate that during both Long-hold and Short-hold vLVC trainings, vLVC swallows had faster laryngeal vestibule closure reaction times and longer durations of laryngeal vestibule closure than in pre-training 5ml liquid swallows. However, only faster laryngeal vestibule closure reaction times transferred to post-training 5ml liquid swallows (20-24% faster), but not prolonged durations of laryngeal vestibule closure. Our findings suggest that swallowing maneuver training has the potential to induce transfer of what was practiced to functional swallowing behavior, although not all practiced behaviors may generalize. These findings are significant for bolstering the effectiveness of dysphagia management in medical settings and should be tested in individuals with dysphagia. Copyright © 2017 Elsevier Inc. All rights reserved.

Evaluation of airway protection: Quantitative timing measures versus penetration/aspiration score.

PubMed

Kendall, Katherine A

2017-10-01

Quantitative measures of swallowing function may improve the reliability and accuracy of modified barium swallow (MBS) study interpretation. Quantitative study analysis has not been widely instituted, however, secondary to concerns about the time required to make measures and a lack of research demonstrating impact on MBS interpretation. This study compares the accuracy of the penetration/aspiration (PEN/ASP) scale (an observational visual-perceptual assessment tool) to quantitative measures of airway closure timing relative to the arrival of the bolus at the upper esophageal sphincter in identifying a failure of airway protection during deglutition. Retrospective review of clinical swallowing data from a university-based outpatient clinic. Swallowing data from 426 patients were reviewed. Patients with normal PEN/ASP scores were identified, and the results of quantitative airway closure timing measures for three liquid bolus sizes were evaluated. The incidence of significant airway closure delay with and without a normal PEN/ASP score was determined. Inter-rater reliability for the quantitative measures was calculated. In patients with a normal PEN/ASP score, 33% demonstrated a delay in airway closure on at least one swallow during the MBS study. There was no correlation between PEN/ASP score and airway closure delay. Inter-rater reliability for the quantitative measure of airway closure timing was nearly perfect (intraclass correlation coefficient = 0.973). The use of quantitative measures of swallowing function, in conjunction with traditional visual perceptual methods of MBS study interpretation, improves the identification of airway closure delay, and hence, potential aspiration risk, even when no penetration or aspiration is apparent on the MBS study. 4. Laryngoscope, 127:2314-2318, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Potential supplementary utility of combined PFA-100 and functional von Willebrand factor testing for the laboratory assessment of desmopressin and factor concentrate therapy in von Willebrand disease.

PubMed

Favaloro, Emmanuel J; Thom, Jim; Patterson, David; Just, Sarah; Baccala, Maria; Dixon, Tracy; Meiring, Muriel; Koutts, Jerry; Rowell, John; Baker, Ross

2009-09-01

We performed a retrospective audit of cross-laboratory testing of desmopressin and factor concentrate therapy to assess the potential utility of supplementary testing using the PFA-100 with functional von Willebrand factor (VWF) activity testing. Data were evaluated for a large number of patients with von Willebrand disease of type 1, type 2A or type 2M, as well as a comparative subset of individuals with haemophilia or carriers of haemophilia. Laboratory testing comprised pre and postdesmopressin, or pre and postconcentrate, evaluation of factor VIII, VWF antigen (VWF:Ag) and VWF ristocetin cofactor activity as traditionally performed, supplemented with collagen-binding (VWF:CB) testing and PFA-100 closure times. In brief, both therapies tended to normalize VWF test parameters and closure times in individuals with type 1 von Willebrand disease, with the level of correction in closure times related to the level of normalization of VWF, particularly the VWF:CB. However, although occasional correction of closure times was observed in patients with type 2A or type 2M von Willebrand disease, these did not in general normalize PFA-100 closure times either with desmopressin or factor concentrate therapy. In these patients, improvement in closure times was more likely in those in whom VWF:CB values normalized or when VWF:CB/VWF:Ag ratios normalized. This study confirms that there is a strong relationship between the presenting levels of plasma VWF and PFA-100 closure times, and that the supplementary combination of PFA-100 and VWF:CB testing might provide added clinical utility to current broadly applied testing strategies limited primarily to VWF:Ag, VWF ristocetin cofactor and factor VIII:coagulant. Future prospective investigations are warranted to validate these relationships and to investigate their therapeutic implications.

Associations with duration of compensation following whiplash sustained in a motor vehicle crash.

PubMed

Casey, Petrina P; Feyer, Anne Marie; Cameron, Ian D

2015-09-01

Continued exposure to compensation systems has been reported as deleterious to the health of participants. Understanding the associations with time to claim closure could allow for targeted interventions aimed at minimising the time participants are exposed to the compensation system. To identify the associations of extended time receiving compensation benefits with the aim of developing a prognostic model that predicts time to claim closure. Prospective cohort study in people with whiplash associated disorder. Time to claim closure, in a privately underwritten fault based third party traffic crash insurance scheme in New South Wales, Australia. Cox proportional hazard regression modelling. Of the 246 participants, 25% remained in the compensation system longer than 24 months with 15% remaining longer than three years. Higher initial disability (Functional Rating Index≥25 at baseline) (HRR: 95% CI, 1.916: 1.324-2.774, p<0.001); and lower initial mental health as measured by SF-36 Mental Component Score (HRR: 95% CI, 0.973: 0.960-0.987, p<0.001) were significantly and independently associated with an increased time-to-claim closure. Shorter time to claim closure was associated with having no legal involvement (HRR: 95% CI, 1.911: 1.169-3.123, p=0.009); and, not having a prior claim for compensation (HRR: 95% CI, 1.523: 1.062-2.198, p=0.022). Health and insurance related factors are independently associated with time to claim closure. Both factors need to be considered by insurers in their assessment of complexity of claims. Interventions aimed at minimising the impact of these factors could reduce claimants' exposure to the compensation system. In turn insurers can potentially reduce claims duration and cost, while improving the health outcomes of claimants. Copyright © 2015 Elsevier Ltd. All rights reserved.

Quantification of spheno-occipital synchondrosis fusion in a contemporary Malaysian population.

PubMed

Hisham, Salina; Flavel, Ambika; Abdullah, Nurliza; Noor, Mohamad Helmee Mohamad; Franklin, Daniel

2018-03-01

Timing of fusion of the spheno-occipital synchondrosis (SOS) is correlated with age. Previous research, however, has demonstrated variation in the timing of closure among different global populations. The present study aims to quantify the timing of SOS fusion in Malaysian individuals as visualised in multi-detector computed tomography (CT) scans and to thereafter formulate age estimation models based on fusion status. Anonymised cranial CT scans of 336 males and 164 females, aged 5-25 years, were acquired from the National Institute of Forensic Medicine, Hospital Kuala Lumpur and Department of Diagnostic Imaging, Hospital Sultanah Aminah. The scans were received in DICOM format and reconstructed into three-dimensional images using OsiriX. The SOS is scored as open, fusing endocranially, fusing ectocranially or completely fused. Statistical analyses are performed using IBM SPSS Statistics version 24. Transition analysis (Nphases2) is then utilised to calculate age ranges for each stage. To assess the reliability of an observation, intra- and inter-observer agreement is quantified using Fleiss Kappa and was found to be excellent (κ=0.785-0.907 and 0.812). The mean (SD) age for complete fusion is 20.84 (2.84) years in males and 19.78 (3.35) years in females. Transition ages between Stages 0 and 1, 1 and 2, and 2 and 3 in males are 12.52, 13.98 and 15.52 years, respectively (SD 1.37); in females, the corresponding data are 10.47, 12.26 and 13.80 years (SD 1.72). Complete fusion of the SOS was observed in all individuals above the age of 18 years. SOS fusion status provides upper and lower age boundaries for forensic age estimation in the Malaysian sample. Copyright © 2018 Elsevier B.V. All rights reserved.

Coaptive film versus subcuticular suture: comparing skin closure time following identical, single-session, bilateral limb surgery in children.

PubMed

Rebello, Gleeson; Parikh, Ravi; Grottkau, Brian

2009-09-01

This study is a randomized controlled trial comparing skin closure time between coaptive film and subcuticular monocryl sutures in children undergoing identical single session, bilateral limb multiple soft tissue releases. Eight children less than 18 years of age (mean 14.5) with cerebral palsy underwent identical, single session bilateral multiple soft tissue releases in the lower limb from August 2005 to March 2007. There were 50 incisions in all in which 25 incisions were closed with 4-0 intracuticular monocryl sutures and 25 were closed with coaptive film (Steri Strip S; 3M company). Time taken for closure using either technique was recorded. A blinded plastic surgeon used a visual analog scale to assess the cosmetic results at the end of a 3 month follow-up. The average length of incisions closed with coaptive film was almost identical to the corresponding incision on the contralateral limb that was closed with subcuticular monocryl suture (4.45 and 4.81 cm, P=0.66). The average time for skin closure using monocryl sutures was 167.04 seconds compared with the average time of 79.36 seconds when using coaptive film (P <0.0001). There was no significant difference in the cosmetic results or the number of wound complications using either technique. Coaptive film is an attractive and cost-effective option for skin closure after pediatric surgery. The time saved, comparable cosmetic results and lack of complications makes coaptive film an attractive option for skin closure in the pediatric age group.

Deformable Bullnose Energy Absorbing System (BEAS). Report 2: Head-On Impact with a Deformable BEAS and Introducing a Collapsible Arch

DTIC Science & Technology

2011-07-01

gate operations at Belleville Locks and Dam. ........................... 105 Figure 5.20 The non-linear costs for full closure of the locks and dam...Super Cone Fender Front Arch Results ................................................. 96 Table 5.3 Costs Over Time for Full Closure at Particular Corps...Corps Navigation Economics PDT tabulation of costs over time for full closure at the Corps lock and dam structures. Bob Willis also supplied the

A powered vascular staple for the application of segmental bronchial closure in thoracoscopic anatomic segmentectomy.

PubMed

Kuroda, Hiroaki; Yoshida, Tatsuya; Sakao, Yukinori

2017-12-01

We used the powered vascular staple (PVS) instead of the conventional staple technique [the utilization of the powered linier cutter (PLC)] or ligation for total 23 segmental or subsegmental bronchi with less than 10 mm in the bronchial luminal size on computed tomography (CT) in thoracoscopic segmentectomy. Our results suggested that the availability of the PVS represents a novel advance in the armamentarium and may have a possibility of being pervasive widely however, more observative periods and further sample accumulation are needed.

[Gastric perforation caused by primary gastric diffuse large B cell lymphoma].

PubMed

Kim, Ju Seok; Rou, Woo Sun; Ahn, Byung Moo; Moon, Hee Seok; Kang, Sun Hyung; Sung, Jae Kyu; Jeong, Hyun Yong; Song, Kyu-Sang

2015-01-01

Spontaneous gastric perforation is a rare complication of gastric lymphoma that is potentially life threatening since it can progress to sepsis and multi-organ failure. Morbidity also increases due to prolonged hospitalization and delay in initiating chemotherapy. Therefore prompt diagnosis and appropriate treatment is critical to improve prognosis. A 64-year-old man presented to the emergency department with severe abdominal pain. Chest X-ray showed free air below the right diaphragm. Abdominal CT scan also demonstrated free air in the peritoneal cavity with large wall defect in the lesser curvature of gastric lower body. Therefore, the patient underwent emergency operation and primary closure was done. Pathologic specimen obtained during surgery was compatible to diffuse large B cell lymphoma. Fifteen days after primary closure, the patient received subtotal gastrectomy and chemotherapy was initiated after recovery. Patient is currently being followed-up at outpatient department without any particular complications. Herein, we report a rare case of gastric lymphoma that initially presented as peritonitis because of spontaneous gastric perforation.

A reliable and safe gastrotomy closure technique assessed in a porcine survival model pilot study: success of the Queen's closure.

PubMed

Hookey, L C; Bielawska, B; Samis, A; Jalink, D; Ellis, R; Khokhotva, V; Hurlbut, D; Mercer, D

2009-06-01

The evolution of NOTES to clinical implementation has been hampered by lack of a reliable, safe, and easy-to-implement technique for closure of the opening created in accessing the peritoneum. The Queen's closure uses a combination of endoscopic clips and loop devices to seal such defects in the stomach wall. This study aimed to assess the Queen's closure in a porcine survival model. Five 30-kg pigs underwent endoscopic transgastric surgery with exploration of the peritoneum. The endoscope was then withdrawn back into the stomach and the closure performed. The animals were recovered, monitored closely, and underwent endoscopy 1 week after surgery. They were then euthanized at 2 (n = 2) and 3 (n = 3) weeks after surgery with subsequent necropsy. The mean procedure time (from intubation of the esophagus to withdrawal of the endoscope) was 79 minutes (range 45-105 minutes) with a mean time of exploration of the peritoneum of 14 minutes (range 8-25 minutes). All animals recovered well with no apparent pain, distress, or signs of infection. Endoscopic examination 1 week after surgery revealed all the closures to be intact and only identifiable by a small ulcer. At necropsy, the gastrotomy site was identifiable only by minor serosal adhesions. Histological study demonstrated full-thickness closure with minimal inflammation. The Queen's closure is a reliable and safe technique that provides full-thickness gastrotomy closure without any observed complications. The technique has proven to be transferable knowledge that holds promise for clinical implementation.

Outcomes of mechanical stapling for postlaryngectomy open pharyngotomy closure.

PubMed

Paddle, Paul; Husain, Inna; McHugh, Lauren; Franco, Ramon

2017-03-01

A total laryngectomy (TL) is performed as a primary or salvage therapy for laryngeal carcinoma. Pharyngotomy closure after TL is typically performed using manual sutures. Automatic stapling devices are routinely used in thoracoabdominal surgery, but have not been widely accepted for use in pharyngotomy closure. Previously described closed stapling techniques of pharyngeal closure do not allow direct evaluation of surgical margins and are limited to endolaryngeal disease. We describe an open technique for pharyngotomy closure using a mechanical stapling device. Retrospective review. A review was conducted of 16 total laryngectomies performed from May 2008 to August 2015 utilizing an Ethicon Endopath ETS Compact-Flex 45 stapler. Sixteen patients (15 male, one female), mean age 69 years, received open TL (14 salvage, two primary) with endostapler pharyngeal closure and primary tracheoesophageal puncture (TEP). Surgical time averaged 218 minutes. Median time to swallowing was 4 days (range, 2-240 days) and mean hospital stay 6 days (range, 3-10 days). Fistula incidence was 31% (5/16) overall and 36% (5/14) in the postradiation patients. Mechanical stapling is a simple method for postlaryngectomy open pharyngotomy closure. This technique allows evaluation of margins, easy primary TEP, and the opportunity for early swallowing and shorter hospital stays. In addition, it can be performed for closure of salvage laryngectomies with rates of fistula formation similar to that found in the literature using suture closure techniques. Future studies are necessary to compare oncological results and surgical complications between the open and closed stapling techniques and to traditional suture closure. 4 Laryngoscope, 127:605-610, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Hyperoxia and hypergravity are independent risk factors of atelectasis in healthy sitting humans: a pulmonary ultrasound and SPECT/CT study.

PubMed

Dussault, C; Gontier, E; Verret, C; Soret, M; Boussuges, A; Hedenstierna, G; Montmerle-Borgdorff, S

2016-07-01

Aeroatelectasis has developed in aircrew flying routine peacetime flights on the latest generation high-performance aircraft, when undergoing excessive oxygen supply. To single out the effects of hyperoxia and hypergravity on lung tissue compression, and on ventilation and perfusion, eight subjects were studied before and after 1 h 15 min exposure to +1 to +3.5 Gz in a human centrifuge. They performed the protocol three times, breathing air, 44.5% O2, or 100% O2 and underwent functional and topographical imaging of the whole lung by ultrasound and single-photon emission computed tomography combined with computed tomography (SPECT/CT). Ultrasound lung comets (ULC) and atelectasis both increased after exposure. The number of ULC was <1 pre protocol (i.e., normal lung) and larger post 100% O2 (22 ± 3, mean ± SD) than in all other conditions (P < 0.001). Post 44.5% O2 differed from air (P < 0.05). Seven subjects showed low- to medium-grade atelectasis post 100% O2 There was an effect on grade of gas mixture and hypergravity, with interaction (P < 0.001, respectively); 100% O2, 44.5% O2, and air differed from each other (P < 0.05). SPECT ventilation and perfusion were always normal. Ultrasound concurred with CT in showing normal lung in the upper third and ULC/atelectasis in posterior and inferior areas, not for other localizations. In conclusion, hyperoxia and hypergravity are independent risk factors of reversible atelectasis formation. Ultrasound is a useful screening tool. Together with electrical impedance tomography measurements (reported separately), these findings show that zones with decreased ventilation prone to transient airway closure are present above atelectatic areas. Copyright © 2016 the American Physiological Society.

Evaluation of a novel technique for wound closure using a barbed suture.

PubMed

Murtha, Amy P; Kaplan, Andrew L; Paglia, Michael J; Mills, Benjie B; Feldstein, Michael L; Ruff, Gregory L

2006-05-01

Suture knots present several disadvantages in wound closure, because they are tedious to tie and place ischemic demands on tissue. Bulky knots may be a nidus for infection, and they may extrude through skin weeks after surgery. Needle manipulations during knot-tying predispose the surgeon to glove perforation. A barbed suture was developed that is self-anchoring, requiring no knots or slack management for wound closure. The elimination of knot tying may have advantages over conventional wound closure methods. This prospective, randomized, controlled trial was designed to show that the use of barbed suture in dermal closure of the Pfannenstiel incision during nonemergent cesarean delivery surgery produces scar cosmesis at 5 weeks that is no worse than that observed with conventional closure using 3-0 polydioxanone suture. Cosmesis was assessed by review of postoperative photographs by a blinded, independent plastic surgeon using the modified Hollander cosmesis score. Secondary endpoints included infection, dehiscence, pain, closure time, and other adverse events. The study enrolled 195 patients, of whom 188 were eligible for analysis. Cosmesis scores did not significantly differ between the barbed suture group and the control group. Rates of infection, dehiscence, and other adverse events did not significantly differ between the two groups. Closure time and pain scores were comparable between the groups. The barbed suture represents an innovative option for wound closure. With a cosmesis and safety profile that is similar to that of conventional suture technique, it avoids the drawbacks inherent to suture knots.

[Perforated peptic ulcer closure: laparoscopic or open?

PubMed

Alekberzade, A V; Krylov, N N; Rustamov, E A; Badalov, D A; Popovtsev, M A

To compare laparoscopic and open closure of perforated peptic ulcer (PPU). The study included 153 patients who underwent PPU suturing. 78 patients underwent laparoscopic closure (laparoscopic group) and open suturing via upper midline laparotomy was performed in 75 cases (open group). Surgery time, postoperative pain severity, time of analgesics intake, postoperative complications, hospital-stay and and cosmetic effect were compared. Laparoscopic PPU closure may be effective and accessible in experienced endoscopic surgeon. It significantly reduces postoperative pain severity, need for analgesics, incidence of postoperative complications and provides excellent cosmetic effect. However, there is greater time of surgery compared with open intervention. There were no significant differences in hspital-stay between groups. Laparoscopic PPU suturing can be considered a good alternative to open surgery. Further researches are needed for standardization, assessment of safety, real advantages and disadvantages of laparoscopic technique.

Autocracy bias in informal groups under need for closure.

PubMed

Pierro, Antonio; Mannetti, Lucia; De Grada, Eraldo; Livi, Stefano; Kruglanski, Arie W

2003-03-01

Two experiments investigated the tendency of groups with members under high (vs. low) need for cognitive closure to develop an autocratic leadership structure in which some members dominate the discussion, constitute the "hubs" of communication, and influence the group more than other members. The first experiment found that high (vs. low) need for closure groups, as assessed via dispositional measure of the need for closure, manifested greater asymmetry of conversational floor control, such that members with autocratic interactional style were more conversationally dominant and influential than less autocratic members. The second experiment manipulated the need for closure via time pressure and utilized a social network analysis. Consistent with expectation, groups under time pressure (vs. no pressure) showed a greater asymmetry of participation, of centrality, and of prestige among the group members, such that the more focal members were perceived to exert the greater influence over the groups' decisions.

CT measurement of indomethacin-induced cerebral hemodynamic changes in the newborn piglet

NASA Astrophysics Data System (ADS)

Brown, Derek W.; Hadway, Jennifer; Lee, Ting-Yim

2003-05-01

Patent ductus arteriosus (PDA), a common condition among preterm infants, increases the risk of intraventricular hemorrhage, bronchopulmonary dysplasia, and death in afflicted individuals. Current clinical treatment of PDA relies on use of the drug indomethacin to close the ductus arteriosus. In the present study, we have investigated the effect of indomethacin on cerebral blood flow (CBF), cerebral blood volume (CBV), and cerebral mean transit time (MTT) in newborn piglets using computed tomography (CT) perfusion. Twenty newborn piglets divided by age into two groups, less than 12 hours of age (n = 10) and greater than 12 hours of age (n = 10) were studied. Five piglets in each group received indomethacin treatment (0.2 mg/kg infused over 30 min) while remaining piglets served as controls. No significant changes in CBF were observed in control groups. In both indomethacin treated groups, average CBF decreased 32.3% and 34.3% (P > 0.05) below baseline immediately post infusion in piglets less than and greater than 12 hours of age respectively. Piglets less than 12hours of age treated with indomethacin also exhibited a delayed increase in CBF, maximum average increase of 41.7% (P > 0.05) above baseline at 210 min post infusion, a response not observed in the corresponding group of piglets greater than 12 hours of age. The observed age dependent response may be due to functional/anatomical closure of the PDA.

A comparison of septal stapler to suture closure in septoplasty: a prospective, randomized trial evaluating the effect on operative time.

PubMed

Sowerby, Leigh J; Wright, Erin D

2013-11-01

Septoplasty requires coaptation of the mucosal flaps at the conclusion of the procedure; classically this is done with nasal packing. Quilting sutures provide a welcome alternative to packing, but can be time-consuming to place. A septal stapler has recently been developed that provides a rapid alternative to quilting sutures but the timesaving has not been quantified. This study was a prospective, randomized trial comparing a septal stapler to quilting suture for coaptation of mucosal flaps in septoplasty. After meeting inclusion criteria, patients underwent septoplasty and inferior turbinoplasty. The total operative time, surgical segment times, including time for closure was recorded. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores were recorded. A sample size of 16 was determined to detect a difference of 5 minutes in closure time. A total of 16 patients were enrolled in the study. The mean time for closure with septal stapler was 35 ± 22 seconds vs 7 minutes ± 1 minute 10 seconds for suture closure (p < 0.0001). The mean total operative time using the septal stapler was 28 minutes ± 6 minutes whereas 43 minutes ± 13 minutes was required for suture (p = 0.014). No difference in postoperative complications or mucosal healing was seen; preoperative and postoperative improvement in NOSE scores was comparable. Coaptation of the mucosal flaps in septoplasty with a septal stapler affords a timesaving in the operating room with no difference in operative outcome. © 2013 ARS-AAOA, LLC.

77 FR 59883 - Magnuson-Stevens Fishery Conservation and Management Act Provisions; Fisheries of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-01

... are operating without a yellowtail flounder closure cap for the first time. The scallop fleet continues to use a proactive, near real-time system for avoiding yellowtail flounder; however, the negative... AM for GB yellowtail flounder implements time and area closures based on the magnitude of the overage...

75 FR 16007 - Drawbridge Operation Regulation; Lower Grand River, Iberville Parish, LA

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-31

... minutes to the end of the morning scheduled closure period to provide more time for school buses to... scheduled closure period to provide more time for school buses to transit across the bridge. Extra time is... 75 pontoon bridge, mile 38.4, in Iberville Parish, Louisiana. The Iberville Parish School Board...

Angle closure in younger patients.

PubMed Central

Chang, Brian M; Liebmann, Jeffrey M; Ritch, Robert

2002-01-01

PURPOSE: Angle-closure glaucoma is rare in children and young adults. Only scattered cases associated with specific clinical entities have been reported. We evaluated the findings in patients in our database aged 40 or younger with angle closure. METHODS: Our database was searched for patients with angle closure who were 40 years old or younger. Data recorded included age at initial consultation; age at the time of diagnosis; gender; results of slit-lamp examination, gonioscopy, and ultrasound biomicroscopy (from 1993 onward); clinical diagnosis; and therapy. Patients with previous incisional surgery were excluded, as were patients with anterior chamber proliferative mechanisms leading to angle closure. RESULTS: Sixty-seven patients (49 females, 18 males) met entry criteria. Mean age (+/- SD) at the time of consultation was 34.4 +/- 9.4 years (range, 3-68 years). Diagnoses included plateau iris syndrome (35 patients), iridociliary cysts (8 patients), retinopathy of prematurity (7 patients), uveitis (5 patients), isolated nanophthalmos (3 patients), relative pupillary block (2 patients), Weill-Marchesani syndrome (3 patients), and 1 patient each with Marfan syndrome, miotic-induced angle closure, persistent hyperplastic primary vitreous, and idiopathic lens subluxation. CONCLUSION: The etiology of angle closure in young persons is different from that in the older population and is typically associated with structural or developmental ocular anomalies rather than relative pupillary block. Following laser iridotomy, these eyes should be monitored for recurrent angle closure and the need for additional laser or incisional surgical intervention. PMID:12545694

Particulate contamination from siliconized rubber closures for freeze drying.

PubMed

Gebhardt, U; Grumbridge, N A; Knoch, A

1996-01-01

It can be shown that siliconized closures for freeze drying may cause the opalescence and turbidity observed in freeze-dried products after reconstitution. Closures of different rubber composition show different intensities of turbidity when treated identically with the same quantity and type of silicone oil. Clear solutions are obtained after reconstitution if ETFE-coated closures are used instead of siliconized closures. Samples stored at 4 degrees C for up to 6 months show no change in the intensity of turbidity, while the turbidity of samples manufactured with siliconized closures and stored at higher temperatures increase with time. Samples with ETFE-coated closures show clear solutions when stored at 25 degrees C and 37 degrees C for up to 6 months and at 45 degrees C for 3 months. After 6 months only a very weak opalescence could be observed in these samples.

Platinum/zeolite catalyst for reforming n-hexane: Kinetic and mechanistic considerations

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

Lane, G.S.; Modica, F.S.; Miller, J.T.

A platinum/L-zeolite-reforming catalyst exhibits activity and selectivity for converting n-hexane into benzene than other Pt catalyst. The reaction pathways indicate that for all catalysts, e.g., Pt/K L or Pt/K Y, benzene is formed as a primary product by one-six-ring closure and methylcyclopentane is formed as a primary product via one-five-ring closure. The ratio for one-six to one-five-ring closure, however, is about two times greater for the Pt/K L than for the Pt/K Y, or other platinum catalysts. The preference for the one-six-ring closure in L zeolite appears to be related to the optimum pore size of the L zeolite. Inmore » addition to an increased selectivity for one-six-ring closure, the Pt/K L-zeolite catalyst also displays increased reactivity. For example, the turnover frequency of the Pt/K L-zeolite catalyst is 10 times higher for formation of benzene and 3.3 times higher for formation of methylcyclopentane compared with the Pt/K Y-zeolite catalyst. Although the Pt/K L is more reactive than Pt/K Y, the apparent activation energies, 54 kcal/mol for one-six-ring closure and 39 kcal/mol for one-five-ring closure, are the same for both catalysts. Differences in reactivity are associated with an increase in the preexponential term for the Pt/K L catalyst. The increased aromatics selectivity for Pt/K L is consistent with the confinement model which proposes that n-hexane is adsorbed as a six-ring pseudo-cycle resembling the transition state for one-six-ring closure.« less

The Influence of Closing Poor Performing Primary Schools on the Educational Attainment of Students

ERIC Educational Resources Information Center

De Witte, Kristof; Van Klaveren, Chris

2014-01-01

This paper examines whether the closure of poor performing primary schools improved students' educational attainment. It is believed that school closure affects children's educational outcomes positively because children switch to better primary schools. At the same time, school closure creates a social disturbance such that educational outcomes…

40 CFR 267.142 - Cost estimate for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... that on-site disposal capacity will exist at all times over the life of the facility. (3) The closure...) The owner or operator must keep the following at the facility during the operating life of the... PERMIT Financial Requirements § 267.142 Cost estimate for closure. (a) The owner or operator must have at...

40 CFR 267.142 - Cost estimate for closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... that on-site disposal capacity will exist at all times over the life of the facility. (3) The closure...) The owner or operator must keep the following at the facility during the operating life of the... PERMIT Financial Requirements § 267.142 Cost estimate for closure. (a) The owner or operator must have at...

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.

Is there a relationship between wound infections and laceration closure times?

PubMed Central

2012-01-01

Background Lacerations account for a large number of ED visits. Is there a “golden period” beyond which lacerations should not be repaired primarily? What type of relationship exists between time of repair and wound infection rates? Is it linear or exponential? Currently, the influence of laceration age on the risk of infection in simple lacerations repaired is not clearly defined. We conducted this study to determine the influence of time of primary wound closure on the infection rate. Methods This is a prospective observational study of patients who presented to the Emergency Department (ED) with a laceration requiring closure from April 2009 to November 2010. The wound closure time was defined as the time interval from when the patient reported laceration occurred until the time of the start of the wound repair procedure. Univariate analysis was performed to determine the factors predictive of infection. A non-parametric Wilcoxon rank-sum test was performed to compare the median differences of time of laceration repair. Chi-square (Fisher's exact) tests were performed to test for infection differences with regard to gender, race, location of laceration, mechanism of injury, co-morbidities, type of anesthesia and type of suture material used. Results Over the study period, 297 participants met the inclusion criteria and were followed. Of the included participants, 224 (75.4%) were male and 73 (24.6%) were female. Ten patients (3.4%) developed a wound infection. Of these infections, five occurred on hands, four on extremities (not hands) and one on the face. One of these patients was African American, seven were Hispanic and two were Caucasian (p = 0.0005). Median wound closure time in the infection group was 867 min and in the non-infection group 330 min (p = 0.03). Conclusions Without controlling various confounding factors, the median wound closure time for the lacerations in the wound infection group was statistically significantly longer than in the non-infection group. PMID:22835090

Onset and extent of platelet inhibition by clopidogrel loading in patients undergoing elective coronary stenting: the Plavix Reduction Of New Thrombus Occurrence (PRONTO) trial.

PubMed

Gurbel, Paul A; Cummings, Charles C; Bell, Christopher R; Alford, Amanda B; Meister, Andrew F; Serebruany, Victor L

2003-02-01

Despite the common practice of clopidogrel loading for coronary stenting, the time dependence and degree of platelet inhibition after this therapy are not well defined. We sought to establish an optimal clopidogrel dosing regimen for sustained platelet inhibition in stented patients. Platelets were assessed by conventional aggregation with 5 micromol/L adenosine diphosphate (ADP), 1 microg/mL collagen (COLL), and 750 micromol/L arachidonic acid; whole blood aggregation by 1 microg/mL collagen (WBA); shear-induced closure time (CT); contractile force (CF); and expression of 9 surface receptors by flow cytometry in 100 patients undergoing elective stent placement without glycoprotein (GP) IIb/IIIa receptor antagonists. Blood was obtained at baseline and serially over 5 days poststenting after different clopidogrel loading regimens: 300 mg 24 hours before (Group A), 12 hours before (Group B), 3 to 6 hours before (Group C), and 75 mg at the time of intervention (Group D). Before stenting, ADP, COLL, CT, and WBA were reduced by clopidogrel loading (P <.05). CF was not affected by clopidogrel. Before stenting, GP IIb/IIIa expression increased in groups A through C (P <.05), whereas PECAM-1 and CD107a were reduced (P <.05). At 2 hours and 2 days poststenting, platelets, in general, exhibited an increase in activity that was most inhibited by clopidogrel loading. Clopidogrel inhibited GP Ib, platelet/endothelial cell adhesion molecule-1, CD 107a, CD 151, and GP IIb/IIIa expression at day 5 poststenting. A 300 mg clopidogrel load given 3 to 24 hours before stenting inhibits platelets at the time of the procedure and reduces poststent activity more than a 75 mg dose given at the time of the procedure. The inhibition of adhesive molecule expression may also contribute an antithrombotic effect. Poststent activation of platelets may warrant higher periprocedural dosing.

The Effect of Rural Hospital Closures on Community Economic Health

PubMed Central

Holmes, George M; Slifkin, Rebecca T; Randolph, Randy K; Poley, Stephanie

2006-01-01

Objective To examine the effect of rural hospital closures on the local economy. Data Sources U.S. Census Bureau, OSCAR, Medicare Cost Reports, and surveys of individuals knowledgeable about local hospital closures. Study Design Economic data at the county level for 1990–2000 were combined with information on hospital closures. The study sample was restricted to rural counties experiencing a closure during the sample period. Longitudinal regression methods were used to estimate the effect of hospital closure on per-capita income, unemployment rate, and other community economic measures. Models included both leading and lagged closure terms allowing a preclosure economic downturn as well as time for the closure to be fully realized by the community. Data Collection Information on closures was collected by contacting every state hospital association, reconciling information gathered with that contained in the American Hospital Association file and OIG reports. Principal Findings Results indicate that the closure of the sole hospital in the community reduces per-capita income by $703 (p<0.05) or 4 percent (p<0.05) and increases the unemployment rate by 1.6 percentage points (p<0.01). Closures in communities with alternative sources of hospital care had no long-term economic impact, although income decreased for 2 years following the closure. Conclusions The local economic effects of a hospital closure should be considered when regulations that affect hospitals' financial well-being are designed or changed. PMID:16584460

Assessment of Severe Extremity Wound Bioburden at the Time of Definitive Wound Closure or Coverage: Correlation With Subsequent Postclosure Deep Wound Infection (Bioburden Study).

PubMed

Bosse, Michael J; Murray, Clinton K; Carlini, Anthony R; Firoozabadi, Reza; Manson, Theodore; Scharfstein, Daniel O; Wenke, Joseph C; Zadnik, Mary; Castillo, Renan C

2017-04-01

Infection remains the most common and significant complication after high-energy fractures. The Bioburden Study is a multicenter, prospective, observational cohort study of wound bacterial bioburden and antibiotic care in severe open lower extremity fractures. The aims of this study are to (1) characterize the contemporary extremity wound "bioburden" at the time of definitive wound closure; (2) determine the concordance between polymerase chain reaction results and hospital microbiology; (3) determine, among those who develop deep infections, the concordance between the pathogens at wound closure and at deep infection; and (4) compare the probability of deep infection between those who did and did not receive an appropriate course of antibiotics based on bioburden at the time of wound closure. To address these aims, sites collected tissue samples from severe lower extremity injuries at the time of wound closure and at first surgery for treatment of a deep infection, nonunion, flap failure, amputation, or other complications (because these surgeries may be due to undetected infection). Otherwise, if no further surgical treatment occurred, participants were followed for 12 months. The study was conducted at 38 US trauma centers and has enrolled 655 participants aged 18-64 years. This is the first large multi-institutional study evaluating the wound bioburden of severe open tibia fractures and correlating this bioburden with the risk of wound complications after definitive soft tissue closure.

Assessment of platelet-derived growth factor using A splinted full thickness dermal wound model in bearded dragons (Pogona vitticeps).

PubMed

Keller, Krista A; Paul-Murphy, Joanne; Weber, E P Scott; Kass, Philip H; Guzman, Sanchez-Migallon David; Park, Shin Ae; Raghunathan, Vijay Krishna; Gustavsen, Kate A; Murphy, Christopher J

2014-12-01

Wounds in reptiles are a common reason for presentation to a veterinarian. At this time there is limited information on effective topical medications to aid in wound closure. The objectives of this study were to translate the splinted, full-thickness dermal wound model, validated in mice, to the bearded dragon (Pogona vitticeps) and to determine the effect of topical becaplermin (BP), a platelet-derived growth factor (0.01%), on the rate of wound closure. Ten bearded dragons were anesthetized and two full-thickness cutaneous wounds were made on the dorsum of each lizard. Encircling splints were applied surrounding each wound and subsequently covered by a semi-occlusive dressing. Five lizards had one wound treated with BP and the adjacent wound treated with a vehicle control. Five additional lizards had one wound treated with saline and the second wound treated with a vehicle control. Wounds were imaged daily, and the wound area was measured using digital image analysis. The change in percentage wound closure over 17 days and the time to 50% wound closure was compared among the four treatment groups. There was no significant difference in wound closure rates between BP-treated and saline-treated wounds or in the time to 50% wound closure between any treatments. Vehicle-treated wounds adjacent to saline-treated wounds closed significantly slower than did BP (P < 0.010), saline (P < 0.001), and vehicle-treated wounds adjacent to BP-treated wounds (P < 0.013). Our preliminary study indicates that the splinted wound model, with modifications, may be used to determine wound closure rates in bearded dragons. When compared with saline, BP did not have a significant effect on wound closure rates, while the vehicle alone delayed wound closure. Histologic analysis of experimentally created wounds throughout the wound healing process is needed to further evaluate the effects of these treatments on reptile dermal wound healing.

Protecting an island nation from extreme pandemic threats: Proof-of-concept around border closure as an intervention.

PubMed

Boyd, Matt; Baker, Michael G; Mansoor, Osman D; Kvizhinadze, Giorgi; Wilson, Nick

2017-01-01

Countries are well advised to prepare for future pandemic risks (e.g., pandemic influenza, novel emerging agents or synthetic bioweapons). These preparations do not typically include planning for complete border closure. Even though border closure may not be instituted in time, and can fail, there might still plausible chances of success for well organized island nations. To estimate costs and benefits of complete border closure in response to new pandemic threats, at an initial proof-of-concept level. New Zealand was used as a case-study for an island country. An Excel spreadsheet model was developed to estimate costs and benefits. Case-study specific epidemiological data was sourced from past influenza pandemics. Country-specific healthcare cost data, valuation of life, and lost tourism revenue were imputed (with lost trade also in scenario analyses). For a new pandemic equivalent to the 1918 influenza pandemic (albeit with half the mortality rate, "Scenario A"), it was estimated that successful border closure for 26 weeks provided a net societal benefit (e.g., of NZ$11.0 billion, USD$7.3 billion). Even in the face of a complete end to trade, a net benefit was estimated for scenarios where the mortality rate was high (e.g., at 10 times the mortality impact of "Scenario A", or 2.75% of the country's population dying) giving a net benefit of NZ$54 billion (USD$36 billion). But for some other pandemic scenarios where trade ceased, border closure resulted in a net negative societal value (e.g., for "Scenario A" times three for 26 weeks of border closure-but not for only 12 weeks of closure when it would still be beneficial). This "proof-of-concept" work indicates that more detailed cost-benefit analysis of border closure in very severe pandemic situations for some island nations is probably warranted, as this course of action might sometimes be worthwhile from a societal perspective.

Greater Success of Primary Fascial Closure of the Open Abdomen: A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results.

PubMed

Kääriäinen, M; Kuuskeri, M; Helminen, M; Kuokkanen, H

2017-06-01

The open abdomen technique is a standard procedure in the treatment of intra-abdominal catastrophe. Achieving primary abdominal closure within the initial hospitalization is a main objective. This study aimed to analyze the success of closure rate and the effect of negative pressure wound therapy, mesh-mediated medial traction, and component separation on the results. We present the treatment algorithm used in our institution in open abdomen situations based on these findings. Open abdomen patients (n = 61) treated in Tampere University Hospital from May 2005 until October 2013 were included in the study. Patient characteristics, treatment prior to closure, closure technique, and results were retrospectively collected and analyzed. The first group included patients in whom direct or bridged fascial closure was achieved, and the second group included those in whom only the skin was closed or a free skin graft was used. Background variables and variables related to surgery were compared between groups. Most of the open abdomen patients (72.1%) underwent fascial defect repair during the primary hospitalization, and 70.5% of them underwent direct fascial closure. Negative pressure wound therapy was used as a temporary closure method for 86.9% of the patients. Negative pressure wound therapy combined with mesh-mediated medial traction resulted in the shortest open abdomen time (p = 0.039) and the highest fascial repair rate (p = 0.000) compared to negative pressure wound therapy only or no negative pressure wound therapy. The component separation technique was used for 11 patients; direct fascial closure was achieved in 5 and fascial repair by bridging the defect with mesh was achieved in 6. A total of 8 of 37 (21.6%) patients with mesh repair had a mesh infection. The negative pressure wound therapy combined with mesh-mediated medial traction promotes definitive fascial closure with a high closure rate and a shortened open abdomen time. The component separation technique can be used to facilitate fascial repair but it does not guarantee direct fascial closure in open abdomen patients.

Online Work Force Analyzes Social Media to Identify Consequences of an Unplanned School Closure - Using Technology to Prepare for the Next Pandemic.

PubMed

Rainey, Jeanette J; Kenney, Jasmine; Wilburn, Ben; Putman, Ami; Zheteyeva, Yenlik; O'Sullivan, Megan

During an influenza pandemic, the United States Centers for Disease Control and Prevention (CDC) may recommend school closures. These closures could have unintended consequences for students and their families. Publicly available social media could be analyzed to identify the consequences of an unplanned school closure. As a proxy for an unplanned, pandemic-related school closure, we used the district-wide school closure due to the September 10-18, 2012 teachers' strike in Chicago, Illinois. We captured social media posts about the school closure using the Radian6 social media-monitoring platform. An online workforce from Amazon Mechanical Turk categorized each post into one of two groups. The first group included relevant posts that described the impact of the closure on students and their families. The second group included irrelevant posts that described the political aspects of the strike or topics unrelated to the school closure. All relevant posts were further categorized as expressing a positive, negative, or neutral sentiment. We analyzed patterns of relevant posts and sentiment over time and compared our findings to household surveys conducted after other unplanned school closures. We captured 4,546 social media posts about the district-wide school closure using our search criteria. Of these, 930 (20%) were categorized as relevant by the online workforce. Of the relevant posts, 619 (67%) expressed a negative sentiment, 51 (5%) expressed a positive sentiment, and 260 (28%) were neutral. The number of relevant posts, and especially those with a negative sentiment, peaked on day 1 of the strike. Negative sentiment expressed concerns about childcare, missed school lunches, and the lack of class time for students. This was consistent with findings from previously conducted household surveys. Social media are publicly available and can readily provide information on the impact of an unplanned school closure on students and their families. Using social media to assess the impact of an unplanned school closure due to a public health event would be informative. An online workforce can effectively assist with the review process.

Online Work Force Analyzes Social Media to Identify Consequences of an Unplanned School Closure – Using Technology to Prepare for the Next Pandemic

PubMed Central

Rainey, Jeanette J.; Kenney, Jasmine; Wilburn, Ben; Putman, Ami; Zheteyeva, Yenlik; O’Sullivan, Megan

2016-01-01

Background During an influenza pandemic, the United States Centers for Disease Control and Prevention (CDC) may recommend school closures. These closures could have unintended consequences for students and their families. Publicly available social media could be analyzed to identify the consequences of an unplanned school closure. Methods As a proxy for an unplanned, pandemic-related school closure, we used the district-wide school closure due to the September 10–18, 2012 teachers’ strike in Chicago, Illinois. We captured social media posts about the school closure using the Radian6 social media-monitoring platform. An online workforce from Amazon Mechanical Turk categorized each post into one of two groups. The first group included relevant posts that described the impact of the closure on students and their families. The second group included irrelevant posts that described the political aspects of the strike or topics unrelated to the school closure. All relevant posts were further categorized as expressing a positive, negative, or neutral sentiment. We analyzed patterns of relevant posts and sentiment over time and compared our findings to household surveys conducted after other unplanned school closures. Results We captured 4,546 social media posts about the district-wide school closure using our search criteria. Of these, 930 (20%) were categorized as relevant by the online workforce. Of the relevant posts, 619 (67%) expressed a negative sentiment, 51 (5%) expressed a positive sentiment, and 260 (28%) were neutral. The number of relevant posts, and especially those with a negative sentiment, peaked on day 1 of the strike. Negative sentiment expressed concerns about childcare, missed school lunches, and the lack of class time for students. This was consistent with findings from previously conducted household surveys. Conclusion Social media are publicly available and can readily provide information on the impact of an unplanned school closure on students and their families. Using social media to assess the impact of an unplanned school closure due to a public health event would be informative. An online workforce can effectively assist with the review process. PMID:27655229

Delineation of First-Order Elastic Property Closures for Hexagonal Metals Using Fast Fourier Transforms

PubMed Central

Landry, Nicholas W.; Knezevic, Marko

2015-01-01

Property closures are envelopes representing the complete set of theoretically feasible macroscopic property combinations for a given material system. In this paper, we present a computational procedure based on fast Fourier transforms (FFTs) for delineation of elastic property closures for hexagonal close packed (HCP) metals. The procedure consists of building a database of non-zero Fourier transforms for each component of the elastic stiffness tensor, calculating the Fourier transforms of orientation distribution functions (ODFs), and calculating the ODF-to-elastic property bounds in the Fourier space. In earlier studies, HCP closures were computed using the generalized spherical harmonics (GSH) representation and an assumption of orthotropic sample symmetry; here, the FFT approach allowed us to successfully calculate the closures for a range of HCP metals without invoking any sample symmetry assumption. The methodology presented here facilitates for the first time computation of property closures involving normal-shear coupling stiffness coefficients. We found that the representation of these property linkages using FFTs need more terms compared to GSH representations. However, the use of FFT representations reduces the computational time involved in producing the property closures due to the use of fast FFT algorithms. Moreover, FFT algorithms are readily available as opposed to GSH codes. PMID:28793566

The modern staged repair of classic bladder exstrophy: a detailed postoperative management strategy for primary bladder closure.

PubMed

Stec, Andrew A; Baradaran, Nima; Schaeffer, Anthony; Gearhart, John P; Matthews, Ranjiv I

2012-10-01

Successful primary bladder closure of classic bladder exstrophy sets the stage for development of adequate bladder capacity and eventual voided continence. The postoperative pathway following primary bladder closure at the authors' institution is quantitatively and qualitatively detailed. Sixty-five consecutive newborns (47 male) undergoing primary closure of classic bladder exstrophy were identified and data were extracted relating to immediate postoperative care. Overall success rate was utilized to validate the pathway. Mean age at time of primary closure was 4.6 days and mean hospital stay was 35.8 days. Osteotomy was performed in 19 patients (mean age 8.8 days), and was not required in 39 infants (mean age 2.9 days). All patients were immobilized for 4 weeks. Tunneled epidural analgesia was employed in 61/65 patients. All patients had ureteral catheters and a suprapubic tube, along with a comprehensive antibiotic regimen. Postoperative total parenteral nutrition was commonly administered, and enteral feedings started around day 4.6. Our success rate of primary closure was 95.4%. A detailed and regimented plan for bladder drainage, immobilization, pain control, nutrition, antimicrobial prophylaxis, and adequate healing time is a cornerstone for the postoperative management of the primary closure of bladder exstrophy. Copyright © 2011 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Evaluation of the effectiveness of octreotide in the conservative treatment of postoperative enterocutaneous fistulas.

PubMed

Alivizatos, Vassilos; Felekis, Dimitrios; Zorbalas, Athanasios

2002-01-01

The aim of this study was to evaluate the effectiveness of Octreotide as an adjunct treatment to total parenteral nutrition in the spontaneous closure of postoperative enterocutaneous fistulas. Medical records of 39 patients with postoperative enterocutaneous fistulas treated in our Department between January 1988 and August 2000 were reviewed. Sixteen patients had duodenal fistulas and 23 had jejunal or ileal fistulas. According to the daily output, there were 20 low fistula output and 19 high fistula output. Conservative treatment consisted of nutritional support with total parenteral nutrition in all the patients. Administration of Octreotide (100 micrograms every 8 hours, subcutaneously) was done in 21 consecutive patients until spontaneous closure of the fistulas or their subsequent surgical closure. The occurrence of fistulas closure was compared using the Fisher's exact test. A mean reduction of 50% of fistula output was noted in all the patients who received Octreotide, within 24 hours of its administration. Spontaneous closure was achieved in 13 patients of the Octreotide group (mean closure time: 15.3 days, range: 6-35) and in 12 patients treated only with total parenteral nutrition (mean closure time: 13.9 days, range: 7-25); this difference was not significant (P = 0.5). Also, the fistula closure rate was not influenced by the anatomic site, the high or low output, and the age of the patient. The results of this study suggest that, as an adjunct treatment to total parenteral nutrition, Octreotide reduces rapidly the fistula output without significant influence in the spontaneous closure rate.

Two-Way Satellite Time and Frequency Transfer (TWSTFT) Calibration Constancy From Closure Sums

DTIC Science & Technology

2008-12-01

40th Annual Precise Time and Time Interval (PTTI) Meeting 587 TWO-WAY SATELLITE TIME AND FREQUENCY TRANSFER ( TWSTFT ) CALIBRATION...Paris, France Abstract Two-way Satellite Time and Frequency Transfer ( TWSTFT ) is considered to be the most accurate means of long-distance...explanations for small, but non-zero, biases observed in the closure sums of uncalibrated data are presented. I. INTRODUCTION TWSTFT [1] has

Body mass index affects time to definitive closure after damage control surgery.

PubMed

Haricharan, Ramanath N; Dooley, Adam C; Weinberg, Jordan A; McGwin, Gerald; MacLennan, Paul A; Griffin, Russell L; Rue, Loring W; Reiff, Donald A

2009-06-01

A growing body of literature demonstrates that irrespective of the mechanism of injury, obesity is associated with significantly worse morbidity and mortality after trauma. Among patients requiring damage control laparotomy (DCL), clinical experience suggests that obesity affects time to definitive closure though this association has never been demonstrated quantitatively. All patients at an academic Level I trauma center requiring a DCL between January 2002 and December 2006 (N = 148) were included. Information pertaining to demographic, injury, and clinical characteristics was abstracted from patient medical records. The risk of specific complications including pneumonia, renal failure, and sepsis was compared between normal and overweight/obese patients, as measured by body mass index (BMI). The lengths of intensive care unit (ICU) stay and mechanical ventilation as well as time to abdominal closure were also compared. The risk of pneumonia, sepsis, and renal failure was 2.05-times, 1.77-times, and 2.84-times higher among overweight patients compared with patients with a normal BMI. The risk of pneumonia, sepsis, and renal failure was 2.01-times, 4.24-times, and 1.85-times higher among obese patients compared with those with a normal BMI. Obese patients also had a significantly longer ICU length of stay (28.7 days vs. 15.1 days; p < 0.0001), longer hospitalization (39.3 days vs. 27.0 days; p = 0.008), and time to definitive closure (8.4 days vs. 3.9 days; p = 0.03) compared with patients with a normal BMI. Among patients requiring DCL, those who are overweight or obese have a prolonged time to definitive closure. These patients also experience a significantly longer ICU course and a higher risk of pneumonia.

40 CFR 264.142 - Cost estimate for closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the cost of final closure at the point in the facility's active life when the extent and manner of its... costs for on-site disposal if he can demonstrate that on-site disposal capacity will exist at all times over the life of the facility. (3) The closure cost estimate may not incorporate any salvage value that...

Guinea pig ductus arteriosus. II - Irreversible closure after birth.

NASA Technical Reports Server (NTRS)

Fay, F. S.; Cooke, P. H.

1972-01-01

To investigate the mechanism underlying irreversibility of ductal closure after birth, studies were undertaken to determine the exact time course for the onset of irreversible closure of the guinea pig ductus arteriosus. Parallel studies of the reactivity of ductal smooth muscle to oxygen and studies of the postpartum cellular changes within the vessel were also carried out.

Thinning guidelines from crown area relationships for young hardwood plantations

Treesearch

Jeffrey W. Stringer; Luke Cecil

2010-01-01

Crown closure in hardwood plantations signals the first opportunity to apply density control treatments such as thinning or release. The proper timing of these treatments is a function of stocking levels and is generally scheduled within several years after initial crown closure. Predicting crown closure for a plantation provides practitioners with the ability to plan...

Clinical and subclinical leaks after low colorectal anastomosis: a clinical and radiologic study.

PubMed

Lim, Michael; Akhtar, Saleem; Sasapu, Kishore; Harris, Keith; Burke, Dermot; Sagar, Peter; Finan, Paul

2006-10-01

This study was designed to examine the natural history of subclinical leaks and their effect on bowel function and quality of life and to evaluate water-soluble contrast enema features that predict anastomotic healing after leaks. Consecutive patients who underwent low rectal anastomosis were followed up postoperatively for leaks. All leaks were confirmed radiologically with CT scanning and water-soluble contrast enema imaging. Water-soluble contrast enemas were serially repeated to identify healing. Characteristics on initial water-soluble contrast enema were correlated with observed healing. Postoperatively, patients were required to fill in a quality of life and a bowel function questionnaire. A total of 138 patients underwent low rectal anastomosis procedures with a median follow-up period of 26 (interquartile range, 19-37) months. There were 23 documented leaks of which 13 (9 percent) presented clinically and 10 (8 percent) presented subclinically. Ileostomy closure was possible in 4 of 13 (30 percent) patients with a clinical leak and all 10 (100 percent) patients with a subclinical leak. Median quality of life scores were lower for patients with clinical leaks and no ileostomy closure (P = 0.03). Bowel function for subclinical leak patients and clinical leak patients with ileostomy closure were similarly impaired. The presence of a cavity (P = 0.01) and a stricture (P = 0.01) at the anastomotic site were unfavorable radiologic features associated with nonhealing. Subclinical leaks are more benign in their natural history compared with clinical leaks. Quality of life and bowel function is no better in patients with a subclinical leak compared with patients with a clinical leak who have ileostomy closure. Anastomotic leaks may resolve if favorable radiologic features are present.

Early Versus Delayed Source Control in Open Abdomen Management for Severe Intra-abdominal Infections: A Retrospective Analysis on 111 Cases.

PubMed

Rausei, Stefano; Pappalardo, Vincenzo; Ruspi, Laura; Colella, Antonio; Giudici, Simone; Ardita, Vincenzo; Frattini, Francesco; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo

2018-03-01

Time to source control plays a determinant prognostic role in patients having severe intra-abdominal infections (IAIs). Open abdomen (OA) management became an effective treatment option for peritonitis. Aim of this study was to analyze the correlation between time to source control and outcome in patients presenting with abdominal sepsis and treated by OA. We retrospectively analyzed 111 patients affected by abdominal sepsis and treated with OA from May 2007 to May 2015. Patients were classified according to time interval from first patient evaluation to source control. The end points were intra-hospital mortality and primary fascial closure rate. The in-hospital mortality rate was 21.6% (24/111), and the primary fascial closure rate was 90.9% (101/111). A time to source control ≥6 h resulted significantly associated with a poor prognosis and a lower fascial closure rate (mortality 27.0 vs 9.0%, p = 0.04; primary fascial closure 86 vs 100%, p = 0.02). We observed a direct increase in mortality (and a reduction in closure rate) for each 6-h delay in surgery to source control. Early source control using OA management significantly improves outcome of patients with severe IAIs. This damage control approach well fits to the treatment of time-related conditions, particularly in case of critically ill patients.

Clinical evaluation of neodymium-iron-boron (Ne2Fe14B) rare earth magnets in the treatment of mid line diastemas

PubMed Central

Manoj-Kumar, Mitta; Gowri-Sankar, Singaraju; Chaitanya, Nellore; Vivek-Reddy, Ganugapanta; Venkatesh, Nettam

2016-01-01

Background To evaluate the closure of midline diastema using the Neodymium-Iron-Boron magnets and to compare the treatment duration of midline diastemas with the use of magnets compared to regular orthodontic treatment. Material and Methods Thirty patients with age group 12 to 30 years with the midline diastema ranging from 0.5 to 3mm were selected. These patients were divided into two groups. Diastema closure in one group was accomplished by conventional method, in other group was done with Ne2Fe14B magnets. These magnets were fitted to the labial surfaces of the maxillary central incisors such a way that the opposite poles of the magnets face each other. At each appointment, study models and radiographs were taken for study subjects and the midline diastema was measured using digital vernier calipers on the study models obtained. Descriptive statistics carried out using Paired t-test. Results Subjects treated with Ne2Fe14B magnets showed a significant difference compared to fixed orthodontic appliance subjects with respect to time of closure, rate of space closure and incisal inclination. Significant difference between 2 groups with reduction of 64.6 days in time to diastema closure in subjects treated with Ne2Fe14B magnets (P<0.05). Conclusions Ne2Fe14B magnets more efficient in complete closure of mid line diastema in less duration of time. Key words:Midline diastema, Ne2Fe14B magnets, rare earth magnets, space closure. PMID:27034757

Efficient algorithms and implementations of entropy-based moment closures for rarefied gases

NASA Astrophysics Data System (ADS)

Schaerer, Roman Pascal; Bansal, Pratyuksh; Torrilhon, Manuel

2017-07-01

We present efficient algorithms and implementations of the 35-moment system equipped with the maximum-entropy closure in the context of rarefied gases. While closures based on the principle of entropy maximization have been shown to yield very promising results for moderately rarefied gas flows, the computational cost of these closures is in general much higher than for closure theories with explicit closed-form expressions of the closing fluxes, such as Grad's classical closure. Following a similar approach as Garrett et al. (2015) [13], we investigate efficient implementations of the computationally expensive numerical quadrature method used for the moment evaluations of the maximum-entropy distribution by exploiting its inherent fine-grained parallelism with the parallelism offered by multi-core processors and graphics cards. We show that using a single graphics card as an accelerator allows speed-ups of two orders of magnitude when compared to a serial CPU implementation. To accelerate the time-to-solution for steady-state problems, we propose a new semi-implicit time discretization scheme. The resulting nonlinear system of equations is solved with a Newton type method in the Lagrange multipliers of the dual optimization problem in order to reduce the computational cost. Additionally, fully explicit time-stepping schemes of first and second order accuracy are presented. We investigate the accuracy and efficiency of the numerical schemes for several numerical test cases, including a steady-state shock-structure problem.

The generalized drift flux approach: Identification of the void-drift closure law

NASA Technical Reports Server (NTRS)

Boure, J. A.

1989-01-01

The main characteristics and the potential advantages of generalized drift flux models are presented. In particular it is stressed that the issue on the propagation properties and on the mathematical nature (hyperbolic or not) of the model and the problem of closure are easier to tackle than in two fluid models. The problem of identifying the differential void-drift closure law inherent to generalized drift flux models is then addressed. Such a void-drift closure, based on wave properties, is proposed for bubbly flows. It involves a drift relaxation time which is of the order of 0.25 s. It is observed that, although wave properties provide essential closure validity tests, they do not represent an easily usable source of quantitative information on the closure laws.

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.

Novel application of polyelectrolyte multilayers as nanoscopic closures with hermetic sealing.

PubMed

Marcott, Stephanie A; Ada, Sena; Gibson, Phillip; Camesano, Terri A; Nagarajan, R

2012-03-01

Closure systems for personnel protection applications, such as protective clothing or respirator face seals, should provide effective permeation barrier to toxic gases. Currently available mechanical closure systems based on the hook and loop types (example, Velcro) do not provide adequate barrier to gas permeation. To achieve hermetic sealing, we propose a nonmechanical, nanoscopic molecular closure system based on complementary polyelectrolyte multilayers, one with a polycation outermost layer and the other with a polyanion outermost layer. The closure surfaces were prepared by depositing polyelectrolyte multilayers under a variety of deposition conditions, on conformable polymer substrates (thin films of polyethylene teraphthalate, PET or polyimide, PI). The hermetic sealing property of the closures was evaluated by measuring the air flow resistance using the dynamic moisture permeation cell (DMPC) at different humidity conditions. The DMPC measurements show that the polyelectrolyte multilayer closures provide significantly large resistance to air flow, approximately 20-800 times larger than that possible with conventional hook and loop type closure systems, at all humidity levels (from 5 to 95% relative humidity). Hence, from the point of view of providing a hermetic seal against toxic gas permeation, the polyelectrolyte multilayer closures are viable candidates for further engineering development. However, the adhesive strength of the multilayer closures measured by atomic force microscopy suggests that the magnitude of adhesion is much smaller than what is possible with mechanical closures. Therefore, we envisage the development of a composite closure system combining the mechanical closure to provide strong adhesion and the multilayer closure to provide hermetic sealing. © 2012 American Chemical Society

Modeling of combined effects of divertor closure and advanced magnetic configuration on detachment in DIII-D by SOLPS

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

Si, Hang; Guo, Houyang Y.; Covele, Brent

One of the major challenges facing the design and operation of next-step high-power steady-state fusion devices is to develop a divertor solution for handling power exhaust, while ensuring acceptable divertor target plate erosion, which necessitates access to divertor detachment at relative low main plasma densities compatible with current drive and high plasma confinement. Detailed modeling with SOLPS is carried out to examine the effect of divertor closure on detachment with the normal single null divertor (SD) configuration, as well as one of the advanced divertor configurations, such as x-divertor (XD) respectively. The SOLPS modeling for a high confinement plasma in DIII-D finds that increasing divertor closure with SD reduces the upstream separatrix density at the onset of detachment frommore » $$1.18\\times {{10}^{19}}\\,{{{\\rm m}}^{-3}}$$ to $$0.88\\times {{10}^{19}}\\,{{{\\rm m}}^{-3}}$$. Furthermore, coupling the divertor closure with XD further promotes the onset of divertor detachment at a still lower upstream separatrix density, down to the value of $$0.67\\times {{10}^{19}}\\,{{{\\rm m}}^{-3}}$$, thus, showing that divertor closure and advanced magnetic configuration can work synergistically to facilitate divertor detachment.« less

Modeling of combined effects of divertor closure and advanced magnetic configuration on detachment in DIII-D by SOLPS

DOE PAGES

Si, Hang; Guo, Houyang Y.; Covele, Brent; ...

2018-04-04

One of the major challenges facing the design and operation of next-step high-power steady-state fusion devices is to develop a divertor solution for handling power exhaust, while ensuring acceptable divertor target plate erosion, which necessitates access to divertor detachment at relative low main plasma densities compatible with current drive and high plasma confinement. Detailed modeling with SOLPS is carried out to examine the effect of divertor closure on detachment with the normal single null divertor (SD) configuration, as well as one of the advanced divertor configurations, such as x-divertor (XD) respectively. The SOLPS modeling for a high confinement plasma in DIII-D finds that increasing divertor closure with SD reduces the upstream separatrix density at the onset of detachment frommore » $$1.18\\times {{10}^{19}}\\,{{{\\rm m}}^{-3}}$$ to $$0.88\\times {{10}^{19}}\\,{{{\\rm m}}^{-3}}$$. Furthermore, coupling the divertor closure with XD further promotes the onset of divertor detachment at a still lower upstream separatrix density, down to the value of $$0.67\\times {{10}^{19}}\\,{{{\\rm m}}^{-3}}$$, thus, showing that divertor closure and advanced magnetic configuration can work synergistically to facilitate divertor detachment.« less

Dynamic Ocean Management Increases the Efficiency and Efficacy of Fisheries Management

NASA Astrophysics Data System (ADS)

Dunn, D. C.; Maxwell, S.; Boustany, A. M.; Halpin, P. N.

2016-12-01

In response to the inherent dynamic nature of the oceans and continuing difficulty in managing ecosystem impacts of fisheries, interest in the concept of dynamic ocean management, or real-time management of ocean resources, has accelerated in the last several years. However, scientists have yet to quantitatively assess the efficiency of dynamic management over static management. Of particular interest is how scale influences effectiveness, both in terms of how it reflects underlying ecological processes and how this relates to potential efficiency gains. In this presentation, we attempt to address both the empirical evidence gap and further the ecological theory underpinning dynamic management. We illustrate, through the simulation of closures across a range of spatiotemporal scales, that dynamic ocean management can address previously intractable problems at scales associated with coactive and social patterns (e.g., competition, predation, niche partitioning, parasitism and social aggregations). Further, it can significantly improve the efficiency of management: as the resolution of the individual closures used increases (i.e., as the closures become more targeted) the percent of target catch forgone or displaced decreases, the reduction ratio (bycatch/catch) increases, and the total time-area required to achieve the desired bycatch reduction decreases. The coarser management measures (annual time-area closures and monthly full fishery closures) affected up to 4-5x the target catch and required 100-200x the time-area of the dynamic measures (grid-based closures and move-on rules). To achieve similar reductions in juvenile bycatch, the fishery would forgo or displace between USD 15-52 million in landings using a static approach over a dynamic management approach.

Positive Catch & Economic Benefits of Periodic Octopus Fishery Closures: Do Effective, Narrowly Targeted Actions 'Catalyze' Broader Management?

PubMed

Oliver, Thomas A; Oleson, Kirsten L L; Ratsimbazafy, Hajanaina; Raberinary, Daniel; Benbow, Sophie; Harris, Alasdair

2015-01-01

Eight years of octopus fishery records from southwest Madagascar reveal significant positive impacts from 36 periodic closures on: (a) fishery catches and (b) village fishery income, such that (c) economic benefits from increased landings outweigh costs of foregone catch. Closures covered ~20% of a village's fished area and lasted 2-7 months. Octopus landings and catch per unit effort (CPUE) significantly increased in the 30 days following a closure's reopening, relative to the 30 days before a closure (landings: +718%, p<0.0001; CPUE: +87%, p<0.0001; n = 36). Open-access control sites showed no before/after change when they occurred independently of other management ("no ban", n = 17/36). On the other hand, open-access control sites showed modest catch increases when they extended a 6-week seasonal fishery shutdown ("ban", n = 19/36). The seasonal fishery shutdown affects the entire region, so confound all potential control sites. In villages implementing a closure, octopus fishery income doubled in the 30 days after a closure, relative to 30 days before (+132%, p<0.001, n = 28). Control villages not implementing a closure showed no increase in income after "no ban" closures and modest increases after "ban" closures. Villages did not show a significant decline in income during closure events. Landings in closure sites generated more revenue than simulated landings assuming continued open-access fishing at that site (27/36 show positive net earnings; mean +$305/closure; mean +57.7% monthly). Benefits accrued faster than local fishers' time preferences during 17-27 of the 36 closures. High reported rates of illegal fishing during closures correlated with poor economic performance. We discuss the implications of our findings for broader co-management arrangements, particularly for catalyzing more comprehensive management.

[Factors influencing the prognosis of patent ductus arteriosus in very low birth weight infants].

PubMed

Wang, Chen-Hong; Shi, Li-Ping; Ma, Xiao-Lu; Luo, Fang; Chen, Zheng; Lin, Hui-Jia; DU, Li-Zhong

2016-08-01

To investigate the factors influencing the prognosis of patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants. A total of 194 VLBW infants who were admitted from January 2012 to December 2014 were enrolled as study subjects. According to cardiac ultrasound findings and treatment outcome, these infants were divided into non-PDA group, spontaneous closure group, pharmaceutical closure group, and surgical closure group. Their clinical and echocardiographic characteristics were analyzed. The spontaneous closure rate of PDA was 58.7%. The spontaneous closure group showed significantly higher gestational age, birth weight, and proportion of small-for-gestational-age infants than the pharmaceutical and surgical closure groups (P<0.05). The pharmaceutical and surgical closure groups had a significantly higher incidence rate of neonatal respiratory distress syndrome and a significantly higher proportion of infants who were given pulmonary surfactant (PS) than the spontaneous closure group (P<0.05). During different periods of time, the spontaneous closure group had a significantly smaller ductus arteriosus diameter than the pharmaceutical and surgical closure groups (P<0.05). The multivariate logistic regression analysis showed that gestational age, application of PS, and ductus arteriosus diameter at 48 hours were significantly associated with the prognosis of PDA. The major transductal flow pattern in the spontaneous closure group was closing pattern, while in the pharmaceutical and surgical closure groups, the main flow patterns were pulmonary hypertension and growing patterns within 48 hours and growing pattern on days 4 and 7. The VLBW infants have a high spontaneous closure rate of PDA. A decreased closure rate of PDA is associated with the lower gestational age and the application of PS. PDA with a large ductus arteriosus diameter and a growing or pulsatile flow pattern cannot easily achieve spontaneous closure.

Performance characteristics of a novel blood bag in-line closure device and subsequent product quality assessment

PubMed Central

Serrano, Katherine; Levin, Elena; Culibrk, Brankica; Weiss, Sandra; Scammell, Ken; Boecker, Wolfgang F; Devine, Dana V

2010-01-01

BACKGROUND In high-volume processing environments, manual breakage of in-line closures can result in repetitive strain injury (RSI). Furthermore, these closures may be incorrectly opened causing shear-induced hemolysis. To overcome the variability of in-line closure use and minimize RSI, Fresenius Kabi developed a new in-line closure, the CompoFlow, with mechanical openers. STUDY DESIGN AND METHODS The consistency of the performance of the CompoFlow closure device was assessed, as was its effect on component quality. A total of 188 RBC units using CompoFlow blood bag systems and 43 using the standard bag systems were produced using the buffy coat manufacturing method. Twenty-six CompoFlow platelet (PLT) concentrates and 10 control concentrates were prepared from pools of four buffy coats. RBCs were assessed on Days 1, 21, and 42 for cellular variables and hemolysis. PLTs were assessed on Days 1, 3, and 7 for morphology, CD62P expression, glucose, lactate, and pH. A total of 308 closures were excised after processing and the apertures were measured using digital image analysis. RESULTS The use of the CompoFlow device significantly improved the mean extraction time with 0.46 ± 0.11 sec/mL for the CompoFlow units and 0.52 ± 0.13 sec/mL for the control units. The CompoFlow closures showed a highly reproducible aperture after opening (coefficient of variation, 15%) and the device always remained opened. PLT and RBC products showed acceptable storage variables with no differences between CompoFlow and control. CONCLUSIONS The CompoFlow closure devices improved the level of process control and processing time of blood component production with no negative effects on product quality. PMID:20529007

Stigma Sensitivity and the Duration of Temporary Closure Are Affected by Pollinator Identity in Mazus miquelii (Phrymaceae), a Species with Bilobed Stigma.

PubMed

Jin, Xiao-Fang; Ye, Zhong-Ming; Amboka, Grace M; Wang, Qing-Feng; Yang, Chun-Feng

2017-01-01

A sensitive bilobed stigma is thought to assure reproduction, avoid selfing and promote outcrossing. In addition, it may also play a role in pollinator selection since only pollinators with the appropriate body size can trigger this mechanism. However, no experimental study has investigated how the sensitive stigma responds to different pollinators and its potential effects on pollination. Mazus miquelii (Phrymaceae), a plant with a bilobed stigma was studied to investigate the relationship between stigma behaviors and its multiple insect pollinators. The reaction time of stigma closure after touched, duration of temporary closure, and factors determining permanent closure of the stigma were studied when flowers were exposed to different visitors and conducted with hand pollination. Manual stimulation was also used to detect the potential differences in stigmas when touched with different degrees of external forces. Results indicated that, compared to pollinators with a small body size, larger pollinators transferred more pollen grains to the stigma, causing a rapid stigma response and resulting in a higher percentage of permanent closures. Duration of temporary closure was negatively correlated with the speed of stigma closure; a stigma that closed more rapidly reopened more slowly. Manual stimulation showed that reaction time of stigma closure was likely a response to external mechanical forces. Hand pollination treatments revealed that the permanent closure of a stigma was determined by the size of stigmatic pollen load. For large pollinators, the speedy reaction of the stigma might help to reduce pollen loss, enhance pollen germination and avoid obstructing pollen export. Stigmas showed low sensitivity when touched by inferior pollinators, which may have increased the possibility of pollen deposition by subsequent visits. Therefore, the stigma behavior in M. miquelii is likely a mechanism of pollinator selection to maximize pollination success.

Natural orifice transluminal endoscopic surgery gastrotomy closure with an over-the-endoscope clip: a randomized, controlled porcine study (with videos).

PubMed

von Renteln, Daniel; Schmidt, Arthur; Vassiliou, Melina C; Gieselmann, Maria; Caca, Karel

2009-10-01

Secure endoscopic closure of transgastric natural orifice transluminal endoscopic surgery (NOTES) access is of paramount importance. The over-the-scope clip (OTSC) system has previously been shown to be effective for NOTES gastrotomy closure. To compare OTSC gastrotomy closure with surgical closure. Randomized, controlled animal study. Animal facility laboratory. Thirty-six female domestic pigs. Gastrotomies were created by using a needle-knife and an 18-mm balloon. The animals were subsequently randomized to either open surgical repair with interrupted sutures or endoscopic repair with 12-mm OTSCs. In addition, pressurized leak tests were performed in ex vivo specimens of 18-mm scalpel incisions closed with suture (n = 14) and of intact stomachs (n = 10). The mean time for endoscopic closure was 9.8 minutes (range 3-22, SD 5.5). No complications occurred during either type of gastrotomy closure. At necropsy, examination of all OTSC and surgical closures demonstrated complete sealing of gastrotomy sites without evidence of injury to adjacent organs. Pressurized leak tests showed a mean burst pressure of 83 mm Hg (range 30-140, SD 27) for OTSC closures and 67 mm Hg (range 30-130, SD 27.7) for surgical sutures. Ex vivo hand-sewn sutures of 18-mm gastrotomies (n = 14) exhibited a mean burst pressure of 65 mm Hg (range 20-140, SD 31) and intact ex vivo stomachs (n = 10) had a mean burst pressure of 126 mm Hg (range 90-170, SD 28). The burst pressure of ex vivo intact stomachs was significantly higher compared with OTSC closures (P < .01), in vivo surgical closures (P < .01), and ex vivo hand-sewn closures (P < .01). There was a trend toward higher burst pressures in the OTSC closures compared with surgical closures (P = .063) and ex vivo hand-sewn closures (P = .094). In vivo surgical closures demonstrated similar burst pressures compared with ex vivo hand-sewn closures (P = .848). Nonsurvival setting. Endoscopic closure by using the OTSC system is comparable to surgical closure in a nonsurvival porcine model. This technique is easy to perform and is suitable for NOTES gastrotomy closure.

Recurrence intervals for the closure of the Dutch Maeslant surge barrier

NASA Astrophysics Data System (ADS)

van den Brink, Henk W.; de Goederen, Sacha

2017-09-01

The Dutch Maeslant Barrier, a movable surge barrier in the mouth of the river Rhine, closes when there is a surge in the North Sea and the water level in the river at Rotterdam exceeds 3 m above mean sea level. An important aspect of the failure probability is that the barrier might get damaged during a closure and that, within the time needed for repair, a second critical storm surge may occur. With an estimated closure frequency of once in 10 years, the question of how often the barrier has to be closed twice within one month arises.Instead of tackling this problem by the application of statistical models on the (short) observational series, we solve the problem by combining the surge model WAQUA/DCSMv5 with the output of all seasonal forecasts of the European Centre of Medium-Range Weather Forecasting (ECMWF) in the period 1981-2015, whose combination cumulates in a pseudo-observational series of more than 6000 years.We show that the Poisson process model leads to wrong results as it neglects the temporal correlations that are present on daily, weekly and monthly timescales.By counting the number of double events over a threshold of 2.5 m and assuming that the number of events is exponentially related to the threshold, it is found that two closures occur on average once in 150 years within a month, and once in 330 years within a week. The large uncertainty in these recurrence intervals of more than a factor of two is caused by the sensitivity of the results to the Gumbel parameters of the observed record, which are used for bias correction.Sea level rise has a significant impact on the recurrence time for both single and double closures. The recurrence time of single closures doubles with every 18 cm mean sea level rise (assuming that other influences remain unchanged) and double closures double with every 10 cm rise. This implies a 3-14 times higher probability of a double closure for a 15-40 cm sea level rise in 2050 (according to the KNMI climate scenarios).

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.

Calibration of TWSTFT Links Through the Triangle Closure Condition

DTIC Science & Technology

2008-12-01

40th Annual Precise Time and Time Interval (PTTI) Meeting 467 CALIBRATION OF TWSTFT LINKS THROUGH THE TRIANGLE CLOSURE CONDITION Z... TWSTFT (Two-Way Satellite Time and Frequency Transfer, TW for short) is, together with GPS time transfer, the primary technique used for UTC generation...valid OMB control number. 1. REPORT DATE 01 DEC 2008 2. REPORT TYPE N/A 3. DATES COVERED - 4. TITLE AND SUBTITLE Calibration Of Twstft Links

43 CFR 423.14 - How will Reclamation post and delineate closed areas at the site of the closure?

Code of Federal Regulations, 2010 CFR

2010-10-01

... closed areas at the site of the closure? 423.14 Section 423.14 Public Lands: Interior Regulations... RECLAMATION FACILITIES, LANDS, AND WATERBODIES Areas Open and Closed to Public Use § 423.14 How will Reclamation post and delineate closed areas at the site of the closure? Before or at the time of closing all...

The impact of the fecal stream and stasis on immunologic reactions in ileal pouch after restorative proctocolectomy for ulcerative colitis: a prospective, pilot study.

PubMed

Yamamoto, Takayuki; Umegae, Satoru; Kitagawa, Tatsushi; Matsumoto, Koichi

2005-10-01

The etiology of pouch inflammation after restorative proctocolectomy is unknown. The fecal stream and immunological reactions are potential pathological factors. This study was performed to examine the impact of the fecal stream and stasis on immunological reactions in the pouch. Patients who underwent a restorative proctocolectomy with a covering ileostomy for ulcerative colitis were studied. Mucosal biopsy specimens were obtained from both the pouch and the proximal ileum at the time of ileostomy closure, and 3, 6, and 12 months after ileostomy closure. As a control group, normal ileal biopsies were obtained from patients with colonic polyps. At the time of ileostomy closure, mucosal interleukin-1beta, interleukin-6, interleukin-8, and tumor necrosis factor-alpha levels in the pouch and the proximal ileum were not significantly different from those in the normal control group. At 3 months after ileostomy closure, the mucosal cytokine levels in the pouch increased significantly compared with those at ileostomy closure, and their levels were significantly higher than those in the proximal ileum. At 6 and 12 months after ileostomy closure, the mucosal cytokine levels in the pouch did not change significantly compared with those at 3 months after ileostomy closure. The mucosal cytokine levels in the proximal ileum did not change significantly during the entire study. The immunological reactions in the pouch occurred soon after ileostomy closure, and continued for at least 1 yr. The fecal stream and stasis play an important part in the pathogenesis of immunological reactions in the ileal pouch.

Contemporary Approach to the Diagnosis and Management of Primary Angle-Closure Disease.

PubMed

Razeghinejad, M Reza; Myers, Jonathan S

2018-05-16

Primary angle closure disease spectrum varies from a narrow angle to advanced glaucoma. A variety of imaging technologies may assist the clinician in determining the pathophysiology and diagnosis of primary angle closure, but gonioscopy remains a mainstay of clinical evaluation. Laser iridotomy effectively eliminates the pupillary block component of angle closure; however, studies show that in many patients the iridocorneal angle remains narrow from underlying anatomic issues, and increasing lens size often leads to further narrowing over time. Recent studies have further characterized the role of the lens in angle closure disease, and cataract or clear lens extraction is increasingly used earlier in its management. As a first surgical step in angle closure glaucoma, lens extraction alone often effectively controls the pressure with less risk of complications than concurrent or stand alone glaucoma surgery, but may not be sufficient in more advanced or severe disease. We provide a comprehensive review on the primary angle-closure disease nomenclature, imaging, and current laser and surgical management. Copyright © 2018. Published by Elsevier Inc.

Efficient algorithms and implementations of entropy-based moment closures for rarefied gases

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

Schaerer, Roman Pascal, E-mail: schaerer@mathcces.rwth-aachen.de; Bansal, Pratyuksh; Torrilhon, Manuel

We present efficient algorithms and implementations of the 35-moment system equipped with the maximum-entropy closure in the context of rarefied gases. While closures based on the principle of entropy maximization have been shown to yield very promising results for moderately rarefied gas flows, the computational cost of these closures is in general much higher than for closure theories with explicit closed-form expressions of the closing fluxes, such as Grad's classical closure. Following a similar approach as Garrett et al. (2015) , we investigate efficient implementations of the computationally expensive numerical quadrature method used for the moment evaluations of the maximum-entropymore » distribution by exploiting its inherent fine-grained parallelism with the parallelism offered by multi-core processors and graphics cards. We show that using a single graphics card as an accelerator allows speed-ups of two orders of magnitude when compared to a serial CPU implementation. To accelerate the time-to-solution for steady-state problems, we propose a new semi-implicit time discretization scheme. The resulting nonlinear system of equations is solved with a Newton type method in the Lagrange multipliers of the dual optimization problem in order to reduce the computational cost. Additionally, fully explicit time-stepping schemes of first and second order accuracy are presented. We investigate the accuracy and efficiency of the numerical schemes for several numerical test cases, including a steady-state shock-structure problem.« less

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.

Communication strategies and timeliness of response to life critical telemetry alarms.

PubMed

Bonzheim, Kimberly A; Gebara, Rani I; O'Hare, Bridget M; Ellis, R Darin; Brand, Monique A; Balar, Salil D; Stockman, Rita; Sciberras, Annette M; Haines, David E

2011-05-01

A centralized electrocardiogram telemetry monitoring system (TMS) facilitates early identification of critical arrhythmias and acute medical decompensation. Timely intervention can only be performed if abnormalities are communicated rapidly to the direct caregiver. The study objectives were to measure effectiveness of bi-directional voice communication badges versus one-way alphanumeric pagers for telemetry alarm response and communication loop closure. A sequential observational pilot study of nursing response to TMS alarms compared communication technologies on four nursing units in a 1,061 bed tertiary care hospital with 264 TMS channels of telemetry over a 2-year period. Subsequently, the communication technologies were compared in a randomized fashion on a 68-bed progressive cardiac care unit. Caregivers were blinded to the protocol. All alarm responses were recorded during two periods using either pagers or voice communication devices. Alarm response time and closure of the communication loop were analyzed in a blinded fashion. The direct communication functionality of the badge significantly shortened the time to first contact, time to completion, and rate of closure of the communication loop in both the pilot and study phases. Median time to first contact with the communication badge was 0.5  min, compared to 1.6  min with pager communication (p < 0.0003). Communication loop closure was achieved in 100% of clinical alarms using the badge versus 19% with the pager (p < 0.0001). Communication badge technology reduced alarm time to first contact and completion as well as facilitated communication loop closures. Immediate two-way communication significantly impacted practice, alarm management, and resulted in faster bedside care.

[Massive haemoperitoneum due to traumatic rupture of multifocal hepatocarcinoma in the right hepatic lobe. Case report].

PubMed

Spaziani, E; Briganti, M; Saltarelli, A; Iozzino, M; Notarianni, E; Cianni, R; Di Filippo, A; Picchio, M; Ceci, F; Gammardella, P; De Angelis, F; Nardecchia, G; Cipriani, B; Nicodemi, S; Stagnitti, F

2009-01-01

Abdominal blunt trauma is the main cause of death in people younger than 40 years old. The liver injury still represents a challenging problem. Isolated hepatic injury is rare and it occurs more frequentely in polytraumatizated patients and causes massive haemoperitoneum. The Authors report a case of a 83 years-old woman admitted to Emergency Department for syncope due to an active bleeding arising from a rupture of a right hepatic lobe unsuspected tumor. The computer tomography (CT) scans showed a clear pattern of liver laceration of the VI segment with contrast enhancement spreading in the surrounding tissues, and detected a multifocal hepatocarcinoma located in the VI, VII and VIII segments. Patient's haemodinamically unstable conditions suggested an urgent laparotomy. An accurate perihepatic packing with sterile-drape were successfully employed to control liver hemorrage. Temporary abdominal closure, followed by hepatic arteriography and the right hepatic artery embolization, completed the damage control. Re-exploration laparotomy after 72 hours confirmed the definitive haemostasis and the pack removal was performed without complications. CT plays a leading role in the diagnosis of liver damage. The patient's haemodynamic status is the principal criterion determining conservative or operative therapy in blunt liver injury. The early perihepatic packing followed by artheriographic embolization to stop liver hemorrhage showed efficacy and safety for the patient. The packing performed with sterile-drape is able to avoid removal complications and 72 hours timing for the pack removal is effective to avoid re-bleeding.

Presacral abscess as a rare complication of sacral nerve stimulator implantation.

PubMed

Gumber, A; Ayyar, S; Varia, H; Pettit, S

2017-03-01

A 50-year-old man with intractable anal pain attributed to proctalgia fugax underwent insertion of a sacral nerve stimulator via the right S3 vertebral foramen for pain control with good symptomatic relief. Thirteen months later, he presented with signs of sepsis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large presacral abscess. MRI demonstrated increased enhancement along the pathway of the stimulator electrode, indicating that the abscess was caused by infection introduced at the time of sacral nerve stimulator placement. The patient was treated with broad spectrum antibiotics, and the sacral nerve stimulator and electrode were removed. Attempts were made to drain the abscess transrectally using minimally invasive techniques but these were unsuccessful and CT guided transperineal drainage was then performed. Despite this, the presacral abscess progressed, developing enlarging gas locules and extending to the pelvic brim to involve the aortic bifurcation, causing hydronephrosis and radiological signs of impending sacral osteomyelitis. MRI showed communication between the rectum and abscess resulting from transrectal drainage. In view of the progressive presacral sepsis, a laparotomy was performed with drainage of the abscess, closure of the upper rectum and formation of a defunctioning end sigmoid colostomy. Following this, the presacral infection resolved. Presacral abscess formation secondary to an infected sacral nerve stimulator electrode has not been reported previously. Our experience suggests that in a similar situation, the optimal management is to perform laparotomy with drainage of the presacral abscess together with simultaneous removal of the sacral nerve stimulator and electrode.

Presacral abscess as a rare complication of sacral nerve stimulator implantation

PubMed Central

Gumber, A; Ayyar, S; Varia, H

2017-01-01

A 50-year-old man with intractable anal pain attributed to proctalgia fugax underwent insertion of a sacral nerve stimulator via the right S3 vertebral foramen for pain control with good symptomatic relief. Thirteen months later, he presented with signs of sepsis. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large presacral abscess. MRI demonstrated increased enhancement along the pathway of the stimulator electrode, indicating that the abscess was caused by infection introduced at the time of sacral nerve stimulator placement. The patient was treated with broad spectrum antibiotics, and the sacral nerve stimulator and electrode were removed. Attempts were made to drain the abscess transrectally using minimally invasive techniques but these were unsuccessful and CT guided transperineal drainage was then performed. Despite this, the presacral abscess progressed, developing enlarging gas locules and extending to the pelvic brim to involve the aortic bifurcation, causing hydronephrosis and radiological signs of impending sacral osteomyelitis. MRI showed communication between the rectum and abscess resulting from transrectal drainage. In view of the progressive presacral sepsis, a laparotomy was performed with drainage of the abscess, closure of the upper rectum and formation of a defunctioning end sigmoid colostomy. Following this, the presacral infection resolved. Presacral abscess formation secondary to an infected sacral nerve stimulator electrode has not been reported previously. Our experience suggests that in a similar situation, the optimal management is to perform laparotomy with drainage of the presacral abscess together with simultaneous removal of the sacral nerve stimulator and electrode. PMID:28071947

Intraoperative Vascular Neuromonitoring in Patients with Subarachnoid Hemorrhage: A Pilot Study Using Combined Laser-Doppler Spectrophotometry.

PubMed

Schmitz, Emilija; Bischoff, Barbara; Wolf, Dennis; Schmitt, Hubert J; Eyupoglu, Ilker Y; Roessler, Karl; Buchfelder, Michael; Sommer, Björn

2017-11-01

Intraoperative monitoring of cerebral microcirculation in patients with subarachnoid hemorrhage (SAH) may predict the postoperative neurologic outcome. In this pilot study, we examined the value of a novel noninvasive real-time measurement technique for detecting changes in local microcirculation. We used the O2C (Oxygen to see) laser-Doppler spectrophotometry system in 14 patients with Hunt & Hess grade 2-5 SAH who underwent microsurgical cerebral aneurysm clipping. A subdural probe recorded capillary venous oxygenation (SO 2 ), relative hemoglobin concentration, blood cell velocity, and blood flow at a tissue depth of 7 mm. Data were recorded immediately before dural closure. We also recorded somatosensory evoked potentials (SEPs) with median and tibial nerve stimulation. Results were compared with neurologic performance, as measured on the modified Rankin Scale, at the day of discharge from the hospital and 12 months thereafter. Patient functional outcomes after discharge and 12 months were correlated with pathological decreased flow and increased SO 2 values. In 6 of 8 patients, microcirculatory monitoring parameters indicated ischemia during surgery, as shown by electrophysiological SEP changes and infarction detected on the postoperative computed tomography (CT) scan. Pathological SEP results correlated closely with infarct demarcation as seen on CT. Our results indicate the potential benefit of intraoperative combined laser-Doppler flowmetry and spectrophotometry for predicting postoperative clinical outcomes in this small patient sample. Larger-cohort testing is needed to verify our findings and show the possible merits of this novel method. Copyright © 2017 Elsevier Inc. All rights reserved.

Effectiveness of closure of public places with time delay in disease control.

PubMed

Wang, Zhenggang; Szeto, Kwok Yip; Leung, Frederick Chi-Ching

2008-08-25

A theoretical basis for the evaluation of the effciency of quarantine measure is developed in a SIR model with time delay. In this model, the effectiveness of the closure of public places such as schools in disease control, modeled as a high degree node in a social network, is evaluated by considering the effect of the time delay in the identification of the infected. In the context of the SIR model, the relation between the number of infectious individuals who are identified with time delay and then quarantined and those who are not identified and continue spreading the virus are investigated numerically. The social network for the simulation is modeled by a scale free network. Closure measures are applied to those infected nodes with high degrees. The effectiveness of the measure can be controlled by the present value of the critical degree K(C): only those nodes with degree higher than K(C) will be quarantined. The cost C(Q) incurred for the closure measure is assumed to be proportional to the total links rendered inactive as a result of the measure, and generally decreases with K(C), while the medical cost C(Q) incurred for virus spreading increases with K(C). The total social cost (C(M) + C(Q)) will have a minimum at a critical K(*), which depends on the ratio of medical cost coeffcient alpha(M) and closure cost coeffcient alpha(Q). Our simulation results demonstrate a mathematical procedure to evaluate the effciency of quarantine measure. Although the numerical work is based on a scale free network, the procedure can be readily generalized and applied to a more realistic social network to determine the proper closure measure in future epidemics.

Primary closure versus T-tube drainage in laparoscopic common bile duct exploration: a meta-analysis of randomized clinical trials.

PubMed

Wu, Xiangsong; Yang, Yong; Dong, Ping; Gu, Jun; Lu, Jianhua; Li, Maolan; Mu, Jiasheng; Wu, Wenguang; Yang, Jiahua; Zhang, Lin; Ding, Qichen; Liu, Yingbin

2012-08-01

To compare the safety and effectiveness of primary closure with those of T-tube drainage in laparoscopic common bile duct exploration (LCBDE) for choledocholithiasis. A comprehensive search was performed in the PubMed, EmBase, and Cochrane Library databases. Only randomized controlled trials comparing primary closure with T-tube drainage in LCBDE were considered eligible for this meta-analysis. The analyzed outcome variables included postoperative mortality, overall morbidity, biliary complication rate, biliary leak rate, reoperation, operating time, postoperative hospital stay, time to abdominal drain removal, and retained stone. All calculations and statistical tests were performed using ReviewerManager 5.1.2 software. A total of 295 patients (148 patients with primary closure and 147 patients with T-tube drainage) from three trials were identified and analyzed. No deaths occurred in any of the trials. Primary closure showed significantly better results in terms of morbidity (risk ratio (RR), 0.51; 95% confidence interval (CI), 0.30 to 0.88), biliary complication without a combination of retained stone (RR, 0.44; 95% CI, 0.20 to 0.97), reoperation (RR, 0.16; 95% CI, 0.03 to 0.87), operating time (mean difference (MD), -20.72; 95% CI, -29.59 to -11.85), postoperative hospital stay (MD, -3.24; 95% CI, -3.96 to -2.52), and time to abdominal drainage removal (MD, -0.45; 95% CI, -0.86 to -0.04). Statistically significant differences were not found between the two methods in terms of biliary leak, biliary complication, and retained stones. The current meta-analysis indicates that primary closure of the common bile duct is safer and more effective than T-tube drainage for LCBDE. Therefore, we do not recommend routine performance of T-tube drainage in LCBDE.

The impact of rural hospital closures on equity of commuting time for haemodialysis patients: simulation analysis using the capacity-distance model.

PubMed

Matsumoto, Masatoshi; Ogawa, Takahiko; Kashima, Saori; Takeuchi, Keisuke

2012-07-23

Frequent and long-term commuting is a requirement for dialysis patients. Accessibility thus affects their quality of lives. In this paper, a new model for accessibility measurement is proposed in which both geographic distance and facility capacity are taken into account. Simulation of closure of rural facilities and that of capacity transfer between urban and rural facilities are conducted to evaluate the impacts of these phenomena on equity of accessibility among dialysis patients. Post code information as of August 2011 of all the 7,374 patients certified by municipalities of Hiroshima prefecture as having first or third grade renal disability were collected. Information on post code and the maximum number of outpatients (capacity) of all the 98 dialysis facilities were also collected. Using geographic information systems, patient commuting times were calculated in two models: one that takes into account road distance (distance model), and the other that takes into account both the road distance and facility capacity (capacity-distance model). Simulations of closures of rural and urban facilities were then conducted. The median commuting time among rural patients was more than twice as long as that among urban patients (15 versus 7 minutes, p<0.001). In the capacity-distance model 36.1% of patients commuted to the facilities which were different from the facilities in the distance model, creating a substantial gap of commuting time between the two models. In the simulation, when five rural public facilitiess were closed, Gini coefficient of commuting times among the patients increased by 16%, indicating a substantial worsening of equity, and the number of patients with commuting times longer than 90 minutes increased by 72 times. In contrast, closure of four urban public facilities with similar capacities did not affect these values. Closures of dialysis facilities in rural areas have a substantially larger impact on equity of commuting times among dialysis patients than closures of urban facilities. The accessibility simulations using the capacity-distance model will provide an analytic framework upon which rational resource distribution policies might be planned.

The impact of rural hospital closures on equity of commuting time for haemodialysis patients: simulation analysis using the capacity-distance model

PubMed Central

2012-01-01

Background Frequent and long-term commuting is a requirement for dialysis patients. Accessibility thus affects their quality of lives. In this paper, a new model for accessibility measurement is proposed in which both geographic distance and facility capacity are taken into account. Simulation of closure of rural facilities and that of capacity transfer between urban and rural facilities are conducted to evaluate the impacts of these phenomena on equity of accessibility among dialysis patients. Methods Post code information as of August 2011 of all the 7,374 patients certified by municipalities of Hiroshima prefecture as having first or third grade renal disability were collected. Information on post code and the maximum number of outpatients (capacity) of all the 98 dialysis facilities were also collected. Using geographic information systems, patient commuting times were calculated in two models: one that takes into account road distance (distance model), and the other that takes into account both the road distance and facility capacity (capacity-distance model). Simulations of closures of rural and urban facilities were then conducted. Results The median commuting time among rural patients was more than twice as long as that among urban patients (15 versus 7 minutes, p < 0.001). In the capacity-distance model 36.1% of patients commuted to the facilities which were different from the facilities in the distance model, creating a substantial gap of commuting time between the two models. In the simulation, when five rural public facilitiess were closed, Gini coefficient of commuting times among the patients increased by 16%, indicating a substantial worsening of equity, and the number of patients with commuting times longer than 90 minutes increased by 72 times. In contrast, closure of four urban public facilities with similar capacities did not affect these values. Conclusions Closures of dialysis facilities in rural areas have a substantially larger impact on equity of commuting times among dialysis patients than closures of urban facilities. The accessibility simulations using thecapacity-distance model will provide an analytic framework upon which rational resource distribution policies might be planned. PMID:22824294

Predictors of successful closure of patent ductus arteriosus with indomethacin.

PubMed

Ahamed, M F; Verma, P; Lee, S; Vega, M; Wang, D; Kim, M; Fuloria, M

2015-09-01

To determine whether platelet counts can predict the likelihood of successful closure of patent ductus arteriosus (PDA) with indomethacin. This was a retrospective cohort study of infants <32 weeks' gestational age (GA) and birth weight <1500 g with PDA. Clinical characteristics between infants who achieved ductal closure with indomethacin and those who failed were compared. Multivariable logistic regression was used to identify predictors of successful ductal closure. In infants with hemodynamically significant PDA, older GA (odds ratio=1.54; 95% confidence interval: 1.12 to 2.13), male gender (odds ratio=3.02; 95% confidence interval: 1.08 to 8.49) and higher platelet count (odds ratio=1.5; 95% confidence interval: 1.04 to 2.17) prior to indomethacin treatment were associated with successful ductal closure with indomethacin. Older GA, male gender and higher platelet count at time of treatment of hemodynamically significant PDA are predictors of successful ductal closure with indomethacin.

Percutaneous closure of patent foramen ovale without echocardiographic guidance.

PubMed

Jamshidi, Peiman; Wahl, Andreas; Windecker, Stephan; Schwerzmann, Markus; Seiler, Christian; Meier, Bernhard

2007-01-01

A percutaneous patent foramen ovale (PFO) closure procedure includes transesophageal or intracardiac echocardiographic guidance at many centers. We investigated the feasibility and complications of the PFO closure without echocardiography. A total of 420 consecutive patients (185 women and 235 men, mean age 51 +/- 12 years) underwent percutaneous PFO closure without echocardiographic guidance using 7 different devices. Of these, 106 patients (25%) had an associated atrial septal aneurysm. The implantation was successful in 418 patients (99%). There were 12 procedural complications (3%), including embolization of the device or of parts of it with successful percutaneous removal in 5 cases, pericardial tamponade requiring pericardiocentesis in 1 patient, air embolism with transient symptoms in 3 patients, and vascular access problems in 3 patients. In none of the cases, echocardiography had to be summoned during the case or its lack was associated with acute or subsequent problems. The fluoroscopy time and procedure time were 5.4 +/- 2.7 and 25 +/- 17 minutes, respectively. Transthoracic contrast echocardiography, 24 hours after device implantation, detected a residual shunt in 19% of the patients. Percutaneous PFO closure with fluoroscopic guidance only is feasible and has low complication rates, especially with Amplatzer PFO Occluders. The added time and cost of echocardiography during the procedure is not warranted.

Stapler Esophageal Closure During Total Laryngectomy.

PubMed

Ismi, Onur; Unal, Murat; Vayisoglu, Yusuf; Yesilova, Mesut; Helvaci, Ilter; Gorur, Kemal; Ozcan, Cengiz

2017-01-01

Mechanical esophageal closure with stapler during total laryngectomy has been used by various authors to decrease the surgical time and pharyngocutaneous fistula (PCF) rates. In a few of the studies, surgical site infection (SSI) rates are mentioned and none of the studies emphasize the effect of decreased surgical time on postoperative cardiovascular and cerebrovascular complications. In this study, the authors compared the PCF rates, SSI rates, operation times between 30 mechanical stapler and 40 manual esophageal closure during total laryngectomy for laryngeal cancer patients. National Nasocomial Infections Surveillance system (NNISS) scores were recorded and compared between groups. Total laryngectomy and total operation times were lower in the stapler group patients (P < 0.001 for total laryngectomy time, P = 0.024 for total operation time). There were lower rates of pharyngocutaneous fistula (P = 0.032), surgical site infection (P = 0.019), and NNISS scores (P = 0.009) in the stapler group. There was no statistically significant difference between groups regarding postoperative systemic complications (P = 0.451). In conclusion, stapler esophageal closure decreases operation time, PCF, SSI rates, and NNISS scores but not the systemic complication rates. Comorbid illnesses and prolonged surgical time are risk factors for postoperative systemic complications in total laryngectomy patients, but patients with additional illnesses must not encourage the surgeon to use stapler for decreasing postoperative systemic complications.

Accountability in Action: A Comprehensive Guide to Charter School Closure. School Closure Guide

ERIC Educational Resources Information Center

Wechtenhiser, Kim, Ed.; Wade, Andrew, Ed.; Lin, Margaret, Ed.

2011-01-01

Closing a failing charter school is difficult, but it can be done. In fact, it has been done hundreds of times across the country. However, if you are on the staff or the board of a charter school authorizing agency that is facing a closure decision, the fact that other authorizers have closed schools may be of small comfort. You are facing a…

Closure of skin incisions by laser-welding with a combination of two near-infrared diode lasers: preliminary study for determination of optimal parameters

NASA Astrophysics Data System (ADS)

Hu, Liming; Lu, Zhihua; Wang, Biao; Cao, Junsheng; Ma, Xiaobo; Tian, Zhenhua; Gao, Zhijian; Qin, Li; Wu, Xiaodong; Liu, Yun; Wang, Lijun

2011-03-01

Laser welding has the potential to become an effective method for wound closure and healing without sutures. Closure of skin incisions by laser welding with a combination of two near-infrared lasers (980 and 1064 nm), was performed for the first time in this study. One centimeter long, full-thickness incisions were made on the Wistar rat's dorsal skin. The efficiencies of laser-welding with different parameters were investigated. Incision-healing, histology examination, and a tensile strength test of incisions were recorded. Laser welding with the irradiance level of 15.9 W/cm2 for both 980 and 1064-nm lasers and exposure time of 5 s per spot in continuous wave mode yielded a more effective closure and healing with minimal thermal damage, faster recovery, and stronger apposition in comparison with a suturing technique. The conclusion is that skin welding with a combination of two near-infrared diode lasers can be a good candidate for incision closure, and further investigations are in progress for clinical use.

Closure of skin incisions by laser-welding with a combination of two near-infrared diode lasers: preliminary study for determination of optimal parameters.

PubMed

Hu, Liming; Lu, Zhihua; Wang, Biao; Cao, Junsheng; Ma, Xiaobo; Tian, Zhenhua; Gao, Zhijian; Qin, Li; Wu, Xiaodong; Liu, Yun; Wang, Lijun

2011-03-01

Laser welding has the potential to become an effective method for wound closure and healing without sutures. Closure of skin incisions by laser welding with a combination of two near-infrared lasers (980 and 1064 nm), was performed for the first time in this study. One centimeter long, full-thickness incisions were made on the Wistar rat's dorsal skin. The efficiencies of laser-welding with different parameters were investigated. Incision-healing, histology examination, and a tensile strength test of incisions were recorded. Laser welding with the irradiance level of 15.9 W∕cm(2) for both 980 and 1064-nm lasers and exposure time of 5 s per spot in continuous wave mode yielded a more effective closure and healing with minimal thermal damage, faster recovery, and stronger apposition in comparison with a suturing technique. The conclusion is that skin welding with a combination of two near-infrared diode lasers can be a good candidate for incision closure, and further investigations are in progress for clinical use.

Model-Based Comprehensive Analysis of School Closure Policies for Mitigating Influenza Epidemics and Pandemics

PubMed Central

Fumanelli, Laura; Ajelli, Marco; Merler, Stefano; Ferguson, Neil M.; Cauchemez, Simon

2016-01-01

School closure policies are among the non-pharmaceutical measures taken into consideration to mitigate influenza epidemics and pandemics spread. However, a systematic review of the effectiveness of alternative closure policies has yet to emerge. Here we perform a model-based analysis of four types of school closure, ranging from the nationwide closure of all schools at the same time to reactive gradual closure, starting from class-by-class, then grades and finally the whole school. We consider policies based on triggers that are feasible to monitor, such as school absenteeism and national ILI surveillance system. We found that, under specific constraints on the average number of weeks lost per student, reactive school-by-school, gradual, and county-wide closure give comparable outcomes in terms of optimal infection attack rate reduction, peak incidence reduction or peak delay. Optimal implementations generally require short closures of one week each; this duration is long enough to break the transmission chain without leading to unnecessarily long periods of class interruption. Moreover, we found that gradual and county closures may be slightly more easily applicable in practice as they are less sensitive to the value of the excess absenteeism threshold triggering the start of the intervention. These findings suggest that policy makers could consider school closure policies more diffusely as response strategy to influenza epidemics and pandemics, and the fact that some countries already have some experience of gradual or regional closures for seasonal influenza outbreaks demonstrates that logistic and feasibility challenges of school closure strategies can be to some extent overcome. PMID:26796333

Model-Based Comprehensive Analysis of School Closure Policies for Mitigating Influenza Epidemics and Pandemics.

PubMed

Fumanelli, Laura; Ajelli, Marco; Merler, Stefano; Ferguson, Neil M; Cauchemez, Simon

2016-01-01

School closure policies are among the non-pharmaceutical measures taken into consideration to mitigate influenza epidemics and pandemics spread. However, a systematic review of the effectiveness of alternative closure policies has yet to emerge. Here we perform a model-based analysis of four types of school closure, ranging from the nationwide closure of all schools at the same time to reactive gradual closure, starting from class-by-class, then grades and finally the whole school. We consider policies based on triggers that are feasible to monitor, such as school absenteeism and national ILI surveillance system. We found that, under specific constraints on the average number of weeks lost per student, reactive school-by-school, gradual, and county-wide closure give comparable outcomes in terms of optimal infection attack rate reduction, peak incidence reduction or peak delay. Optimal implementations generally require short closures of one week each; this duration is long enough to break the transmission chain without leading to unnecessarily long periods of class interruption. Moreover, we found that gradual and county closures may be slightly more easily applicable in practice as they are less sensitive to the value of the excess absenteeism threshold triggering the start of the intervention. These findings suggest that policy makers could consider school closure policies more diffusely as response strategy to influenza epidemics and pandemics, and the fact that some countries already have some experience of gradual or regional closures for seasonal influenza outbreaks demonstrates that logistic and feasibility challenges of school closure strategies can be to some extent overcome.

Influence and interactions of laryngeal adductors and cricothyroid muscles on fundamental frequency and glottal posture control

PubMed Central

Chhetri, Dinesh K.; Neubauer, Juergen; Sofer, Elazar; Berry, David A.

2014-01-01

The interactions of the intrinsic laryngeal muscles (ILMs) in controlling fundamental frequency (F0) and glottal posture remain unclear. In an in vivo canine model, three sets of intrinsic laryngeal muscles—the thyroarytenoid (TA), cricothyroid (CT), and lateral cricoarytenoid plus interarytenoid (LCA/IA) muscle complex—were independently and accurately stimulated in a graded manner using distal laryngeal nerve stimulation. Graded neuromuscular stimulation was used to independently activate these paired intrinsic laryngeal muscles over a range from threshold to maximal activation, to produce 320 distinct laryngeal phonatory postures. At phonation onset these activation conditions were evaluated in terms of their vocal fold strain, glottal width at the vocal processes, fundamental frequency (F0), subglottic pressure, and airflow. F0 ranged from 69 to 772 Hz and clustered into chest-like and falsetto-like groups. CT activation was always required to raise F0, but could also lower F0 at low TA and LCA/IA activation levels. Increasing TA activation first increased then decreased F0 in all CT and LCA/IA activation conditions. Increasing TA activation also facilitated production of high F0 at a lower onset pressure. Independent control of membranous (TA) and cartilaginous (LCA/IA) glottal closure enabled multiple pathways for F0 control via changes in glottal posture. PMID:25235003

Pursestring closure of the stoma site leads to fewer wound infections: results from a multicenter randomized controlled trial.

PubMed

Lee, Janet T; Marquez, Thao T; Clerc, Daniel; Gie, Olivier; Demartines, Nicolas; Madoff, Robert D; Rothenberger, David A; Christoforidis, Dimitrios

2014-11-01

Surgical site infection after stoma reversal is common. The optimal skin closure technique after stoma reversal has been widely debated in the literature. We hypothesized that pursestring near-complete closure of the stoma site would lead to fewer surgical site infections compared with conventional primary closure. This study was a parallel prospective multicenter randomized controlled trial. This study was conducted at 2 university medical centers. Patients (N = 122) presenting for elective colostomy or ileostomy reversal were selected. Pursestring versus conventional primary closure of stoma sites were compared. Stoma site surgical site infection within 30 days of surgery, overall surgical site infection, delayed healing (open wound for >30 days), time to wound epithelialization, and patient satisfaction were the primary outcomes measured. The pursestring group had a significantly lower stoma site infection rate (2% vs 15%, p = 0.01). There was no difference in delayed healing or patient satisfaction between groups. Time to epithelialization was measured in only 51 patients but was significantly longer in the pursestring group (34.6 ± 20 days vs 24.1 ± 17 days, p = 0.02). This study was limited by the variability in procedures and surgeons, the limited follow-up after 30 days, and the inability to perform blinding. Pursestring closure after stoma reversal has a lower risk of stoma site surgical site infection than conventional primary closure, although wounds may take longer to heal with the use of this approach. NCT01713452 (www.clinicaltrials.gov).

Impact of radiofrequency ablation for patients with varicose veins on the budget of the German statutory health insurance system

PubMed Central

2013-01-01

Objectives In contrast to other countries, surgery still represents the common invasive treatment for varicose veins in Germany. However, radiofrequency ablation, e.g. ClosureFast, becomes more and more popular in other countries due to potential better results and reduced side effects. This treatment option may cause less follow-up costs and is a more convenient procedure for patients, which could justify an introduction in the statutory benefits catalogue. Therefore, we aim at calculating the budget impact of a general reimbursement of ClosureFast in Germany. Methods To assess the budget impact of including ClosureFast in the German statutory benefits catalogue, we developed a multi-cohort Markov model and compared the costs of a “World with ClosureFast” with a “World without ClosureFast” over a time horizon of five years. To address the uncertainty of input parameters, we conducted three different types of sensitivity analysis (one-way, scenario, probabilistic). Results In the Base Case scenario, the introduction of the ClosureFast system for the treatment of varicose veins saves costs of about 19.1 Mio. € over a time horizon of five years in Germany. However, the results scatter in the sensitivity analyses due to limited evidence of some key input parameters. Conclusions Results of the budget impact analysis indicate that a general reimbursement of ClosureFast has the potential to be cost-saving in the German Statutory Health Insurance. PMID:23551943

Evaluation of left ventricular function by tissue Doppler and speckle-derived strain rate echocardiography after percutaneous ductus closure.

PubMed

Amoogzar, Hamid; Shakiba, Ali Mohammad; Derakhshan, Dorna; Ajami, Gholamhossein; Cheriki, Sirous; Borzouee, Mohammad; Edraki, Mohammad Reza; Mehdizadegan, Nima

2015-01-01

The aim of this study was to evaluate the left ventricular systolic and diastolic function before and after transcatheter percutaneous patent ductus arteriosus (PDA) closure. 21 children (age >6 months old) diagnosed with hemodynamically significant PDA underwent percutaneous PDA closure. Conventional, Doppler and tissue Doppler imaging and speckled-derived strain rate echocardiography were done at pre-closure, 1 day (early) and 1 month (late) post-closure. Mean age of the patients (female/male: 1.3) was 17.54 ± 24.7 months with the mean PDA diameter of 3.6 ± 0.8 mm. Systolic measures (ejection fraction, shortening fraction) reduced significantly early after PDA closure (P < 0.05). After 1 month, both improved significantly; ultimately, after 1 month no change was observed in systolic function measures compared with the pre-closure status. Early and late diastolic flow velocities of mitral (E M and A M) reduced considerably in early and late post-closure time (P < 0.05). Both early tissue Doppler early velocity of lateral mitral annulus (E'M) and early to late velocity ratio (E'M/A'M) of lateral mitral annulus decreased significantly (P = 0.02) in early post-closure. After 1 month, E'M increased considerably. (P = 0.01) but E'M/A'M had an insignificant rise (P > 0.05). E M/E'M ratio did not change in early post-closure but it had a considerable reduction in the subsequent month compared with the pre- and early post-closure (P < 0.001 for both occasions). Global and segmental longitudinal strain measures reduced significantly early after PDA closure (P < 0.05) but it improved remarkably in the subsequent month. Transcatheter PDA closure causes a significant decrease in left ventricular performance early after PDA closure which recovers completely within 1 month. Also PDA size can affect post-closure left ventricular function.

A mapping closure for turbulent scalar mixing using a time-evolving reference field

NASA Technical Reports Server (NTRS)

Girimaji, Sharath S.

1992-01-01

A general mapping-closure approach for modeling scalar mixing in homogeneous turbulence is developed. This approach is different from the previous methods in that the reference field also evolves according to the same equations as the physical scalar field. The use of a time-evolving Gaussian reference field results in a model that is similar to the mapping closure model of Pope (1991), which is based on the methodology of Chen et al. (1989). Both models yield identical relationships between the scalar variance and higher-order moments, which are in good agreement with heat conduction simulation data and can be consistent with any type of epsilon(phi) evolution. The present methodology can be extended to any reference field whose behavior is known. The possibility of a beta-pdf reference field is explored. The shortcomings of the mapping closure methods are discussed, and the limit at which the mapping becomes invalid is identified.

Method and apparatus for active tamper indicating device using optical time-domain reflectometry

DOEpatents

Smith, D. Barton; Muhs, Jeffrey D.; Pickett, Chris A.; Earl, D. Duncan

1999-01-01

An optical time-domain reflectometer (OTDR) launches pulses of light into a link or a system of multiplexed links and records the waveform of pulses reflected by the seals in the link(s). If a seal is opened, the link of cables will become a discontinuous transmitter of the light pulses and the OTDR can immediately detect that a seal has been opened. By analyzing the waveform, the OTDR can also quickly determine which seal(s) were opened. In this way the invention functions as a system of active seals. The invention is intended for applications that require long-term surveillance of a large number of closures. It provides immediate tamper detection, allows for periodic access to secured closures, and can be configured for many different distributions of closures. It can monitor closures in indoor and outdoor locations and it can monitor containers or groups of containers located many kilometers apart.

Integration of actomyosin contractility with cell-cell adhesion during dorsal closure.

PubMed

Duque, Julia; Gorfinkiel, Nicole

2016-12-15

In this work, we combine genetic perturbation, time-lapse imaging and quantitative image analysis to investigate how pulsatile actomyosin contractility drives cell oscillations, apical cell contraction and tissue closure during morphogenesis of the amnioserosa, the main force-generating tissue during the dorsal closure in Drosophila We show that Myosin activity determines the oscillatory and contractile behaviour of amnioserosa cells. Reducing Myosin activity prevents cell shape oscillations and reduces cell contractility. By contrast, increasing Myosin activity increases the amplitude of cell shape oscillations and the time cells spend in the contracted phase relative to the expanded phase during an oscillatory cycle, promoting cell contractility and tissue closure. Furthermore, we show that in AS cells, Rok controls Myosin foci formation and Mbs regulates not only Myosin phosphorylation but also adhesion dynamics through control of Moesin phosphorylation, showing that Mbs coordinates actomyosin contractility with cell-cell adhesion during amnioserosa morphogenesis. © 2016. Published by The Company of Biologists Ltd.

Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives.

PubMed

Zempsky, William T; Zehrer, Cindy L; Lyle, Christopher T; Hedbloom, Edwin C

2005-09-01

Our objective was to review and assess the treatment of low-tension wounds and evaluate the cost-effectiveness of wound closure methods. We used a health economic model to estimate cost/closure of adhesive wound closure strips, tissue adhesives and sutures. The model incorporated cost-driving variables: application time, costs and the likelihood and costs of dehiscence and infection. The model was populated with variable estimates derived from the literature. Cost estimates and cosmetic results were compared. Parameter values were estimated using national healthcare and labour statistics. Sensitivity analyses were used to verify the results. Our analysis suggests that adhesive wound closure strips had the lowest average cost per laceration ($7.54), the lowest cost per infected laceration ($53.40) and the lowest cost per laceration with dehiscence ($25.40). The costs for sutures were $24.11, $69.91 and $41.91, respectively; the costs for tissue adhesives were $28.77, $74.68 and $46.68, respectively. The cosmetic outcome for all three treatments was equivalent. We conclude adhesive wound closure strips were both a cost-saving and a cost-effective alternative to sutures and tissue adhesives in the closure of low-tension lacerations.

Factors associated with increasing nursing home closures.

PubMed

Castle, Nicholas G; Engberg, John; Lave, Judith; Fisher, Andrew

2009-06-01

We determine the rate of nursing home closures for 7 years (1999-2005) and examine internal (e.g., quality), organizational (e.g., chain membership), and external (e.g., competition) factors associated with these closures. The names of the closed facilities and dates of closure from state regulators in all 50 states were obtained. This information was linked to the Online Survey, Certification, and Reporting data, which contains information on internal, organizational, and market factors for almost all nursing homes in the United States. One thousand seven hundred and eighty-nine facilities closed over this time period (1999-2005). The average annual rate of closure was about 2 percent of facilities, but the rate of closure was found to be increasing. Nursing homes with higher rates of deficiency citations, hospital-based facilities, chain members, small bed size, and facilities located in markets with high levels of competition were more likely to close. High Medicaid occupancy rates were associated with a high likelihood of closure, especially for facilities with low Medicaid reimbursement rates. As states actively debate about how to redistribute long-term care services/dollars, our findings show that they should be cognizant of the potential these decisions have for facilitating nursing home closures.

Technical advances for abdominal wall closure after intestinal and multivisceral transplantation.

PubMed

Gerlach, Undine A; Pascher, Andreas

2012-06-01

Abdominal wall closure after intestinal transplantation (ITX) or multivisceral transplantation (MVTX) is challenging because of the loss of abdominal domain and wall elasticity as a result of previous operations and donor-to-recipient weight and height mismatch. We report on abdominal wall closure management in 30 ITX and MVTX recipients. In 60% of patients (n = 18), a primary abdominal closure (PAC) was achieved, in 40% (n = 12) a staged closure (SAC) was necessary. Patients with PAC had undergone less pretransplant operations and required less posttransplant relaparotomies. They were mainly ITX recipients or more abdominal domain because of a longer intestinal remnant. A literature review revealed different strategies to overcome a failed primary closure. They focus on graft reduction or an enlargement of the abdominal domain. The latter includes temporary coverage with prosthetic materials for SAC. Definite abdominal closure is achieved by skin only closure, or by using acellular dermal matrix, rotational flaps, rectus muscle fascia or abdominal wall grafts. Abdominal wall reconstruction after ITX/MVTX is commonly demanded and can be conducted by different strategies. The technique should be easy to use in a timely manner and should prevent abdominal infections, intestinal fistulation, incisional hernias, and wound dehiscence.

Effect of transcatheter closure of baffle leaks following senning or mustard atrial redirection surgery on oxygen saturations and polycythaemia.

PubMed

Bentham, James; English, Kate; Hares, Dominic; Gibbs, John; Thomson, John

2012-10-01

The aim of this study was to describe the clinical importance and methods of transcatheter closure of systemic venous baffle leaks after atrial redirection procedures for transposed great vessels. Until the late 1970s, atrial redirection surgery was the principal surgical palliative approach to manage transposed great vessels. Baffle leaks are among the many long-term complications of this type of surgery, and their prevalence increases over time. The clinical consequences of baffle leaks in this population are poorly understood, and the indications for closure are incompletely defined. During outpatient follow-up of 126 patients after atrial redirection surgery, 15 baffle leaks were detected in 11 patients. All underwent transcatheter closure using either an occluding device or a covered stent if there was concomitant baffle obstruction. The average age at the time of the procedure was 26 years (range 6 to 42). Ten of 11 patients were cyanosed at rest or on a simple walk test (median oxygen saturation level 80%, range 65% to 96%). Six of 11 patients were polycythemic before leak closure (median hemoglobin concentration 19 g/dl, range 13.8 to 23). After closure, there was a significant improvement in saturation (median 97%, p <0.0001) and a significant reduction in hemoglobin concentration at 6 months after the procedure (median 14.8 g/dl, p <0.05). There were no procedural adverse events. One patient experienced late device embolization necessitating surgical removal. In conclusion, transcatheter closure of baffle leaks is a technically feasible although frequently complex and lengthy procedure. Closure is associated with an improvement in oxygen saturations and a reduction in polycythaemia. Copyright © 2012 Elsevier Inc. All rights reserved.

Systematization of a set of closure techniques.

PubMed

Hausken, Kjell; Moxnes, John F

2011-11-01

Approximations in population dynamics are gaining popularity since stochastic models in large populations are time consuming even on a computer. Stochastic modeling causes an infinite set of ordinary differential equations for the moments. Closure models are useful since they recast this infinite set into a finite set of ordinary differential equations. This paper systematizes a set of closure approximations. We develop a system, which we call a power p closure of n moments, where 0≤p≤n. Keeling's (2000a,b) approximation with third order moments is shown to be an instantiation of this system which we call a power 3 closure of 3 moments. We present an epidemiological example and evaluate the system for third and fourth moments compared with Monte Carlo simulations. Copyright © 2011 Elsevier Inc. All rights reserved.

The etiology and determinants of hospital closure.

PubMed

Longo, D R; Sohn, M W; Shortell, S M

1996-01-01

This article examines the etiology of hospital closure and the correlates of hospital closure and the extent of similarity in this organizational outcome between pre- and post-Prospective Payment System (PPS) implementation. It also replicates a study from an earlier time period. Findings support the study's main hypotheses: in more stringent and turbulent markets, institutional and strategic variables are more important determinants of hospital closure. Merger acquisitions are found to be similar to both system acquisitions and autonomous hospitals. Standard Metropolitan Statistical Area (SMSA) status and regulation show an effect on hospital closure and merger acquisition. While many similarities exist when compared to the replicated study and findings prior to PPS implementation, it appears that sufficient differences exist to support the hypothesis that the PPS has an impact upon hospital organizational outcome.

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.

Fracture Sustainability Pressure, Temperature, Differential Pressure, and Aperture Closure Data

DOE Data Explorer

Tim Kneafsey

2016-09-30

In these data sets, the experiment time, actual date and time, room temperature, sample temperature, upstream and downstream pressures (measured independently), corrected differential pressure (measured independently and corrected for offset and room temperature) indication of aperture closure by linear variable differential transformer are presented. An indication of the sample is in the file name and in the first line of data.

An Infectious Pseudoaneurysm Caused by Ventricular Septal Defect Occluder in Patent Ductus Arteriosus Closure in a Two-Year-Old Child.

PubMed

Li, Dingyang; Qiu, Qiu; Jin, Jing; Zhang, Changdong; Wang, Lijun; Zhang, Gangcheng

2017-12-12

We present a case of an infectious pseudoaneurysm after patent ductus arteriosus (PDA) closure with a ventricular septal defect (VSD) occluder in a two-year-old child. The aneurysm grew rapidly but was successfully removed in time and the patient survived. To our knowledge, this is the first report of an infectious pseudoaneurysm caused by VSD occluder in PDA closure.

Stigma Sensitivity and the Duration of Temporary Closure Are Affected by Pollinator Identity in Mazus miquelii (Phrymaceae), a Species with Bilobed Stigma

PubMed Central

Jin, Xiao-Fang; Ye, Zhong-Ming; Amboka, Grace M.; Wang, Qing-Feng; Yang, Chun-Feng

2017-01-01

A sensitive bilobed stigma is thought to assure reproduction, avoid selfing and promote outcrossing. In addition, it may also play a role in pollinator selection since only pollinators with the appropriate body size can trigger this mechanism. However, no experimental study has investigated how the sensitive stigma responds to different pollinators and its potential effects on pollination. Mazus miquelii (Phrymaceae), a plant with a bilobed stigma was studied to investigate the relationship between stigma behaviors and its multiple insect pollinators. The reaction time of stigma closure after touched, duration of temporary closure, and factors determining permanent closure of the stigma were studied when flowers were exposed to different visitors and conducted with hand pollination. Manual stimulation was also used to detect the potential differences in stigmas when touched with different degrees of external forces. Results indicated that, compared to pollinators with a small body size, larger pollinators transferred more pollen grains to the stigma, causing a rapid stigma response and resulting in a higher percentage of permanent closures. Duration of temporary closure was negatively correlated with the speed of stigma closure; a stigma that closed more rapidly reopened more slowly. Manual stimulation showed that reaction time of stigma closure was likely a response to external mechanical forces. Hand pollination treatments revealed that the permanent closure of a stigma was determined by the size of stigmatic pollen load. For large pollinators, the speedy reaction of the stigma might help to reduce pollen loss, enhance pollen germination and avoid obstructing pollen export. Stigmas showed low sensitivity when touched by inferior pollinators, which may have increased the possibility of pollen deposition by subsequent visits. Therefore, the stigma behavior in M. miquelii is likely a mechanism of pollinator selection to maximize pollination success. PMID:28539934

Cost-Effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results From PROTECT AF Versus PREVAIL.

PubMed

Freeman, James V; Hutton, David W; Barnes, Geoffrey D; Zhu, Ruo P; Owens, Douglas K; Garber, Alan M; Go, Alan S; Hlatky, Mark A; Heidenreich, Paul A; Wang, Paul J; Al-Ahmad, Amin; Turakhia, Mintu P

2016-06-01

Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost effectiveness compared with anticoagulation has not been evaluated using all available contemporary trial data. We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation (PROTECT AF) and Prospective Randomized Evaluation of the Watchman LAA Closure Device in Patients With Atrial Fibrillation (PREVAIL) randomized trials. Using data from PROTECT AF, the incremental cost-effectiveness ratios compared with warfarin and dabigatran were $20 486 and $23 422 per quality-adjusted life year, respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (8.44, 8.54, and 8.59 quality-adjusted life years, respectively) and more costly. At a willingness-to-pay threshold of $50 000 per quality-adjusted life year, LAA closure was cost effective 90% and 9% of the time under PROTECT AF and PREVAIL assumptions, respectively. These results were sensitive to the rates of ischemic stroke and intracranial hemorrhage for LAA closure and medical anticoagulation. Using data from the PROTECT AF trial, LAA closure with the Watchman device was cost effective; using PREVAIL trial data, Watchman was more costly and less effective than warfarin and dabigatran. PROTECT AF enrolled more patients and has substantially longer follow-up time, allowing greater statistical certainty with the cost-effectiveness results. However, longer-term trial results and postmarketing surveillance of major adverse events will be vital to determining the value of the Watchman in clinical practice. © 2016 American Heart Association, Inc.

Management Modalities for Traumatic Macular Hole: A Systematic Review and Single-Arm Meta-Analysis.

PubMed

Gao, Min; Liu, Kun; Lin, Qiurong; Liu, Haiyun

2017-02-01

The purposes of this study were to (i) determine macular hole (MH) closure rates and visual outcomes by comparing two methods of managing traumatic MH (TMH)-an event resulting in severe loss of visual acuity (VA); (ii) characterize patients who undergo spontaneous TMH closure; (iii) determine which TMH patients should be observed before resorting to surgical repair; and (iv) elucidate factors that influence postoperative visual outcomes. Studies (n=10) of patients who were managed by surgery or observation for TMH were meta-analyzed retrospectively. Management modalities included surgical repair (surgery group) and observation for spontaneous hole closure (observation group). In addition, a 12-case series of articles (1990-2014) on spontaneous hole closure was statistically summarized. SAS and Comprehensive Meta-Analysis (CMA) (version 3.0) were used for analysis. For surgery group patients, the fixed-model pooled event rate for hole closure was 0.919 (range, 0.861-0.954) and for observation group patients, 0.368 (range, 0.236-0.448). The random-model pooled event rate for improvement of visual acuity (VA) for surgery group patients was 0.748 (range, 0.610-0.849) and for observation group patients, 0.505 (range, 0.397-0.613). For patients in both groups, the mean age of spontaneous closure was 18.71±10.64 years; mean size of TMHs, 0.18±0.06 decimal degrees (DD); and mean time for hole closure, 3.38±3.08 months. The pooled event rate for visual improvement was 0.748 (0.610-0.849). Hole closure and VA improvement rates of surgery group patients were significantly higher than those for observation group patients. Patients of ≤ 24 years of age with MH sizes of ≤ 0.2DD were more likely to achieve spontaneous hole closure. The interval of time from injury to surgery was statistically significantly associated with the level of visual improvement.

Monitoring Bacterial Burden, Inflammation and Bone Damage Longitudinally Using Optical and μCT Imaging in an Orthopaedic Implant Infection in Mice

PubMed Central

Niska, Jared A.; Meganck, Jeffrey A.; Pribaz, Jonathan R.; Shahbazian, Jonathan H.; Lim, Ed; Zhang, Ning; Rice, Brad W.; Akin, Ali; Ramos, Romela Irene; Bernthal, Nicholas M.; Francis, Kevin P.; Miller, Lloyd S.

2012-01-01

Background Recent advances in non-invasive optical, radiographic and μCT imaging provide an opportunity to monitor biological processes longitudinally in an anatomical context. One particularly relevant application for combining these modalities is to study orthopaedic implant infections. These infections are characterized by the formation of persistent bacterial biofilms on the implanted materials, causing inflammation, periprosthetic osteolysis, osteomyelitis, and bone damage, resulting in implant loosening and failure. Methodology/Principal Findings An orthopaedic implant infection model was used in which a titanium Kirshner-wire was surgically placed in femurs of LysEGFP mice, which possess EGFP-fluorescent neutrophils, and a bioluminescent S. aureus strain (Xen29; 1×103 CFUs) was inoculated in the knee joint before closure. In vivo bioluminescent, fluorescent, X-ray and μCT imaging were performed on various postoperative days. The bacterial bioluminescent signals of the S. aureus-infected mice peaked on day 19, before decreasing to a basal level of light, which remained measurable for the entire 48 day experiment. Neutrophil EGFP-fluorescent signals of the S. aureus-infected mice were statistically greater than uninfected mice on days 2 and 5, but afterwards the signals for both groups approached background levels of detection. To visualize the three-dimensional location of the bacterial infection and neutrophil infiltration, a diffuse optical tomography reconstruction algorithm was used to co-register the bioluminescent and fluorescent signals with μCT images. To quantify the anatomical bone changes on the μCT images, the outer bone volume of the distal femurs were measured using a semi-automated contour based segmentation process. The outer bone volume increased through day 48, indicating that bone damage continued during the implant infection. Conclusions/Significance Bioluminescent and fluorescent optical imaging was combined with X-ray and μCT imaging to provide noninvasive and longitudinal measurements of the dynamic changes in bacterial burden, neutrophil recruitment and bone damage in a mouse orthopaedic implant infection model. PMID:23082163

CENTRAL PLATEAU REMEDIATION

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

ROMINE, L.D.

2006-02-01

A systematic approach to closure planning is being implemented at the Hanford Site's Central Plateau to help achieve the goal of closure by the year 2035. The overall objective of Central Plateau remediation is to protect human health and the environment from the significant quantity of contaminated material that resulted from decades of plutonium production in support of the nation's defense. This goal will be achieved either by removing contaminants or placing the residual contaminated materials in a secure configuration that minimizes further migration to the groundwater and reduces the potential for inadvertent intrusion into contaminated sites. The approach tomore » Central Plateau cleanup used three key concepts--closure zones, closure elements, and closure process steps--to create an organized picture of actions required to complete remediation. These actions were merged with logic ties, constraints, and required resources to produce an integrated time-phased schedule and cost profile for Central Plateau closure. Programmatic risks associated with implementation of Central Plateau closure were identified and analyzed. Actions to mitigate the most significant risks are underway while high priority remediation projects continue to make progress.« less

Time-resolved computed tomography of the liver: retrospective, multi-phase image reconstruction derived from volumetric perfusion imaging.

PubMed

Fischer, Michael A; Leidner, Bertil; Kartalis, Nikolaos; Svensson, Anders; Aspelin, Peter; Albiin, Nils; Brismar, Torkel B

2014-01-01

To assess feasibility and image quality (IQ) of a new post-processing algorithm for retrospective extraction of an optimised multi-phase CT (time-resolved CT) of the liver from volumetric perfusion imaging. Sixteen patients underwent clinically indicated perfusion CT using 4D spiral mode of dual-source 128-slice CT. Three image sets were reconstructed: motion-corrected and noise-reduced (MCNR) images derived from 4D raw data; maximum and average intensity projections (time MIP/AVG) of the arterial/portal/portal-venous phases and all phases (total MIP/ AVG) derived from retrospective fusion of dedicated MCNR split series. Two readers assessed the IQ, detection rate and evaluation time; one reader assessed image noise and lesion-to-liver contrast. Time-resolved CT was feasible in all patients. Each post-processing step yielded a significant reduction of image noise and evaluation time, maintaining lesion-to-liver contrast. Time MIPs/AVGs showed the highest overall IQ without relevant motion artefacts and best depiction of arterial and portal/portal-venous phases respectively. Time MIPs demonstrated a significantly higher detection rate for arterialised liver lesions than total MIPs/AVGs and the raw data series. Time-resolved CT allows data from volumetric perfusion imaging to be condensed into an optimised multi-phase liver CT, yielding a superior IQ and higher detection rate for arterialised liver lesions than the raw data series. • Four-dimensional computed tomography is limited by motion artefacts and poor image quality. • Time-resolved-CT facilitates 4D-CT data visualisation, segmentation and analysis by condensing raw data. • Time-resolved CT demonstrates better image quality than raw data images. • Time-resolved CT improves detection of arterialised liver lesions in cirrhotic patients.

Positive Catch & Economic Benefits of Periodic Octopus Fishery Closures: Do Effective, Narrowly Targeted Actions ‘Catalyze’ Broader Management?

PubMed Central

Oliver, Thomas A.; Oleson, Kirsten L. L.; Ratsimbazafy, Hajanaina; Raberinary, Daniel; Benbow, Sophie; Harris, Alasdair

2015-01-01

Overview Eight years of octopus fishery records from southwest Madagascar reveal significant positive impacts from 36 periodic closures on: (a) fishery catches and (b) village fishery income, such that (c) economic benefits from increased landings outweigh costs of foregone catch. Closures covered ~20% of a village’s fished area and lasted 2-7 months. Fishery Catches from Each Closed Site Octopus landings and catch per unit effort (CPUE) significantly increased in the 30 days following a closure’s reopening, relative to the 30 days before a closure (landings: +718%, p<0.0001; CPUE: +87%, p<0.0001; n = 36). Open-access control sites showed no before/after change when they occurred independently of other management (“no ban”, n = 17/36). On the other hand, open-access control sites showed modest catch increases when they extended a 6-week seasonal fishery shutdown (“ban”, n = 19/36). The seasonal fishery shutdown affects the entire region, so confound all potential control sites. Fishery Income in Implementing Villages In villages implementing a closure, octopus fishery income doubled in the 30 days after a closure, relative to 30 days before (+132%, p<0.001, n = 28). Control villages not implementing a closure showed no increase in income after “no ban” closures and modest increases after “ban” closures. Villages did not show a significant decline in income during closure events. Net Economic Benefits from Each Closed Site Landings in closure sites generated more revenue than simulated landings assuming continued open-access fishing at that site (27/36 show positive net earnings; mean +$305/closure; mean +57.7% monthly). Benefits accrued faster than local fishers’ time preferences during 17-27 of the 36 closures. High reported rates of illegal fishing during closures correlated with poor economic performance. Broader Co-Management We discuss the implications of our findings for broader co-management arrangements, particularly for catalyzing more comprehensive management. PMID:26083862

The TopClosure® 3S System, for skin stretching and a secure wound closure.

PubMed

Topaz, Moris; Carmel, Narin-Nard; Silberman, Adi; Li, Ming Sen; Li, Yong Zhong

2012-07-01

The principle of stretching wound margins for primary wound closure is commonly practiced and used for various skin defects, leading at times to excessive tension and complications during wound closure. Different surgical techniques, skin stretching devices and tissue expanders have been utilized to address this issue. Previously designed skin stretching devices resulted in considerable morbidity. They were invasive by nature and associated with relatively high localized tissue pressure, frequently leading to necrosis, damage and tearing of skin at the wound margins. To assess the clinical effectiveness and performance and, to determine the safety of TopClosure® for gradual, controlled, temporary, noninvasive and invasive applications for skin stretching and secure wound closing, the TopClosure® device was applied to 20 patients for preoperative skin lesion removal and to secure closure of a variety of wound sizes. TopClosure® was reinforced with adhesives, staples and/or surgical sutures, depending on the circumstances of the wound and the surgeon's judgment. TopClosure® was used prior to, during and/or after surgery to reduce tension across wound edges. No significant complications or adverse events were associated with its use. TopClosure® was effectively used for preoperative skin expansion in preparation for dermal resection (e.g., congenital nevi). It aided closure of large wounds involving significant loss of skin and soft tissue by mobilizing skin and subcutaneous tissue, thus avoiding the need for skin grafts or flaps. Following surgery, it was used to secure closure of wounds under tension, thus improving wound aesthetics. A sample case study will be presented. We designed TopClosure®, an innovative device, to modify the currently practiced concept of wound closure by applying minimal stress to the skin, away from damaged wound edges, with flexible force vectors and versatile methods of attachment to the skin, in a noninvasive or invasive manner.

Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study.

PubMed

von Renteln, Daniel; Rudolph, Hans-Ulrich; Schmidt, Arthur; Vassiliou, Melina C; Caca, Karel

2010-01-01

Duodenal perforations during diagnostic upper endoscopy are rare; however, when therapeutic techniques are performed, the reported incidence is as great as 2.8%. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality. To compare closure of duodenal perforations by using an over-the-scope clip (OTSC) with a surgical closure. Randomized, controlled animal study. Animal facility laboratory. Domestic pigs (24 females). Large (10-mm) duodenal perforations were created by using an endoscopic needle-knife. The animals were randomly assigned to either open surgical repair (n=12) or endoscopic closure by using the OTSC system (n=12). Pressurized leak tests were performed during necropsy. One major bleed occurred because of a liver injury during creation of the duodenotomy. Mean time for endoscopic closure was 5 minutes (range, 3-8 min; SD +/- 2). No complications occurred during any of the closure procedures. At necropsy, all OTSC and surgical closures demonstrated complete sealing of duodenotomy sites. Pressurized leak tests demonstrated a mean burst pressure of 166 mm Hg (range, 80-260; SD +/- 65) for OTSC closures and 143 mm Hg (range, 30-300, SD +/- 83) for surgical sutures. Ex vivo intact duodenal specimens exhibited a mean burst pressure of 247 mm Hg (range, 200-300; SD +/- 35), which was significantly higher compared with in vivo OTSC and surgical closures (P < .01). There were no significant differences between burst pressures of OTSC and surgical closures (P = .461). Nonsurvival setting. Endoscopic closure of duodenal perforations by using the OTSC system is comparable with surgical closure in a nonsurvival porcine model. This technique is easy to perform and seems suitable for repairing duodenal perforations. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Surgical impact and speech outcome at 2.5 years after one- or two-stage cleft palate closure.

PubMed

Randag, Anna C; Dreise, Marieke M; Ruettermann, Mike

2014-11-01

In the ongoing discussion about timing of palate closure, it is said that early closure is favorable for speech development, but can interfere with maxillary growth. On the other hand, beneficial results on both after one-stage palate closure have also been presented. The assumption that one-stage palate closure leads to less surgical impact on the child probably contributed to the choice for this procedure in most cleft centers. However, no previous research has verified this assumption. The aim of the present study is to compare surgical impact and speech outcome at 2.5 years of age between children who underwent either one- or early two-stage palate closure. Patients underwent either one-stage palate closure between 2007 and 2010 at a median age of 10.8 months (group 1, n=24) or early two-stage closure before 2007 at median ages of 10.4 and 18.2 months, respectively (group 2, n=24). Surgical impact was compared between the two groups by means of duration of surgery, length of hospital stay and number of post-operative complications. Speech outcome was compared by means of resonance problems, nasal air emission, articulation and intelligibility, all assessed at a median age of 2.5 years. The one-stage closure group showed significantly shorter duration of surgery and length of hospital stay (p<0.001 and p=0.001, respectively) and significantly better articulation (p=0.029) than the early two-stage closure group. One-stage palate closure is preferable over early two-stage palate closure with regard to surgical impact and speech development. More extensive, prospective studies, in which maxillary growth is taken into account, should be conducted. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Accuracy of GPS time transfer verified by closure around the world

NASA Technical Reports Server (NTRS)

Lewandowski, Wlodimierz W.; Petit, Gerard; Thomas, Claudine

1992-01-01

The precision of time transfer over intercontinental distances by the Global Positioning System common-view method, using measurements of ionospheric delays, precise ephemerides provided by the Defense Mapping Agency (DMA) and a consistent set of antenna coordinates, reaches 3 to 4 ns for a single 13-minute measurement, and decreases to 2 ns when averaging several measurements over the period of one day. It is thought that even this level of precision can be bettered by improving the ionospheric measurements, the ephemerides of satellites, and the antenna coordinates. In the same conditions, an estimation of the accuracy is attained by using three intercontinental links encircling the Earth to establish a closure condition; the three independent links should add to zero. We have computed such a closure condition over a period of 13 months using data recorded at the Paris Observatory, at the Communications Research Laboratory in Tokyo, and at the National Institute for Standards and Technology in Boulder, Colorado. The closure condition is verified to within a few nanoseconds, but a bias, varying with time, can be detected.

MANTA, a novel plug-based vascular closure device for large bore arteriotomies: technical report.

PubMed

van Gils, Lennart; Daemen, Joost; Walters, Greg; Sorzano, Todd; Grintz, Todd; Nardone, Sam; Lenzen, Mattie; De Jaegere, Peter P T; Roubin, Gary; Van Mieghem, Nicolas M

2016-09-18

Catheter-based interventions have become a less invasive alternative to conventional surgical techniques for a wide array of cardiovascular diseases but often create large arteriotomies. A completely percutaneous technique is attractive as it may reduce the overall complication rate and procedure time. Currently, large bore arteriotomy closure relies on suture-based techniques. Access-site complications are not uncommon and often seem related to closure device failure. The MANTA VCD is a novel collagen-based closure device that specifically targets arteriotomies between 10 and 22 Fr. This technical report discusses the MANTA design concept, practical instructions for use and preliminary clinical experience.

Evaluation of the Momentum Closure Schemes in MPAS-Ocean

NASA Astrophysics Data System (ADS)

Zhao, Shimei; Liu, Yudi; Liu, Wei

2018-04-01

In order to compare and evaluate the performances of the Laplacian viscosity closure, the biharmonic viscosity closure, and the Leith closure momentum schemes in the MPAS-Ocean model, a variety of physical quantities, such as the relative reference potential energy (RPE) change, the RPE time change rate (RPETCR), the grid Reynolds number, the root mean square (RMS) of kinetic energy, and the spectra of kinetic energy and enstrophy, are calculated on the basis of results of a 3D baroclinic periodic channel. Results indicate that: 1) The RPETCR demonstrates a saturation phenomenon in baroclinic eddy tests. The critical grid Reynolds number corresponding to RPETCR saturation differs between the three closures: the largest value is in the biharmonic viscosity closure, followed by that in the Laplacian viscosity closure, and that in the Leith closure is the smallest. 2) All three closures can effectively suppress spurious dianeutral mixing by reducing the grid Reynolds number under sub-saturation conditions of the RPETCR, but they can also damage certain physical processes. Generally, the damage to the rotation process is greater than that to the advection process. 3) The dissipation in the biharmonic viscosity closure is strongly dependent on scales. Most dissipation concentrates on small scales, and the energy of small-scale eddies is often transferred to large-scale kinetic energy. The viscous dissipation in the Laplacian viscosity closure is the strongest on various scales, followed by that in the Leith closure. Note that part of the small-scale kinetic energy is also transferred to large-scale kinetic energy in the Leith closure. 4) The characteristic length scale L and the dimensionless parameter D in the Leith closure are inherently coupled. The RPETCR is inversely proportional to the product of D and L. When the product of D and L is constant, both the simulated RPETCR and the inhibition of spurious dianeutral mixing are the same in all tests using the Leith closure. The dissipative scale in the Leith closure depends on the parameter L, and the dissipative intensity depends on the parameter D. 5) Although optimal results may not be achieved by using the optimal parameters obtained from the 2D barotropic model in the 3D baroclinic simulation, the total energies are dissipative in all three closures. Dissipation is the strongest in the biharmonic viscosity closure, followed by that in the Leith closure, and that in the Laplacian viscosity closure is the weakest. Mesoscale eddies develop the fastest in the biharmonic viscosity closure after the baroclinic adjustment process finishes, and the kinetic energy reaches its maximum, which is attributed to the smallest dissipation of enstrophy in the biharmonic viscosity closure. Mesoscale eddies develop the slowest, and the kinetic energy peak value is the smallest in the Laplacian viscosity closure. Results in the Leith closure are between that in the biharmonic viscosity closure and the Laplacian viscosity closure.

Biomechanical Testing and Histologic Examination of Intradermal Skin Closure in Dogs Using Barbed Suture Device and Non-Barbed Monofilament Suture.

PubMed

Law, Andy Y; Butler, James R; Patnaik, Sourav S; Cooley, James A; Elder, Steven H

2017-01-01

To compare the biomechanical strength and histologic features of 3-0 Glycomer™ 631 barbed suture (V-LOC™ 90 Absorbable Wound Closure Device, Covidien, Mansfield, MA) to non-barbed 3-0 Glycomer™ 631 suture (Biosyn™, Covidien) for intradermal skin wound closure in the dog. Randomized, factorial, in vivo. Eighteen purpose-bred, mature male, and female hound dogs. Eighteen adult hound dogs were randomly assigned to 1 of 3 groups designated by postoperative day of assessment. Six skin incisions were made along the dorsum in the thoracolumbar region of each dog with an equal number (n=3) randomly assigned to closure with barbed or non-barbed suture. Six dogs were euthanatized on postoperative days 3, 10, and 14, respectively. Two additional incisions were made on each dog after euthanasia for baseline data (Day 0). The skin incision specimens were harvested for biomechanical testing and histologic evaluation. Non-barbed closure had significantly higher maximum load at failure (P<.001) and stiffness (P<.001) than barbed closure regardless of day. The average tissue reaction score was significantly higher for barbed closure (P=.008), regardless of day. Suturing time for barbed closures was significantly shorter. There was no significant difference in frequency of complications between closures. Barbed Glycomer™ 631 closures had a significantly lower maximum load at failure and stiffness, and higher average tissue reaction scores, but showed no difference in short term outcome for intradermal closure of dorsally located skin incisions in dogs. © 2016 The American College of Veterinary Surgeons.

Middlesex FUSRAP Site - A Path to Site-Wide Closure - 13416

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

Miller, David M.; Edge, Helen

2013-07-01

The road-map to obtaining closure of the Middlesex Sampling Plant FUSRAP site in Middlesex, New Jersey (NJ) has required a multi-faceted approach, following the CERCLA Process. Since 1998, the US ACE, ECC, and other contractors have completed much of the work required for regulatory acceptance of site closure with unrestricted use. To date, three buildings have been decontaminated, demolished, and disposed of. Two interim storage piles have been removed and disposed of, followed by the additional removal and disposal of over 87,000 tons of radiologically and chemically-impacted subsurface soils by the summer of 2008. The US ACE received a determinationmore » from the EPA for the soils Operable Unit, (OU)-1, in September 2010 that the remedial excavations were acceptable, and meet the criteria for unrestricted use as required by the 2004 Record of Decision (ROD) for OU-1. Following the completion of OU-1, the project delivery team performed additional field investigation of the final Operable Unit for Middlesex, OU-2, Groundwater. As of December 2012, the project delivery team has completed a Supplemental Remedial Investigation, which will be followed with a streamlined Feasibility Study, Proposed Plan, and ROD. Several years of historical groundwater data was available from previous investigations and the FUSRAP Environmental Surveillance Program. Historical data indicated sporadic detections of Volatile Organic Compounds (VOCs), primarily trichloroethylene (TCE), carbon tetrachloride (CT), and methyl tert-butyl ether (MTBE), with no apparent trend or pattern indicating extent or source of the VOC impact. In 2008, the project delivery team initiated efforts to re-assess the Conceptual Site Model (CSM) for groundwater. The bedrock was re-evaluated as a leaky multi-unit aquifer, and a plan was developed for additional investigations for adequate bedrock characterization and delineation of groundwater contaminated primarily by CT, TCE, and tetrachloroethene (PCE). The investigation was designed to accumulate multiple lines of evidence to determine the source and to delineate the extent of contamination, as required to complete the CERCLA Process and gain regulatory acceptance. Investigative techniques included in-well vertical flow tracing, borehole geophysics and packer testing of temporary test holes to characterize contamination in the bedrock fractures beneath the site, and to delineate likely source areas. (authors)« less

Protecting an island nation from extreme pandemic threats: Proof-of-concept around border closure as an intervention

PubMed Central

Boyd, Matt; Baker, Michael G.; Mansoor, Osman D.; Kvizhinadze, Giorgi; Wilson, Nick

2017-01-01

Background Countries are well advised to prepare for future pandemic risks (e.g., pandemic influenza, novel emerging agents or synthetic bioweapons). These preparations do not typically include planning for complete border closure. Even though border closure may not be instituted in time, and can fail, there might still plausible chances of success for well organized island nations. Objective To estimate costs and benefits of complete border closure in response to new pandemic threats, at an initial proof-of-concept level. New Zealand was used as a case-study for an island country. Methods An Excel spreadsheet model was developed to estimate costs and benefits. Case-study specific epidemiological data was sourced from past influenza pandemics. Country-specific healthcare cost data, valuation of life, and lost tourism revenue were imputed (with lost trade also in scenario analyses). Results For a new pandemic equivalent to the 1918 influenza pandemic (albeit with half the mortality rate, “Scenario A”), it was estimated that successful border closure for 26 weeks provided a net societal benefit (e.g., of NZ$11.0 billion, USD$7.3 billion). Even in the face of a complete end to trade, a net benefit was estimated for scenarios where the mortality rate was high (e.g., at 10 times the mortality impact of “Scenario A”, or 2.75% of the country’s population dying) giving a net benefit of NZ$54 billion (USD$36 billion). But for some other pandemic scenarios where trade ceased, border closure resulted in a net negative societal value (e.g., for “Scenario A” times three for 26 weeks of border closure–but not for only 12 weeks of closure when it would still be beneficial). Conclusions This “proof-of-concept” work indicates that more detailed cost-benefit analysis of border closure in very severe pandemic situations for some island nations is probably warranted, as this course of action might sometimes be worthwhile from a societal perspective. PMID:28622344

Explosive Emission and Gap Closure from a Relativistic Electron Beam Diode

DTIC Science & Technology

2013-06-01

relationship, impedance and perveance curves, plasma expansion velocity, and the time-resolved light emission on the surface of the cathode. I...indicating a cathode plasma density ~1017 cm-3 that migrates into the gap at ~50 cm/µs and an anode plasma of lower density ~1012 cm-3 that expands axially... plasma to the gap closure velocity. Initial estimates indicate the closure velocity for this relativistic diode is ~ 10 cm/µs. These measurements

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.

Analysis of randomly time varying systems by gaussian closure technique

NASA Astrophysics Data System (ADS)

Dash, P. K.; Iyengar, R. N.

1982-07-01

The Gaussian probability closure technique is applied to study the random response of multidegree of freedom stochastically time varying systems under non-Gaussian excitations. Under the assumption that the response, the coefficient and the excitation processes are jointly Gaussian, deterministic equations are derived for the first two response moments. It is further shown that this technique leads to the best Gaussian estimate in a minimum mean square error sense. An example problem is solved which demonstrates the capability of this technique for handling non-linearity, stochastic system parameters and amplitude limited responses in a unified manner. Numerical results obtained through the Gaussian closure technique compare well with the exact solutions.

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...

No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomical lung resection.

PubMed

Zakkar, Mustafa; Kanagasabay, Robin; Hunt, Ian

2014-04-01

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether manual closure of the bronchial stump is safer with lower failure rates than mechanical closure using a stapling device following anatomical lung resection. One hundred and twenty-nine papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question as they included sufficient number of patients to reach conclusions regarding the issues of interest for this review. Complications, complication rates and operation time were included in the assessment. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. When looking at manual vs mechanical staples, it was noted that stapler failure can occur in around 4% of cases. The rate of bronchopleural fistula (BPF) development varied more in patients who underwent manual closure (1.5-12.5%) than in patients who underwent mechanical closure (1-5.7%). Although most of the studies reviewed showed no statistical differences between manual and mechanical closure in terms of BPF development, one study, however, showed that manual closure was significantly associated with lower numbers of postoperative BPF, while another study showed that mechanical closure is significantly associated with lower incidence of BPF. When looking at the role of the learning curve and training opportunities, it seems that the surgeon's inexperience when using mechanical staples can contribute to BPF development. A surgeon's experience can play a major role in the prevention of BPF development in patients having manual closure. Manual closure can provide a cheap and reliable technique when compared with costs incurred from using staplers, it is applicable in all situations and can be taught to surgeons in training with an acceptable risk. However, there is a lack of evidence to suggest that manual closure is better than mechanical stapler closure following anatomical lung resection.

Prospective Randomized Study of the Effect of Music on the Efficiency of Surgical Closures.

PubMed

Lies, Shelby R; Zhang, Andrew Y

2015-09-01

Music is commonly played in operating theaters. Some surgeons believe music reduces stress and operative time, while others think music is a distraction and should be avoided. There is limited published evidence evaluating the effects of music on surgical performance. The goal of this study is to evaluate the effect of music on simple wound closure. Plastic surgery residents were asked to perform layered closures on pigs' feet with and without their preferred music playing. Simple randomization was used to assign residents to the music playing first or music playing second group. The time to complete the repair was measured and repairs were graded by blinded faculty. Results were analyzed to determine significant differences in time to complete the task and quality of repair. Participants were retested in a second session with music played in the opposite order to evaluate consistency. Listening to preferred music decreased repair time by 8% for all plastic surgery residents (p = 0.009). Subgroup analysis demonstrated even more significant improvement in speed for senior residents (PGY 4-6), resulting in a 10% decrease in repair time (p = 0.006). The quality of repair was also better in the music group, at 3.3 versus 3.1 (p = 0.047). Retesting revealed results remained significant whether music was played first or second. Playing preferred music made plastic surgery residents faster in completing wound closure with a 10% improvement in senior residents. Music also improved quality of repair as judged by blinded faculty. Our study showed that music improves efficiency of wound closure, which may translate to healthcare cost savings. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Enteral and parenteral nutrition in the conservative treatment of pancreatic fistula: a randomized clinical trial.

PubMed

Klek, Stanislaw; Sierzega, Marek; Turczynowski, Lukasz; Szybinski, Piotr; Szczepanek, Kinga; Kulig, Jan

2011-07-01

Postoperative pancreatic fistula is the most common and potentially life-threatening complication after pancreatic surgery. Although nutritional support is a key component of conservative therapy in such cases, there have been no well-designed clinical trials substantiating the superiority of either total parenteral nutrition or enteral nutrition. This study was conducted to compare the efficacy and safety of both routes of nutritional intervention. A randomized clinical trial was conducted in a tertiary surgical center of pancreatic and gastrointestinal surgery. Seventy-eight patients with postoperative pancreatic fistula were treated conservatively and randomly assigned to groups receiving for 30 days either enteral nutrition or total parenteral nutrition. The primary end point was the 30-day fistula closure rate. After 30 days, closure rates in patients receiving enteral and parenteral nutrition were 60% (24 of 40) and 37% (14 of 38), respectively (P=.043). The odds ratio for the probability that fistula closes on enteral nutrition compared to total parenteral nutrition was 2.571 (95% confidence interval [CI]: 1.031-6.411). Median time to closure was 27 days (95% CI: 21-33) for enteral nutrition, and no median time was reached in total parenteral nutrition (P=.047). A logistic regression analysis identified only 2 factors significantly associated with fistula closure, ie, enteral nutrition (odds ratio=6.136; 95% CI: 1.204-41.623; P=.043) and initial fistula output of ≤200 mL/day (odds ratio=12.701; 95% CI: 9.102-47.241; P<.001). Enteral nutrition is associated with significantly higher closure rates and shorter time to closure of postoperative pancreatic fistula. Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.

Leyla loop: a time-saving suture technique for robotic atrial closure

PubMed Central

Kılıç, Leyla; Şenay, Şahin; Ümit Güllü, A.; Alhan, Cem

2013-01-01

The longer durations of cardiopulmonary bypass and aortic cross-clamp times remain the disadvantages of robotic or minimally invasive cardiac surgery. For this reason, every small contribution to speeding up these procedures is of the utmost importance. Here, we present a practical, easy and time-saving suture technique for atrial closure. It consists of a hand-made loop at one end of the suture and saves the time otherwise consumed by knotting. It may also be used during conventional or minimally invasive cardiac surgery. PMID:23760357

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

Variability in school closure decisions in response to 2009 H1N1: a qualitative systems improvement analysis

PubMed Central

2011-01-01

Background School closure was employed as a non-pharmaceutical intervention against pandemic 2009 H1N1, particularly during the first wave. More than 700 schools in the United States were closed. However, closure decisions reflected significant variation in rationales, decision triggers, and authority for closure. This variability presents the opportunity for improved efficiency and decision-making. Methods We identified media reports relating to school closure as a response to 2009 H1N1 by monitoring high-profile sources and searching Lexis-Nexis and Google news alerts, and reviewed reports for key themes. News stories were supplemented by observing conference calls and meetings with health department and school officials, and by discussions with decision-makers and community members. Results There was significant variation in the stated goal of closure decision, including limiting community spread of the virus, protecting particularly vulnerable students, and responding to staff shortages or student absenteeism. Because the goal of closure is relevant to its timing, nature, and duration, unclear rationales for closure can challenge its effectiveness. There was also significant variation in the decision-making authority to close schools in different jurisdictions, which, in some instances, was reflected in open disagreement between school and public health officials. Finally, decision-makers did not appear to expect the level of scientific uncertainty encountered early in the pandemic, and they often expressed significant frustration over changing CDC guidance. Conclusions The use of school closure as a public health response to epidemic disease can be improved by ensuring that officials clarify the goals of closure and tailor closure decisions to those goals. Additionally, authority to close schools should be clarified in advance, and decision-makers should expect to encounter uncertainty disease emergencies unfold and plan accordingly. PMID:21284865

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.

When the Battle is Lost and Won: Delayed Chest Closure After Bilateral Lung Transplantation.

PubMed

Soresi, Simona; Sabashnikov, Anton; Weymann, Alexander; Zeriouh, Mohamed; Simon, André R; Popov, Aron-Frederik

2015-10-12

In this article we summarize benefits of delayed chest closure strategy in lung transplantation, addressing indications, different surgical techniques, and additional perioperative treatment. Delayed chest closure seems to be a valuable and safe strategy in managing patients with various conditions after lung transplantation, such as instable hemodynamics, need for high respiratory pressures, coagulopathy, and size mismatch. Therefore, this approach should be considered in lung transplant centers to give patients time to recover before the chest is closed.

FGFR3 promotes synchondrosis closure and fusion of ossification centers through the MAPK pathway

PubMed Central

Matsushita, Takehiko; Wilcox, William R.; Chan, Yuk Yu; Kawanami, Aya; Bükülmez, Hülya; Balmes, Gener; Krejci, Pavel; Mekikian, Pertchoui B.; Otani, Kazuyuki; Yamaura, Isakichi; Warman, Matthew L.; Givol, David; Murakami, Shunichi

2009-01-01

Activating mutations in FGFR3 cause achondroplasia and thanatophoric dysplasia, the most common human skeletal dysplasias. In these disorders, spinal canal and foramen magnum stenosis can cause serious neurologic complications. Here, we provide evidence that FGFR3 and MAPK signaling in chondrocytes promote synchondrosis closure and fusion of ossification centers. We observed premature synchondrosis closure in the spine and cranial base in human cases of homozygous achondroplasia and thanatophoric dysplasia as well as in mouse models of achondroplasia. In both species, premature synchondrosis closure was associated with increased bone formation. Chondrocyte-specific activation of Fgfr3 in mice induced premature synchondrosis closure and enhanced osteoblast differentiation around synchondroses. FGF signaling in chondrocytes increases Bmp ligand mRNA expression and decreases Bmp antagonist mRNA expression in a MAPK-dependent manner, suggesting a role for Bmp signaling in the increased bone formation. The enhanced bone formation would accelerate the fusion of ossification centers and limit the endochondral bone growth. Spinal canal and foramen magnum stenosis in heterozygous achondroplasia patients, therefore, may occur through premature synchondrosis closure. If this is the case, then any growth-promoting treatment for these complications of achondroplasia must precede the timing of the synchondrosis closure. PMID:18923003

Influence of Timing of Delayed Hard Palate Closure on Articulation Skills in 3-Year-Old Danish Children with Unilateral Cleft Lip and Palate

ERIC Educational Resources Information Center

Willadsen, Elisabeth; Boers, Maria; Schöps, Antje; Kisling-Møller, Mia; Nielsen, Joan Bogh; Jørgensen, Line Dahl; Andersen, Mikael; Bolund, Stig; Andersen, Helene Søgaard

2018-01-01

Background: Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. Aims: To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral…

Fire scar growth and closure rates in white oak (Quercus alba) and the implications for prescribed burning

Treesearch

Michael C. Stambaugh; Kevin T. Smith; Daniel C. Dey

2017-01-01

In burned forestlands, fire scar wounds commonly occur on tree stems as a result of cambial heating. In hardwood forests in particular, wounding can lead to stem decay with the extent of decay being related to scar size and exposure time. Therefore, wound closure rates are important to understand in the context of fire management such that allowing sufficient time for...

Cleft palate caused by congenital teratoma.

PubMed

Veyssière, Alexis; Streit, Libor; Traoré, Hamady; Bénateau, Hervé

2017-02-01

A cleft palate results from incomplete fusion of the lateral palatine processes, the median nasal septum and the median palatine process. This case report describes a rare case of congenital teratoma originating from the nasal septum that may have interfered with the fusion of the palatal shelves during embryonic development, resulting in a cleft palate. An infant girl was born at 40 weeks of gestation weighing 3020 g with a complete cleft palate associated with a large central nasopharyngeal tumour. Computed tomography (CT) of the head showed a well defined mass of mixed density. The tumour was attached to the nasal septum in direct contact with the cleft palate. A biopsy confirmed the teratoma. Tumour resection was performed at 5 months, soft palate reconstruction at 7 months and hard palate closure at 14 months. There was no sign of local recurrence 1 year later. Most teratomas are benign and the prognosis is usually good. However, recurrence is not rare if germ cell carcinomatous foci are present within the teratoma. For these reasons, we advocate the use of a two-stage procedure in which closure of the cleft palate is postponed until histological examination confirms complete excision of the teratoma.

[A Case of Laparoscopic Repair of Internal Hernia after Laparoscope-Assisted Distal Gastrectomy with Antecolic Roux-en-Y Reconstruction].

PubMed

Maezawa, Yukio; Cho, Haruhiko; Kano, Kazuki; Nakajima, Tetsushi; Ikeda, Kousuke; Yamada, Takanobu; Sato, Tsutomu; Ohshima, Takashi; Rino, Yasushi; Masuda, Munetaka; Ogata, Takashi; Yoshikawa, Takaki

2017-10-01

A 72-year-old woman had undergone laparoscope-assisted distal gastrectomy with D1 plus lymph node dissection and antecolic Roux-en-Y reconstruction for early gastric cancer. She visited our department outpatient clinic with left upper abdominal pain 1 year and 9 months after the surgery. CT revealed a spiral sign of the superior mesenteric arteriovenous branch. An internal hernia was suspected on hospitalization. Although abdominal symptoms were relieved by conservative treatment, the hernia persisted. Laparoscopic surgery was performed and revealed that almost entire small intestine had been affected due to Petersen's defect. Since no ischemic changes were observed, the defect was repaired laparoscopically with suture closure. There has been no recurrence of internal hernia after the laparoscopic surgery. Internal hernia after distal gastrectomy is relatively rare. However, the risk of internal hernia is high due to the gap between the elevated jejunum and transverse colon mesentery in Roux-en-Y reconstruction and can lead to intestinal necrosis. Since an internal hernia can occur in patients who have undergone gastric resection with Roux-en-Y reconstruction, suture closure of Petersen's defect should be performed to prevent this occurrence.

Atelectasis after free rectus transfer and abdominal wall reconstruction.

PubMed

Lo, Jamie O; Weber, Stephen M; Andersen, Peter E; Gross, Neil D; Gosselin, Marc; Wax, Mark K

2008-10-01

Atelectasis is commonly encountered in patients undergoing rectus abdominus tissue transfer. Primary closure of the anterior rectus sheath may contribute to this process. Augmentation of the closure with mesh may decrease the incidence of Atelectasis. In this retrospective review 32 patients with preoperative and postoperative augmentation were compared to 23 who had primary closure of the anterior rectus sheath. Augmentation consisted of acellular dermis (25) or mesh (7). Postoperative atelectasis was radiographically detected in: 91% (n=29) of augmented patients versus 83% (n=19) of primary closure patients. Major atelectasis in 41% (n=13) of augmented patients versus 61% (n=14) of primary closure patients p<.05. The incidence of atelectasis was independent of skin flap size and operative times. The use of acellular dermis or mesh to augment the abdominal wall appears to reduce the high incidence of postoperative atelectasis following rectus-free flap harvest. Copyright (c) 2008 Wiley Periodicals, Inc. Head Neck 2008.

The effects of school closures on influenza outbreaks and pandemics: systematic review of simulation studies.

PubMed

Jackson, Charlotte; Mangtani, Punam; Hawker, Jeremy; Olowokure, Babatunde; Vynnycky, Emilia

2014-01-01

School closure is a potential intervention during an influenza pandemic and has been investigated in many modelling studies. To systematically review the effects of school closure on influenza outbreaks as predicted by simulation studies. We searched Medline and Embase for relevant modelling studies published by the end of October 2012, and handsearched key journals. We summarised the predicted effects of school closure on the peak and cumulative attack rates and the duration of the epidemic. We investigated how these predictions depended on the basic reproduction number, the timing and duration of closure and the assumed effects of school closures on contact patterns. School closures were usually predicted to be most effective if they caused large reductions in contact, if transmissibility was low (e.g. a basic reproduction number <2), and if attack rates were higher in children than in adults. The cumulative attack rate was expected to change less than the peak, but quantitative predictions varied (e.g. reductions in the peak were frequently 20-60% but some studies predicted >90% reductions or even increases under certain assumptions). This partly reflected differences in model assumptions, such as those regarding population contact patterns. Simulation studies suggest that school closure can be a useful control measure during an influenza pandemic, particularly for reducing peak demand on health services. However, it is difficult to accurately quantify the likely benefits. Further studies of the effects of reactive school closures on contact patterns are needed to improve the accuracy of model predictions.

Utility and Scope of Rapid Prototyping in Patients with Complex Muscular Ventricular Septal Defects or Double-Outlet Right Ventricle: Does it Alter Management Decisions?

PubMed

Bhatla, Puneet; Tretter, Justin T; Ludomirsky, Achi; Argilla, Michael; Latson, Larry A; Chakravarti, Sujata; Barker, Piers C; Yoo, Shi-Joon; McElhinney, Doff B; Wake, Nicole; Mosca, Ralph S

2017-01-01

Rapid prototyping facilitates comprehension of complex cardiac anatomy. However, determining when this additional information proves instrumental in patient management remains a challenge. We describe our experience with patient-specific anatomic models created using rapid prototyping from various imaging modalities, suggesting their utility in surgical and interventional planning in congenital heart disease (CHD). Virtual and physical 3-dimensional (3D) models were generated from CT or MRI data, using commercially available software for patients with complex muscular ventricular septal defects (CMVSD) and double-outlet right ventricle (DORV). Six patients with complex anatomy and uncertainty of the optimal management strategy were included in this study. The models were subsequently used to guide management decisions, and the outcomes reviewed. 3D models clearly demonstrated the complex intra-cardiac anatomy in all six patients and were utilized to guide management decisions. In the three patients with CMVSD, one underwent successful endovascular device closure following a prior failed attempt at transcatheter closure, and the other two underwent successful primary surgical closure with the aid of 3D models. In all three cases of DORV, the models provided better anatomic delineation and additional information that altered or confirmed the surgical plan. Patient-specific 3D heart models show promise in accurately defining intra-cardiac anatomy in CHD, specifically CMVSD and DORV. We believe these models improve understanding of the complex anatomical spatial relationships in these defects and provide additional insight for pre/intra-interventional management and surgical planning.

Cost-Effectiveness of Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation Based on Results from PROTECT AF vs. PREVAIL

PubMed Central

Freeman, James V.; Hutton, David W.; Barnes, Geoffrey D.; Zhu, Ruo P.; Owens, Douglas K.; Garber, Alan M.; Go, Alan S.; Hlatky, Mark A.; Heidenreich, Paul A.; Wang, Paul J.; Al-Ahmad, Amin; Turakhia, Mintu P.

2016-01-01

Background Randomized trials of left atrial appendage (LAA) closure with the Watchman device have shown varying results, and its cost-effectiveness compared to anticoagulation has not been evaluated using all available contemporary trial data. Methods and Results We used a Markov decision model to estimate lifetime quality-adjusted survival, costs, and cost-effectiveness of LAA closure with Watchman, compared directly with warfarin and indirectly with dabigatran, using data from the long-term (mean 3.8 year) follow-up of PROTECT AF and PREVAIL randomized trials. Using data from PROTECT AF, the incremental cost-effectiveness ratios (ICER) compared to warfarin and dabigatran were $20,486 and $23,422 per quality adjusted life year (QALY), respectively. Using data from PREVAIL, LAA closure was dominated by warfarin and dabigatran, meaning that it was less effective (8.44, 8.54, and 8.59 QALYs, respectively) and more costly. At a willingness-to-pay-threshold of $50,000 per QALY, LAA closure was cost-effective 90% and 9% of the time under PROTECT AF and PREVAIL assumptions, respectively. These results were sensitive to the rates of ischemic stroke and intracranial hemorrhage for LAA closure and medical anticoagulation. Conclusions Using data from the PROTECT AF trial, LAA closure with the Watchman device was cost-effective; using PREVAIL trial data, Watchman was more costly and less effective than warfarin and dabigatran. PROTECT AF enrolled more patients and has substantially longer follow-up time, allowing greater statistical certainty with the cost-effectiveness results. However, longer term trial results and post-marketing surveillance of major adverse events will be vital to determining the value of the Watchman in clinical practice. PMID:27307517

Hormonal regulation of floret closure of rice (Oryza sativa)

PubMed Central

Huang, Youming; Zeng, Xiaochun

2018-01-01

Plant hormones play important roles in regulating every aspect of growth, development, and metabolism of plants. We are interested in understanding hormonal regulation of floret opening and closure in plants. This is a particularly important problem for hybrid rice because regulation of flowering time is vitally important in hybrid rice seed production. However, little was known about the effects of plant hormones on rice flowering. We have shown that jasmonate and methyl jasmonate play significant roles in promoting rice floret opening. In this study, we investigated the effects of auxins including indole-3-acidic acid (IAA), indole-3-butyric acid (IBA), 1-naphthalene-acetic acid (NAA), 2,4-dichlorophenoxy acetic acid (2,4-D) and 3,6-dichloro-2-methoxybenzoic acid (DIC) and abscisic acid (ABA) on floret closure of four fertile and three sterile varieties of rice. The results from field studies in three growing seasons in 2013–2015 showed that the percentages of closed florets were significantly lower in plants treated with IAA, IBA, 2,4-D, DIC and NAA and that the durations of floret opening were significantly longer in plants treated with the same auxins. The auxins exhibited time- and concentration-dependant effects on floret closure. ABA displayed opposite effects of auxins because it increased the percentages of floret closure and decreased the length of floret opening of rice varieties. The degree of auxin-inhibiting and ABA-promoting effects on floret closure was varied somewhat but not significantly different among the rice varieties. Endogenous IAA levels were the highest in florets collected shortly before opening followed by a sharp decline in florets with maximal angles of opening and a significant jump of IAA levels shortly after floret closure in both fertile and sterile rice plants. ABA levels showed an opposite trend in the same samples. Our results showed that auxins delayed but ABA promoted the closure of rice floret regardless of the varieties. PMID:29879200

Cost-effectiveness of Ward Closure to Control Outbreaks of Norovirus Infection in United Kingdom National Health Service Hospitals.

PubMed

Sadique, Zia; Lopman, Ben; Cooper, Ben S; Edmunds, W John

2016-02-01

Norovirus is the most common cause of outbreaks of acute gastroenteritis in National Health Service hospitals in the United Kingdom. Wards (units) are often closed to new admissions to stop the spread of the virus, but there is limited evidence describing the cost-effectiveness of ward closure. An economic analysis based on the results from a large, prospective, active-surveillance study of gastroenteritis outbreaks in hospitals and from an epidemic simulation study compared alternative ward closure options evaluated at different time points since first infection, assuming different efficacies of ward closure. A total of 232 gastroenteritis outbreaks occurring in 14 hospitals over a 1-year period were analyzed. The risk of a new outbreak in a hospital is significantly associated with the number of admission, general medical, and long-stay wards that are concurrently affected but is less affected by the level of community transmission. Ward closure leads to higher costs but reduces the number of new outbreaks by 6%-56% and the number of clinical cases by 1%-55%, depending on the efficacy of the intervention. The incremental cost per outbreak averted varies from £10 000 ($14 000) to £306 000 ($428 000), and the cost per case averted varies from £500 ($700) to £61 000 ($85 000). The cost-effectiveness of ward closure decreases as the efficacy of the intervention increases, and the cost-effectiveness increases with the timing of the intervention. The efficacy of ward closure is critical from a cost-effectiveness perspective. Ward closure may be cost-effective, particularly if targeted to high-throughput units. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Waves and tides responsible for the intermittent closure of the entrance of a small, sheltered tidal wetland at San Francisco, CA

USGS Publications Warehouse

Hanes, D.M.; Ward, K.; Erikson, L.H.

2011-01-01

Crissy Field Marsh (CFM; http://www.nps.gov/prsf/planyourvisit/crissy-field-marsh-and-beach.htm) is a small, restored tidal wetland located in the entrance to San Francisco Bay just east of the Golden Gate. The marsh is small but otherwise fairly typical of many such restored wetlands worldwide. The marsh is hydraulically connected to the bay and the adjacent Pacific Ocean by a narrow sandy channel. The channel often migrates and sometimes closes completely, which effectively blocks the tidal connection to the ocean and disrupts the hydraulics and ecology of the marsh. Field measurements of waves and tides have been examined in order to evaluate the conditions responsible for the intermittent closure of the marsh entrance. The most important factor found to bring about the entrance channel closure is the occurrence of large ocean waves. However, there were also a few closure events during times with relatively small offshore waves. Examination of the deep-water directional wave spectra during these times indicates the presence of a small secondary peak corresponding to long period swell from the southern hemisphere, indicating that CFM and San Francisco Bay in general may be more susceptible to long period ocean swell emanating from the south or southwest than the more common ocean waves coming from the northwest. The tidal records during closure events show no strong relationship between closures and tides, other than that closures tend to occur during multi-day periods with successively increasing high tides. It can be inferred from these findings that the most important process to the intermittent closure of the entrance to CFM is littoral sediment transport driven by the influence of ocean swell waves breaking along the CFM shoreline at oblique angles. During periods of large, oblique waves the littoral transport of sand likely overwhelms the scour potential of the tidal flow in the entrance channel. ?? 2011.

A novel high-pressure vessel for simultaneous observations of seismic velocity and in situ CO2 distribution in a porous rock using a medical X-ray CT scanner

NASA Astrophysics Data System (ADS)

Jiang, Lanlan; Nishizawa, Osamu; Zhang, Yi; Park, Hyuck; Xue, Ziqiu

2016-12-01

Understanding the relationship between seismic wave velocity or attenuation and CO2 saturation is essential for CO2 storage in deep saline formations. In the present study, we describe a novel upright high-pressure vessel that is designed to keep a rock sample under reservoir conditions and simultaneously image the entire sample using a medical X-ray CT scanner. The pressure vessel is composed of low X-ray absorption materials: a carbon-fibre-enhanced polyetheretherketone (PEEK) cylinder and PEEK vessel closures supported by carbon-fibre-reinforced plastic (CFRP) joists. The temperature was controlled by a carbon-coated film heater and an aramid fibre thermal insulator. The assembled sample cell allows us to obtain high-resolution images of rock samples during CO2 drainage and brine imbibition under reservoir conditions. The rock sample was oriented vertical to the rotation axis of the CT scanner, and seismic wave paths were aligned parallel to the rotation axis to avoid shadows from the acoustic transducers. The reconstructed CO2 distribution images allow us to calculate the CO2 saturation in the first Fresnel zone along the ray path between transducers. A robust relationship between the seismic wave velocity or attenuation and the CO2 saturation in porous rock was obtained from experiments using this pressure vessel.

40 CFR 264.113 - Closure; time allowed for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

....113 Section 264.113 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... the final volume of hazardous wastes, or the final volume of non-hazardous wastes if the owner or...

Does centralisation of acute obstetric care reduce intrapartum and first-week mortality? An empirical study of over 1 million births in the Netherlands.

PubMed

Poeran, Jashvant; Borsboom, Gerard J J M; de Graaf, Johanna P; Birnie, Erwin; Steegers, Eric A P; Mackenbach, Johan P; Bonsel, Gouke J

2014-07-01

In this hypothetical analysis with retrospective cohort data (1,160,708 hospital births) we estimated outcome of centralisation of acute obstetric care, i.e., closure of 10 hospitals (out of 99) in The Netherlands. The main outcome was predicted intrapartum and first-week mortality (further referred to as neonatal mortality) for several subgroups of patients affected by two centralisation scenarios: (1) closure of the 10 smallest hospitals; (2) closure of the 10 smallest hospitals, but avoiding adjacent closures. Predictions followed from regression coefficients from a multilevel logistic regression model. Scenario 1 resulted in doubled travel time, and 10% increased mortality (210 [0.34%] to 231 [0.38%] cases). Scenario 2 showed less effect on mortality (268 [0.33%] to 259 [0.32%] cases) and travel time. Heterogeneity in hospital organisational features caused simultaneous improvement and deterioration of predicted neonatal mortality. Consequences vary for subgroups. We demonstrate that (in The Netherlands) centralisation of acute obstetric care according to the 'closure-of-the-smallest-rule' yields suboptimal outcomes. In order to develop an optimal strategy one would need to consider all positive and negative effects, e.g., organisational heterogeneity of closing and surviving hospitals, differential effects for patient subgroups, increased travel time, and financial aspects. The provided framework may be beneficial for other countries considering centralisation of acute obstetric care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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.

Transient left ventricular systolic dysfunction following surgical closure of large patent ductus arteriosus among children and adolescents operated at the cardiac centre, Ethiopia.

PubMed

Tilahun, Birkneh; Tefera, Endale

2013-05-31

Patent ductus arteriosus (PDA) is one of the commonest congenital heart diseases that require closure within the first few months after birth. The residential area of patients affects the size of the PDA: living in highlands, like most places in Ethiopia, is a risk for having larger sized PDA. Closure of these congenital heart defects is usually performed at an early age in places where capable centers are available. In Ethiopia, closure of these defects is done on mission basis often at an older age. Recently, limited reports came about the occurrence of postoperative left ventricular systolic dysfunction (POLVD) following closure of PDA though full explanation is still lacking. To determine the rate of and time to improvement of POLVD and the factors associated with it in children and adolescents who underwent surgical closure of PDA. All children and adolescents who underwent surgical closure of PDA at the Cardiac Center, Ethiopia (CCE) had postoperative follow up with echocardiography. Serial left ventricular ejection fraction (LVEF) and fiber shortening (FS) values were recorded for all of them. SPSS 20 was used to analyze the data. A total of 36 children and adolescents who underwent surgical closure of PDA from January 2009 to December 2012 and who fulfilled the inclusion criteria were studied. Their mean age at intervention was 8.52 years (SD = 5.23 years), 77.80% were females. The mean duct size as determined by either echocardiography or intra-operative by the surgeon was 10.31 mm (SD = 3.20 mm). They were followed for a mean duration of 24.80 months (SD = 12.36 months) following surgical closure of PDA. The mean LVEF and FS decreased from 65.06% and 35.28% preoperatively to 54.83% and 28.40% post-operatively respectively. Fifteen (42.86%) of the patients had a post-operative LVEF of less than 55%. The mean time to normalization of systolic function was 5.11 weeks (SD = 3.30 weeks). Having an associated cardiac lesion was an independent predictor of POLVD. We conclude that there is a high rate of POLVD following surgical closure of large PDA in highlanders. We recommend a serial and systematic follow up of these children postoperatively. Those with a significant cardiac dysfunction may need cardiac medications like Angiotensin Converting Enzyme Inhibitors (ACEI).

Biopsy of CT-Occult Bone Lesions Using Anatomic Landmarks for CT Guidance.

PubMed

Hillen, Travis J; Talbert, Robert J; Friedman, Michael V; Long, Jeremiah R; Jennings, Jack W; Wessell, Daniel E; Baker, Jonathan C

2017-07-01

The purpose of this study is to evaluate the histopathologic diagnostic yield, sample size, procedural time, and dose-length product (DLP) for the biopsy of CT-occult lesions found at MRI or PET or both. A retrospective review of our radiology information system for biopsies of CT-occult lesions using CT guidance from January 1, 2010, through December 31, 2014, was performed and compared with a selection of CT-guided biopsies of CT-evident bone lesions during the same period. The data were then evaluated for diagnostic yield of histopathologic diagnosis, procedural time, use of sedation medication, DLP, and size of specimens obtained. A total of 30 CT-occult biopsies met the inclusion criteria. Twenty-seven of those biopsies had results that were concordant with the patient's primary histopathologic diagnosis, imaging findings, and clinical course. In the CT-evident lesion group, concordant histopathologic abnormalities were identified in 27 of 30 patients. There was a statistically significant increase in number of samples obtained for the CT-evident lesions compared with CT-occult lesions. There was no statistically significant difference in total specimen length, DLP, number of CT scans, procedural time, or use of sedation medication between the CT-occult and CT-evident biopsy groups. Biopsy of CT-occult lesions using anatomic landmarks achieves diagnostic yields similar to those for CT-guided biopsy of CT-evident lesions.

PFO and Migraine: Is There a Role for Closure?

PubMed

Rayhill, Melissa; Burch, Rebecca

2017-03-01

Observational studies suggest that closure of a patent foramen ovale for other indications may reduce or even eliminate migraine attacks, particularly migraine with aura. The first randomized clinical trial of patent foramen ovale (PFO) closure for prevention of migraine, the MIST trial, showed negative results. The results of the other two completed studies in this area have recently been published in the last year. PRIMA and PREMIUM were also both negative for their primary endpoints. The PREMIUM trial did show a reduction in headache days in the migraine with aura subgroup but the final results of this subset analysis have not been published. There may be an as yet undetermined subgroup of patients with migraine who would benefit from closure, but slow recruitment has been a barrier to further study. Several potentially life-threatening procedure-related adverse events occurred in the clinical trials. At this time, we recommend against offering PFO closure as a preventive treatment for migraine. Based on available observational data, patients for whom PFO closure is indicated for other reasons may see some improvement in their migraines.

Effect of Live Poultry Market Closure on Avian Influenza A(H7N9) Virus Activity in Guangzhou, China, 2014

PubMed Central

Yuan, Jun; Lau, Eric H.Y.; Li, Kuibiao; Leung, Y.H. Connie; Yang, Zhicong; Xie, Caojun; Liu, Yufei; Liu, Yanhui; Ma, Xiaowei; Liu, Jianping; Li, Xiaoquan; Chen, Kuncai; Luo, Lei; Di, Biao; Cowling, Benjamin J.; Leung, Gabriel M.; Peiris, Malik

2015-01-01

We assessed the effect of closing live poultry markets in China on influenza A(H7N9) virus detection and viability. Intensive sampling was carried out before, during, and after a 2-week citywide market closure; the markets were cleaned and disinfected at the beginning of the closure period. Swab samples were collected at different sites within the markets and tested for H7N9 by real-time reverse transcription PCR and culture. During the closure, H7N9 viral RNA detection and isolation rates in retail markets decreased by 79% (95% CI 64%–88%) and 92% (95% CI 58%–98%), respectively. However, viable H7N9 virus could be cultured from wastewater samples collected up to 2 days after the market closure began. Our findings indicates that poultry workers and the general population are constantly exposed to H7N9 virus at these markets and that market closure and disinfection rapidly reduces the amount of viable virus. PMID:26402310

Comparison Of Intake Gate Closure Methods At Lower Granite, Little Goose, Lower Monumental, And Mcnary Dams Using Risk-Based Analysis

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

Gore, Bryan F.; Blackburn, Tyrone R.; Heasler, Patrick G.

2001-01-19

The objective of this report is to compare the benefits and costs of modifications proposed for intake gate closure systems at four hydroelectric stations on the Lower Snake and Upper Columbia Rivers in the Walla Walla District that are unable to meet the COE 10-minute closure rule due to the installation of fish screens. The primary benefit of the proposed modifications is to reduce the risk of damage to the station and environs when emergency intake gate closure is required. Consequently, this report presents the results and methodology of an extensive risk analysis performed to assess the reliability of powerhousemore » systems and the costs and timing of potential damages resulting from events requiring emergency intake gate closure. As part of this analysis, the level of protection provided by the nitrogen emergency closure system was also evaluated. The nitrogen system was the basis for the original recommendation to partially disable the intake gate systems. The risk analysis quantifies this protection level.« less

Evaluating the use of fibrin glue for sealing low-output enterocutaneous fistulas: study protocol for a randomized controlled trial.

PubMed

Wu, Xiuwen; Ren, Jianan; Wang, Gefei; Wang, Jianzhong; Wang, Feng; Fan, Yueping; Li, Yuanxin; Han, Gang; Zhou, Yanbing; Song, Xiaofei; Quan, Bin; Yao, Min; Li, Jieshou

2015-10-07

The management of an enterocutaneous fistula poses a significant challenge to surgeons and is often associated with a costly hospital stay and long-term discomfort. The use of fibrin glue in the fistula tract has been shown to promote closure of low output enterocutaneous fistulas. Our previous nonrandomized study demonstrated that autologous platelet-rich fibrin glue treatment significantly decreased time to fistula closure and promoted closure rates. However, there are several limitations in the study, which may lead to bias in our conclusion. Thus, a multicenter, randomized, controlled clinical trial is required. The study is designed as a randomized, open-label, three-arm, multicenter study in nine Chinese academic hospitals for evaluating the efficacy and safety of fibrin glue for sealing low-output fistulas. An established number of 171 fistula patients will undergo prospective random assignment to autologous fibrin glue, commercial porcine fibrin sealants or drainage cessation (1:1:1). The primary endpoint is fistula closure time (defined as the interval between the day of enrollment and day of fistula closure) during the 14-day treatment period. To our knowledge, this is the first study to evaluate the safety and efficacy of both autologous and commercial fibrin glue sealing for patients with low-output volume fistulas. NCT01828892 . Registration date: April 2013.

Jasmonate-mediated stomatal closure under elevated CO2 revealed by time-resolved metabolomics

USDA-ARS?s Scientific Manuscript database

Foliar stomatal movements are critical for regulating plant water status and gas exchange. Elevated carbon dioxide (CO2) concentrations are known to induce stomatal closure. However, current knowledge on CO2 signal transduction in stomatal guard cells is limited. Here we report the metabolomic respo...

Infering and Calibrating Triadic Closure in a Dynamic Network

NASA Astrophysics Data System (ADS)

Mantzaris, Alexander V.; Higham, Desmond J.

In the social sciences, the hypothesis of triadic closure contends that new links in a social contact network arise preferentially between those who currently share neighbours. Here, in a proof-of-principle study, we show how to calibrate a recently proposed evolving network model to time-dependent connectivity data. The probabilistic edge birth rate in the model contains a triadic closure term, so we are also able to assess statistically the evidence for this effect. The approach is shown to work on data generated synthetically from the model. We then apply this methodology to some real, large-scale data that records the build up of connections in a business-related social networking site, and find evidence for triadic closure.

Simulated precipitation diurnal cycles over East Asia using different CAPE-based convective closure schemes in WRF model

NASA Astrophysics Data System (ADS)

Yang, Ben; Zhou, Yang; Zhang, Yaocun; Huang, Anning; Qian, Yun; Zhang, Lujun

2018-03-01

Closure assumption in convection parameterization is critical for reasonably modeling the precipitation diurnal variation in climate models. This study evaluates the precipitation diurnal cycles over East Asia during the summer of 2008 simulated with three convective available potential energy (CAPE) based closure assumptions, i.e. CAPE-relaxing (CR), quasi-equilibrium (QE), and free-troposphere QE (FTQE) and investigates the impacts of planetary boundary layer (PBL) mixing, advection, and radiation on the simulation by using the weather research and forecasting model. The sensitivity of precipitation diurnal cycle to PBL vertical resolution is also examined. Results show that the precipitation diurnal cycles simulated with different closures all exhibit large biases over land and the simulation with FTQE closure agrees best with observation. In the simulation with QE closure, the intensified PBL mixing after sunrise is responsible for the late-morning peak of convective precipitation, while in the simulation with FTQE closure, convective precipitation is mainly controlled by advection cooling. The relative contributions of different processes to precipitation formation are functions of rainfall intensity. In the simulation with CR closure, the dynamical equilibrium in the free troposphere still can be reached, implying the complex cause-effect relationship between atmospheric motion and convection. For simulations in which total CAPE is consumed for the closures, daytime precipitation decreases with increased PBL resolution because thinner model layer produces lower convection starting layer, leading to stronger downdraft cooling and CAPE consumption. The sensitivity of the diurnal peak time of precipitation to closure assumption can also be modulated by changes in PBL vertical resolution. The results of this study help us better understand the impacts of various processes on the precipitation diurnal cycle simulation.

Nonlinear closures for scale separation in supersonic magnetohydrodynamic turbulence

NASA Astrophysics Data System (ADS)

Grete, Philipp; Vlaykov, Dimitar G.; Schmidt, Wolfram; Schleicher, Dominik R. G.; Federrath, Christoph

2015-02-01

Turbulence in compressible plasma plays a key role in many areas of astrophysics and engineering. The extreme plasma parameters in these environments, e.g. high Reynolds numbers, supersonic and super-Alfvenic flows, however, make direct numerical simulations computationally intractable even for the simplest treatment—magnetohydrodynamics (MHD). To overcome this problem one can use subgrid-scale (SGS) closures—models for the influence of unresolved, subgrid-scales on the resolved ones. In this work we propose and validate a set of constant coefficient closures for the resolved, compressible, ideal MHD equations. The SGS energies are modeled by Smagorinsky-like equilibrium closures. The turbulent stresses and the electromotive force (EMF) are described by expressions that are nonlinear in terms of large scale velocity and magnetic field gradients. To verify the closures we conduct a priori tests over 137 simulation snapshots from two different codes with varying ratios of thermal to magnetic pressure ({{β }p}=0.25,1,2.5,5,25) and sonic Mach numbers ({{M}s}=2,2.5,4). Furthermore, we make a comparison to traditional, phenomenological eddy-viscosity and α -β -γ closures. We find only mediocre performance of the kinetic eddy-viscosity and α -β -γ closures, and that the magnetic eddy-viscosity closure is poorly correlated with the simulation data. Moreover, three of five coefficients of the traditional closures exhibit a significant spread in values. In contrast, our new closures demonstrate consistently high correlations and constant coefficient values over time and over the wide range of parameters tested. Important aspects in compressible MHD turbulence such as the bi-directional energy cascade, turbulent magnetic pressure and proper alignment of the EMF are well described by our new closures.

Community-based evaluation of laparoscopic versus open simple closure of perforated peptic ulcers.

PubMed

Kuwabara, Kazuaki; Matsuda, Shinya; Fushimi, Kiyohide; Ishikawa, Koichi B; Horiguchi, Hiromasa; Fujimori, Kenji

2011-11-01

Several studies have advocated laparoscopic simple closure (LSC) as the treatment of choice for perforated peptic ulcer disease (PUD). However, there has been no comprehensive community-based evaluation of the advantages of using LSC over open simple closure (OSC). Using an administrative database, we evaluated LSC versus OSC for patients with perforated ulcers. From 6,334 patients with perforated ulcers, we identified 2,909 simple closure cases between 2006 and 2010. Study variables were demographics, mortality, co-morbidities, complications, ulcer location, surgical timing, blood transfusion, postoperative ventilation, operating room (OR) time, time to resumption of oral food intake, length of stay (LOS), and total charges. After matching patient baseline variables between OSC and LSC, we performed multivariate analyses to assess the impacts of LSC on mortality, complications, and ventilation administration. A total of 2,073 OSC cases and 836 LSC cases were identified in 670 hospitals. Younger age, duodenal ulcer, and pre-existing PUD were indicators for selection of LSC. Matching analysis indicated a correlation between LSC and lower mortality, less frequent postoperative and overall blood transfusion, shorter LOS, earlier return to oral intake, and longer OR time. There was no difference between OSC and LSC in complication rate or mortality. Longer OR time was correlated with a higher complication rate and the need for ventilation, the latter of which was independently associated with an increase in mortality. Because longer OR time was associated with more frequent complications and ventilation, surgeons should obtain the skills and strategies necessary to accomplish LSC without extending OR time improperly.

No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomical lung resection

PubMed Central

Zakkar, Mustafa; Kanagasabay, Robin; Hunt, Ian

2014-01-01

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether manual closure of the bronchial stump is safer with lower failure rates than mechanical closure using a stapling device following anatomical lung resection. One hundred and twenty-nine papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question as they included sufficient number of patients to reach conclusions regarding the issues of interest for this review. Complications, complication rates and operation time were included in the assessment. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. When looking at manual vs mechanical staples, it was noted that stapler failure can occur in around 4% of cases. The rate of bronchopleural fistula (BPF) development varied more in patients who underwent manual closure (1.5–12.5%) than in patients who underwent mechanical closure (1–5.7%). Although most of the studies reviewed showed no statistical differences between manual and mechanical closure in terms of BPF development, one study, however, showed that manual closure was significantly associated with lower numbers of postoperative BPF, while another study showed that mechanical closure is significantly associated with lower incidence of BPF. When looking at the role of the learning curve and training opportunities, it seems that the surgeon's inexperience when using mechanical staples can contribute to BPF development. A surgeon's experience can play a major role in the prevention of BPF development in patients having manual closure. Manual closure can provide a cheap and reliable technique when compared with costs incurred from using staplers, it is applicable in all situations and can be taught to surgeons in training with an acceptable risk. However, there is a lack of evidence to suggest that manual closure is better than mechanical stapler closure following anatomical lung resection. PMID:24351508

Failure of mesenteric defect closure after Roux-en-Y gastric bypass.

PubMed

Hope, William W; Sing, Ronald F; Chen, Albert Y; Lincourt, Amy E; Gersin, Keith S; Kuwada, Timothy S; Heniford, B Todd

2010-01-01

Bowel obstructions following Roux-en-Y gastric bypass (RYGB) are a significant issue often caused by internal herniation. Controversy continues as to whether mesenteric defect closure is necessary to decrease the incidence of internal hernias after RYGB. Our purpose was to evaluate the effectiveness of closing the mesenteric defect at the jejunojejunostomy in patients who underwent RYGB by examining this potential space at reoperation for any reason. We retrospectively reviewed medical records of patients undergoing surgery after RYGB from August 1999 to October 2008 to determine the status of the mesentery at the jejunojejunostomy. Eighteen patients underwent surgery 2 to 19 months after open (n=8) or laparoscopic (n=10) RYGB. All patients had documented suture closure of their jejunojejunostomy at the time of RYGB. Permanent (n=12) or absorbable (n=6) sutures were used for closures. Patients lost 23.6 kg to 62.1 kg before a reoperation was required for a ventral hernia (n=8), cholecystectomy (n=4), abdominal pain (n=4), or small bowel obstruction (n=2). Fifteen of the 18 patients had open mesenteric defects at the jejunojejunostomy despite previous closure; none were the cause for reoperation. Routine suture closure of mesenteric defects after RYGB may not be an effective permanent closure likely due to the extensive fat loss and weight loss within the mesentery.

Effective school actions for mitigating seasonal influenza outbreaks in Niigata, Japan.

PubMed

Sugisaki, Koshu; Seki, Nao; Tanabe, Naohito; Saito, Reiko; Sasaki, Asami; Sasaki, Satoshi; Suzuki, Hiroshi

2013-01-01

Japan has implemented various school actions during seasonal influenza outbreaks since the 1950's under the School Health Law. However, the effective duration, extent, and timing of closures remain unresolved. We conducted a retrospective study on the relationship between elementary class closures and influenza outbreak control during four consecutive influenza seasons from the 2004-2005 to 2007-2008 school years in Joetsu, Niigata, Japan. Among a total of 1,061 classes of 72 schools, 624 cases of influenza outbreaks were documented among 61 schools. Class closures were carried out in a total of 62 cases in response to influenza outbreak, which was defined as a student absentee rate of greater than 10% due to influenza or influenza-like illness. Of these cases, two-day class closures were conducted the day after reaching a 10% student absentee rate in 28 cases and other types of closures were initiated in 34 cases. A markedly higher number of outbreak cases ended within one week for two-day class closures compared to the other types of closures (82.1% vs. 20.6%, respectively). The significant association between two-day class closures and interruption of an outbreak within one week was confirmed using a multivariable model adjusted for the season, grade, day of the week of an outbreak start, and absentee rate on the day of an outbreak start (OR, 3.18; 95% CI, 1.12-9.07; p = 0.030). Our results suggest that a two-day class closure carried out the day after reaching a 10% absentee rate is an effective approach for mitigating influenza outbreaks in elementary schools.

Variation in the schedules of somite and neural development in frogs

PubMed Central

Sáenz-Ponce, Natalia; Mitgutsch, Christian; del Pino, Eugenia M.

2012-01-01

The timing of notochord, somite, and neural development was analyzed in the embryos of six different frog species, which have been divided into two groups, according to their developmental speed. Rapid developing species investigated were Xenopus laevis (Pipidae), Engystomops coloradorum, and Engystomops randi (Leiuperidae). The slow developers were Epipedobates machalilla and Epipedobates tricolor (Dendrobatidae) and Gastrotheca riobambae (Hemiphractidae). Blastopore closure, notochord formation, somite development, neural tube closure, and the formation of cranial neural crest cell-streams were detected by light and scanning electron microscopy and by immuno-histochemical detection of somite and neural crest marker proteins. The data were analyzed using event pairing to determine common developmental aspects and their relationship to life-history traits. In embryos of rapidly developing frogs, elongation of the notochord occurred earlier relative to the time point of blastopore closure in comparison with slowly developing species. The development of cranial neural crest cell-streams relative to somite formation is accelerated in rapidly developing frogs, and it is delayed in slowly developing frogs. The timing of neural tube closure seemed to be temporally uncoupled with somite formation. We propose that these changes are achieved through differential timing of developmental modules that begin with the elongation of the notochord during gastrulation in the rapidly developing species. The differences might be related to the necessity of developing a free-living tadpole quickly in rapid developers. PMID:23184997

Leg ulcer treatment outcomes with new ovine collagen extracellular matrix dressing: a retrospective case series.

PubMed

Bohn, Gregory A; Gass, Kimberly

2014-10-01

The purpose of this study was to describe the rate of closure observed in venous leg ulcers during treatment with ovine collagen extracellular matrix dressings and compression. Fourteen patients with 23 wounds were retrospectively evaluated with respect to healing rates, time to closure, and weekly facility charge fees.

76 FR 49664 - Drawbridge Operation Regulation; Beaufort Channel, Beaufort, NC

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-11

... for emergencies. This closure has been an annual closure for the past several years therefore there are no traffic logs with past openings for this time of year. Most of the vessel traffic consists of... Friday, except Federal holidays. FOR FURTHER INFORMATION CONTACT: If you have questions on this rule...

50 CFR 679.22 - Closures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 11 2011-10-01 2011-10-01 false Closures. 679.22 Section 679.22 Wildlife... any fishing year, vessels with a Federal fisheries permit under § 679.4 are prohibited in that part of... Conservation Zone. Trawling is prohibited at all times in the area defined in Figure 10 to this part as the...

50 CFR 635.28 - Closures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... been allocated a portion of the Purse Seine category quota under § 635.27(a)(4) may fish for BFT. Such vessel may be used to fish for yellowfin, bigeye, albacore, or skipjack tuna at any time, however... closure, NMFS will also take into consideration the criteria specified in § 635.27(a)(8). (b) Sharks. (1...

50 CFR 635.28 - Closures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... been allocated a portion of the Purse Seine category quota under § 635.27(a)(4) may fish for BFT. Such vessel may be used to fish for yellowfin, bigeye, albacore, or skipjack tuna at any time, however... closure, NMFS will also take into consideration the criteria specified in § 635.27(a)(8). (b) Sharks. (1...

Optimization and large scale computation of an entropy-based moment closure

NASA Astrophysics Data System (ADS)

Kristopher Garrett, C.; Hauck, Cory; Hill, Judith

2015-12-01

We present computational advances and results in the implementation of an entropy-based moment closure, MN, in the context of linear kinetic equations, with an emphasis on heterogeneous and large-scale computing platforms. Entropy-based closures are known in several cases to yield more accurate results than closures based on standard spectral approximations, such as PN, but the computational cost is generally much higher and often prohibitive. Several optimizations are introduced to improve the performance of entropy-based algorithms over previous implementations. These optimizations include the use of GPU acceleration and the exploitation of the mathematical properties of spherical harmonics, which are used as test functions in the moment formulation. To test the emerging high-performance computing paradigm of communication bound simulations, we present timing results at the largest computational scales currently available. These results show, in particular, load balancing issues in scaling the MN algorithm that do not appear for the PN algorithm. We also observe that in weak scaling tests, the ratio in time to solution of MN to PN decreases.

Acute effects of aircraft noise on cardiovascular admissions - an interrupted time-series analysis of a six-day closure of London Heathrow Airport caused by volcanic ash.

PubMed

Pearson, Tim; Campbell, Michael J; Maheswaran, Ravi

2016-08-01

Acute noise exposure may acutely increase blood pressure but the hypothesis that acute exposure to aircraft noise may trigger cardiovascular events has not been investigated. This study took advantage of a six-day closure of a major airport in April 2010 caused by volcanic ash to examine if there was a decrease in emergency cardiovascular hospital admissions during or immediately after the closure period, using an interrupted daily time-series study design. The population living within the 55dB(A) noise contour was substantial at 0.7 million. The average daily admission count was 13.9 (SD 4.4). After adjustment for covariates, there was no evidence of a decreased risk of hospital admission from cardiovascular disease during the closure period (relative risk 0.97 (95% CI 0.75-1.26)). Using lags of 1-7 days gave similar results. Further studies are needed to investigate if transient aircraft noise exposure can trigger acute cardiovascular events. Copyright © 2016. Published by Elsevier Ltd.

Optimization and large scale computation of an entropy-based moment closure

DOE PAGES

Hauck, Cory D.; Hill, Judith C.; Garrett, C. Kristopher

2015-09-10

We present computational advances and results in the implementation of an entropy-based moment closure, M N, in the context of linear kinetic equations, with an emphasis on heterogeneous and large-scale computing platforms. Entropy-based closures are known in several cases to yield more accurate results than closures based on standard spectral approximations, such as P N, but the computational cost is generally much higher and often prohibitive. Several optimizations are introduced to improve the performance of entropy-based algorithms over previous implementations. These optimizations include the use of GPU acceleration and the exploitation of the mathematical properties of spherical harmonics, which aremore » used as test functions in the moment formulation. To test the emerging high-performance computing paradigm of communication bound simulations, we present timing results at the largest computational scales currently available. Lastly, these results show, in particular, load balancing issues in scaling the M N algorithm that do not appear for the P N algorithm. We also observe that in weak scaling tests, the ratio in time to solution of M N to P N decreases.« less

New suturing technique for robotic-assisted vaginal cuff closure during single-site hysterectomy.

PubMed

Shin, So-Jin; Chung, Hyewon; Kwon, Sang-Hoon; Cha, Soon-Do; Cho, Chi-Heum

2017-06-01

To describe a simple and efficient technique for suturing the vaginal cuff in robotic-assisted single-site hysterectomy using barbed suture and a straight needle. Consecutive patients undergoing robotic-assisted single-site hysterectomy from February 2014 to August 2015 at Dong San Hospital, Keimyung University were included. Surgeons used two barbed sutures in a running fashion to close the vaginal cuff. A barbed suture was exclusively used with a straightened needle in upward direction from posterior vaginal cuff to anterior vaginal cuff which played a pivotal role for closure. A total of 100 patients underwent robotic-assisted single-site hysterectomy. The total operation time was 132.5 min and vaginal cuff closure time was 12.0 min. There were no postoperative complications; vaginal cuff dehiscence, vaginal cuff infection, and vaginal bleeding that require surgical intervention or admission. The use of barbed suture with straightened needle to close the vaginal cuff in robotic-assisted single-site hysterectomy is easy to perform and demonstrates safety and efficacy. This technique offers secure, fast, and effective incision closure.

Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes

PubMed Central

Bamigboye, Anthony A; Hofmeyr, G Justus

2014-01-01

Background Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal layers at caesarean section may or may not confer benefit, hence the need to evaluate whether this step should be omitted or routinely performed. Objectives The objective of this review was to assess the effects of non-closure as an alternative to closure of the peritoneum at caesarean section on intraoperative and immediate- and long-term postoperative outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (1 November 2013). Selection criteria Randomised controlled trials comparing leaving the visceral or parietal peritoneum, or both, unsutured at caesarean section with a technique which involves suturing the peritoneum in women undergoing elective or emergency caesarean section. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked it for accuracy. Main results A total of 29 trials were included in this review and 21 trials (17,276 women) provided data that could be included in an analysis. The quality of the trials was variable. 1. Non-closure of visceral and parietal peritoneum versus closure of both parietal layers Sixteen trials involving 15,480 women, were included and analysed, when both parietal peritoneum was left unclosed versus when both peritoneal surfaces were closed. Postoperative adhesion formation was assessed in only four trials with 282 women, and no difference was found between groups (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.76 to 1.29). There was significant reduction in the operative time (mean difference (MD) -5.81 minutes, 95% CI -7.68 to -3.93). The duration of hospital stay in a total of 13 trials involving 14,906 women, was also reduced (MD -0.26, 95% CI -0.47 to -0.05) days. In a trial involving 112 women, reduced chronic pelvic pain was found in the peritoneal non-closure group. 2. Non-closure of visceral peritoneum only versus closure of both peritoneal surfaces Three trials involving 889 women were analysed. There was an increase in adhesion formation (two trials involving 157 women, RR 2.49, 95% CI 1.49 to 4.16) which was limited to one trial with high risk of bias.There was reduction in operative time, postoperative days in hospital and wound infection. There was no significant reduction in postoperative pyrexia. 3. Non-closure of parietal peritoneum only versus closure of both peritoneal layers The two identified trials involved 573 women. Neither study reported on postoperative adhesion formation. There was reduction in operative time and postoperative pain with no difference in the incidence of postoperative pyrexia, endometritis, postoperative duration of hospital stay and wound infection. In only one study, postoperative day one wound pain assessed by the numerical rating scale, (MD -1.60, 95% CI -1.97 to -1.23) and chronic abdominal pain d by the visual analogue score (MD -1.10, 95% CI -1.39 to -0.81) was reduced in the non-closure group. 4. Non-closure versus closure of visceral peritoneum when parietal peritoneum is closed There was reduction in all the major urinary symptoms of frequency, urgency and stress incontinence when the visceral peritoneum is left unsutured. Authors’ conclusions There was a reduction in operative time across all the subgroups. There was also a reduction in the period of hospitalisation postcaesarean section except in the subgroup where parietal peritoneum only was not sutured where there was no difference in the period of hospitalisation. The evidence on adhesion formation was limited and inconsistent. There is currently insufficient evidence of benefit to justify the additional time and use of suture material necessary for peritoneal closure. More robust evidence on long-term pain, adhesion formation and infertility is needed. Plain Language Summary Closure versus non-closure of the peritoneum at caesarean section: long- and short-term outcome Not stitching the peritoneum after caesarean section takes less theatre time and therefore has less cost, but information on possible long-term disadvantages are limited. There are many ways of performing a caesarean section and the techniques used depend on a number factors including the clinical situation and the preference of the operator. The peritoneum is a thin membrane of cells supported by a thin layer of connective tissue, and during caesarean section these peritoneal surfaces have to be cut through in order to reach the uterus and for the baby to be born. Following a caesarean section, it has been standard practice to close the peritoneum by stitching (suturing) the two layers of tissue that line the abdomen and cover the internal organs, to restore the anatomy. It has however been suggested that peritoneal adhesions may be more likely rather than less likely when the peritoneum is sutured, possibly as a result of a tissue reaction to the suture material. This review of trials sought to address whether to routinely suture these thin layers of tissue or not after delivering a baby by caesarean section. Twenty-nine randomised controlled trials were identified, with differences in their methodological quality; 21 trials involving over 17,000 women contributing data to the review. Several minutes were saved when the peritoneum was not stitched, and with a shorter period of hospital stay in most of the women. Postoperative adhesion formation was assessed in only four trials with 282 women, and no difference was found when leaving both layers of peritoneumunclosed was compared with closure of both. Longer-term outcomes were not adequately assessed, particularly adhesion formation, subfertility and ease of other surgeries in later life. Although the methodological quality of trials was variable, the results were in general consistent between the trials of better and poorer quality. Further studies are needed to further assess all these outcomes. PMID:25110856

Life Support System Technologies for NASA Exploration Missions

NASA Technical Reports Server (NTRS)

Ewert, Michael K.

2007-01-01

The Lunar Mars Life Support Test series successfully demonstrated integration and operation of advanced technologies for closed-loop life support systems, including physicochemical and biological subsystems. Increased closure was obtained when targeted technologies, such as brine dewatering subsystems, were added to further process life support system byproducts to recover resources. Physicochemical and biological systems can be integrated satisfactorily to achieve desired levels of closure. Imbalances between system components, such as differences in metabolic quotients between human crews and plants, must be addressed. Each subsystem or component that is added to increase closure will likely have added costs, ranging from initial launch mass, power, thermal, crew time, byproducts, etc., that must be factored into break even analysis. Achieving life support system closure while maintaining control of total mass and system complexity will be a challenge.

Experimental Evaluation of a Deformable Registration Algorithm for Motion Correction in PET-CT Guided Biopsy.

PubMed

Khare, Rahul; Sala, Guillaume; Kinahan, Paul; Esposito, Giuseppe; Banovac, Filip; Cleary, Kevin; Enquobahrie, Andinet

2013-01-01

Positron emission tomography computed tomography (PET-CT) images are increasingly being used for guidance during percutaneous biopsy. However, due to the physics of image acquisition, PET-CT images are susceptible to problems due to respiratory and cardiac motion, leading to inaccurate tumor localization, shape distortion, and attenuation correction. To address these problems, we present a method for motion correction that relies on respiratory gated CT images aligned using a deformable registration algorithm. In this work, we use two deformable registration algorithms and two optimization approaches for registering the CT images obtained over the respiratory cycle. The two algorithms are the BSpline and the symmetric forces Demons registration. In the first optmization approach, CT images at each time point are registered to a single reference time point. In the second approach, deformation maps are obtained to align each CT time point with its adjacent time point. These deformations are then composed to find the deformation with respect to a reference time point. We evaluate these two algorithms and optimization approaches using respiratory gated CT images obtained from 7 patients. Our results show that overall the BSpline registration algorithm with the reference optimization approach gives the best results.

The Relationship of Financial Pressures and Community Characteristics to Closure of Private Safety Net Clinics.

PubMed

Li, Suhui; Dor, Avi; Pines, Jesse M; Zocchi, Mark S; Hsia, Renee Y

2016-10-01

In order to better understand what threatens vulnerable populations' access to primary care, it is important to understand the factors associated with closing safety net clinics. This article examines how a clinic's financial position, productivity, and community characteristics are associated with its risk of closure. We examine patterns of closures among private-run primary care clinics (PCCs) in California between 2006 and 2012. We use a discrete-time proportional hazard model to assess relative hazard ratios of covariates, and a random-effect hazard model to adjust for unobserved heterogeneity among PCCs. We find that lower net income from patient care, smaller amount of government grants, and lower productivity were associated with significantly higher risk of PCC closure. We also find that federally qualified health centers and nonfederally qualified health centers generally faced the same risk factors of closure. These results underscore the critical role of financial incentives in the long-term viability of safety net clinics. © The Author(s) 2015.

Probabilistic density function method for nonlinear dynamical systems driven by colored noise.

PubMed

Barajas-Solano, David A; Tartakovsky, Alexandre M

2016-05-01

We present a probability density function (PDF) method for a system of nonlinear stochastic ordinary differential equations driven by colored noise. The method provides an integrodifferential equation for the temporal evolution of the joint PDF of the system's state, which we close by means of a modified large-eddy-diffusivity (LED) closure. In contrast to the classical LED closure, the proposed closure accounts for advective transport of the PDF in the approximate temporal deconvolution of the integrodifferential equation. In addition, we introduce the generalized local linearization approximation for deriving a computable PDF equation in the form of a second-order partial differential equation. We demonstrate that the proposed closure and localization accurately describe the dynamics of the PDF in phase space for systems driven by noise with arbitrary autocorrelation time. We apply the proposed PDF method to analyze a set of Kramers equations driven by exponentially autocorrelated Gaussian colored noise to study nonlinear oscillators and the dynamics and stability of a power grid. Numerical experiments show the PDF method is accurate when the noise autocorrelation time is either much shorter or longer than the system's relaxation time, while the accuracy decreases as the ratio of the two timescales approaches unity. Similarly, the PDF method accuracy decreases with increasing standard deviation of the noise.

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.

Bayesian Divergence-Time Estimation with Genome-Wide SNP Data of Sea Catfishes (Ariidae) Supports Miocene Closure of the Panamanian Isthmus.

PubMed

Stange, Madlen; Sánchez-Villagra, Marcelo R; Salzburger, Walter; Matschiner, Michael

2018-01-27

The closure of the Isthmus of Panama has long been considered to be one of the best defined biogeographic calibration points for molecular divergence-time estimation. However, geological and biological evidence has recently cast doubt on the presumed timing of the initial isthmus closure around 3 Ma but has instead suggested the existence of temporary land bridges as early as the Middle or Late Miocene. The biological evidence supporting these earlier land bridges was based either on only few molecular markers or on concatenation of genome-wide sequence data, an approach that is known to result in potentially misleading branch lengths and divergence times, which could compromise the reliability of this evidence. To allow divergence-time estimation with genomic data using the more appropriate multi-species coalescent model, we here develop a new method combining the SNP-based Bayesian species-tree inference of the software SNAPP with a molecular clock model that can be calibrated with fossil or biogeographic constraints. We validate our approach with simulations and use our method to reanalyze genomic data of Neotropical army ants (Dorylinae) that previously supported divergence times of Central and South American populations before the isthmus closure around 3 Ma. Our reanalysis with the multi-species coalescent model shifts all of these divergence times to ages younger than 3 Ma, suggesting that the older estimates supporting the earlier existence of temporary land bridges were artifacts resulting at least partially from the use of concatenation. We then apply our method to a new RAD-sequencing data set of Neotropical sea catfishes (Ariidae) and calibrate their species tree with extensive information from the fossil record. We identify a series of divergences between groups of Caribbean and Pacific sea catfishes around 10 Ma, indicating that processes related to the emergence of the isthmus led to vicariant speciation already in the Late Miocene, millions of years before the final isthmus closure. © The Author(s) 2018. Published by Oxford University Press, on behalf of the Society of Systematic Biologists.

Complete closure of artificial gastric ulcer after endoscopic submucosal dissection by combined use of a single over-the-scope clip and through-the-scope clips (with videos).

PubMed

Maekawa, Satoshi; Nomura, Ryosuke; Murase, Takayuki; Ann, Yasuyoshi; Harada, Masaru

2015-02-01

A 5-7 day hospital stay is usually needed after endoscopic submucosal dissection (ESD) of gastric tumor because of the possibility of delayed perforation or bleeding. The aim of this study was to evaluate the efficacy of combined use of a single over-the-scope clip (OTSC) and through-the-scope clips (TTSCs) to achieve complete closure of artificial gastric ulcer after ESD. We prospectively studied 12 patients with early gastric cancer or gastric adenoma. We performed complete closure of post-ESD artificial gastric ulcer using a combination of a single OTSC and TTSCs. Mean size of post-ESD artificial ulcer was 54.6 mm. The mean operating time for the closure procedure was 15.2 min., and the success rate was 91.7 % (11/12). Patients who underwent complete closure of post-ESD artificial gastric ulcer could be discharged the day after ESD and the closing procedure. Complete closure of post-ESD artificial gastric ulcer using a combination of a single OTSC and TTSCs is useful for shortening the period of hospitalization and reducing treatment cost.

[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.

A statistical analysis of the dependency of closure assumptions in cumulus parameterization on the horizontal resolution

NASA Technical Reports Server (NTRS)

Xu, Kuan-Man

1994-01-01

Simulated data from the UCLA cumulus ensemble model are used to investigate the quasi-universal validity of closure assumptions used in existing cumulus parameterizations. A closure assumption is quasi-universally valid if it is sensitive neither to convective cloud regimes nor to horizontal resolutions of large-scale/mesoscale models. The dependency of three types of closure assumptions, as classified by Arakawa and Chen, on the horizontal resolution is addressed in this study. Type I is the constraint on the coupling of the time tendencies of large-scale temperature and water vapor mixing ratio. Type II is the constraint on the coupling of cumulus heating and cumulus drying. Type III is a direct constraint on the intensity of a cumulus ensemble. The macroscopic behavior of simulated cumulus convection is first compared with the observed behavior in view of Type I and Type II closure assumptions using 'quick-look' and canonical correlation analyses. It is found that they are statistically similar to each other. The three types of closure assumptions are further examined with simulated data averaged over selected subdomain sizes ranging from 64 to 512 km. It is found that the dependency of Type I and Type II closure assumptions on the horizontal resolution is very weak and that Type III closure assumption is somewhat dependent upon the horizontal resolution. The influences of convective and mesoscale processes on the closure assumptions are also addressed by comparing the structures of canonical components with the corresponding vertical profiles in the convective and stratiform regions of cumulus ensembles analyzed directly from simulated data. The implication of these results for cumulus parameterization is discussed.

Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy - a systematic review.

PubMed

Acosta, Stefan; Björck, Martin; Petersson, Ulf

2017-01-01

The aim of this paper was to review the literature on vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in open abdomen therapy. It was designed as systematic review of observational studies. A Pub Med, EMBASE and Cochrane search from 2007/01-2016/07 was performed combining the Medical Subject Headings "vacuum", "mesh-mediated fascial traction", "temporary abdominal closure", "delayed abdominal closure", "open abdomen", "abdominal compartment syndrome", "negative pressure wound therapy" or "vacuum assisted wound closure". Eleven original studies were found including patients numbering from 7 to 111. Six studies were prospective and five were retrospective. Nine studies were on mixed surgical (n = 9), vascular (n = 6) and trauma (n = 6) patients, while two were exclusively on vascular patients. The primary fascial closure rate per protocol varied from 80-100%. The time to closure of the open abdomen varied between 9-32 days. The entero-atmospheric fistula rate varied from 0-10.0%. The in-hospital survival rate varied from 57-100%. In the largest prospective study, the incisional hernia rate among survivors at 63 months of median follow-up was 54% (27/50), and 16 (33%) repairs out of 48 incisional hernias were performed throughout the study period. The study patients reported lower short form health survey (SF-36) scores than the mean reference population, mainly dependent on the prevalence of major co-morbidities. There was no difference in SF-36 scores or a modified ventral hernia pain questionnaire (VHPQ) at 5 years of follow up between those with versus those without incisional hernias. A high primary fascial closure rate can be achieved with the vacuum-assisted wound closure and meshmediated fascial traction technique in elderly, mainly non-trauma patients, in need of prolonged open abdomen therapy.

Concomitant surgical closure of left atrial appendage: A systematic review and meta-analysis.

PubMed

Ando, Masahiko; Funamoto, Masaki; Cameron, Duke E; Sundt, Thoralf M

2018-03-12

Although percutaneous closure of the left atrial appendage is supported as a potential alternative to lifelong anticoagulation in patients with atrial fibrillation, comprehensive evidence on surgical left atrial appendage closure in heart surgery is limited. We conducted a meta-analysis of studies comparing patients who underwent open cardiac surgery with or without left atrial appendage closure. A literature search was performed on PubMed, Embase, and Cochrane Trials databases. Outcomes of interest were 30-day/in-hospital mortality and cerebrovascular accident. I 2 statistics were used to evaluate heterogeneity, and publication bias was evaluated by Begg's and Egger's tests. We reviewed 1284 articles and selected for main analysis 7 articles including 3897 patients (1963 in the left atrial appendage closure group and 1934 in the non-left atrial appendage closure group). Among the 7 studies, 3 were randomized-controlled studies, 3 were propensity-matched studies, and 1 was a case-matching study. At 30-day/in-hospital follow-up, left atrial appendage closure was significantly associated with decreased risk of mortality and cerebrovascular accident (odds ratio, 0.384, 95% confidence interval, 0.233-0.631 for mortality, and odds ratio, 0.622, 95% confidence interval, 0.388-0.998 for cerebrovascular accident). Stratified analysis demonstrated that this association was more prominent in preoperative atrial fibrillation strata. Concomitant surgical left atrial appendage closure should be considered at the time of open cardiac surgery, particularly among those in atrial fibrillation preoperatively. The benefit of left atrial appendage closure for patients not in atrial fibrillation and for those undergoing nonvalvular surgery is still unclear. Further prospective investigations are indicated. Copyright © 2018. Published by Elsevier Inc.

Pre/post-closure assessment of groundwater pharmaceutical fate in a wastewater-facility-impacted stream reach.

PubMed

Bradley, Paul M; Barber, Larry B; Clark, Jimmy M; Duris, Joseph W; Foreman, William T; Furlong, Edward T; Givens, Carrie E; Hubbard, Laura E; Hutchinson, Kasey J; Journey, Celeste A; Keefe, Steffanie H; Kolpin, Dana W

2016-10-15

Pharmaceutical contamination of contiguous groundwater is a substantial concern in wastewater-impacted streams, due to ubiquity in effluent, high aqueous mobility, designed bioactivity, and to effluent-driven hydraulic gradients. Wastewater treatment facility (WWTF) closures are rare environmental remediation events; offering unique insights into contaminant persistence, long-term wastewater impacts, and ecosystem recovery processes. The USGS conducted a combined pre/post-closure groundwater assessment adjacent to an effluent-impacted reach of Fourmile Creek, Ankeny, Iowa, USA. Higher surface-water concentrations, consistent surface-water to groundwater concentration gradients, and sustained groundwater detections tens of meters from the stream bank demonstrated the importance of WWTF effluent as the source of groundwater pharmaceuticals as well as the persistence of these contaminants under effluent-driven, pre-closure conditions. The number of analytes (110 total) detected in surface water decreased from 69 prior to closure down to 8 in the first post-closure sampling event approximately 30 d later, with a corresponding 2 order of magnitude decrease in the cumulative concentration of detected analytes. Post-closure cumulative concentrations of detected analytes were approximately 5 times higher in proximal groundwater than in surface water. About 40% of the 21 contaminants detected in a downstream groundwater transect immediately before WWTF closure exhibited rapid attenuation with estimated half-lives on the order of a few days; however, a comparable number exhibited no consistent attenuation during the year-long post-closure assessment. The results demonstrate the potential for effluent-impacted shallow groundwater systems to accumulate pharmaceutical contaminants and serve as long-term residual sources, further increasing the risk of adverse ecological effects in groundwater and the near-stream ecosystem. Published by Elsevier B.V.

Pre/post-closure assessment of groundwater pharmaceutical fate in a wastewater‑facility-impacted stream reach

USGS Publications Warehouse

Bradley, Paul M.; Barber, Larry B.; Clark, Jimmy M.; Duris, Joseph W.; Foreman, William T.; Furlong, Edward T.; Givens, Carrie E.; Hubbard, Laura E.; Hutchinson, Kasey J.; Journey, Celeste A.; Keefe, Steffanie H.; Kolpin, Dana W.

2016-01-01

Pharmaceutical contamination of contiguous groundwater is a substantial concern in wastewater-impacted streams, due to ubiquity in effluent, high aqueous mobility, designed bioactivity, and to effluent-driven hydraulic gradients. Wastewater treatment facility (WWTF) closures are rare environmental remediation events; offering unique insights into contaminant persistence, long-term wastewater impacts, and ecosystem recovery processes. The USGS conducted a combined pre/post-closure groundwater assessment adjacent to an effluent-impacted reach of Fourmile Creek, Ankeny, Iowa, USA. Higher surface-water concentrations, consistent surface-water to groundwater concentration gradients, and sustained groundwater detections tens of meters from the stream bank demonstrated the importance of WWTF effluent as the source of groundwater pharmaceuticals as well as the persistence of these contaminants under effluent-driven, pre-closure conditions. The number of analytes (110 total) detected in surface water decreased from 69 prior to closure down to 8 in the first post-closure sampling event approximately 30 d later, with a corresponding 2 order of magnitude decrease in the cumulative concentration of detected analytes. Post-closure cumulative concentrations of detected analytes were approximately 5 times higher in proximal groundwater than in surface water. About 40% of the 21 contaminants detected in a downstream groundwater transect immediately before WWTF closure exhibited rapid attenuation with estimated half-lives on the order of a few days; however, a comparable number exhibited no consistent attenuation during the year-long post-closure assessment. The results demonstrate the potential for effluent-impacted shallow groundwater systems to accumulate pharmaceutical contaminants and serve as long-term residual sources, further increasing the risk of adverse ecological effects in groundwater and the near-stream ecosystem.

Factors affecting successful closure of hemodynamically significant patent ductus arteriosus with indomethacin in extremely low birth weight infants.

PubMed

Yang, Chuan-Zhong; Lee, Jiun

2008-05-01

The incidence of patent ductus arteriosus (PDA) is high in extremely low birth weight (ELBW) infants. Indomethacin has been widely used in the prophylaxis and treatment of hemodynamically significant PDA. This retrospective study was undertaken to identify factors such as birth weight, gestational age, gender, fetal growth retardation, ductal size, timing of the first dose of indomethacin and side effects of indomethacin, which may affect the successful closure of the PDA with indomethacin in ELBW infants. A cohort of 139 ELBW infants who had received indomethacin treatment for PDA during a consecutive period of more than three years (September 2000 to December 2003) was retrospectively analyzed. Administration of indomethacin was associated with closure of PDA in 108 (77.7%) of 139 ELBW infants, and only 19.4% of infants required surgical ligation of the ductus eventually. There was no significant relationship between closure of PDA with gestational age, gender, fetal growth retardation, and ductal size. A higher birth weight and early use of indomethacin after birth could significantly increase the closure rate of PDA (P<0.05). Side effects of indomethacin such as transient oliguria and hyponatremia during indomethacin therapy did not affect PDA closure. Indomethacin is effective for the treatment of PDA in ELBW infants. A higher rate of ductal closure is related to the increase of birth weight. PDA closure with indomethacin is age-related, and early administration of indomethacin could increase PDA closure and reduce the incidence of hyponatremia. There is no significant difference in major morbidities such as bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and retinopathy of prematurity (ROP) after early treatment. Early screening for hemodynamically significant PDA in ELBW infants and early treatment with indomethacin are recommended.

The closure problem for turbulence in meteorology and oceanography

NASA Technical Reports Server (NTRS)

Pierson, W. J., Jr.

1985-01-01

The dependent variables used for computer based meteorological predictions and in plans for oceanographic predictions are wave number and frequency filtered values that retain only scales resolvable by the model. Scales unresolvable by the grid in use become 'turbulence'. Whether or not properly processed data are used for initial values is important, especially for sparce data. Fickian diffusion with a constant eddy diffusion is used as a closure for many of the present models. A physically realistic closure based on more modern turbulence concepts, especially one with a reverse cascade at the right times and places, could help improve predictions.

Transient left ventricular systolic dysfunction following surgical closure of large patent ductus arteriosus among children and adolescents operated at the cardiac centre, Ethiopia

PubMed Central

2013-01-01

Background Patent ductus arteriosus (PDA) is one of the commonest congenital heart diseases that require closure within the first few months after birth. The residential area of patients affects the size of the PDA: living in highlands, like most places in Ethiopia, is a risk for having larger sized PDA. Closure of these congenital heart defects is usually performed at an early age in places where capable centers are available. In Ethiopia, closure of these defects is done on mission basis often at an older age. Recently, limited reports came about the occurrence of postoperative left ventricular systolic dysfunction (POLVD) following closure of PDA though full explanation is still lacking. Objective To determine the rate of and time to improvement of POLVD and the factors associated with it in children and adolescents who underwent surgical closure of PDA. Method All children and adolescents who underwent surgical closure of PDA at the Cardiac Center, Ethiopia (CCE) had postoperative follow up with echocardiography. Serial left ventricular ejection fraction (LVEF) and fiber shortening (FS) values were recorded for all of them. SPSS 20 was used to analyze the data. Results A total of 36 children and adolescents who underwent surgical closure of PDA from January 2009 to December 2012 and who fulfilled the inclusion criteria were studied. Their mean age at intervention was 8.52 years (SD = 5.23 years), 77.80% were females. The mean duct size as determined by either echocardiography or intra-operative by the surgeon was 10.31 mm (SD = 3.20 mm). They were followed for a mean duration of 24.80 months (SD = 12.36 months) following surgical closure of PDA. The mean LVEF and FS decreased from 65.06% and 35.28% preoperatively to 54.83% and 28.40% post-operatively respectively. Fifteen (42.86%) of the patients had a post-operative LVEF of less than 55%. The mean time to normalization of systolic function was 5.11 weeks (SD = 3.30 weeks). Having an associated cardiac lesion was an independent predictor of POLVD. Conclusions We conclude that there is a high rate of POLVD following surgical closure of large PDA in highlanders. We recommend a serial and systematic follow up of these children postoperatively. Those with a significant cardiac dysfunction may need cardiac medications like Angiotensin Converting Enzyme Inhibitors (ACEI). PMID:23721219

Perfusion CT helps decision making for thrombolysis when there is no clear time of onset

PubMed Central

Hellier, K D; Hampton, J L; Guadagno, J V; Higgins, N P; Antoun, N M; Day, D J; Gillard, J H; Warburton, E A; Baron, J‐C

2006-01-01

Current guidelines on thrombolysis post stroke with recombinant tissue plasminogen activator (rt‐PA) exclude its use where time of onset is unknown, thus denying some patients potentially beneficial treatment. Contrast enhanced perfusion computed tomography (pCT) imaging can be used together with plain CT and information on clinical deficits to decide whether or not thrombolysis should be initiated even though the exact time of stroke onset is unknown. Based on the results of pCT and CT, rt‐PA was administered to two patients with unknown time of stroke onset; one of the patients also underwent suction thrombectomy. Results in both cases were excellent. PMID:16484659

A clinical investigation of force delivery systems for orthodontic space closure.

PubMed

Nightingale, C; Jones, S P

2003-09-01

To investigate the force retention, and rates of space closure achieved by elastomeric chain and nickel titanium coil springs. Randomized clinical trial. Eastman Dental Hospital, London and Queen Mary's University Hospital, Roehampton, 1998-2000. Twenty-two orthodontic patients, wearing the pre-adjusted edgewise appliance undergoing space closure in opposing quadrants, using sliding mechanics on 0.019 x 0.025-inch posted stainless steel archwires. Medium-spaced elastomeric chain [Durachain, OrthoCare (UK) Ltd., Bradford, UK] and 9-mm nickel titanium coil springs [OrthoCare (UK) Ltd.] were placed in opposing quadrants for 15 patients. Elastomeric chain only was used in a further seven patients. The initial forces on placement and residual forces at the subsequent visit were measured with a dial push-pull gauge [Orthocare (UK) Ltd]. Study models of eight patients were taken before and after space closure, from which measurements were made to establish mean space closure. The forces were measured in grammes and space closure in millimetres. Fifty-nine per cent (31/53) of the elastomeric sample maintained at least 50 per cent of the initial force over a time period of 1-15 weeks. No sample lost all its force, and the mean loss was 47 per cent (range: 0-76 per cent). Nickel titanium coil springs lost force rapidly over 6 weeks, following that force levels plateaued. Forty-six per cent (12/26) maintained at least 50 per cent of their initial force over a time period of 1-22 weeks, and mean force loss was 48 per cent (range: 12-68 per cent). The rate of mean weekly space closure for elastomeric chain was 0.21 mm and for nickel titanium coil springs 0.26 mm. There was no relationship between the initial force applied and rate of space closure. None of the sample failed during the study period giving a 100 per cent response rate. In clinical use, the force retention of elastomeric chain was better than previously concluded. High initial forces resulted in high force decay. Nickel titanium coil springs and elastomeric chain closed spaces at a similar rate.

Understanding the Risk Factors of Trauma Center Closures

PubMed Central

Shen, Yu-Chu; Hsia, Renee Y.; Kuzma, Kristen

2011-01-01

Objectives We analyze whether hazard rates of shutting down trauma centers are higher due to financial pressures or in areas with vulnerable populations (such as minorities or the poor). Materials and Methods This is a retrospective study of all hospitals with trauma center services in urban areas in the continental US between 1990 and 2005, identified from the American Hospital Association Annual Surveys. These data were linked with Medicare cost reports, and supplemented with other sources, including the Area Resource File. We analyze the hazard rates of trauma center closures among several dimensions of risk factors using discrete-time proportional hazard models. Results The number of trauma center closures increased from 1990 to 2005, with a total of 339 during this period. The hazard rate of closing trauma centers in hospitals with a negative profit margin is 1.38 times higher than those hospitals without the negative profit margin (P < 0.01). Hospitals receiving more generous Medicare reimbursements face a lower hazard of shutting down trauma centers (ratio: 0.58, P < 0.01) than those receiving below average reimbursement. Hospitals in areas with higher health maintenance organizations penetration face a higher hazard of trauma center closure (ratio: 2.06, P < 0.01). Finally, hospitals in areas with higher shares of minorities face a higher risk of trauma center closure (ratio: 1.69, P < 0.01). Medicaid load and uninsured populations, however, are not risk factors for higher rates of closure after we control for other financial and community characteristics. Conclusions Our findings give an indication on how the current proposals to cut public spending could exacerbate the trauma closure particularly among areas with high shares of minorities. In addition, given the negative effect of health maintenance organizations on trauma center survival, the growth of Medicaid managed care population should be monitored. Finally, high shares of Medicaid or uninsurance by themselves are not independent risk factors for higher closure as long as financial pressures are mitigated. Targeted policy interventions and further research on the causes, are needed to address these systems-level disparities. PMID:19704354

Understanding the risk factors of trauma center closures: do financial pressure and community characteristics matter?

PubMed

Shen, Yu-Chu; Hsia, Renee Y; Kuzma, Kristen

2009-09-01

We analyze whether hazard rates of shutting down trauma centers are higher due to financial pressures or in areas with vulnerable populations (such as minorities or the poor). This is a retrospective study of all hospitals with trauma center services in urban areas in the continental US between 1990 and 2005, identified from the American Hospital Association Annual Surveys. These data were linked with Medicare cost reports, and supplemented with other sources, including the Area Resource File. We analyze the hazard rates of trauma center closures among several dimensions of risk factors using discrete-time proportional hazard models. The number of trauma center closures increased from 1990 to 2005, with a total of 339 during this period. The hazard rate of closing trauma centers in hospitals with a negative profit margin is 1.38 times higher than those hospitals without the negative profit margin (P < 0.01). Hospitals receiving more generous Medicare reimbursements face a lower hazard of shutting down trauma centers (ratio: 0.58, P < 0.01) than those receiving below average reimbursement. Hospitals in areas with higher health maintenance organizations penetration face a higher hazard of trauma center closure (ratio: 2.06, P < 0.01). Finally, hospitals in areas with higher shares of minorities face a higher risk of trauma center closure (ratio: 1.69, P < 0.01). Medicaid load and uninsured populations, however, are not risk factors for higher rates of closure after we control for other financial and community characteristics. Our findings give an indication on how the current proposals to cut public spending could exacerbate the trauma closure particularly among areas with high shares of minorities. In addition, given the negative effect of health maintenance organizations on trauma center survival, the growth of Medicaid managed care population should be monitored. Finally, high shares of Medicaid or uninsurance by themselves are not independent risk factors for higher closure as long as financial pressures are mitigated. Targeted policy interventions and further research on the causes, are needed to address these systems-level disparities.

[Massive pleural effusion complicating chronic pancreatitis. Treatment by endoscopic closure of a pancreatic-mediastinal fistula].

PubMed

Trudzinski, F C; Rädle, J; Treiber, G; Kramm, T; Sybrecht, G W

2008-11-01

A 53-year-old man was admitted because of anuria, dyspnea and a septic temperature. The patients' history included chronic alcoholism, chronic pancreatitis, COPD and a right nephrectomy because of nephrolithiasis. Urosepsis was initially suspected. The patients' clinical condition and nutritional state were severely reduced. Laboratory findings revealed severe systemic inflammation (leucocyte count: 22.4/nl, CRP: 324 mg/l). Computed tomography showed a large left-sided pleural effusion, encapsulated abdominal fluid below the diaphragm and alongside the pancreatic tail. After aspiration of the pleural effusion the diagnosis of an exsudate with elevated concentration of lipase (56,000 U/l) was confirmed. Endoscopic ultrasound showed a 3-4 cm pseudocystic mass originating in the region of the pancreatic tail. The ERP depicted chronic pancreatitis with strictures and destruction of the pancreatic duct. Two fistulae were identified, one proximal to a ductal stricture in the pancreatic head and a second one in the pancreatic tail which corresponded to the reported pseudocyst. The patient was admitted to the ICU with symptoms of impending sepsis. The pleural effusion was treated with CT-guided chest drainage. The initial endoscopic attempt at stent closure of the fistula failed because it was possible to pass through the ductal stricture only with a thin hydrophilic wire and small-lumen catheter. However, injection of fibrin glue into the proximal pancreatic duct over a length of 2 cm obliterated the fistula and the pleural effusion was resolved. Pancreatic-pleural or pancreatic-mediastinal fistula is a rare complication of pancreatitis associated with unilateral pleural effusion. Combined internal endoscopic drainage and external chest drainage is the treatment of choice. After failure of routine endoscopic therapy, endoscopic closure of fistulas using fibrin glue might offer an alternative treatment strategy.

High negative pressure subcutaneous suction drain for managing debilitating subcutaneous emphysema secondary to tube thoracostomy for an iatrogenic post computed tomography guided transthoracic needle biopsy pneumothorax: Case report and review of literature.

PubMed

Ahmed, Zeeshan; Patel, Pinakin; Singh, Suresh; Sharma, Raj Govind; Somani, Pankaj; Gouri, Abdul Rauf; Singh, Shiv

2016-01-01

Subcutaneous emphysema is a common complication of tube thoracostomy. Though self-limiting, it should be treated when it causes palpebral closure, dyspnea, dysphagia or undue disfigurement resulting in anxiety and distress to the patient. A 72year old man who was a known case of COPD on bronchodilators developed a large pneumothorax and respiratory distress after a CT guided transthoracic lung biopsy done for a lung opacity (approx. 3×3cm) at the right hilar region on Chest X-ray. Within 24h of an urgent tube thoracostomy, patient developed intractable subcutaneous emphysema with closure of palpebral fissure and dyspnea unresponsive to increasing suction on chest tube. A subcutaneous fenestrated drain was placed mid-way between the nipple and clavicle in the mid-clavicular line bilaterally. Continuous negative suction (-150mmHg) resulted in immediate, sustained relief and complete resolution within 5days. Extensive and debilitating SE (subcutaneous emphysema) has to be treated promptly to relieve patient discomfort, dysphagia or imminent respiratory compromise. A variety of treatment have been tried including infraclavicular blow-hole incisions, subcutaneous drains +/- negative pressure suction, fenestrated angiocatheters, Vacuum assisted dressings and increasing suction on a pre-existing chest tube. We describe a high negative pressure subcutaneous suction drain which provides immediate and sustained relief in debilitating SE. Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. High negative pressure subcutaneous suction drain provides immediate and sustained relief in extensive and debilitating SE. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Durability of central aortic valve closure in patients with continuous flow left ventricular assist devices.

PubMed

McKellar, Stephen H; Deo, Salil; Daly, Richard C; Durham, Lucian A; Joyce, Lyle D; Stulak, John M; Park, Soon J

2014-01-01

A competent aortic valve is essential to providing effective left ventricular assist device support. We have adopted a practice of central aortic valve closure by placing a simple coaptation stitch at left ventricular assist device implantation in patients with significant aortic insufficiency. We conducted a follow-up study to evaluate the efficacy and durability of this procedure. The study included patients who had undergone continuous flow left ventricular assist device implantation. The patients were divided into 2 groups, those who did not require any aortic procedure because the valve was competent and those who underwent central aortic valve closure for mild or greater aortic regurgitation. The clinical endpoints were mortality, progression or recurrence of aortic insufficiency, and reoperation for aortic valve pathologic features. Aortic insufficiency was measured qualitatively from mild to severe on a scale of 0 to 5. A total of 123 patients received continuous flow left ventricular assist devices from February 2007 to August 2011. Of those, 18 (15%) underwent central aortic valve closure at left ventricular assist device implantation because of significant aortic insufficiency (1.8 ± 1.4) and 105 who did not (competent aortic valve, 0.15 ± 0.43; P < .01). At follow-up (median, 312 days; range, 0-1429 days), the mean aortic insufficiency score remained low for the patients with central aortic valve closure (0.27 ± 0.46) in contrast to those without central aortic valve closure who experienced aortic insufficiency progression (0.78 ± 0.89; P = .02). In addition, the proportion of patients with more than mild aortic insufficiency was significantly less in the central aortic valve closure group (0% vs 18%; P = .05). The patients in the central aortic valve closure group were significantly older and had a greater incidence of renal failure at baseline. The 30-day mortality was greater in the central aortic valve closure group, but the late survival was similar between the 2 groups. No reoperations were required for recurrent aortic insufficiency. The results of our study have shown that repair of aortic insufficiency with a simple central coaptation stitch is effective and durable in left ventricular assist device-supported patients, with follow-up extending into 2 years. Although aortic insufficiency progressed over time in those with minimal native valve regurgitation initially, no such progression was noted in those with central aortic valve closure. Additional investigation is needed to evaluate whether prophylactic central aortic valve closure should be performed at left ventricular assist device implantation to avoid problematic aortic regurgitation developing over time, in particular in patients undergoing left ventricular assist device implantation for life-long (destination therapy) support. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Use of adhesive surgical tape with the absorbable continuous subcuticular suture.

PubMed

Kolt, Jeremy D

2003-08-01

The absorbable continuous subcuticular suture is frequently used to close surgical incisions where the aim is healing by primary intention. A form of adhesive surgical tape is commonly also placed over the wound but this combination closure seems to have its development based on anecdotal, rather than experimental evidence. The present study reviews the scientific literature on the development of sutureless wound closure and presents the current evidence for the use of combination wound closure. Review was undertaken of the medical literature using the PubMed Internet database and cross-referencing major -articles on the subject. The following combinations of key words were searched: skin closure, wound closure, suture technique, sutureless, adhesive tape, op-site, staples, subcuticular suture, complication, infection and scars. Taped closure alone has advantages of lower wound infection rates and greater wound tensile strength, but disadvantages of epidermal reaction, skin edge inversion, doubtful safety and time required for meticulous surgical technique. The use of the continuous absorbable subcuticular suture allows accurate skin edge approximation, which increases the safety margin. The combination closure has a slightly superior cosmetic result to sutureless techniques but no study has been performed to compare the results of combination subcuticular suture and tape, with tape or subcuticular suture alone. There is no evidence in the scientific literature to justify or support the practice of closing a surgical wound with both subcuticular suture and adhesive surgical tape.

Pilonidal sinus disease surgery in children: the first study to compare crystallized phenol application to primary excision and closure.

PubMed

Ates, Ufuk; Ergun, Ergun; Gollu, Gulnur; Sozduyar, Sumeyye; Kologlu, Meltem; Cakmak, Murat; Dindar, Huseyin; Yagmurlu, Aydin

2018-03-01

Pilonidal sinus (PS) is an infectious and inflammatory disease of sacrococcygeal region. Current methods include; surgical excision with/without suturing the defect, rhomboid excision and flap and chemical substance application. In this study, crystallized phenol application was compared to excision and primary closure. This retrospective study included pediatric patients with PS who were treated with excision and primer closure technique and phenol application. The patients' medical data were analyzed retrospectively. This study included 117 patients with PS. There were 52 girls (44%) and 65 boys (56%). Mean age of children was 15.6 (12-20) years. Excision and primary closure were applied to 77 patients (66%) and phenol was applied to 40 patients (34%). The children in phenol group were discharged on the operation day; mean hospitalization time in the excision and primary closure group was 2.7 (1-14) days. Mean follow up was 44.6 (8-82) months for primary excision and closure group and 8.1 (1-19) months for phenol group. Although many surgical and non-surgical treatment modalities have been described for PS, the optimal one remains unknown. Limited with the retrospective nature of the data, crystallized phenol application seems a feasible minimal invasive alternative to primary closure of PS with lower recurrence and complication rates in children. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

Transcatheter closure of post-operative residual ventricular septal defect using a patent ductus arteriosus closure device in an adult: a case report.

PubMed

Djer, Mulyadi M; Idris, Nikmah S; Alwi, Idrus; Wijaya, Ika P

2014-07-01

Transcatheter closure of perimembranous and muscular ventricular septal defect (VSD) has been performed widely and it has more advantages compare to surgery. However, transcatheter closure of residual VSD post operation of complex congenital heart disease is still challenging because of the complexity of anatomy and concern about device stability, so the operator should meticulously choose the most appropriate technique and device. We would like to report a case of transcatheter closure of residual VSD post Rastelli operation in a patient with double outlet right ventricle (DORV), sub-aortic VSD, severe infundibulum pulmonary stenosis (PS) and single coronary artery. The patient had undergone operations for four times, but he still had intractable heart failure that did not response to medications. On the first attempt. we closed the VSD using a VSD occluder, unfortunately the device embolized into the descending aorta, but fortunately we was able to snare it out. Then we decided to close the VSD using a patent ductus arteriosus (PDA occluder). On transesophageal echocardiography (TEE) and angiography evaluation, the device position was stable. Post transcatheter VSD closure, the patient clinical condition improved significantly and he could finally be discharged after a long post-surgery hospitalization. Based on this experience we concluded that the transcatheter closure of residual VSD in complex CHD using PDA occluder could be an effective alternative treatment.

Chlorella Induces Stomatal Closure via NADPH Oxidase-Dependent ROS Production and Its Effects on Instantaneous Water Use Efficiency in Vicia faba

PubMed Central

Li, Yan; Xu, Shan-Shan; Gao, Jing; Pan, Sha; Wang, Gen-Xuan

2014-01-01

Reactive oxygen species (ROS) have been established to participate in stomatal closure induced by live microbes and microbe-associated molecular patterns (MAMPs). Chlorella as a beneficial microorganism can be expected to trigger stomatal closure via ROS production. Here, we reported that Chlorella induced stomatal closure in a dose-and time-dependent manner in epidermal peels of Vicia faba. Using pharmacological methods in this work, we found that the Chlorella-induced stomatal closure was almost completely abolished by a hydrogen peroxide (H2O2) scavenger, catalase (CAT), significantly suppressed by an NADPH oxidase inhibitor, diphenylene iodonium chloride (DPI), and slightly affected by a peroxidase inhibitor, salicylhydroxamic acid (SHAM), suggesting that ROS production involved in Chlorella-induced stomatal closure is mainly mediated by DPI-sensitive NADPH oxidase. Additionally, Exogenous application of optimal concentrations of Chlorella suspension improved instantaneous water use efficiency (WUEi) in Vicia faba via a reduction in leaf transpiration rate (E) without a parallel reduction in net photosynthetic rate (Pn) assessed by gas-exchange measurements. The chlorophyll fluorescence and content analysis further demonstrated that short-term use of Chlorella did not influence plant photosynthetic reactions center. These results preliminarily reveal that Chlorella can trigger stomatal closure via NADPH oxidase-dependent ROS production in epidermal strips and improve WUEi in leave levels. PMID:24687099

Chlorella induces stomatal closure via NADPH oxidase-dependent ROS production and its effects on instantaneous water use efficiency in Vicia faba.

PubMed

Li, Yan; Xu, Shan-Shan; Gao, Jing; Pan, Sha; Wang, Gen-Xuan

2014-01-01

Reactive oxygen species (ROS) have been established to participate in stomatal closure induced by live microbes and microbe-associated molecular patterns (MAMPs). Chlorella as a beneficial microorganism can be expected to trigger stomatal closure via ROS production. Here, we reported that Chlorella induced stomatal closure in a dose-and time-dependent manner in epidermal peels of Vicia faba. Using pharmacological methods in this work, we found that the Chlorella-induced stomatal closure was almost completely abolished by a hydrogen peroxide (H2O2) scavenger, catalase (CAT), significantly suppressed by an NADPH oxidase inhibitor, diphenylene iodonium chloride (DPI), and slightly affected by a peroxidase inhibitor, salicylhydroxamic acid (SHAM), suggesting that ROS production involved in Chlorella-induced stomatal closure is mainly mediated by DPI-sensitive NADPH oxidase. Additionally, Exogenous application of optimal concentrations of Chlorella suspension improved instantaneous water use efficiency (WUEi) in Vicia faba via a reduction in leaf transpiration rate (E) without a parallel reduction in net photosynthetic rate (Pn) assessed by gas-exchange measurements. The chlorophyll fluorescence and content analysis further demonstrated that short-term use of Chlorella did not influence plant photosynthetic reactions center. These results preliminarily reveal that Chlorella can trigger stomatal closure via NADPH oxidase-dependent ROS production in epidermal strips and improve WUEi in leave levels.

77 FR 15284 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Coastal Migratory Pelagic...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-15

... Migratory Pelagic Resources of the Gulf of Mexico and South Atlantic; Closure AGENCY: National Marine...: Temporary rule; closure. SUMMARY: NMFS closes the commercial sector of the coastal migratory pelagic fishery... king mackerel resource. DATES: This rule is effective 12:01 a.m., local time, March 14, 2012, through...

76 FR 70346 - Drawbridge Operation Regulation; Isle of Wight (Sinepuxent) Bay, Ocean City, MD

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-14

... past 10 years. The majority of vessels that transit under this bridge this time of year are... familiar with this bridge closure because for the past 10 years the Coast Guard has allowed the bridge to... can minimize delay. This closure has occurred every year for the past 10 years; therefore, mariners...

Building the vision, a series of AZTech ITS model deployment success stories for the Phoenix metropolitan area : number four : spreading the word : effectively communicating conditions of county roads and city streets

DOT National Transportation Integrated Search

1998-01-01

The Highway Closure and Restriction System (HCRS) is a statewide service of the Arizona Department of Transportation (ADOT), providing travelers with timely traffic information on scheduled and : unscheduled state roadway closures. The HCRS does an o...

Trigger Happy: The Troubling Trend of Primary School Closures in Glasgow City Schools

ERIC Educational Resources Information Center

Koch, Joshua F.

2010-01-01

This paper examines the continuing trend of school closures in Glasgow, Scotland. Particular attention will be paid to Stonedyke Primary School, which Glasgow City Council was proposing to close at the time of this research. Current statistical data and research is used to better examine the current crisis Stonedyke Primary faces. Furthermore,…

75 FR 39705 - Notice of Temporary Closures on Public Lands in Northwestern Elko County, NV

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-12

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLNV0100000 L10600000.JJ0000 LXSS130F0000... Northwestern Elko County, NV AGENCY: Bureau of Land Management, Interior. ACTION: Notice of Temporary Closures... effect for the dates and times specified in this Notice on public lands administered by the Bureau of...

Measurement of time delay for a prospectively gated CT simulator.

PubMed

Goharian, M; Khan, R F H

2010-04-01

For the management of mobile tumors, respiratory gating is the ideal option, both during imaging and during therapy. The major advantage of respiratory gating during imaging is that it is possible to create a single artifact-free CT data-set during a selected phase of the patient's breathing cycle. The purpose of the present work is to present a simple technique to measure the time delay during acquisition of a prospectively gated CT. The time delay of a Philips Brilliance BigBore (Philips Medical Systems, Madison, WI) scanner attached to a Varian Real-Time Position Management (RPM) system (Varian Medical Systems, Palo Alto, CA) was measured. Two methods were used to measure the CT time delay: using a motion phantom and using a recorded data file from the RPM system. In the first technique, a rotating wheel phantom was altered by placing two plastic balls on its axis and rim, respectively. For a desired gate, the relative positions of the balls were measured from the acquired CT data and converted into corresponding phases. Phase difference was calculated between the measured phases and the desired phases. Using period of motion, the phase difference was converted into time delay. The Varian RPM system provides an external breathing signal; it also records transistor-transistor logic (TTL) 'X-Ray ON' status signal from the CT scanner in a text file. The TTL 'X-Ray ON' indicates the start of CT image acquisition. Thus, knowledge of the start time of CT acquisition, combined with the real-time phase and amplitude data from the external respiratory signal, provides time-stamping of all images in an axial CT scan. The TTL signal with time-stamp was used to calculate when (during the breathing cycle) a slice was recorded. Using the two approaches, the time delay between the prospective gating signal and CT simulator has been determined to be 367 +/- 40 ms. The delay requires corrections both at image acquisition and while setting gates for the treatment delivery; otherwise the simulation and treatment may not be correlated with the patient's breathing.

Orthodontic Replacement of Lost Permanent Molar with Neighbor Molar: A Six-Year Follow-Up

PubMed Central

Shintcovsk, Ricardo Lima; Knop, Luegya Amorim Henriques; Sampaio, Luana Paz

2017-01-01

Extraction is very frequent indication in orthodontic planning, especially when there are crowding, biprotrusion, and aesthetically unpleasant profiles. Next to extraction comes space closure, which represents a challenge for orthodontists because of extended treatment time, discomfort created for the patient, tissue tolerance, and stability concerns. When it comes to what mechanics to choose for space closure, loops present two major advantages in relation to sliding mechanics: absence of abrasion and possibility to reach pure dental translation. A case is presented where an adult female patient with early loss of the first lower permanent molars, minor lower crowding, and tooth biprotrusion was treated with upper first bicuspids extraction along with upper and lower space closure done with T-loops to promote best space closure control in order to correct the malocclusion and enhance facial aesthetics. PMID:29318054

Evaluation of intradermal absorbable and mattress sutures to close pilonidal sinus wounds with Limberg flap: a prospective randomized comparative study.

PubMed

Çetin, Kenan; Sikar, Hasan Ediz; Kocaoğlu, Aytaç Emre; Kündeş, Muhammet Fikri; Karahan, Mehmet; Kaptanoğlu, Levent

2018-02-01

We aimed to compare skin closure techniques, standard (intermittent mattress) and continuous subcuticular sutures, following Limberg flap procedure. From July 2013 to July 2015, 92 patients with sacrococcygeal pilonidal disease were prospectively randomized into 2 groups consisting of 46 patients for both. Patients underwent sinus excision and closure with Limberg flap; continuous subcuticular suture was used in subcuticular group (SG) and intermittent mattress sutures were used in mattress group (MG) for skin closure. Characteristics of patients, features of pilonidal disease, macerations, infections, wound dehiscence, flap necrosis, operation time, time of drain removal, wound complications, early recurrences, and time till return to work were compared between the 2 groups. There was no statistical difference between groups per sex, age, body mass index, smoking, number of sinuses, depth of intergluteal sulcus, distance of incision to anus, volume of extracted tissue, number of hair follicles per cm 2 , recurrence, operation, and mean follow-up time. Two patients showed signs of wound complications (4.4%) in SG, whereas 8 cases (17.4%) showed signs in MG (P < 0.05). One patient in SG had surgical site infection and required antibiotics (2.2%), where as there were 6 cases treated in MG (13.0%) (P < 0.05). Removal of drain tube, and time till return to work rates are lower for SG than MG (P < 0.05). In conclusion, surgical procedures which include Limberg flap method and subcuticular closure may reduce infection and maceration rates. Future studies are needed to achieve greater detailed evaluation.

Materials Characterization of Electron Beam Melted Ti-6Al-4V

NASA Technical Reports Server (NTRS)

Draper, Susan; Lerch, Brad; Rogers, Richard; Martin, Richard; Locci, Ivan; Garg, Anita

2015-01-01

An in-depth material characterization of Electron Beam Melted (EBM) Ti-6Al-4V material has been completed. Hot Isostatic Pressing (HIP) was utilized to close porosity from fabrication and also served as a material heat treatment to obtain the desired microstructure. The changes in the microstructure and chemistry from the powder to pre-HIP and post-HIP material have been analyzed. Computed tomography (CT) scans indicated porosity closure during HIP and high-density inclusions scattered throughout the specimens. The results of tensile and high cycle fatigue (HCF) testing are compared to conventional Ti-6Al-4V. The EBM Ti-6Al-4V had similar or superior mechanical properties compared to conventionally manufactured Ti-6Al-4V.

Proceedings of the International Wire and Cable Symposium (36th) Held in Arlington, Virginia on 17-19 November 1987.

DTIC Science & Technology

1987-11-19

Sistemas ), Madrid, Ltd., Chiba-ken, Japan 693 Spain 629 New Universal Splice Closure System-D. A Novel Evaluation Technique and Refractive Kunze, E...conveyor- road , ’,Ne rcsu’-c mus ’ be approx ima tel y equalI in Besides this closu’- which +ullfils the di amete- toc the cable a nd moreover- must...Ocl;tialt] W’ircittt I’t C’ 7111’cc Zi’t ict M letI)Ccr cit t’t ctw’eeit cccctllI iti te . Flt’fil ct’ tI i’’l ’c’ictt’d t)ilt tcc cac.kic ict’ toc

Growth-incompetent monomers of human calcitonin lead to a noncanonical direct relationship between peptide concentration and aggregation lag time.

PubMed

Kamgar-Parsi, Kian; Hong, Liu; Naito, Akira; Brooks, Charles L; Ramamoorthy, Ayyalusamy

2017-09-08

The role of the peptide hormone calcitonin in skeletal protection has led to its use as a therapeutic for osteoporosis. However, calcitonin aggregation into amyloid fibrils limits its therapeutic efficacy, necessitating a modification of calcitonin's aggregation kinetics. Here, we report a direct relationship between human calcitonin (hCT) concentration and aggregation lag time. This kinetic trend was contrary to the conventional understanding of amyloid aggregation and persisted over a range of aggregation conditions, as confirmed by thioflavin-T kinetics assays, CD spectroscopy, and transmission EM. Dynamic light scattering, 1 H NMR experiments, and seeded thioflavin-T assay results indicated that differences in initial peptide species contribute to this trend more than variations in the primary nucleus formation rate. On the basis of kinetics modeling results, we propose a mechanism whereby a structural conversion of hCT monomers is needed before incorporation into the fibril. Our kinetic mechanism recapitulates the experimentally observed relationship between peptide concentration and lag time and represents a novel mechanism in amyloid aggregation. Interestingly, hCT at low pH and salmon calcitonin (sCT) exhibited the canonical inverse relationship between concentration and lag time. Comparative studies of hCT and sCT with molecular dynamics simulations and CD indicated an increased α-helical structure in sCT and low-pH hCT monomers compared with neutral-pH hCT, suggesting that α-helical monomers represent a growth-competent species, whereas unstructured random coil monomers represent a growth-incompetent species. Our finding that initial monomer concentration is positively correlated with lag time in hCT aggregation could help inform future efforts for improving therapeutic applications of CT. © 2017 by The American Society for Biochemistry and Molecular Biology, Inc.

A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management.

PubMed

Semb, Gunvor; Enemark, Hans; Friede, Hans; Paulin, Gunnar; Lilja, Jan; Rautio, Jorma; Andersen, Mikael; Åbyholm, Frank; Lohmander, Anette; Shaw, William; Mølsted, Kirsten; Heliövaara, Arja; Bolund, Stig; Hukki, Jyri; Vindenes, Hallvard; Davenport, Peter; Arctander, Kjartan; Larson, Ola; Berggren, Anders; Whitby, David; Leonard, Alan; Neovius, Erik; Elander, Anna; Willadsen, Elisabeth; Bannister, R Patricia; Bradbury, Eileen; Henningsson, Gunilla; Persson, Christina; Eyres, Philip; Emborg, Berit; Kisling-Møller, Mia; Küseler, Annelise; Granhof Black, Birthe; Schöps, Antje; Bau, Anja; Boers, Maria; Andersen, Helene Søgaard; Jeppesen, Karin; Marxen, Dorte; Paaso, Marjukka; Hölttä, Elina; Alaluusua, Suvi; Turunen, Leena; Humerinta, Kirsti; Elfving-Little, Ulla; Tørdal, Inger Beate; Kjøll, Lillian; Aukner, Ragnhild; Hide, Øydis; Feragen, Kristin Billaud; Rønning, Elisabeth; Skaare, Pål; Brinck, Eli; Semmingsen, Ann-Magritt; Lindberg, Nina; Bowden, Melanie; Davies, Julie; Mooney, Jeanette; Bellardie, Haydn; Schofield, Nina; Nyberg, Jill; Lundberg, Maria; Karsten, Agneta Linder-Aronson; Larson, Margareta; Holmefjord, Anders; Reisæter, Sigvor; Pedersen, Nina-Helen; Rasmussen, Therese; Tindlund, Rolf; Sæle, Paul; Blomhoff, Reidunn; Jacobsen, Gry; Havstam, Christina; Rizell, Sara; Enocson, Lars; Hagberg, Catharina; Najar Chalien, Midia; Paganini, Anna; Lundeborg, Inger; Marcusson, Agneta; Mjönes, Anna-Britta; Gustavsson, Annica; Hayden, Christine; McAleer, Eilish; Slevan, Emma; Gregg, Terry; Worthington, Helen

2017-02-01

Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project. Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes. Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years. The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series. ISRCTN29932826.

Clinical relevance of coronary angiography at the time of percutaneous closure of a patent foramen ovale.

PubMed

Wahl, Andreas; Praz, Fabien; Seiler, Christian; Windecker, Stephan; Meier, Bernhard

2007-11-01

The value of incidental coronary angiography during percutaneous shunt closure to screen for asymptomatic coronary artery disease (CAD) is unknown. On the occasion of percutaneous closure of patent foramen ovale (PFO), incidental coronary angiography routinely offered to men >40 and women >50 years, or younger patients with particular risk patterns, was performed in 575 patients (64% men, mean age 55 +/- 10 years, mean 1.5 +/- 1.1 cardiovascular risk factors) without overt history, signs, or symptoms of CAD. CAD was found in 164 patients (29%); 53 (9%) had >or=50% diameter stenoses. Thirty patients (5%) had one-vessel, 13 (2%) two-vessel, and 10 (2%) three-vessel disease. Patients with CAD (n = 164) were older (60 +/- 9 vs. 53 +/- 10 years; P < 0.0001), more frequently male (76% vs. 59%; P = 0.0002), and had a higher body mass index (26.5 +/- 4.0 vs. 25.4 +/- 4.6; P = 0.006) and more cardiovascular risk factors (2.0 +/- 1.1 vs. 1.2 +/- 1.0; P < 0.0001). There were six procedural complications (1%). Two were unequivocally related to coronary angiography: one minor stroke (diplopia), and one iatrogenic dissection of the right coronary ostium requiring stenting. Furthermore, four arteriovenous fistulae at the puncture site requiring elective surgical closure were possibly related to coronary angiography. Forty-five patients (8% of total) underwent percutaneous (n = 43) or surgical (n = 2) revascularization. In selected asymptomatic patients referred for percutaneous PFO closure, incidental coronary angiography discloses a rather high prevalence of clinically unsuspected CAD. These findings are relevant not only for timely revascularization but also for maintenance of long-term antiplatelet therapy beyond the few months recommended after PFO closure. (c) 2007 Wiley-Liss, Inc.

A novel technique for transcatheter patent ductus arteriosus closure in extremely preterm infants using commercially available technology.

PubMed

Zahn, Evan M; Nevin, Phillip; Simmons, Charles; Garg, Ruchira

2015-02-01

To describe a new technique for transcatheter patent ductus arteriosus (PDA) closure in extremely preterm infants using commercially available technology. PDA in premature neonates continues to be a significant clinical problem contributing importantly to both morbidity and mortality. Surgical ligation and medical therapy both have their drawbacks. Hospital records and catheterization reports of all premature neonates (< 32 weeks gestation) who underwent transcatheter PDA closure between March 2013 and February 2014 were reviewed. Particular attention was paid to procedural details, complications, and short and mid-term outcomes. Six premature infants born at gestational ages ranging between 26 and 31 weeks (median, 26 weeks) underwent attempted transcatheter PDA closure using the Amplatzer Vascular Plug II (AVP II). Median age and weight was 21.5 days (16-80 days) and 1,180 g (870-2,240 g), respectively. Fluoroscopy and echocardiography were used to guide device. Contrast angiography was not used in any patient. Complete closure was achieved in all patients with no major procedural complications. Median fluoroscopy and procedural times were 9.4 (0-19.5) and 51.5 (33-87) min, respectively. All patients were alive at the time of this report. There were no instances of device migration, left pulmonary artery (LPA), or aortic coarctation. This preliminary study demonstrates that transcatheter PDA closure can be successfully performed in extremely preterm neonates using currently available technology with a high success rate and a low incidence of complications. This report also describes a novel transvenous approach using a combination of echocardiography and judicious use of fluoroscopy to avoid arterial access in this fragile patient population. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Percutaneous closure of patent ductus arteriosus in small infants with significant lung disease may offer faster recovery of respiratory function when compared to surgical ligation.

PubMed

Abu Hazeem, Anas A; Gillespie, Matthew J; Thun, Haley; Munson, David; Schwartz, Matthew C; Dori, Yoav; Rome, Jonathan J; Glatz, Andrew C

2013-10-01

To describe our experience with percutaneous closure of patent ductus arteriosus (PDA) in small infants and compare outcomes to matched surgical patients. Ligation via thoracotomy has been used to close PDAs in small infants, but has been associated with respiratory and hemodynamic compromise. We hypothesized that percutaneous closure would offer faster recovery of respiratory function. Patients <4 kg requiring positive pressure ventilation who underwent percutaneous PDA closure between January 2000 and April 2012 were reviewed and matched to contemporary surgical patients on gestational age (GA), birth weight (BW), procedure weight (WT), and ventilation mode. Patients returned to baseline respiratory status when the product of mean airway pressure and FiO2 returned to pre-procedural levels. Eight matched pairs were included. Median BW, GA, and WT were 1.43 kg (0.52-2.97), 29.8 weeks (24-39), and 2.8 kg (2.2-3.9) for catheter patients and 1.55 kg (0.48-3.04), 29 weeks (23-37), and 2.75 kg (2.3-4.2) for surgical patients. Complete PDA closure occurred in all. The median time to return to baseline respiratory status was significantly shorter in the percutaneous group (17 hr (range 0-113) vs. 53 hr (range 13-219), P < 0.05). In the percutaneous group, two patients developed mild aortic coarctation, one mild left pulmonary artery stenosis, and four femoral vascular thromboses which all resolved with medical therapy. Surgical complications included significant respiratory and cardiac compromise, rib fractures and urinary retention. Percutaneous closure of PDA in small infants on respiratory support is equivalent in safety and efficacy and may offer shorter recovery time than surgical ligation. Copyright © 2013 Wiley Periodicals, Inc.

Reappraisal of adhesive strapping as treatment for infantile umbilical hernia.

PubMed

Yanagisawa, Satohiko; Kato, Mototoshi; Oshio, Takehito; Morikawa, Yasuhide

2016-05-01

Most umbilical hernias spontaneously close by 3-5 years of age; therefore, surgical repair is considered only in children whose hernias have not closed by this point. At present, adhesive strapping is not the preferred treatment for umbilical hernias because of the lack of supporting evidence regarding its efficacy, and its association with skin complications. This aim of this study was to examine umbilical hernia closure on ultrasonography, and reassess the merits of adhesive strapping. Between January 2013 and December 2014, 89 infants underwent adhesive strapping for umbilical hernia. The strapping was changed once a week. The diameter of the hernia orifice was measured on ultrasonography every 2 weeks until closure. The closure speed (CS) of the hernia orifice was compared between the infants treated with adhesive strapping and those undergoing observation alone. The association between CS and birthweight, gestational age, diameter of the hernia orifice, and timing of treatment (before 12 weeks of age vs between 12 and 26 weeks of age) was also analyzed. Closure was achieved after 2-13 weeks of strapping in 81 infants (91%), and the likelihood of closure was not affected by the diameter of the hernia orifice, gestational age, or the timing of treatment. The mean CS of the infants treated with adhesive strapping was significantly faster than that of the infants undergoing observation alone (2.59 vs 0.37 mm/week, P < 0.05). Adhesive strapping was discontinued in five of the 89 infants (5.6%) due to severe skin complications. Adhesive strapping promoted early spontaneous umbilical hernia closure compared with observation alone, regardless of the diameter of the hernia orifice. Adhesive strapping is an effective alternative to surgery and observation. © 2015 Japan Pediatric Society.

[3D printing in neurosurgery: a specific model for patients with craniosynostosis].

PubMed

Jiménez Ormabera, Borja; Díez Valle, Ricardo; Zaratiegui Fernández, Javier; Llorente Ortega, Marcos; Unamuno Iñurritegui, Xabier; Tejada Solís, Sonia

Craniosynostosis is a rare condition and requires a personalised surgical approach, which is why we consider the use of 3D printed models beneficial in the surgical planning of this procedure. Acrylonitrile butadiene styrene plastic skull models were designed and printed from CT images of patients between 3 and 6 months of age with craniosynostosis of different sutures. The models were used to simulate surgical procedures. Four models of four patients with craniosynostosis were produced: two with closure of the metopic suture and two with sagittal suture closure. The mean age of the patients was 5 months (3-6m) and the mean duration of the surgery was 286min (127-380min). The acrylonitrile butadiene styrene plastic models printed for the project proved to be optimal for the simulation of craniosynostosis surgeries, both anatomically and in terms of mechanical properties and reaction to surgical instruments. 3D printers have a wide range of medical applications and they offer an easy and affordable way to produce skull models. The acrylonitrile butadiene styrene material is suitable for the production of operable bone models as it faithfully reproduces the mechanical characteristics of bone tissue. Copyright © 2017 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

Isolated Major Aortopulmonary Collateral as the Sole Pulmonary Blood Supply to an Entire Lung Segment.

PubMed

Kim, Hannah S; Grady, R Mark; Shahanavaz, Shabana

2017-01-01

Congenital systemic-to-pulmonary collateral arteries or major aortopulmonary collaterals are associated with cyanotic congenital heart disease with decreased pulmonary blood flow. Though it is usually associated with congenital heart diseases, there is an increased incidence of isolated acquired aortopulmonary collaterals in premature infants with chronic lung disease. Interestingly, isolated congenital aortopulmonary collaterals can occur without any lung disease, which may cause congestive heart failure and require closure. We present a neonate with an echocardiogram that showed only left-sided heart dilation. Further workup with a CT angiogram demonstrated an anomalous systemic artery from the descending thoracic aorta supplying the left lower lobe. He eventually developed heart failure symptoms and was taken to the catheterization laboratory for closure of the collateral. However, with the collateral being the only source of blood flow to the entire left lower lobe, he required surgical unifocalization. Isolated aortopulmonary collaterals without any other congenital heart disease or lung disease are rare. Our patient is the first reported case to have an isolated aortopulmonary collateral being the sole pulmonary blood supply to an entire lung segment. Due to its rarity, there is still much to learn about the origin and development of these collaterals that possibly developed prenatally.

Improved attenuation correction for respiratory gated PET/CT with extended-duration cine CT: a simulation study

NASA Astrophysics Data System (ADS)

Zhang, Ruoqiao; Alessio, Adam M.; Pierce, Larry A.; Byrd, Darrin W.; Lee, Tzu-Cheng; De Man, Bruno; Kinahan, Paul E.

2017-03-01

Due to the wide variability of intra-patient respiratory motion patterns, traditional short-duration cine CT used in respiratory gated PET/CT may be insufficient to match the PET scan data, resulting in suboptimal attenuation correction that eventually compromises the PET quantitative accuracy. Thus, extending the duration of cine CT can be beneficial to address this data mismatch issue. In this work, we propose to use a long-duration cine CT for respiratory gated PET/CT, whose cine acquisition time is ten times longer than a traditional short-duration cine CT. We compare the proposed long-duration cine CT with the traditional short-duration cine CT through numerous phantom simulations with 11 respiratory traces measured during patient PET/CT scans. Experimental results show that, the long-duration cine CT reduces the motion mismatch between PET and CT by 41% and improves the overall reconstruction accuracy by 42% on average, as compared to the traditional short-duration cine CT. The long-duration cine CT also reduces artifacts in PET images caused by misalignment and mismatch between adjacent slices in phase-gated CT images. The improvement in motion matching between PET and CT by extending the cine duration depends on the patient, with potentially greater benefits for patients with irregular breathing patterns or larger diaphragm movements.

Time to wound closure in trauma patients with disorders in wound healing is shortened by supplements containing antioxidant micronutrients and glutamine: a PRCT.

PubMed

Blass, Sandra C; Goost, Hans; Tolba, René H; Stoffel-Wagner, Birgit; Kabir, Koroush; Burger, Christof; Stehle, Peter; Ellinger, Sabine

2012-08-01

: We hypothesize that wound closure in trauma patients with disorders in wound healing is accelerated by supplementation of antioxidant micronutrients and glutamine. In a randomized, double-blind, placebo-controlled trial, 20 trauma patients with disorders in wound healing were orally supplemented with antioxidant micronutrients (ascorbic acid, α-tocopherol, β-carotene, zinc, selenium) and glutamine (verum) or they received isoenergetic amounts of maltodextrine (placebo) for 14 days. Plasma/serum levels of micronutrients, glutamine, and vascular endothelial growth factor-A (VEGF-A) were determined before and after supplementation. In the wound, several parameters of microcirculation were measured. Time from study entry to wound closure was recorded. Micronutrients in plasma/serum did not change except for selenium which increased in the verum group (1.1 ± 0.2 vs. 1.4 ± 0.2 μmol/l; P = 0.009). Glutamine decreased only in the placebo group (562 ± 68 vs. 526 ± 55 μmol/l; P = 0.047). The prevalence of hypovitaminoses and the concentration of VEGF-A did not change. Considering microcirculation, only O(2)-saturation decreased in the placebo group (56.7 ± 23.4 vs. 44.0 ± 24.0 [arbitrary units]; P = 0.043). Wound closure occurred more rapidly in the verum than in the placebo group (35 ± 22 vs. 70 ± 35 d; P = 0.01). Time to wound closure can be shortened by oral antioxidant and glutamine containing supplements in trauma patients with disorders in wound healing. Copyright © 2012 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Osteoporotic risk and physeal closure in prepubertal ovariohysterectomized cats.

PubMed

Uçmak, Melih; Yılmaz, Özge Turna; Gündüz, Mehmet Can; Uçmak, Zeynep Günay; Duzgun, Oktay; Eskiyurt, Nurten; Oruç, Coşkun Umut; Genç, Sema; Erzengin, Ömer Mehmet; Karaçam, Esra

2015-10-01

We aimed to examine the early effects of prepubertal ovariohysterectomy (P-OHE) on bone loss and proximal physeal closure in cats. Fourteen kittens randomly underwent P-OHE or sham operations (S-OP) at three months (mo) of age and were allocated to group I and group II. Each mo between four and nine mo of age, dual-energy X-ray absorptiometry (DEXA) scans were performed to determine the total body bone mineral density (BMD) and bone mineral content (BMC). Proximal radial physeal closure and radial length were determined by radiography. Bone-specific alkaline phosphatase (BAP), carboxy-terminal collagen teleopeptide (CTX), 17-β estradiol, progesterone, calcium (Ca) and phosphorus (P) were measured in the serum samples. No significant differences were observed between the groups in terms of BMD, BMC, BAP, BAP/CTX, P, progesterone and body weight (BW) (between 4 and 9mo) and for Ca (between 5 and 9mo) and for CTX levels (between 4 and 8mo). The 17-β estradiol was significantly higher at 6, 8 and 9mo of age in the S-OP group due to puberty (P=0.02, P=0.03 and P=0.02 respectively). Although there was a significant difference (P=0.0002) between the P-OHE and S-OP groups in terms of the proximal radial physeal closure times (7.43±0.20mo and 6.14±0.14mo, respectively), no significant difference was observed for the mean radius length (10.59±0.10cm and 10.06±0.27cm, respectively) at the last evaluation time. In conclusion, prepubertal ovariohysterectomized cats do not have any osteoporotic risks until nine mo of age and exhibit a delayed physeal closure time without a change in radius length. Copyright © 2015. Published by Elsevier B.V.

Direct Percutaneous Left Ventricular Access and Port Closure

PubMed Central

Barbash, Israel M.; Saikus, Christina E.; Faranesh, Anthony Z.; Ratnayaka, Kanishka; Kocaturk, Ozgur; Chen, Marcus Y.; Bell, Jamie A.; Virmani, Renu; Schenke, William H.; Hansen, Michael S.; Slack, Michael C.; Lederman, Robert J.

2012-01-01

Objectives This study sought to evaluate feasibility of nonsurgical transthoracic catheter-based left ventricular (LV) access and closure. Background Implanting large devices, such as mitral or aortic valve prostheses, into the heart requires surgical exposure and repair. Reliable percutaneous direct transthoracic LV access and closure would allow new nonsurgical therapeutic procedures. Methods Percutaneous direct LV access was performed in 19 swine using real-time magnetic resonance imaging (MRI) and an “active” MRI needle antenna to deliver an 18-F introducer sheath. The LV access ports were closed percutaneously using a commercial ventricular septal defect occluder and an “active” MRI delivery cable for enhanced visibility. We used “permissive pericardial tamponade” (temporary fluid instillation to separate the 2 pericardial layers) to avoid pericardial entrapment by the epicardial disk. Techniques were developed in 8 animals, and 11 more were followed up to 3 months by MRI and histopathology. Results Imaging guidance allowed 18-F sheath access and closure with appropriate positioning of the occluder inside the transmyocardial tunnel. Of the survival cohort, immediate hemostasis was achieved in 8 of 11 patients. Failure modes included pericardial entrapment by the epicardial occluder disk (n = 2) and a true-apex entry site that prevented hemostatic apposition of the endocardial disk (n = 1). Reactive pericardial effusion (192 ± 118 ml) accumulated 5 ± 1 days after the procedure, requiring 1-time drainage. At 3 months, LV function was preserved, and the device was endothelialized. Conclusions Direct percutaneous LV access and closure is feasible using real-time MRI. A commercial occluder achieved hemostasis without evident deleterious effects on the LV. Having established the concept, further clinical development of this approach appears realistic. PMID:22192372

The Immediate and Delayed Post-Debridement Effects on Tissue Bacterial Wound Counts of Hypochlorous Acid Versus Saline Irrigation in Chronic Wounds.

PubMed

Hiebert, John M; Robson, Martin C

2016-01-01

Introduction: Wound debridement is considered essential in chronic wound management. Hypochlorous acid has been shown to be an effective agent in reducing wound bacterial counts in open wounds. Ultrasound-enabled wound debridement is an effective and efficient method of debridement. This study compared ultrasound irrigation with hypochlorous acid versus saline irrigation for wound debridement on pre- and postoperative wounds and determined regrowth of bacteria over 1 week period of time. Finally, the outcome of definitive wound closure of the clinically clean-appearing wounds was recorded. Methods: Seventeen consenting adult patients with chronic open wounds were randomly selected for study. The patients were randomly divided into the hypochlorous acid irrigation or saline irrigation group. All patients provided pre- and postoperative tissue samples for qualitative and quantitative bacteriology. For the time (7 days) between the debridement procedure and the definitive closure procedure, the wounds were dressed with a silver-impregnated dressing and a hydroconductive dressing. Results : Both types of irrigation in the ultrasonic system initially lowered the bacterial counts by 4 to 6 logs. However, by the time of definitive closure, the saline-irrigated wounds had bacterial counts back up to 10 5 whereas the hypochlorous acid-irrigated wounds remained at 10 2 or fewer. More than 80% of patients in the saline group had postoperative closure failure compared with 25% of patients in the hypochlorous acid group. Conclusions: Hypochlorous acid irrigation with ultrasound debridement reduced bacterial growth in chronic open wounds more efficiently than saline alone. Postoperative wound closure outcomes suggest a remarkable reduction in wound complications after wound debridement using hypochlorous acid irrigation with ultrasound versus saline alone.

Stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy.

PubMed

Probst, Pascal; Hüttner, Felix J; Klaiber, Ulla; Knebel, Phillip; Ulrich, Alexis; Büchler, Markus W; Diener, Markus K

2015-11-06

Resections of the pancreatic body and tail reaching to the left of the superior mesenteric vein are defined as distal pancreatectomy. Most distal pancreatectomies are elective treatments for chronic pancreatitis, benign or malignant diseases, and they have high morbidity rates of up to 40%. Pancreatic fistula formation is the main source of postoperative morbidity, associated with numerous further complications. Researchers have proposed several surgical resection and closure techniques of the pancreatic remnant in an attempt to reduce these complications. The two most common techniques are scalpel resection followed by hand-sewn closure of the pancreatic remnant and stapler resection and closure. To compare the rates of pancreatic fistula in people undergoing distal pancreatectomy using scalpel resection followed by hand-sewn closure of the pancreatic remnant versus stapler resection and closure. We searched Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Biosis and Science Citation Index from database inception to October 2015. We included randomised controlled trials (RCTs) comparing stapler versus scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy (irrespective of language or publication status). Two authors independently assessed trials for inclusion and extracted the data. Taking into consideration the clinical heterogeneity between the trials (e.g. different endpoint definitions), we analysed data using a random-effects model with Review Manager (RevMan), calculating risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). In two eligible trials, a total of 381 participants underwent distal pancreatic resection and were randomised to closure of the pancreatic remnant either with stapler (n = 191) or scalpel resection followed by hand-sewn closure (n = 190). One was a single centre pilot RCT and the other was a multicentre blinded RCT. The single centre pilot RCT evaluated 69 participants in five intervention arms (stapler, hand-sewn, fibrin glue, mesh and pancreaticojejunostomy), although we only assessed the stapler and hand-sewn closure groups (14 and 15 participants, respectively). The multicentre RCT had two interventional arms: stapler (n = 177) and hand-sewn closure (n = 175). The rate of postoperative pancreatic fistula was the main outcome, and it occurred in 79 of 190 participants in the hand-sewn group compared to 65 of 191 participants in the stapler group. Neither the individual trials nor the meta-analysis showed a significant difference between resection techniques (RR 0.90; 95% CI 0.55 to 1.45; P = 0.66). In the same way, postoperative mortality and operation time did not differ significantly. The single centre RCT had an unclear risk of bias in the randomisation, allocation and both blinding domains. However, the much larger multicentre RCT had a low risk of bias in all domains. Due to the small number of events and the wide confidence intervals that cannot exclude clinically important benefit or harm with stapler versus hand-sewn closure, there is a serious possibility of imprecision, making the overall quality of evidence moderate. The quality of evidence is moderate and mainly based on the high weight of the results of one multicentre RCT. Unfortunately, there are no other completed RCTs on this topic except for one relevant ongoing trial. Neither stapler nor scalpel resection followed by hand-sewn closure of the pancreatic remnant for distal pancreatectomy showed any benefit compared to the other method in terms of postoperative pancreatic fistula, overall postoperative mortality or operation time. Currently, the choice of closure is left up to the preference of the individual surgeon and the anatomical characteristics of the patient. Another (non-European) multicentre trial (e.g. with an equality or non-inferiority design) would help to corroborate the findings of this meta-analysis. Future trials assessing novel methods of stump closure should compare them either with stapler or hand-sewn closure as a control group to ensure comparability of results.

An in vitro comparison of the effects of voluven (6% hydroxyethyl starch 130/0.4) and hespan (6% hydroxyethyl starch 670/0.75) on measures of blood coagulation in canine blood.

PubMed

Griego-Valles, Michelle; Buriko, Yekaterina; Prittie, Jennifer E; Fox, Philip R

2017-01-01

To assess primary and secondary hemostasis following in vitro dilution of canine whole blood (WB) with hydroxyethyl starch (HES) 130/0.4 and HES 670/0.75. In vitro experimental study. Private practice, teaching hospital. Twenty-five healthy dogs. Each dog underwent venipuncture and 18 mL of venous blood was sampled once. Collected blood was separated in 4 aliquots. Aliquot A served as baseline sample. The remaining tubes of WB were diluted with 0.9% saline, HES 670/0.75 and HES 130/0.4 at a ratio of 1:5.5. Dilutional effects were evaluated using prothrombin time (PT), activated partial thromboplastin time (aPTT), packed cell volume (PCV), thromboelastography (TEG), and platelet closure time (Ct), which was measured using a platelet function analyzer (PFA). Clot strength (ie, G value) was calculated from measured TEG values. Significant increases in PT (P < 0.05) and aPTT (P < 0.05) were documented following WB dilution with saline. Dilution of WB with HES 670/0.75 and HES 130/0.4 resulted in significant hypocoagulable changes in K, MA and G (P < 0.05) compared to baseline and saline. When comparing saline to HES 670/0.75, both R and K values were significantly increased (P < 0.05). K value was significantly increased (P < 0.05) when comparing baseline to HES 130/0.4 and HES 670/0.75. Ct (P < 0.05) was significantly prolonged after WB dilution with HES solutions but not after saline. Dilution of WB with HES 670/0.75 and HES 130/0.4 resulted in changes in primary and secondary hemostasis. Although there were small differences between saline and HES 670/0.75, no differences between HES solutions were evident in this small study. This may suggest there would be minimal increases in bleeding risk when either solution is administered to dogs at low doses. Clinical relevance of our findings requires further investigation. © Veterinary Emergency and Critical Care Society 2016.

Limited diagnostic value of Dual-Time-Point (18)F-FDG PET/CT imaging for classifying solitary pulmonary nodules in granuloma-endemic regions both at visual and quantitative analyses.

PubMed

Chen, Song; Li, Xuena; Chen, Meijie; Yin, Yafu; Li, Na; Li, Yaming

2016-10-01

This study is aimed to compare the diagnostic power of using quantitative analysis or visual analysis with single time point imaging (STPI) PET/CT and dual time point imaging (DTPI) PET/CT for the classification of solitary pulmonary nodules (SPN) lesions in granuloma-endemic regions. SPN patients who received early and delayed (18)F-FDG PET/CT at 60min and 180min post-injection were retrospectively reviewed. Diagnoses are confirmed by pathological results or follow-ups. Three quantitative metrics, early SUVmax, delayed SUVmax and retention index(the percentage changes between the early SUVmax and delayed SUVmax), were measured for each lesion. Three 5-point scale score was given by blinded interpretations performed by physicians based on STPI PET/CT images, DTPI PET/CT images and CT images, respectively. ROC analysis was performed on three quantitative metrics and three visual interpretation scores. One-hundred-forty-nine patients were retrospectively included. The areas under curve (AUC) of the ROC curves of early SUVmax, delayed SUVmax, RI, STPI PET/CT score, DTPI PET/CT score and CT score are 0.73, 0.74, 0.61, 0.77 0.75 and 0.76, respectively. There were no significant differences between the AUCs in visual interpretation of STPI PET/CT images and DTPI PET/CT images, nor in early SUVmax and delayed SUVmax. The differences of sensitivity, specificity and accuracy between STPI PET/CT and DTPI PET/CT were not significantly different in either quantitative analysis or visual interpretation. In granuloma-endemic regions, DTPI PET/CT did not offer significant improvement over STPI PET/CT in differentiating malignant SPNs in both quantitative analysis and visual interpretation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Surgical repair of a congenital sternal cleft in a cat.

PubMed

Schwarzkopf, Ilona; Bavegems, Valerie C A; Vandekerckhove, Peter M F P; Melis, Sanne M; Cornillie, Pieter; de Rooster, Hilde

2014-07-01

To describe the clinical findings, diagnosis, and treatment of an incomplete cleft of the 5th-8th sternebra and a cranioventral abdominal wall hernia in a 2 month old Ragdoll kitten and to evaluate the short- and long-term outcome. Clinical report. Ragdoll cat (n = 1), 2 months old. Sternal cleft was confirmed by thoracic radiographs. Computed tomography (CT) was used to plan an optimal surgical approach. A ventral median incision was made, starting at the 3rd sternebra and extended into the abdomen. Ostectomy of the proximal part of the 5th left sternebra was performed. Lateral periosteal flaps were created, unfolded, and absorbable monofilament sutures preplaced to facilitate closure and the repair was reinforced by 2 peristernal sutures. A bone graft was applied, and the free margin of the omentum was sutured to the cranial aspect of the wound. No major complications occurred. At 3 weeks, CT scan confirmed approximation of the hemisternebrae and at 10 months, complete fusion of the hemisternebrae had not occurred, but a strong connection of the sternal bars was present. Sternal cleft is a rare congenital abnormality that can be corrected surgically with favorable outcome. © Copyright 2014 by The American College of Veterinary Surgeons.

Biphasic β-TCP mixed with silicon increases bone formation in critical site defects in rabbit calvaria.

PubMed

Calvo-Guirado, José Luis; Garces, Miguel; Delgado-Ruiz, Rafael Arcesio; Ramirez Fernandez, Maria P; Ferres-Amat, Eduard; Romanos, Georgios E

2015-08-01

The aim of this study was to assess the bone regeneration of critical size defects in rabbit calvarias filled with β-TCP doped with silicon. Twenty-one New Zealand rabbits were used in this study. Two critical size defects were created in the parietal bones. Three experimental groups were evaluated: Test A (HA/β-TCP granules alone), Test B (HA/β-TCP granules plus 3% silicon), Control (empty defect). The animals were sacrificed at 8 and 12 weeks. Evaluation was performed by μCT analysis and histomorphometry. μCT evaluation showed higher volume reduction in Test A group compared with Test B (P < 0.05). The Test B group showed the highest values for cortical closure and bone formation around the particles, followed by Test A and controls (P < 0.05). Within the limitations of this animal study, it can be concluded that HA/β-TCP plus 3% silicon increases bone formation in critical size defects in rabbit calvarias, and the incorporation of 3% silicon reduces the resorption rate of the HA/β-TCP granules. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Comparing diameter growth of stands prior to canopy closure to diameter growth of stands after canopy closure

Treesearch

Thomas J. Dean; D. Andrew Scott; Ray A. Newbold

2010-01-01

Three models are compared for their ability to account for differences in diameter growth associated with different stages of stand development. Data for the comparisons were collected in young loblolly pine plantations treated variously at time of planting for the first 10 years since establishment. Neither the growth-growing stock model nor the accelerated...

Lesson Closure: An Important Piece of the Student Learning Puzzle

ERIC Educational Resources Information Center

Ganske, Kathy

2017-01-01

As we seek ways to improve literacy teaching and learning, we need to be careful not to overlook lesson closure as an opportunity to solidify student learning. This Teaching Tip describes the importance of taking time at the ends of lessons, days, and weeks to revisit what students have learned as a means for helping them synthesize and assimilate…

75 FR 64171 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Reef Fish Fishery of the Gulf of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-19

... prevent overfishing of Gulf greater amberjack. DATES: Closure is effective 12:01 a.m., local time, October... harvest to the quota is crucial to meeting the legal requirements to prevent and end overfishing and.... This closure is intended to prevent overfishing of Gulf greater amberjack and increase the likelihood...

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.

Transesophageal echocardiography and intracardiac echocardiography differently predict potential technical challenges or failures of interatrial shunts catheter-based closure.

PubMed

Rigatelli, Gianluca; Rigateli, Gianluca; Cardaioli, Paolo; Braggion, Gabriele; Aggio, Silvio; Giordan, Massimo; Magro, Beatrice; Nascimben, Alberto; Favaro, Alberto; Roncon, Loris; Rincon, Loris

2007-02-01

We sought to prospectively assess the role of transesophageal (TEE) and intracardiac echocardiography (ICE) in detecting potential technical difficulties or failures in patients submitted to interatrial shunts percutaneous closure. We prospectively enrolled 46 consecutive patients (mean age 35+/-28, 8 years, 30 female) referred to our center for catheter-based closure of interatrial shunts. All patients were screened with TEE before the intervention. Patients who met the inclusion criteria underwent ICE study before the closure attempt (40 patients). TEE detected potential technical difficulties in 22.5% (9/40) patients, whereas ICE detected technical difficulties in 32.5% (13/40 patients). In patients with positive TEE/ICE the procedural success (92.4% versus 100% and, P = ns) and follow-up failure rate (7.7% versus 0%, P = ns) were similar to patients with negative TEE/ICE, whereas the fluoroscopy time (7 +/- 1.2 versus 5 +/- 0.7 minutes, P < 0.03), the procedural time (41 +/- 4.1 versus 30 +/- 8.2 minutes, P +/- 0.03), and technical difficulties rate (23.1% versus 0%, P = 0.013) were higher. Differences between ICE and TEE in the evaluation of rims, measurement of ASD or fossa ovalis, and detection of venous valve and embryonic septal membrane remnants impacted on technical challenges and on procedural and fluoroscopy times but did not influence the success rate and follow-up failure rate.

Prediction of accrual closure date in multi-center clinical trials with discrete-time Poisson process models.

PubMed

Tang, Gong; Kong, Yuan; Chang, Chung-Chou Ho; Kong, Lan; Costantino, Joseph P

2012-01-01

In a phase III multi-center cancer clinical trial or a large public health study, sample size is predetermined to achieve desired power, and study participants are enrolled from tens or hundreds of participating institutions. As the accrual is closing to the target size, the coordinating data center needs to project the accrual closure date on the basis of the observed accrual pattern and notify the participating sites several weeks in advance. In the past, projections were simply based on some crude assessment, and conservative measures were incorporated in order to achieve the target accrual size. This approach often resulted in excessive accrual size and subsequently unnecessary financial burden on the study sponsors. Here we proposed a discrete-time Poisson process-based method to estimate the accrual rate at time of projection and subsequently the trial closure date. To ensure that target size would be reached with high confidence, we also proposed a conservative method for the closure date projection. The proposed method was illustrated through the analysis of the accrual data of the National Surgical Adjuvant Breast and Bowel Project trial B-38. The results showed that application of the proposed method could help to save considerable amount of expenditure in patient management without compromising the accrual goal in multi-center clinical trials. Copyright © 2012 John Wiley & Sons, Ltd.

Effects of repeated gas sterilization on closure rates of ameroid ring constrictors in vitro.

PubMed

Kimberlin, William W; Wardlaw, Jennifer L; Madsen, Richard W

2016-01-01

To determine the effect of repeated gas sterilization on rate of closure of ameroid ring constrictors in vitro. Twenty-four 3.5-mm ameroid ring constrictors. Ameroid ring constrictors were allocated to 1 of 4 treatment groups (6/group) to undergo gas sterilization 0, 1, 5, or 10 times. After sterilization, constrictors were incubated in canine plasma at a protein concentration of 3 g/dL for 27 days. A digital camera was used to obtain images of the constrictors prior to and at various points during incubation, and lumen diameter was measured. Mean ± SD percentage of lumen closure for all groups of ameroid ring constrictors combined was 85.2 ± 1.6% at day 0 (prior to plasma incubation) and 95.4 ± 0.8% at day 27. Mean lumen area was 3.64 ± 0.43 mm(2) (95% confidence interval, 2.67 to 4.77 mm(2)) at day 0 and 1.32 ± 0.25 mm(2) (95% confidence interval, 0.76 to 2.04 mm(2)) at day 27. None of the ameroid ring constrictors had closed completely by day 27. Overall closure rates for ameroid ring constrictors appeared to be unaffected by repeated gas sterilization up to 10 times. Findings suggested that veterinary surgeons can resterilize ameroid ring constrictors up to 10 times with confidence that ring properties would remain suitable for clinical use.

Efficacy of stapler pharyngeal closure after total laryngectomy: A systematic review.

PubMed

Aires, Felipe T; Dedivitis, Rogério A; Castro, Mario Augusto F; Bernardo, Wanderley Marques; Cernea, Claudio Roberto; Brandão, Lenine Garcia

2014-05-01

Some primary studies compare manual and mechanical pharyngeal closures after total laryngectomy. The purpose of this study was to evaluate the advantages of the mechanical suture in pharyngeal closure. The literature survey included research in MEDLINE, EMBASE, and LILACS. The intervention analyzed was stapler-assisted pharyngeal closure, whereas the control group was manual suture pharyngeal closure. The survey resulted in 319 studies. However, 4 studies were selected (417 patients). In the group of patients in whom the stapler was used, the incidence of pharyngocutaneous fistula was 8.7%, whereas in the other, it was 22.9%, with an absolute risk reduction of 15% (95% confidence interval [CI], 0.02-0.28; p = .02; I(2) = 66%). Regarding the surgical time, the average difference was 80 minutes in favor of the stapler group (95% CI, 23.16-136.58 minutes; p < .006). The difference for starting oral feeding was 8 days in favor of the mechanical suture (95% CI, 4.01-11.73 days; p < .001). Patients who underwent mechanical suture had a shorter hospitalization period. Copyright © 2013 Wiley Periodicals, Inc.

Modified off-midline closure of pilonidal sinus disease.

PubMed

Saber, Aly

2014-05-01

Numerous surgical procedures have been described for pilonidal sinus disease, but treatment failure and disease recurrence are frequent. Conventional off-midline flap closures have relatively favorable surgical outcomes, but relatively unfavorable cosmetic outcomes. The author reported outcomes of a new simplified off-midline technique for closure of the defect after complete excision of the sinus tracts. Two hundred patients of both sexes were enrolled for modified D-shaped excisions were used to include all sinuses and their ramifications, with a simplified procedure to close the defect. The overall wound infection rate was 12%, (12.2% for males and 11.1% for females). Wound disruption was necessitating laying the whole wound open and management as open technique. The overall wound disruption rate was 6%, (6.1% for males and 5.5% for females) and the overall recurrence rate was 7%. Our simplified off-midline closure without flap appeared to be comparable to conventional off-midline closure with flap, in terms of wound infection, wound dehiscence, and recurrence. Advantages of the simplified procedure include potentially reduced surgery complexity, reduced surgery time, and improved cosmetic outcome.

Valve for controlling solids flow

DOEpatents

Feldman, David K.

1980-01-01

A fluidized solids control valve is disclosed that is particularly well adapted for use with a flow of coal or char that includes both large particles and fines. The particles may or may not be fluidized at various times during the operation. The valve includes a tubular body that terminates in a valve seat covered by a normally closed closure plate. The valve body at the seat and the closure plate is provided with aligned longitudinal slots that receive a pivotally supported key plate. The key plate is positionable by an operator in inserted, intermediate and retracted positions respecting the longitudinal slot in the valve body. The key plate normally closes the slot within the closure plate but is shaped and aligned obliquely to the longitudinal slot within the valve body to provide progressively increasing slot openings between the inserted and retracted positions. Transfer members are provided between the operator, key plate and closure plate to move the closure plate into an open position only when the key plate is retracted from the longitudinal slot within the valve body.

Accelerated re-epithelialization of partial-thickness skin wounds by a topical betulin gel: Results of a randomized phase III clinical trials program.

PubMed

Barret, Juan P; Podmelle, Fred; Lipový, Břetislav; Rennekampff, Hans-Oliver; Schumann, Hauke; Schwieger-Briel, Agnes; Zahn, Tobias R; Metelmann, Hans-Robert

2017-09-01

The clinical significance of timely re-epithelialization is obvious in burn care, since delayed wound closure is enhancing the risk of wound site infection and extensive scarring. Topical treatments that accelerate wound healing are urgently needed to reduce these sequelae. Evidence from preliminary studies suggests that betulin can accelerate the healing of different types of wounds, including second degree burns and split-thickness skin graft wounds. The goal of this combined study program consisting of two randomized phase III clinical trials in parallel is to evaluate whether a topical betulin gel (TBG) is accelerating re-epithelialization of split-thickness skin graft (STSG) donor site wounds compared to standard of care. Two parallel blindly evaluated, randomised, controlled, multicentre phase III clinical trials were performed in adults undergoing STSG surgery (EudraCT nos. 2012-003390-26 and 2012-000777-23). Donor site wounds were split into two equal halves and randomized 1:1 to standard of care (a non-adhesive moist wound dressing) or standard of care plus TBG consisting of 10% birch bark extract and 90% sunflower oil (Episalvan, Birken AG, Niefern-Oeschelbronn, Germany). The primary efficacy assessment was the intra-individual difference in time to wound closure assessed from digital photographs by three blinded experts. A total of 219 patients were included and treated in the two trials. Wounds closed faster with TBG than without it (15.3 vs. 16.5 days; mean intra-individual difference=-1.1 days [95% CI, -1.5 to -0.7]; p<0.0001). This agreed with unblinded direct clinical assessment (difference=-2.1 days [95% CI, -2.7 to -1.5]; p<0.0001). Adverse events possibly related to treatment were mild or moderate and mostly at the application site. TBG accelerates re-epithelialization of partial thickness wounds compared to the current standard of care, providing a well-tolerated contribution to burn care in practice. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

A high-throughput three-dimensional cell migration assay for toxicity screening with mobile device-based macroscopic image analysis

PubMed Central

Timm, David M.; Chen, Jianbo; Sing, David; Gage, Jacob A.; Haisler, William L.; Neeley, Shane K.; Raphael, Robert M.; Dehghani, Mehdi; Rosenblatt, Kevin P.; Killian, T. C.; Tseng, Hubert; Souza, Glauco R.

2013-01-01

There is a growing demand for in vitro assays for toxicity screening in three-dimensional (3D) environments. In this study, 3D cell culture using magnetic levitation was used to create an assay in which cells were patterned into 3D rings that close over time. The rate of closure was determined from time-lapse images taken with a mobile device and related to drug concentration. Rings of human embryonic kidney cells (HEK293) and tracheal smooth muscle cells (SMCs) were tested with ibuprofen and sodium dodecyl sulfate (SDS). Ring closure correlated with the viability and migration of cells in two dimensions (2D). Images taken using a mobile device were similar in analysis to images taken with a microscope. Ring closure may serve as a promising label-free and quantitative assay for high-throughput in vivo toxicity in 3D cultures. PMID:24141454

Novel percutaneous suture-mediated patent foramen ovale closure technique. Early results of the NobleStitch EL Italian Registry.

PubMed

Gaspardone, Achille; De Marco, Federico; Sgueglia, Gregory A; De Santis, Antonella; Iamele, Maria; D'Ascoli, Emanuela; Tusa, Maurizio; Corciu, Anca; Mullen, Michael; Nobles, Anthony; Carminati, Mario; Bedogni, Francesco

2018-04-03

To assess the efficacy of a novel percutaneous "device-less" suture mediated patent foramen ovale (PFO) closure system. Between June 2016 and October 2017, a prospective registry aimed at assessing the safety and efficacy of the NobleStitch EL (HeartStitch, Fountain Valley, CA) suture-based PFO closure system was carried out at 12 sites in Italy. Among 200 consecutive evaluated patients, 192 were considered suitable for suture-mediated PFO closure (44±13 years, 114 women). Suture of the septum with the NobleStitch EL system was carried out successfully in 186 (96%) patients. Median fluoroscopy time was 16.1 (13.0-22.5) minutes and contrast volume 200 (150-270) ml. At 206±130 days follow-up, microbubbles transthoracic echocardiography with Valsalva maneuver revealed no RLS (grade 0) in 139 (75%) patients and RLS grade ≤1 in 166 (89%) patients. Significant RLS was present in 20 (11%) patients (grade 2 and 3 in 11 and 9 patients, respectively). There were no device-related complications. The early results of this first Italian Registry indicates that the suture mediated "deviceless" closure of PFO is feasible in the majority of septal anatomies, provides an effective closure of PFO comparable to traditional devices with an excellent safety profile at medium term follow-up.

T-tube drainage versus primary closure after open common bile duct exploration.

PubMed

Gurusamy, Kurinchi Selvan; Koti, Rahul; Davidson, Brian R

2013-06-21

Between 5% and 11% of people undergoing cholecystectomy have common bile duct stones. Stones may be removed at the time of cholecystectomy by opening and clearing the common bile duct. The optimal technique is unclear. The aim is to assess the benefits and harms of T-tube drainage versus primary closure without biliary stent after open common bile duct exploration for common bile duct stones. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2013. We included all randomised clinical trials comparing T-tube drainage versus primary closure after open common bile duct exploration. Two of four authors independently identified the studies for inclusion and extracted data. We analysed the data with both the fixed-effect and the random-effects model using Review Manager (RevMan) analyses. For each outcome we calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence interval (CI) based on intention-to-treat analysis. We included six trials randomising 359 participants, 178 to T-tube drainage and 181 to primary closure. All trials were at high risk of bias. There was no significant difference in mortality between the two groups (4/178 (weighted percentage 1.2%) in the T-tube group versus 1/181 (0.6%) in the primary closure group; RR 2.25; 95% CI 0.55 to 9.25; six trials). There was no significant difference in the serious morbidity rate between the two groups (24/136 (weighted serious morbidity rate, 145 events per 1000 patients) in the T-tube group versus 9/136 (weighted serious morbidity rate, 66 events per 1000 patients) in the primary closure group; RaR 2.19; 95% CI 0.98 to 4.91; four trials). Quality of life and return to work were not reported in any of the trials. The operating time was significantly longer in the T-tube drainage group compared with the primary closure group (MD 28.90 minutes; 95% CI 17.18 to 40.62 minutes; one trial). The hospital stay was significantly longer in the T-tube drainage group compared with the primary closure group (MD 4.72 days; 95% CI 0.83 days to 8.60 days; five trials). T-tube drainage appeared to result in significantly longer operating time and hospital stay compared with primary closure without any apparent evidence of benefit on clinically important outcomes after open common bile duct exploration. Based on the currently available evidence, there is no justification for the routine use of T-tube drainage after open common bile duct exploration in patients with common bile duct stones. T-tube drainage should not be used outside well designed randomised clinical trials. More randomised trials comparing the effects of T-tube drainage versus primary closure after open common bile duct exploration may be needed. Such trials should be conducted with low risk of bias and assessing the long-term beneficial and harmful effects of T-tube drainage, including long-term complications such as bile stricture and recurrence of common bile duct stones.

Impact of adding a second layer to a single unlocked closure of a Cesarean uterine incision: randomized controlled trial.

PubMed

Bennich, G; Rudnicki, M; Wilken-Jensen, C; Lousen, T; Lassen, P D; Wøjdemann, K

2016-04-01

To investigate short- and long-term effects on residual myometrial thickness (RMT) of adding a second layer to a single unlocked closure of a Cesarean uterine incision. This was a randomized double-blind controlled trial. Healthy nulliparous women scheduled for first-time elective Cesarean delivery were operated on using a modified version of the Misgav Ladach surgical technique. The women were examined by transabdominal ultrasound before discharge from the maternity ward and by transvaginal saline contrast sonohysterography at a minimum of 5 months postpartum. Seventy-six nulliparae met the criteria and agreed to participate in the study. Thirty-five women were assigned to the single-layer technique and 38 to the double-layer unlocked closure technique. Groups were comparable regarding gestational age at delivery, duration of surgery and perioperative blood loss. There was no difference in RMT between the two groups, both at time of discharge (mean ± SD, 20.2 ± 8.0 mm vs 21.0 ± 9.7 mm) and after 5 months postpartum (mean, 5.7 ± 2.9 mm vs 5.7 ± 2.2 mm). RMT was approximately half that of the normal myometrium at both examinations. The results of this study suggest that double-layer closure of a Cesarean uterine incision does not increase RMT compared with single-layer closure when an unlocked technique is used. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.

Comparison of helical and cine acquisitions for 4D-CT imaging with multislice CT.

PubMed

Pan, Tinsu

2005-02-01

We proposed a data sufficiency condition (DSC) for four-dimensional-CT (4D-CT) imaging on a multislice CT scanner, designed a pitch factor for a helical 4D-CT, and compared the acquisition time, slice sensitivity profile (SSP), effective dose, ability to cope with an irregular breathing cycle, and gating technique (retrospective or prospective) of the helical 4D-CT and the cine 4D-CT on the General Electric (GE) LightSpeed RT (4-slice), Plus (4-slice), Ultra (8-slice) and 16 (16-slice) multislice CT scanners. To satisfy the DSC, a helical or cine 4D-CT acquisition has to collect data at each location for the duration of a breathing cycle plus the duration of data acquisition for an image reconstruction. The conditions for the comparison were 20 cm coverage in the cranial-caudal direction, a 4 s breathing cycle, and half-scan reconstruction. We found that the helical 4D-CT has the advantage of a shorter scan time that is 10% shorter than that of the cine 4D-CT, and the disadvantages of 1.8 times broadening of SSP and requires an additional breathing cycle of scanning to ensure an adequate sampling at the start and end locations. The cine 4D-CT has the advantages of maintaining the same SSP as slice collimation (e.g., 8 x 2.5 mm slice collimation generates 2.5 mm SSP in the cine 4D-CT as opposed to 4.5 mm in the helical 4D-CT) and a lower dose by 4% on the 8- and 16-slice systems, and 8% on the 4-slice system. The advantage of faster scanning in the helical 4D-CT will diminish if a repeat scan at the location of a breathing irregularity becomes necessary. The cine 4D-CT performs better than the helical 4D-CT in the repeat scan because it can scan faster and is more dose efficient.

Loop-anchor purse-string closure of gastrotomy in NOTES(R) procedures: survival studies in a porcine model.

PubMed

Romanelli, John R; Desilets, David J; Chapman, Christopher N; Surti, Vihar C; Lovewell, Carolanne; Earle, David B

2010-12-01

Transgastric NOTES(®) procedures remain without a simple method to close the gastrotomy. In four survival swine studies, we have tested a novel gastric closure device: the loop-anchor purse-string (LAPS) closure system. In four anesthetized pigs, an endoscopic gastrotomy was performed. Four loop anchors were arrayed in a 2-cm square pattern around the gastrotomy. The endoscope was passed into the abdominal cavity, and the gastrotomy was cinched closed. Procedure times ranged from 50-180 minutes. Three pigs survived 14 days. One animal was sacrificed early due to signs of sepsis. Another animal developed fevers and was treated with antibiotics. At necropsy, there were no abscesses, including in the septic animal. Histologic examination revealed evidence of healing in all animals. The LAPS system holds promise with early success in an animal model. Future human studies are needed to determine viability as a human visceral closure device.

Periodic direct current does not promote wound closure in an in vitro dynamic model of cell migration.

PubMed

Godbout, Charles; Frenette, Jérôme

2006-01-01

A prevailing paradigm is that electrical fields can promote cell migration and tissue healing. To further validate this paradigm, we tested the hypothesis that periodic direct current (DC) can enhance wound closure using an in vitro dynamic model of cell migration. Layers of primary fibroblasts were wounded and treated with DC under various voltages. Repair area, cell velocity, and directionality as well as lamellipodium area were evaluated at different times. Direct current had no beneficial effect on cell migration. Moreover, prolonged stimulation under the highest voltage led to significant reduction in wound closure and cell velocity. The reduction of membrane protusions in stimulated cells may be associated with the deleterious effect of DC. Contrary to the authors' expectations, they found that periodic DC did not promote wound closure, a finding that emphasizes the need to clarify the complex effects of electrical fields on migrating cells.

On the lagrangian 1-form structure of the hyperbolic calogero-moser system

NASA Astrophysics Data System (ADS)

Jairuk, Umpon; Tanasittikosol, Monsit; Yoo-Kong, Sikarin

2017-06-01

In this work, we present the Lagrangian 1-form structure of the hyperbolic Calogero-Moser system in both discrete-time level and continuous-time level. The discrete-time hyperbolic Calogero-Moser system is obtained by considering pole reduction of the semi-discrete Kadomtsev-Petviashvili (KP) equation. Furthermore, it is shown that the hyperbolic Calogero-Moser system possesses the key relation, known as the discrete-time closure relation. This relation is a consequence of the compatibility property of the temporal Lax matrices. The continuous-time hierarchy of the hyperbolic Calogero-Moser system is obtained by taking two successive continuum limits, namely, the skewed limit and full limit. With these successive limits, the continuous-time closure relation is also obtained and is shown to hold at the continuous level.

Measurement of cardiac output from dynamic pulmonary circulation time CT

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

Yee, Seonghwan, E-mail: Seonghwan.Yee@Beaumont.edu; Scalzetti, Ernest M.

Purpose: To introduce a method of estimating cardiac output from the dynamic pulmonary circulation time CT that is primarily used to determine the optimal time window of CT pulmonary angiography (CTPA). Methods: Dynamic pulmonary circulation time CT series, acquired for eight patients, were retrospectively analyzed. The dynamic CT series was acquired, prior to the main CTPA, in cine mode (1 frame/s) for a single slice at the level of the main pulmonary artery covering the cross sections of ascending aorta (AA) and descending aorta (DA) during the infusion of iodinated contrast. The time series of contrast changes obtained for DA,more » which is the downstream of AA, was assumed to be related to the time series for AA by the convolution with a delay function. The delay time constant in the delay function, representing the average time interval between the cross sections of AA and DA, was determined by least square error fitting between the convoluted AA time series and the DA time series. The cardiac output was then calculated by dividing the volume of the aortic arch between the cross sections of AA and DA (estimated from the single slice CT image) by the average time interval, and multiplying the result by a correction factor. Results: The mean cardiac output value for the six patients was 5.11 (l/min) (with a standard deviation of 1.57 l/min), which is in good agreement with the literature value; the data for the other two patients were too noisy for processing. Conclusions: The dynamic single-slice pulmonary circulation time CT series also can be used to estimate cardiac output.« less

Composite time-lapse computed tomography and micro finite element simulations: A new imaging approach for characterizing cement flows and mechanical benefits of vertebroplasty.

PubMed

Stadelmann, Vincent A; Zderic, Ivan; Baur, Annick; Unholz, Cynthia; Eberli, Ursula; Gueorguiev, Boyko

2016-02-01

Vertebroplasty has been shown to reinforce weak vertebral bodies and reduce fracture risks, yet cement leakage is a major problem that can cause severe complications. Since cement flow is nearly impossible to control during surgery, small volumes of cement are injected, but then mechanical benefits might be limited. A better understanding of cement flows within bone structure is required to further optimize vertebroplasty and bone augmentation in general. We developed a novel imaging method, composite time-lapse CT, to characterize cement flow during injection. In brief, composite-resolution time-lapse CT exploits the qualities of microCT and clinical CT. The method consists in overlaying low-resolution time-lapse CT scans acquired during injection onto pre-operative high-resolution microCT scans, generating composite-resolution time-lapse CT series of cement flow within bone. In this in vitro study, composite-resolution time-lapse CT was applied to eight intact and five artificially fractured cadaveric vertebrae during vertebroplasty. The time-lapse scans were acquired at one-milliliter cement injection steps until a total of 10 ml cement was injected. The composite-resolution series were then converted into micro finite element models to compute strains distribution under virtual axial loading. Relocation of strain energy density within bone structure was observed throughout the progression of the procedure. Interestingly, the normalized effect of cement injection on the overall stiffness of the vertebrae was similar between intact and fractured specimens, although at different orders of magnitude. In conclusion, composite time-lapse CT can picture cement flows during bone augmentation. The composite images can also be easily converted into finite element models to compute virtual strain distributions under loading at every step of an injection, providing deeper understanding on the biomechanics of vertebroplasty. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Quantitative Prediction of Stone Fragility From Routine Dual Energy CT: Ex vivo proof of Feasibility.

PubMed

Ferrero, Andrea; Montoya, Juan C; Vaughan, Lisa E; Huang, Alice E; McKeag, Ian O; Enders, Felicity T; Williams, James C; McCollough, Cynthia H

2016-12-01

Previous studies have demonstrated a qualitative relationship between stone fragility and internal stone morphology. The goal of this study was to quantify morphologic features from dual-energy computed tomography (CT) images and assess their relationship to stone fragility. Thirty-three calcified urinary stones were scanned with micro-CT. Next, they were placed within torso-shaped water phantoms and scanned with the dual-energy CT stone composition protocol in routine use at our institution. Mixed low- and high-energy images were used to measure volume, surface roughness, and 12 metrics describing internal morphology for each stone. The ratios of low- to high-energy CT numbers were also measured. Subsequent to imaging, stone fragility was measured by disintegrating each stone in a controlled ex vivo experiment using an ultrasonic lithotripter and recording the time to comminution. A multivariable linear regression model was developed to predict time to comminution. The average stone volume was 300 mm 3 (range: 134-674 mm 3 ). The average comminution time measured ex vivo was 32 seconds (range: 7-115 seconds). Stone volume, dual-energy CT number ratio, and surface roughness were found to have the best combined predictive ability to estimate comminution time (adjusted R 2  = 0.58). The predictive ability of mixed dual-energy CT images, without use of the dual-energy CT number ratio, to estimate comminution time was slightly inferior, with an adjusted R 2 of 0.54. Dual-energy CT number ratios, volume, and morphologic metrics may provide a method for predicting stone fragility, as measured by time to comminution from ultrasonic lithotripsy. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Quantitative prediction of stone fragility from routine single and dual energy CT: proof of feasibility

PubMed Central

Ferrero, Andrea; Montoya, Juan C.; Vaughan, Lisa E.; Huang, Alice E.; McKeag, Ian O.; Enders, Felicity T.; Williams, James C.; McCollough, Cynthia H.

2016-01-01

Rationale and Objectives Previous studies have demonstrated a qualitative relationship between stone fragility and internal stone morphology. The goal of this study was to quantify morphological features from dual-energy CT images and assess their relationship to stone fragility. Materials and Methods Thirty-three calcified urinary stones were scanned with micro CT. Next, they were placed within torso-shaped water phantoms and scanned with the dual-energy CT stone composition protocol in routine use at our institution. Mixed low-and high-energy images were used to measure volume, surface roughness, and 12 metrics describing internal morphology for each stone. The ratios of low- to high-energy CT numbers were also measured. Subsequent to imaging, stone fragility was measured by disintegrating each stone in a controlled ex vivo experiment using an ultrasonic lithotripter and recording the time to comminution. A multivariable linear regression model was developed to predict time to comminution. Results The average stone volume was 300 mm3 (range 134–674 mm3). The average comminution time measured ex vivo was 32 s (range 7–115 s). Stone volume, dual-energy CT number ratio and surface roughness were found to have the best combined predictive ability to estimate comminution time (adjusted R2= 0.58). The predictive ability of mixed dual-energy CT images, without use of the dual-energy CT number ratio, to estimate comminution time was slightly inferior, with an adjusted R2 of 0.54. Conclusion Dual-energy CT number ratios, volume, and morphological metrics may provide a method for predicting stone fragility, as measured by time to comminution from ultrasonic lithotripsy. PMID:27717761

Energy budget above a high-elevation subalpine forest in complex topography

USGS Publications Warehouse

Turnipseed, A.A.; Blanken, P.D.; Anderson, D.E.; Monson, Russell K.

2002-01-01

Components of the energy budget were measured above a subalpine coniferous forest over two complete annual cycles. Sensible and latent heat fluxes were measured by eddy covariance. Bowen ratios ranged from 0.7 to 2.5 in the summer (June-September) depending upon the availability of soil water, but were considerably higher (???3-6) during winter (December-March). Energy budget closure averaged better than 84% on a half-hourly basis in both seasons with slightly greater closure during the winter months. The energy budget showed a dependence on friction velocity (u*), approaching complete closure at u* values greater than 1 m s-1. The dependence of budget closure on u* explained why energy balance was slightly better in the winter as opposed to summer, since numerous periods of high turbulence occur in winter. It also explained the lower degree of energy closure (???10% less) during easterly upslope flow since these periods were characterized by low wind speeds (U < 4 m s-1) and friction velocities (u* < 0.5 m s-1). Co-spectral analysis suggests a shift of flux density towards higher frequencies under conditions where closure was obtained. It is suggested that low frequency contributions to the flux and advection were responsible for the lack of day-time energy budget closure. These effects were reduced at high friction velocities observed at our site. Our ability to close the energy budget at night was also highly dependent on friction velocity, approaching near closure (???90%) at u* values between 0.7 and 1.1 m s-1. Below this range, the airflow within the canopy becomes decoupled with the flow above. Above this range, insufficient temperature resolution of the sonic anemometer obscured the small temperature fluctuations, rendering measurements intractable. ?? 2002 Elsevier Science B.V. All rights reserved.

Coincidental Impact of Transcatheter Patent Foramen Ovale Closure on Migraine with and without Aura - A Comprehensive Meta-Analysis.

PubMed

Kanwar, Siddak M; Noheria, Amit; DeSimone, Christopher V; Rabinstein, Alejandro A; Asirvatham, Samuel J

2016-03-01

We analyzed the literature to assess the coincidental impact on migraines of transcatheter patent foramen ovale (PFO) closure performed for secondary stroke prevention. We searched Medline, EMBASE, and the Cochrane database for studies published up until August 2013. We included English-language studies that provided information on complete resolution or improvement in migraine headaches following PFO closure. Two study authors identified 375 original articles and both independently reviewed 32 relevant manuscripts. Data including study methodology, inclusion criteria, PFO closure and migraine outcomes were extracted manually from all eligible studies. Pooled odds (and probability) of resolution or improvement of migraine headaches were calculated using random-effects models. Twenty studies were analyzed. Most were uncontrolled studies that included a small number of patients with cryptogenic stroke who had undergone PFO closure and had variable time of followup. The probability of complete resolution of migraine with PFO closure (18 studies, 917 patients) was 0.46 (95% confidence interval 0.39, 0.53) and of any improvement in migraine (17 studies, 881 patients) was 0.78 (0.74, 0.82). There was evidence for publication bias in studies reporting on improvement in migraines (Begg's p=0.002), but not for studies on complete resolution of migraine (p=0.3). In patients with aura, the probability of complete resolution of migraine post-PFO closure was 0.54 (0.43, 0.65), and in those without aura, complete resolution occurred in 0.39 (0.29, 0.51). Among patients with unexplained stroke and migraine undergoing transcatheter PFO closure, resolution of headaches occurred in a majority of patients with aura and for a smaller proportion of patients without aura.

Prospective experimental study of transrectal viscerotomy closure using transanal endoscopic suture vs. circular stapler: a step toward NOTES.

PubMed

Diana, M; Leroy, J; Wall, J; De Ruijter, V; Lindner, V; Dhumane, P; Mutter, D; Marescaux, J

2012-06-01

Endoluminal full-thickness closure of the rectal wall is critical in emerging procedures including endoscopic submucosal dissection and transrectal natural orifice transluminal endoscopic surgery (NOTES). This study aimed to compare manual suture using the transanal endoscopic operation platform (TEO; Karl Storz, Tüttlingen, Germany) with the end-to-end anastomosis hemorrhoid circular stapler (EEA; Covidien, Dublin, Ireland) for closure of the rectal viscerotomy during transrectal NOTES segmental colectomy. A total of 12 swine underwent transrectal hybrid NOTES partial colectomies. Animals were divided into two groups according to the viscerotomy closure technique: 1) TEO manual suture; 2) EEA circular stapler closure. Mean (± SD) viscerotomy closure time was 67.5 ± 59.5 minutes and 31.5 ± 19.6 minutes for TEO and EEA, respectively. There was one conversion to laparoscopy in the TEO group and a misfiring in the EEA group that required a TEO salvage suture. There was one positive air-leak test in each group. Peritoneal fluid collected at the end of the procedure tested positive for bacterial contamination in all cases. A mild stenosis was present in 4 /6 viscerotomies (67 %) in the TEO group and in 1/6 (17 %) in the EEA group on endoscopic control. Inflammatory changes were mild in 3/5 (60 %) and 4/5 (80 %) viscerotomies in the TEO and EEA groups, respectively, whereas severe inflammation was found in 2/5 (TEO) and 1 /5 (EEA). Transrectal viscerotomy closure using the EEA circular stapler technique is feasible, easy to perform, and histologically comparable to suture closure through a TEO platform. It may offer an attractive alternative for NOTES segmental colectomies and endoscopic resections. © Georg Thieme Verlag KG Stuttgart · New York.

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.

[Clinical epidemiological study of neural tube defects classified according to the five sites of closure].

PubMed

Sanchis Calvo, A; Martínez- Frías, M

2001-02-01

To identify the frequency at birth of neural tube defects (NTD) in the Spanish population. NTDs were considered as a whole as well as according to the different sites of closure failure, following the theory of multisite closure of the neural tube. To analyze the epidemiological characteristics of the different sites. Data derived from the Spanish Collaborative Study of Congenital Malformations (ECEMC), from April 1976 to March 1995. Among the 1,222,698 live births during this period, 784 infants had NTD were controlled. Among these, 784 infants had NTD. The prevalence of NTD in our population was 1.01 per 1,000 births, a frequency which is considered medium-to low. Only 5.74% of the NTD were of known etiology: 2.17% were genic, 1.27% were chromosomic and 2.29% were environmental. Excluding NTD of genetic etiology, whether genic or chromosomic, most of the remaining were isolated defects (multifactorial) and 16.78% multiple malformations. Site 1, where the closure of the neural tube starts, represented 24% of all the affected sites. However, more than 50% of the NTDs corresponded to closure failure at the junction of two sites. As in other populations with a low prevalence of NTD at birth, the prevalence of these defects in our population showed a trend to decrease with time, due to the possibility of interrupting gestation after prenatal diagnosis. All the NTD could be classified according to the theory of multisite closure of the neural tube, including 13 cases with several noncontiguous affected sites. Two types of NTD were observed: in the first, closure failed to occur and in the second, two closures failed to meet.

Development of CT and 3D-CT Using Flat Panel Detector Based Real-Time Digital Radiography System

NASA Astrophysics Data System (ADS)

Ravindran, V. R.; Sreelakshmi, C.; Vibin, Vibin

2008-09-01

The application of Digital Radiography in the Nondestructive Evaluation (NDE) of space vehicle components is a recent development in India. A Real-time DR system based on amorphous silicon Flat Panel Detector has been developed for the NDE of solid rocket motors at Rocket Propellant Plant of VSSC in a few years back. The technique has been successfully established for the nondestructive evaluation of solid rocket motors. The DR images recorded for a few solid rocket specimens are presented in the paper. The Real-time DR system is capable of generating sufficient digital X-ray image data with object rotation for the CT image reconstruction. In this paper the indigenous development of CT imaging based on the Realtime DR system for solid rocket motor is presented. Studies are also carried out to generate 3D-CT image from a set of adjacent CT images of the rocket motor. The capability of revealing the spatial location and characterisation of defect is demonstrated by the CT and 3D-CT images generated.

CRYPTOSPORIDIUM LOG-INACTIVATION WITH OZONE USING EFFLUENT CT 10, GEOMETRIC MEAN CT 10 EXTENDED INTEGRATED CT 10 AND EXTENDED-CSTR CALCULATIONS

EPA Science Inventory

The draft Long Term 2 Enhanced Surface Water Treatment Rule ("LT2ESWTR") contains Cryptosporidium log-inactivation CT tables. Depending on the water temperature, the Cryptosporidium CT values that are listed are 15 to 25 times greater than CT values fo...

The effectiveness of low-dose desmopressin in improving hypothermia-induced impairment of primary haemostasis under influence of aspirin - a randomized controlled trial.

PubMed

Tsui, Pui Yee; Cheung, Chi Wai; Lee, Yvonne; Leung, Susan Wai Sum; Ng, Kwok Fu Jacobus

2015-05-28

Mild hypothermia (34-35 °C) increases perioperative blood loss. Our previous studies showed that desmopressin could have in vitro beneficial effects on hypothermia-induced primary haemostasis impairment. In this study, we investigate the in vitro effects of desmopressin on hypothermia-induced primary haemostasis impairment under the influence of aspirin in healthy volunteers. Sixty healthy volunteers were randomly allocated to taking aspirin 100 mg or placebo for three days. On the sixth day blood samples were taken before and after the injection of desmopressin (1.5 microgram or 5 microgram) or normal saline subcutaneously. Measurements including Platelet Function Analyzer (PFA-100®) closure times, plasma von Willebrand Factor antigen, haemoglobin and platelet levels were made at 32 °C and 37 °C respectively. Collagen/epinephrine closure time (EPICT) was significantly prolonged by 21.13 % (95 %CI 2.34-39.74 %, p = 0.021) in aspirin group at 37 °C. While hypothermia alone prolonged both collagen/adenosine diphosphate (ADPCT) and EPICT by 17.63 % (95 %CI 13.5-20.85 %, p < 0.001) and 8.0 % (95 %CI 6.38-10.04 %, p = 0.024) respectively, addition of aspirin only further prolonged EPICT by 19.9 % (95 %CI 3.32-36.49 %, p = 0.013). In aspirin group, desmopressin 1.5 microgram and 5 microgram significantly reduced ADPCT to below baseline levels at 37 °C (p = 0.025 and <0.001 respectively), whereas reduction in EPICT was seen with desmopressin 5 microgram (p =0.008). The effect was less pronounced at 32 °C, with a significant reduction in EPICT obtained with a dosage of 5 microgram only (p = 0.011). It was shown that aspirin could further potentiate the hypothermia-induced closure time prolongations. Low dose desmopressin (1.5 microgram) reduced PFA-100® closure times towards baseline. A higher dosage (5 microgram) further reduced the closure times below baseline. Therefore low dose desmopressin (1.5 microgram) might have the potential to correct hypothermia-induced primary haemostasis impairment under the influence of aspirin during the perioperative period. ClinicalTrials.gov: NCT01382134.

Timely Antecedent CT or MRI Can Help Predict Hemorrhage Site of Posttreatment Head and Neck Cancer, With Digital Subtraction Angiography Used as the Reference Standard.

PubMed

Ku, Yi-Kang; Wong, Yon-Cheong; Fu, Chen-Ju; Tseng, Hsiao-Jung; Wang, Li-Jen; Wang, Chao-Jan; Chin, Shy-Chyi

2016-04-01

We investigated the timing of CT and MRI performed before digital subtraction angiography (DSA) in the prediction of hemorrhage sites in patients with head and neck cancers who present with acute oral or neck bleeding after receiving treatment. A total of 123 DSA examinations that evaluated 123 oral or neck bleeding events in 85 patients were analyzed. The last CT or MRI examinations performed within a time frame of 0-337 days before transarterial embolization were reviewed retrospectively, with three findings (pseudoaneurysm, air-containing necrotic tissue, and residual tumor) used to predict hemorrhage sites. DSA findings of pseudoaneurysm or active contrast extravasation were used as a reference standard. The sensitivity of CT and MRI for correctly predicting hemorrhage sites was used to determine the optimal timing of CT or MRI examinations performed before DSA. A total of 8.9% of the DSA examinations (11/123) had equivocal findings but were followed by another bleeding event for which DSA findings were positive. CT or MRI was statistically significantly better at predicting hemorrhage sites in patients with bleeding events associated with nonhypopharyngeal cancers (p = 0.019) than in those with bleeding events associated with hypopharyngeal cancers. The sensitivity of CT or MRI in the prediction of hemorrhage sites was statistically significantly higher for the common carotid artery and the internal carotid artery when CT or MRI was performed less than 30 days before bleeding events occurred. Prediction of hemorrhagic sites was better with the use of CT angiography than with the use of enhanced CT or MRI, although it was not statistically significant. DSA findings can temporarily be equivocal. CT or MRI examinations performed within 30 days of bleeding events can predict the site of hemorrhage. If no CT or MRI findings from the past 30 days are available, we suggest performing emergent CT angiography for the sake of obtaining better arterial detail.

Dynamic modelling of costs and health consequences of school closure during an influenza pandemic

PubMed Central

2012-01-01

Background The purpose of this article is to evaluate the cost-effectiveness of school closure during a potential influenza pandemic and to examine the trade-off between costs and health benefits for school closure involving different target groups and different closure durations. Methods We developed two models: a dynamic disease model capturing the spread of influenza and an economic model capturing the costs and benefits of school closure. Decisions were based on quality-adjusted life years gained using incremental cost-effectiveness ratios. The disease model is an age-structured SEIR compartmental model based on the population of Oslo. We studied the costs and benefits of school closure by varying the age targets (kindergarten, primary school, secondary school) and closure durations (1–10 weeks), given pandemics with basic reproductive number of 1.5, 2.0 or 2.5. Results The cost-effectiveness of school closure varies depending on the target group, duration and whether indirect costs are considered. Using a case fatality rate (CFR) of 0.1-0.2% and with current cost-effectiveness threshold for Norway, closing secondary school is the only cost-effective strategy, when indirect costs are included. The most cost-effective strategies would be closing secondary schools for 8 weeks if R0=1.5, 6 weeks if R0=2.0, and 4 weeks if R0= 2.5. For severe pandemics with case fatality rates of 1-2%, similar to the Spanish flu, or when indirect costs are disregarded, the optimal strategy is closing kindergarten, primary and secondary school for extended periods of time. For a pandemic with 2009 H1N1 characteristics (mild severity and low transmissibility), closing schools would not be cost-effective, regardless of the age target of school children. Conclusions School closure has moderate impact on the epidemic’s scope, but the resulting disruption to society imposes a potentially great cost in terms of lost productivity from parents’ work absenteeism. PMID:23140513

Stroke prevention by percutaneous closure of patent foramen ovale: a systematic review and meta-analysis.

PubMed

Wolfrum, Mathias; Froehlich, Georg M; Knapp, Guido; Casaubon, Leanne K; DiNicolantonio, James J; Lansky, Alexandra J; Meier, Pascal

2014-03-01

The role of percutaneous closure of patent foramen oval (PFO) in patients with cryptogenic stroke has been very controversial for years due to a lack of clear evidence. Systematic review and meta-analysis of the effect of percutaneous PFO closure for secondary prevention of cryptogenic strokes as compared to best medical therapy (BMT). Trials were identified through a literature search until 28 May 2013. Controlled clinical trials (randomised and non-randomised) comparing percutaneous PFO closure with BMT. Main end point of interest was stroke. A random effects model was used to calculate the pooled relative risks (RR) with 95% CIs. A total of 14 studies (three randomised controlled trials (RCT) and 11 non-randomised observational studies (non-RCT)), and a total of 4335 patients were included for this analysis. There was no significant treatment effect of PFO closure regarding stroke among the RCT (RR 0.66, 95% CI 0.37 to 1.19, p=0.171). However, among non-RCT stroke was reduced (RR 0.37, 95% CI 0.20 to 0.67, p<0.001) after PFO closure. A time-to-event (stroke) analysis, combining all three RCT and the two non-RCT which applied strict multivariate adjustments, showed a borderline significant risk reduction after PFO closure (HR 0.58, 95% CI 0.33 to 0.99, p=0.047). Neither risk of bleeding nor mortality differed significantly between the groups. However, there was a higher incidence of new onset atrial fibrillation in the closure group (RR 3.50, 95% CI 1.47 to 8.35, p=0.005). Percutaneous closure of PFO in patients with cryptogenic stroke does not appear superior to medical therapy according to currently available randomised data. Furthermore, it is associated with an increased incidence of atrial fibrillation. However, there are signals pointing towards a potential benefit and more research should be strongly encouraged.

Transapical access closure: the TA PLUG device†

PubMed Central

Brinks, Henriette; Nietlispach, Fabian; Göber, Volkhard; Englberger, Lars; Wenaweser, Peter; Meier, Bernhard; Carrel, Thierry; Huber, Christoph

2013-01-01

OBJECTIVES Percutaneous closure of the transapical (TA) access site for large-calibre devices is an unsolved issue. We report the first experimental data on the TA PLUG device for true-percutaneous closure following large apical access for transcatheter aortic valve implantation. METHODS The TA PLUG, a self-sealing full-core closure device, was implanted in an acute animal study in six pigs (60.2 ± 0.7 kg). All the pigs received 100 IU/kg of heparin. The targeted activated clotting time was left to normalize spontaneously. After accessing the left ventricular apex with a 39 French introducer, the closure plug device was delivered with a 33 French over-the-wire system under fluoroscopic guidance into the apex. Time to full haemostasis as well as rate of bleeding was recorded. Self-anchoring properties were assessed by haemodynamic push stress under adrenalin challenge. An additional feasibility study was conducted in four pigs (58.4 ± 1.1 kg) with full surgical exposure of the apex, and assessed device anchoring by pull-force measurements with 0.5 Newton (N) increments. All the animals were electively sacrified. Post-mortem analysis of the heart was performed and the renal embolic index assessed. RESULTS Of six apical closure devices, five were correctly inserted and fully deployed at the first attempt. One became blocked in the delivery system and was placed successfully at the second attempt. In all the animals, complete haemostasis was immediate and no leak was recorded during the 5-h observation period. Neither leak nor any device dislodgement was observed under haemodynamic push stress with repeated left ventricular peak pressure of up to 220 mmHg. In the feasibility study assessing pull-stressing, device migration occurred at a force of 3.3 ± 0.5 N corresponding to 247.5 mmHg. Post-mortem analyses confirmed full expansion of all devices at the intended target. No macroscopic damage was identified at the surrounding myocardium. The renal embolic index was zero. CONCLUSIONS True-percutaneous left ventricular apex closure following large access is feasible with the self-sealing TA PLUG. The device allows for immediate haemostasis and a reliable anchoring in the acute animal setting. This is the first report of a true-percutaneous closure for large-calibre transcatheter aortic valve implantation access. PMID:23842759

Systemic Air Embolism After CT-guided Lung Biopsy

ClinicalTrials.gov

2017-11-27

Patients Who Underwent Percutaneous Lung Biopsy Under CT Guidance; Patients Who Presented Systemic Air Embolism After Percutaneous Lung Biopsy Under CT Guidance Depicted at the Time of the Procedure on a Whole Thoracic CT

Remote sensing of aquatic vegetation distribution in Taihu Lake using an improved classification tree with modified thresholds.

PubMed

Zhao, Dehua; Jiang, Hao; Yang, Tangwu; Cai, Ying; Xu, Delin; An, Shuqing

2012-03-01

Classification trees (CT) have been used successfully in the past to classify aquatic vegetation from spectral indices (SI) obtained from remotely-sensed images. However, applying CT models developed for certain image dates to other time periods within the same year or among different years can reduce the classification accuracy. In this study, we developed CT models with modified thresholds using extreme SI values (CT(m)) to improve the stability of the models when applying them to different time periods. A total of 903 ground-truth samples were obtained in September of 2009 and 2010 and classified as emergent, floating-leaf, or submerged vegetation or other cover types. Classification trees were developed for 2009 (Model-09) and 2010 (Model-10) using field samples and a combination of two images from winter and summer. Overall accuracies of these models were 92.8% and 94.9%, respectively, which confirmed the ability of CT analysis to map aquatic vegetation in Taihu Lake. However, Model-10 had only 58.9-71.6% classification accuracy and 31.1-58.3% agreement (i.e., pixels classified the same in the two maps) for aquatic vegetation when it was applied to image pairs from both a different time period in 2010 and a similar time period in 2009. We developed a method to estimate the effects of extrinsic (EF) and intrinsic (IF) factors on model uncertainty using Modis images. Results indicated that 71.1% of the instability in classification between time periods was due to EF, which might include changes in atmospheric conditions, sun-view angle and water quality. The remainder was due to IF, such as phenological and growth status differences between time periods. The modified version of Model-10 (i.e. CT(m)) performed better than traditional CT with different image dates. When applied to 2009 images, the CT(m) version of Model-10 had very similar thresholds and performance as Model-09, with overall accuracies of 92.8% and 90.5% for Model-09 and the CT(m) version of Model-10, respectively. CT(m) decreased the variability related to EF and IF and thereby improved the applicability of the models to different time periods. In both practice and theory, our results suggested that CT(m) was more stable than traditional CT models and could be used to map aquatic vegetation in time periods other than the one for which the model was developed. Copyright © 2011 Elsevier Ltd. All rights reserved.

Experimental study on visual detection for fatigue of fixed-position staff.

PubMed

Nie, Baisheng; Huang, Xin; Chen, Yang; Li, Anjin; Zhang, Ruming; Huang, Jinxin

2017-11-01

Fatigue can lead to decreased work performance and poorer safety and health condition. Fatigue is ubiquitous in production and in life, while the research on it is mainly concentrated in the automotive driving, aircraft piloting and other fields, and it is insufficient to study on the fatigue of fixed-position staff. This paper puts forward a non-contact visual image method, which can monitor the extent of fatigue of fixed-position staff. Fatigue threshold used in judgment is obtained by processing the recorded data of visual images of the experimental subjects when fatiguing and by analyzing eye closure time, percentage of eyelid closure (PERCLOS) value, frequency and number of blinks. The results show that there is significant difference among the four indicators before and after experiment subjects undergo fatigue. The fatigue of experimental subjects is obvious when eye closure time is 3.5 s/min, PERCLOS value 6%, and blink frequency 0.4 times/s. This provides a reference for a wider range of detection of fatigue and a method for avoiding mistakes and accidents. Copyright © 2017 Elsevier Ltd. All rights reserved.

The effects of acclimation and rates of temperature change on critical thermal limits in Tenebrio molitor (Tenebrionidae) and Cyrtobagous salviniae (Curculionidae).

PubMed

Allen, Jessica L; Clusella-Trullas, Susana; Chown, Steven L

2012-05-01

Critical thermal limits provide an indication of the range of temperatures across which organisms may survive, and the extent of the lability of these limits offers insights into the likely impacts of changing thermal environments on such survival. However, investigations of these limits may be affected by the circumstances under which trials are undertaken. Only a few studies have examined these effects, and typically not for beetles. This group has also not been considered in the context of the time courses of acclimation and its reversal, both of which are important for estimating the responses of species to transient temperature changes. Here we therefore examine the effects of rate of temperature change on critical thermal maxima (CT(max)) and minima (CT(min)), as well as the time course of the acclimation response and its reversal in two beetle species, Tenebrio molitor and Cyrtobagous salviniae. Increasing rates of temperature change had opposite effects on T. molitor and C. salviniae. In T. molitor, faster rates of change reduced both CT(max) (c. 2°C) and CT(min) (c. 3°C), while in C. salviniae faster rates of change increased both CT(max) (c. 6°C) and CT(min) (c. 4°C). CT(max) in T. molitor showed little response to acclimation, while the response to acclimation of CT(min) was most pronounced following exposure to 35°C (from 25°C) and was complete within 24 h. The time course of acclimation of CT(max) in C. salviniae was 2 days when exposed to 36°C (from c. 26°C), while that of CT(min) was less than 3 days when exposed to 18°C. In T. molitor, the time course of reacclimation to 25°C after treatments at 15°C and 35°C at 75% RH was longer than the time course of acclimation, and varied from 3-6 days for CT(max) and 6 days for CT(min). In C. salviniae, little change in CT(max) and CT(min) (<0.5°C) took place in all treatments suggesting that reacclimation may only occur after the 7 day period used in this study. These results indicate that both T. molitor and C. salviniae may be restricted in their ability to respond to transient temperature changes at short-time scales, and instead may have to rely on behavioral adjustments to avoid deleterious effects at high temperatures. Copyright © 2012 Elsevier Ltd. All rights reserved.

Modelling the impact of local reactive school closures on critical care provision during an influenza pandemic

PubMed Central

House, Thomas; Baguelin, Marc; Van Hoek, Albert Jan; White, Peter J.; Sadique, Zia; Eames, Ken; Read, Jonathan M.; Hens, Niel; Melegaro, Alessia; Edmunds, W. John; Keeling, Matt J.

2011-01-01

Despite the fact that the 2009 H1N1 pandemic influenza strain was less severe than had been feared, both seasonal epidemics of influenza-like-illness and future influenza pandemics have the potential to place a serious burden on health services. The closure of schools has been postulated as a means of reducing transmission between children and hence reducing the number of cases at the peak of an epidemic; this is supported by the marked reduction in cases during school holidays observed across the world during the 2009 pandemic. However, a national policy of long-duration school closures could have severe economic costs. Reactive short-duration closure of schools in regions where health services are close to capacity offers a potential compromise, but it is unclear over what spatial scale and time frame closures would need to be made to be effective. Here, using detailed geographical information for England, we assess how localized school closures could alleviate the burden on hospital intensive care units (ICUs) that are reaching capacity. We show that, for a range of epidemiologically plausible assumptions, considerable local coordination of school closures is needed to achieve a substantial reduction in the number of hospitals where capacity is exceeded at the peak of the epidemic. The heterogeneity in demand per hospital ICU bed means that even widespread school closures are unlikely to have an impact on whether demand will exceed capacity for many hospitals. These results support the UK decision not to use localized school closures as a control mechanism, but have far wider international public-health implications. The spatial heterogeneities in both population density and hospital capacity that give rise to our results exist in many developed countries, while our model assumptions are sufficiently general to cover a wide range of pathogens. This leads us to believe that when a pandemic has severe implications for ICU capacity, only widespread school closures (with their associated costs and organizational challenges) are sufficient to mitigate the burden on the worst-affected hospitals. PMID:21288945

Control of aperture closure during reach-to-grasp movements in parkinson’s disease

PubMed Central

Rand, M. K.; Smiley-Oyen, A. L.; Shimansky, Y. P.; Bloedel, J. R.; Stelmach, G. E.

2007-01-01

This study examined whether the pattern of coordination between arm-reaching toward an object (hand transport) and the initiation of aperture closure for grasping is different between PD patients and healthy individuals, and whether that pattern is affected by the necessity to quickly adjust the reach-to-grasp movement in response to an unexpected shift of target location. Subjects reached for and grasped a vertical dowel, the location of which was indicated by illuminating one of the three dowels placed on a horizontal plane. In control conditions, target location was fixed during the trial. In perturbation conditions, target location was shifted instantaneously by switching the illumination to a different dowel during the reach. The hand distance from the target at which the subject initiated aperture closure (aperture closure distance) was similar for both the control and perturbation conditions within each group of subjects. However, that distance was significantly closer to the target in the PD group than in the control group. The timing of aperture closure initiation varied considerably across the trials in both groups of subjects. In contrast, aperture closure distance was relatively invariant, suggesting that aperture closure initiation was determined by spatial parameters of arm kinematics rather than temporal parameters. The linear regression analysis of aperture closure distance showed that the distance was highly predictable based on the following three parameters: the amplitude of maximum grip aperture, hand velocity, and hand acceleration. This result implies that a control law, the arguments of which include the above parameters, governs the initiation of aperture closure. Further analysis revealed that the control law was very similar between the subject groups under each condition as well as between the control and perturbation conditions for each group. Consequently, the shorter aperture closure distance observed in PD patients apparently is a result of the hypometria of their grip aperture and bradykinesia of hand transport movement, rather than a consequence of a deficit in transport-grasp coordination. It is also concluded that the perturbation of target location does not disrupt the transport-grasp coordination in either healthy individuals or PD patients. PMID:16307233

Control of aperture closure during reach-to-grasp movements in Parkinson's disease.

PubMed

Rand, M K; Smiley-Oyen, A L; Shimansky, Y P; Bloedel, J R; Stelmach, G E

2006-01-01

This study examined whether the pattern of coordination between arm-reaching toward an object (hand transport) and the initiation of aperture closure for grasping is different between PD patients and healthy individuals, and whether that pattern is affected by the necessity to quickly adjust the reach-to-grasp movement in response to an unexpected shift of target location. Subjects reached for and grasped a vertical dowel, the location of which was indicated by illuminating one of the three dowels placed on a horizontal plane. In control conditions, target location was fixed during the trial. In perturbation conditions, target location was shifted instantaneously by switching the illumination to a different dowel during the reach. The hand distance from the target at which the subject initiated aperture closure (aperture closure distance) was similar for both the control and perturbation conditions within each group of subjects. However, that distance was significantly closer to the target in the PD group than in the control group. The timing of aperture closure initiation varied considerably across the trials in both groups of subjects. In contrast, aperture closure distance was relatively invariant, suggesting that aperture closure initiation was determined by spatial parameters of arm kinematics rather than temporal parameters. The linear regression analysis of aperture closure distance showed that the distance was highly predictable based on the following three parameters: the amplitude of maximum grip aperture, hand velocity, and hand acceleration. This result implies that a control law, the arguments of which include the above parameters, governs the initiation of aperture closure. Further analysis revealed that the control law was very similar between the subject groups under each condition as well as between the control and perturbation conditions for each group. Consequently, the shorter aperture closure distance observed in PD patients apparently is a result of the hypometria of their grip aperture and bradykinesia of hand transport movement, rather than a consequence of a deficit in transport-grasp coordination. It is also concluded that the perturbation of target location does not disrupt the transport-grasp coordination in either healthy individuals or PD patients.

Evaluation of a new imaging tool for use with major trauma cases in the emergency department.

PubMed

Crönlein, Moritz; Holzapfel, Konstantin; Beirer, Marc; Postl, Lukas; Kanz, Karl-Georg; Pförringer, Dominik; Huber-Wagner, Stefan; Biberthaler, Peter; Kirchhoff, Chlodwig

2016-11-17

The aim of this study was to evaluate potential benefits of a new diagnostic software prototype (Trauma Viewer, TV) automatically reformatting computed tomography (CT) data on diagnostic speed and quality, compared to CT-image data evaluation using a conventional CT console. Multiple trauma CT data sets were analysed by one expert radiology and one expert traumatology fellow independently twice, once using the TV and once using the secondary conventional CT console placed in the CT control room. Actual analysis time and precision of diagnoses assessment were evaluated. The TV and CT-console results were compared respectively, but also a comparison to the initial multiple trauma CT reports assessed by emergency radiology fellows considered as the gold standard was performed. Finally, design and function of the Trauma Viewer were evaluated in a descriptive manner. CT data sets of 30 multiple trauma patients were enrolled. Mean time needed for analysis of one CT dataset was 2.43 min using the CT console and 3.58 min using the TV respectively. Thus, secondary conventional CT console analysis was on average 1.15 min shorter compared to the TV analysis. Both readers missed a total of 11 diagnoses using the secondary conventional CT console compared to 12 missed diagnoses using the TV. However, none of these overlooked diagnoses resulted in an Abbreviated Injury Scale (AIS) > 2 corresponding to life threatening injuries. Even though it took the two expert fellows a little longer to analyse the CT scans on the prototype TV compared to the CT console, which can be explained by the new user interface of the TV, our preliminary results demonstrate that, after further development, the TV might serve as a new diagnostic feature in the trauma room management. Its high potential to improve time and quality of CT-based diagnoses might help in fast decision making regarding treatment of severely injured patients.

Prevalence of Imaging Biomarkers to Guide the Planning of Acute Stroke Reperfusion Trials.

PubMed

Jiang, Bin; Ball, Robyn L; Michel, Patrik; Jovin, Tudor; Desai, Manisha; Eskandari, Ashraf; Naqvi, Zack; Wintermark, Max

2017-06-01

Imaging biomarkers are increasingly used as selection criteria for stroke clinical trials. The goal of our study was to determine the prevalence of commonly studied imaging biomarkers in different time windows after acute ischemic stroke onset to better facilitate the design of stroke clinical trials using such biomarkers for patient selection. This retrospective study included 612 patients admitted with a clinical suspicion of acute ischemic stroke with symptom onset no more than 24 hours before completing baseline imaging. Patients with subacute/chronic/remote infarcts and hemorrhage were excluded from this study. Imaging biomarkers were extracted from baseline imaging, which included a noncontrast head computed tomography (CT), perfusion CT, and CT angiography. The prevalence of dichotomized versions of each of the imaging biomarkers in several time windows (time since symptom onset) was assessed and statistically modeled to assess time dependence (not lack thereof). We created tables showing the prevalence of the imaging biomarkers pertaining to the core, the penumbra and the arterial occlusion for different time windows. All continuous imaging features vary over time. The dichotomized imaging features that vary significantly over time include: noncontrast head computed tomography Alberta Stroke Program Early CT (ASPECT) score and dense artery sign, perfusion CT infarct volume, and CT angiography collateral score and visible clot. The dichotomized imaging features that did not vary significantly over time include the thresholded perfusion CT penumbra volumes. As part of the feasibility analysis in stroke clinical trials, this analysis and the resulting tables can help investigators determine sample size and the number needed to screen. © 2017 American Heart Association, Inc.

SU-F-J-172: Hybrid MR/CT Compatible Phantom for MR-Only Based Radiotherapy

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

Kim, M; Lee, S; Song, K

2016-06-15

Purpose: Development of hybrid MR/CT compatible phantom was introduced to fully establish MR image only radiation treatment and this suggested technique using in-house developed hybrid MR/CT compatible phantom image would utilize to generate radiation treatment planning and perform dose calculation without multi-modal registration process or generation of pseudo CT. Methods: Fundamental characteristics for “hybrid MR/CT compatible phantom” was established: Relaxation times equivalent to human tissue, dielectric properties, homogeneous relaxation times, sufficient strength to fabricate a torso, ease of handling, a wide variety of density material for calibration, chemical and physical stability over an extended time. For this requirements, chemical componentmore » in each tested plug which would be tissue equivalent to human tissue on MR and CT image and production of phantom body and plug was performed. Chemical component has described below: Agaros, GdCl{sub 3}, NaN{sub 3}, NaCl, K{sub 2}Co{sub 3}, deionized-distilled water. Various mixture of chemical component to simulate human tissue on both MR and CT image was tested by measuring T1, T2 relaxation time and signal intensity (SI) on MR image and Hounsfield unit (HU) on CT and each value was compared. The hybrid MR/CT compatible phantom with 14 plugs was designed and has made. Total height and external diameter was decided by internal size of 32 channel MR head-coil. Results: Tissue-equivalent chemical component materials and hybrid MR/CT compatible phantom was developed. The range of T1, T2 relaxation time and SI on MR image, HU on CT was acquired and could be adjusted to correspond to simulated human tissue. Conclusion: Current result shows its possibility for MR-only based radiotherapy and the best mixing rate of chemical component for tissue-equivalent image on MR and CT was founded. However, additional technical issues remain to be overcome. Conversion of SI on MR image into HU and dose calculation based on converted MRI will be progressing.« less

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

Fogg, P; Aland, T; West, M

Purpose: To investigate the effects of external surrogate and tumour motion by observing the reconstructed phases and AveCT in an Amplitude and Time based 4DCT. Methods: Based on patient motion studies, Cos6 and sinusoidal motions were simulated as external surrogate and tumour motions in a motion phantom. The diaphragm and tumour motions may or may not display the same waveform therefore the same and different waveforms were programmed into the phantom, scanned and reconstructed based on Amplitude and Time. The AveCT and phases were investigated with these different scenarios. The AveCT phantom images were also compared with CBCT phantom imagesmore » programmed with the same motions. Results: For the same surrogate and tumour sin motions, the phases (Amplitude and Time) and AveCT indicated similar motions based on the position of the BB at the slice and displayed contrast values respectively. For cos6 motions, due to the varied time the tumour spends at each position, the Amplitude and Time based phases differed. The AveCT images represented the actual tumour motions and the Time and Amplitude based phases were represented by the surrogate with varied times. Conclusion: Different external surrogate and tumour motions may result in different displayed image motions when observing the AveCT and reconstructed phases. During the 4DCT, the surrogate motion is readily available for observation of the amplitude and time of the diaphragm position. Following image reconstruction, the user may need to observe the AveCT in addition to the reconstructed phases to comprehend the time weightings of the tumour motion during the scan. This may also apply to 3D CBCT images where the displayed tumour position in the images is influenced by the long duration of the CBCT. Knowledge of the tumour motion represented by the greyscale of the AveCT may also assist in CBCT treatment beam verification matching.« less

Environmental Impact Statement. Proposed Closure of Los Angeles AFB, California and Relocation of Space Systems Division. Appendix F. Public Comments

DTIC Science & Technology

1990-11-01

ALLY. COPIESOF Mif soam o~ am 17 OF IL me AND C01101. so STROM.I SWO 1340 MR 17 VAROU O0110308 C2OIS. INCLDO A COS1 OF A Sa Is PSWASS AN CON ~SLDAWR...55145 TO GTSoi. .1W AX m s . CON SNINI NT SAWS I ca55 m"= Dmu 1wim IMP STANTS IsCT am IL 539 PROM CALINOSNIA. VON CZRPLA FFS. 4 IP S 45 PRECU? T IL 3...LOGISTICAL 4*41.011 "AT CUITTCASLY. 22 TWO CON ? NT P.Ilf 95415 CRE553TIN ISS . 11 ALSO VAS 11 K ADP5LAS Too TOWD 1351 TW110 SLDWN AN 2I RETE FEES 1W PT

A Case of an Aortic Abscess around the Elephant Trunk.

PubMed

Fujii, Takeshiro; Kawasaki, Muneyasu; Katayanagi, Tomoyuki; Okuma, Shinnosuke; Masuhara, Hiroshi; Shiono, Noritsugu; Watanabe, Yoshinori

2015-01-01

A 52-year-old male patient with a history of total arch replacement using the elephant trunk technique for acute aortic dissection 4 years before visited our hospital with the chief complaint of persistent fever. Chest computed tomography (CT) suggested prosthetic vascular graft infection, which was treated surgically after chemotherapy. The first surgery consisted of debridement of an abscess around the vascular graft and in the aorta around the elephant trunk, and thoracic descending aorta replacement and vacuum-assisted closure (VAC) in view of the risk of bleeding from the peripheral region of the elephant trunk. One week later, omental filling was performed as the second step. This is a very rare case of aortic abscess around the elephant trunk that could successfully be managed by graft-conserving treatment.

The Effect on Somatic Growth of Surgical and Catheter Treatment of Secundum Atrial Septal Defects.

PubMed

Chlebowski, Meghan M; Dai, Hongying; Kaine, Stephen F

2017-10-01

Historical studies suggest an association between atrial septal defect (ASD) and impaired growth with inconsistent improvement following closure. Limited data exist regarding the impact on growth in the era of transcatheter therapy. To evaluate the effect of closure on growth, we conducted a retrospective review of patients undergoing surgical or transcatheter closure during two time periods. Four hundred patients with isolated secundum ASD were divided into three cohorts: early surgical, contemporary surgical, and transcatheter. Data collected included demographics; height, weight, and body mass index (BMI) percentiles; catheterization hemodynamics; and co-morbidities. For all cohorts, there was no significant change in height or weight percentiles during two years after ASD closure. Age at repair was later for contemporary surgical and transcatheter cohorts (p < 0.0001). In the transcatheter cohort, mean Qp:Qs was 1.65 ± 0.54, but there was no correlation between greater Qp:Qs and decreased somatic growth. Subgroup analysis for patients with any initial growth percentile <5th percentile demonstrated a significant change in weight and BMI percentiles in the first two years after closure (p < 0.0004). The advent of transcatheter therapy shifted institutional practice to later age at repair for both surgical and transcatheter closure. There was no significant change in weight and height percentiles during two years after closure. Only patients with initial weight and BMI <5th percentile had improved growth after treatment. Concern for impaired growth should not generally be an indication for early ASD repair. However, early repair may be indicated in children with existing significant growth failure.

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.

Program closure and change among VA substance abuse treatment programs.

PubMed

Floyd, A S

1999-10-01

The population of Veterans Affairs (VA) substance abuse treatment programs in 1990 and 1994 was examined to determine which factors-program legitimacy or cost-accounted for program closure and change. Legitimacy is a concept in institutional theory that organizations tend to take on a form appropriate to the environment. The study had two competing hypotheses. The first was that if external pressures push programs to produce high-quality and efficient treatment, then those that are initially closer to the legitimate form should be less likely to close later, and among surviving programs they should be less likely to experience change. The second hypothesis was that cost is the primary factor in program closure and change. The study used data from administrative surveys of all VA programs (273 in 1990 and 389 in 1994). Program legitimacy variables measured whether programs offered the prevalent type of treatment, such as 12-step groups or behavioral treatment, and had the prevalent type of staff. Program costs did not explain closure or change. For inpatient programs, the risk of closure increased in facilities with more than one substance abuse treatment program. The risk of closure increased for outpatient programs offering the prevalent type of treatment, contrary to what was predicted by the legitimacy hypothesis. Inpatient programs that offered the prevalent treatment were less likely to change the type of treatment offered. Patterns of change differed over time for inpatient and outpatient programs. Legitimacy factors, rather than cost, seem to play a role in program closure and change, although the picture is clearer for inpatient programs than for outpatient programs.

The hyaloid vasculature facilitates basement membrane breakdown during choroid fissure closure in the zebrafish eye.

PubMed

James, Andrea; Lee, Chanjae; Williams, Andre M; Angileri, Krista; Lathrop, Kira L; Gross, Jeffrey M

2016-11-15

A critical aspect of vertebrate eye development is closure of the choroid fissure (CF). Defects in CF closure result in colobomas, which are a significant cause of childhood blindness worldwide. Despite the growing number of mutated loci associated with colobomas, we have a limited understanding of the cell biological underpinnings of CF closure. Here, we utilize the zebrafish embryo to identify key phases of CF closure and regulators of the process. Utilizing Laminin-111 as a marker for the basement membrane (BM) lining the CF, we determine the spatial and temporal patterns of BM breakdown in the CF, a prerequisite for CF closure. Similarly, utilizing a combination of in vivo time-lapse imaging, β-catenin immunohistochemistry and F-actin staining, we determine that tissue fusion, which serves to close the fissure, follows BM breakdown closely. Periocular mesenchyme (POM)-derived endothelial cells, which migrate through the CF to give rise to the hyaloid vasculature, possess distinct actin foci that correlate with regions of BM breakdown. Disruption of talin1, which encodes a regulator of the actin cytoskeleton, results in colobomas and these correlate with structural defects in the hyaloid vasculature and defects in BM breakdown. cloche mutants, which entirely lack a hyaloid vasculature, also possess defects in BM breakdown in the CF. Taken together, these data support a model in which the hyaloid vasculature and/or the POM-derived endothelial cells that give rise to the hyaloid vasculature contribute to BM breakdown during CF closure. Copyright © 2016 Elsevier Inc. All rights reserved.

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.

Matrix exponential-based closures for the turbulent subgrid-scale stress tensor.

PubMed

Li, Yi; Chevillard, Laurent; Eyink, Gregory; Meneveau, Charles

2009-01-01

Two approaches for closing the turbulence subgrid-scale stress tensor in terms of matrix exponentials are introduced and compared. The first approach is based on a formal solution of the stress transport equation in which the production terms can be integrated exactly in terms of matrix exponentials. This formal solution of the subgrid-scale stress transport equation is shown to be useful to explore special cases, such as the response to constant velocity gradient, but neglecting pressure-strain correlations and diffusion effects. The second approach is based on an Eulerian-Lagrangian change of variables, combined with the assumption of isotropy for the conditionally averaged Lagrangian velocity gradient tensor and with the recent fluid deformation approximation. It is shown that both approaches lead to the same basic closure in which the stress tensor is expressed as the matrix exponential of the resolved velocity gradient tensor multiplied by its transpose. Short-time expansions of the matrix exponentials are shown to provide an eddy-viscosity term and particular quadratic terms, and thus allow a reinterpretation of traditional eddy-viscosity and nonlinear stress closures. The basic feasibility of the matrix-exponential closure is illustrated by implementing it successfully in large eddy simulation of forced isotropic turbulence. The matrix-exponential closure employs the drastic approximation of entirely omitting the pressure-strain correlation and other nonlinear scrambling terms. But unlike eddy-viscosity closures, the matrix exponential approach provides a simple and local closure that can be derived directly from the stress transport equation with the production term, and using physically motivated assumptions about Lagrangian decorrelation and upstream isotropy.

Estimation of potential and limits of bivalve closure response to detect contaminants: application to cadmium.

PubMed

Tran, Damien; Ciret, Pierre; Ciutat, Aurélie; Durrieu, Gilles; Massabuau, Jean-Charles

2003-04-01

Bivalve closure responses to detect contaminants have often been studied in ecotoxicology as an aquatic pollution biosensor. We present a new laboratory procedure to estimate its potential and limits for various contaminants and animal susceptible to stress. The study was performed in the Asiatic clam Corbicula fluminea and applied to cadmium. To take into account the rate of spontaneous closures, we integrated stress problems associated with fixation by a valve in common apparatus and the spontaneous rhythm associated with circadian activity to focus on conditions with the lowest probability of spontaneous closing. Moreover, we developed an original system by impedance valvometry, using light-weight impedance electrodes, to study free-ranging animals in low-stress conditions and a new analytical approach to describe valve closure behavior as a function of response time and concentration of contaminant. In C. fluminea, we show that cadmium concentrations above 50 microg/L can be detected within less than 1 h, concentrations down to 16 microg/L require 5 h of integration time, and values lower than 16 microg/L cannot be distinguished from background noise. Our procedure improved by a factor of six the cadmium sensitivity threshold reported in the literature. Problems of field applications are discussed.

Robot-assisted partial nephrectomy for large renal masses: a multi-institutional series.

PubMed

Delto, Joan C; Paulucci, David; Helbig, Michael W; Badani, Ketan K; Eun, Daniel; Porter, James; Abaza, Ronney; Hemal, Ashok K; Bhandari, Akshay

2018-06-01

To compare peri-operative outcomes after robot-assisted partial nephrectomy (RAPN) for cT2a (7 to <10 cm) to cT1 tumours. Patients with a cT1a (n = 1 358, 76.4%), cT1b (n = 379, 21.3%) or cT2a (n = 41, 2.3%) renal mass were identified from a multi-institutional RAPN database. Intra- and postoperative outcomes were compared for cT2a masses vs cT1a and cT1b masses using multivariable regression models (linear, logistic, Poisson etc.), adjusting for operating surgeon and a modified R.E.N.A.L. nephrometry score that excluded the radius component. The median sizes for cT1a, cT1b and cT2a tumours were 2.5, 5.0 and 8.0 cm, respectively (P < 0.001) with modified R.E.N.A.L. nephrometry scores being 6.0, 6.5 and 7.0, respectively (cT1a, P < 0.001; cT1b, P = 0.105). RAPN for cT2a vs cT1a masses was associated with a 12% increase in operating time (P < 0.001), a 32% increase in estimated blood loss (P < 0.001), a 7% increase in ischaemia time (P = 0.008), a 3.93 higher odds of acute kidney injury at discharge (95% confidence interval [CI] 1.33, 8.76; P = 0.009) and a higher risk of recurrence (hazard ratio [HR] 10.9, 95% CI 1.31, 92.2; P = 0.027). RAPN for cT2a vs cT1b masses was associated with a 12% increase in blood loss (P = 0.036), a 5% increase in operating time (P = 0.062) and a marginally higher risk of recurrence (HR 11.2, 95% CI 0.77, 11.5; P = 0.059). RAPN for cT2a tumours was not associated with differences in complications (cT1a, P = 0.535; cT1b, P = 0.382), positive margins (cT1a, P = 0.972; cT1b, P = 0.681), length of stay (cT1a, P = 0.507; cT1b, P = 0.513) or renal function decline up to 24 months post-RAPN (cT1a, P = 0.124; cT1b, P = 0.467). For T2a tumours RAPN is a feasible treatment option in a select patient population when performed by experienced surgeons in institutions equipped to manage postoperative complications. Although RAPN was associated with greater blood loss and longer operating and ischaemia time in T2a tumours, it was not associated with greater complication or positive surgical margin rates compared with T1 tumours. Renal function preservation rates were equivalent for up to 24 months postoperatively; however, 12-month recurrence-free survival was significantly lower in the T2a group. Extended follow-up is required to further evaluate long-term survival. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

Priming with a combination of proangiogenic growth factors improves wound healing in normoglycemic mice

PubMed Central

Ackermann, Maximilian; Wolloscheck, Tanja; Wellmann, Axel; Li, Vincent W.; Li, William W.; Konerding, Moritz A.

2012-01-01

Growth factors and/or angiogenic factors are supposed to improve wound healing. The aim of our study was to evaluate the effects of subcutaneous pretreatment with combinatory proangiogenic factors on wound closure, mechanical properties, vessel density, and morphology. Twenty-eight Balb/c mice were divided equally into two groups. A mixture of VEGF (35.0 μg), bFGF (2.5 μg), and PDGF (3.5 μg) was administered 3, 5, and 7 days subcutaneously to 14 mice before full thickness skin punch biopsy wounding, whereas 14 control animals received three times 0.2 ml saline solution. Wound sizes were assessed daily and the repaired tissues were harvested 7 days after complete wound closure. Complete closure (≥95% healing of initial wound area) was reached in all proangiogenic pretreated animals on day 10, whereas controls needed 13 days for complete closure. Tensile strengths were nearly twofold higher than in the controls (p≤0.01). The punch biopsy material revealed 4.2 fold higher vessel densities in the proangiogenic pretreated group. On day 17, the vessel densities in the proangiogenic pretreated wounds were also 3.2 fold higher than in the untreated controls. No significant differences were seen in the collagen ratio. Pretreatment with proangiogenic factors revealed several significant effects on wound healing: faster time to closure, a higher vessel density, better functional outcome. These results suggest a beneficial effect of pretreatment with combinatory growth factors in mouse skin wounds without impaired wound healing. This might be exploited in further investigations in diabetic healing as a therapeutic approach for elective surgery. PMID:21373751

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.

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.

Purse-string double-layer closure: a novel technique for repairing the uterine incision during cesarean section.

PubMed

Turan, Cem; Büyükbayrak, Esra Esim; Yilmaz, Aylin Onan; Karsidag, Yasemin Karageyim; Pirimoglu, Meltem

2015-04-01

To compare the classical double-layer uterine closure to a double-layer purse-string uterine closure (Turan technique) in cesarean section regarding short- and long-term results. Patients were randomized into either the double-layer purse-string uterine closure arm (study group, 84 patients) or the classical double-layer uterine closure arm (control group, 84 patients). For short-term comparison, a detailed transvaginal ultrasound examination was planned in all patients 6 weeks after the operation and a wedge-shaped defect in the uterine incision scar was accepted as uterine scar defect and recorded. For the long-term comparison, subsequent pregnancies of these patients were followed up for any complication. The number of patients with ultrasonographically visible uterine scar defect was 12 (23.5% of all scar defects) in the study group whereas it was 39 (76.5% of all scar defects) in the control group (P < 0.001, χ(2) = 15.42). Demographic data, operation time, hospitalization time, preoperative and postoperative hemoglobin values were not significantly different between the groups. During the 2-year of the follow-up period, five patients in the study group and six patients in the control group became pregnant again. No complication during their pregnancies and second cesarean operation were encountered. With the Turan technique, the uterine incision length becomes shorter, and the frequency of uterine scar defect is lower regarding short-term results. More data is needed for long-term results. ClinicalTrials.gov NCT01287611. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Spontaneous Closure of Patent Ductus Arteriosus in Infants ≤1500 g.

PubMed

Semberova, Jana; Sirc, Jan; Miletin, Jan; Kucera, Jachym; Berka, Ivan; Sebkova, Sylva; O'Sullivan, Sinead; Franklin, Orla; Stranak, Zbynek

2017-08-01

Patent ductus arteriosus (PDA) remains a challenging issue in very low birth weight (VLBW) infants, and its management varies widely. Our aim in this study was to document the natural course of ductus arteriosus in a cohort of VLBW infants who underwent conservative PDA management with no medical or surgical intervention. A retrospective cohort study conducted in 2 European level-3 neonatal units. A total of 368 VLBW infants were born within the study period. Two hundred and ninety-seven infants were free of congenital malformations or heart defects and survived to hospital discharge. Out of those, 280 infants received truly conservative PDA management. In 237 (85%) of nontreated infants, the PDA closed before hospital discharge. The Kaplan-Meier model was used to document the incidence proportion of PDA closure over time for different gestational age groups. The median time to ductal closure was 71, 13, 8, and 6 days in <26+0, 26+0 to 27+6, 28+0 to 29+6, and ≥30 weeks, respectively. For different birth weight groups, the median was 48, 22, 9, and 8 days in infants weighing <750, 750 to 999, 1000 to 1249, and 1250 to 1500 g, respectively. No statistically significant relationship was found between PDA closure before hospital discharge and neonatal morbidities. The likelihood of PDA spontaneous closure in VLBW infants is extremely high. We provide in our findings a platform for future placebo-controlled trials focused on the smallest and youngest infants. Copyright © 2017 by the American Academy of Pediatrics.

Effect of giant charge-transfer resonance σCT 109 barn on operation of magnetic fusion reactor below ``critical energy.''

NASA Astrophysics Data System (ADS)

Hester, Timothy; Maglich, Bogdan; Scott, Dan; Vaucher, Alexander

2016-10-01

Charge transfer (CT) reactivity was assumed to be negligible compared to ionization (IO) before Belfast measurements1-3 revealed the opposite: CT predominance over IO, σCT 109 b , σCT /σIO U 100 , below critical `atomic unit of velocity', vo = 2.2 ×108cms-1 , which is orbital velocity of e in H atom. Near vo, U = 1 , i.e. σCT σIO . Critical ion energy is T0 (lab) = k 25 M [ KeV ] = 200 KeV for [ ERR : md : MbegChr = 0 x 2329 , MendChr = 0 x 232 A , nParams = 1 ] = ion mass [ amu ] = 4 for DT mix ; k = 2 . ``Burnout'' pumping that requires U << 1 is inoperable in the U >> 1 regime whereas CT continually acts like compressor increasing operating vacuum pressure during neutral beam discharge to 10-3 Torr/0.3 s; this, in turn, sets upper limits to ion life-time against neutralization to τ =10-6 s. τ is 105 times shorter than thermalization time constant; hence plasma cannot be created. Lawson4 was unaware of CT resonance; his ``critical temperature'' (30 KeV for DT) should be replaced with T0.

Towards a TWSTFT network time transfer

NASA Astrophysics Data System (ADS)

Jiang, Z.

2008-12-01

TWSTFT (Two Way Satellite Time and Frequency Transfer, TW hereafter) is a major technique used in TAI (International Atomic Time) generation. More than two-thirds of TAI clocks and almost all the primary frequency standards are transferred using TW. Up to now, the only geometry in TAI time transfer is single-link. However, the TAI TW time transfer data are highly redundant. In general, for an N-point network, there are N(N - 1)/2 independently measured links. Among them, only N - 1 will be used. We then have (N2 - 3N + 2)/2 redundant links. As a function of N, the redundant measurements increase quickly (cf figure 1 and table 1). At present, for the European-American network N = 13, but only 12 out of a total of 78 measured links are used in TAI. For the Asia-Pacific regions, N = 8. Full use of the high redundancy is an effective way to improve TAI without new cost. The sum of three TW links that form a closed triangle is the triangle closure. Theoretically a closure is expected to be zero if there are no measurement errors, namely the triangle closure condition. A non-zero closure is a true error and an index of the time link quality. A redundant link sets a geometric constraint. There are (N2 - 3N + 2)/2 independent conditions in a network. In 2006, Jiang and Petit (Proc. EFTF 2006 pp 468-75) proposed a mathematical model to adjust the closures to zero by global network processing. In consequence, time transfer between any two points through any link(s) in the network gives exactly the same result with the same uncertainty. This is the so-called network time transfer. In this paper, the author introduces his recent works on completing the network model by adding the calibration, the uncertainty estimation and the quality assessment using GPS PPP (time transfer by precise point positioning (PPP hereafter)) (Kouba and Héroux 2001 GPS Solut. 5 12-28, Ray and Senior 2005 Metrologia 42 215-32, Orgiazzi et al 2005 Proc. IEEE FCS 2005 pp 337-45, Defraigne et al 2007 Proc. EFTF 2007 pp 909-13, Petit and Jiang 2008 Int. J. Navig. Obs. 2008 1-8). As an independent technique with higher short-term stability, PPP is then a good reference to evaluate the improvement in the network time transfer. The gain is at least 30%. The new method also gives a solution for the high redundancy in the TAI international TW time transfer network. The TAI software Tsoft is operational to perform the network time transfer.

Modified Off-Midline Closure of Pilonidal Sinus Disease

PubMed Central

Saber, Aly

2014-01-01

Background: Numerous surgical procedures have been described for pilonidal sinus disease, but treatment failure and disease recurrence are frequent. Conventional off-midline flap closures have relatively favorable surgical outcomes, but relatively unfavorable cosmetic outcomes. Aim: The author reported outcomes of a new simplified off-midline technique for closure of the defect after complete excision of the sinus tracts. Patients and Methods: Two hundred patients of both sexes were enrolled for modified D-shaped excisions were used to include all sinuses and their ramifications, with a simplified procedure to close the defect. Results: The overall wound infection rate was 12%, (12.2% for males and 11.1% for females). Wound disruption was necessitating laying the whole wound open and management as open technique. The overall wound disruption rate was 6%, (6.1% for males and 5.5% for females) and the overall recurrence rate was 7%. Conclusion: Our simplified off-midline closure without flap appeared to be comparable to conventional off-midline closure with flap, in terms of wound infection, wound dehiscence, and recurrence. Advantages of the simplified procedure include potentially reduced surgery complexity, reduced surgery time, and improved cosmetic outcome. PMID:24926445

Influence of glottal closure on the phonatory process in ex vivo porcine larynges.

PubMed

Birk, Veronika; Kniesburges, Stefan; Semmler, Marion; Berry, David A; Bohr, Christopher; Döllinger, Michael; Schützenberger, Anne

2017-10-01

Many cases of disturbed voice signals can be attributed to incomplete glottal closure, vocal fold oscillation asymmetries, and aperiodicity. Often these phenomena occur simultaneously and interact with each other, making a systematic, isolated investigation challenging. Therefore, ex vivo porcine experiments were performed which enable direct control of glottal configurations. Different pre-phonatory glottal gap sizes, adduction levels, and flow rates were adjusted. The resulting glottal closure types were identified in a post-processing step. Finally, the acoustic quality, aerodynamic parameters, and the characteristics of vocal fold oscillation were analyzed in reference to the glottal closure types. Results show that complete glottal closure stabilizes the phonation process indicated through a reduced left-right phase asymmetry, increased amplitude and time periodicity, and an increase in the acoustic quality. Although asymmetry and periodicity parameter variation covers only a small range of absolute values, these small variations have a remarkable influence on the acoustic quality. Due to the fact that these parameters cannot be influenced directly, the authors suggest that the (surgical) reduction of the glottal gap seems to be a promising method to stabilize the phonatory process, which has to be confirmed in future studies.

Prognosis of canine patients with nasal tumors according to modified clinical stages based on computed tomography: a retrospective study.

PubMed

Kondo, Yumi; Matsunaga, Satoru; Mochizuki, Manabu; Kadosawa, Tsuyoshi; Nakagawa, Takayuki; Nishimura, Ryohei; Sasaki, Nobuo

2008-03-01

To evaluate the efficacy of clinical staging based on computed tomography (CT) imaging over the World Health Organization (WHO) staging system based on radiography for nasal tumors in dogs, a retrospective study was conducted. This study used 112 dogs that had nasal tumors; they had undergone radiography and CT and had been histologically confirmed as having nasal tumors. Among 112 dogs, 85 (75.9%) were diagnosed as adenocarcinoma. Then they were analyzed for survival time according to each staging system. More than 70% of the patients with adenocarcinoma were classified as having WHO stage III. The patients classified under WHO stage II tended to survive longer than those classified under WHO stage III. Dogs classified under WHO stage III were further grouped into CT stages III and IV, and CT stage III patients had a significantly longer survival time than CT stage IV patients. In addition, patients treated with a combination of surgery and radiation had a significantly longer survival time than the patients who did not receive any treatment in CT stage III. On the other hand, different treatment modalities did not show a significant difference in the survival time of CT stage IV dogs. The results suggest that WHO stage III dogs may have various levels of tumor progression, indicating that the CT staging system may be more accurate than the WHO staging system.

Three-Dimensional Magnetic Resonance Imaging Quantification of Glenoid Bone Loss Is Equivalent to 3-Dimensional Computed Tomography Quantification: Cadaveric Study.

PubMed

Yanke, Adam B; Shin, Jason J; Pearson, Ian; Bach, Bernard R; Romeo, Anthony A; Cole, Brian J; Verma, Nikhil N

2017-04-01

To assess the ability of 3-dimensional (3D) magnetic resonance imaging (MRI, 1.5 and 3 tesla [T]) to quantify glenoid bone loss in a cadaveric model compared with the current gold standard, 3D computed tomography (CT). Six cadaveric shoulders were used to create a bone loss model, leaving the surrounding soft tissues intact. The anteroposterior (AP) dimension of the glenoid was measured at the glenoid equator and after soft tissue layer closure the specimen underwent scanning (CT, 1.5-T MRI, and 3-T MRI) with the following methods (0%, 10%, and 25% defect by area). Raw axial data from the scans were segmented using manual mask manipulation for bone and reconstructed using Mimics software to obtain a 3D en face glenoid view. Using calibrated Digital Imaging and Communications in Medicine images, the diameter of the glenoid at the equator and the area of the glenoid defect was measured on all imaging modalities. In specimens with 10% or 25% defects, no difference was detected between imaging modalities when comparing the measured defect size (10% defect P = .27, 25% defect P = .73). All 3 modalities demonstrated a strong correlation with the actual defect size (CT, ρ = .97; 1.5-T MRI, ρ = .93; 3-T MRI, ρ = .92, P < .0001). When looking at the absolute difference between the actual and measured defect area, no significance was noted between imaging modalities (10% defect P = .34, 25% defect P = .47). The error of 3-T 3D MRI increased with increasing defect size (P = .02). Both 1.5- and 3-T-based 3D MRI reconstructions of glenoid bone loss correlate with measurements from 3D CT scan data and actual defect size in a cadaveric model. Regardless of imaging modality, the error in bone loss measurement tends to increase with increased defect size. Use of 3D MRI in the setting of shoulder instability could obviate the need for CT scans. The goal of our work was to develop a reproducible method of determining glenoid bone loss from 3D MRI data and hence eliminate the need for CT scans in this setting. This will lead to decreased cost of care as well as decreased radiation exposure to patients. The long-term goal is a fully automated system that is as approachable for clinicians as current 3D CT technology. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Efficient Learning of Continuous-Time Hidden Markov Models for Disease Progression

PubMed Central

Liu, Yu-Ying; Li, Shuang; Li, Fuxin; Song, Le; Rehg, James M.

2016-01-01

The Continuous-Time Hidden Markov Model (CT-HMM) is an attractive approach to modeling disease progression due to its ability to describe noisy observations arriving irregularly in time. However, the lack of an efficient parameter learning algorithm for CT-HMM restricts its use to very small models or requires unrealistic constraints on the state transitions. In this paper, we present the first complete characterization of efficient EM-based learning methods for CT-HMM models. We demonstrate that the learning problem consists of two challenges: the estimation of posterior state probabilities and the computation of end-state conditioned statistics. We solve the first challenge by reformulating the estimation problem in terms of an equivalent discrete time-inhomogeneous hidden Markov model. The second challenge is addressed by adapting three approaches from the continuous time Markov chain literature to the CT-HMM domain. We demonstrate the use of CT-HMMs with more than 100 states to visualize and predict disease progression using a glaucoma dataset and an Alzheimer’s disease dataset. PMID:27019571

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.

Circle Time for Social and Emotional Learning in Primary School

ERIC Educational Resources Information Center

Cefai, Carmel; Ferrario, Erika; Cavioni, Valeria; Carter, Audrey; Grech, Tracy

2014-01-01

This paper discusses the findings and implications of a semi-randomised control trial study on the effectiveness of circle time (CT) on primary school students' social and emotional learning, as well as classroom teachers' and students' experience of CT. A social and emotional learning programme was delivered through CT by trained classroom…

Use of negative pressure wound therapy in the treatment of neonatal and pediatric wounds: a retrospective examination of clinical outcomes.

PubMed

Baharestani, Mona Mylene

2007-06-01

The clinical effectiveness of negative pressure wound therapy for the management of acute and chronic wounds is well documented in the adult population but information regarding its use in the pediatric population is limited. A retrospective, descriptive study was conducted to examine the clinical outcomes of using negative pressure wound therapy in the treatment of pediatric wounds. The medical records of 24 consecutive pediatric patients receiving negative pressure wound therapy were reviewed. Demographic data, wound etiology, time to closure, closure method, duration of negative pressure wound therapy, complications, dressing change frequency, dressing type used, and pressure settings were analyzed. All categorical variables in the dataset were summarized using frequency (count and percentages) and all continuous variables were summarized using median (minimum, maximum). The 24 pediatric patients (mean age 8.5 years [range 14 days to 18 years old]) had 24 wounds - 12 (50%) were infected at baseline. Sixteen patients had hypoalbuminemia and six had exposed hardware and bone in their wounds. Twenty-two wounds reached full closure in a median time of 10 days (range 2 to 45) following negative pressure wound therapy and flap closure (11), split-thickness skin graft (three), secondary (four), and primary (four) closure. Pressures used in this population ranged from 50 to 125 mm Hg and most wounds were covered with reticulated polyurethane foam. One patient developed a fistula during the course of negative pressure wound therapy. When coupled with appropriate systemic antibiotics, surgical debridement, and medical and nutritional optimization, in this population negative pressure wound therapy resulted in rapid granulation tissue and 92% successful wound closure. Future neonatal and pediatric negative pressure wound therapy usage registries and prospective studies are needed to provide a strong evidence base from which treatment decisions can be made in the management of these challenging cases, especially pertaining to the safety and efficacy of pressure settings, dressings, and interposing contact layer selection.

A Prospective Randomized Clinical Trial of Single vs. Double Layer Closure of Hysterotomy at the Time of Cesarean Delivery: The Effect on Uterine Scar Thickness.

PubMed

Bamberg, Christian; Dudenhausen, Joachim W; Bujak, Verena; Rodekamp, Elke; Brauer, Martin; Hinkson, Larry; Kalache, Karim; Henrich, Wolfgang

2018-06-01

 We undertook a randomized clinical trial to examine the outcome of a single vs. a double layer uterine closure using ultrasound to assess uterine scar thickness.  Participating women were allocated to one of three uterotomy suture techniques: continuous single layer unlocked suturing, continuous locked single layer suturing, or double layer suturing. Transvaginal ultrasound of uterine scar thickness was performed 6 weeks and 6 - 24 months after Cesarean delivery. Sonographers were blinded to the closure technique.  An "intent-to-treat" and "as treated" ANOVA analysis included 435 patients (n = 149 single layer unlocked suturing, n = 157 single layer locked suturing, and n = 129 double layer suturing). 6 weeks postpartum, the median scar thickness did not differ among the three groups: 10.0 (8.5 - 12.3 mm) single layer unlocked vs. 10.1 (8.2 - 12.7 mm) single layer locked vs. 10.8 (8.1 - 12.8 mm) double layer; (p = 0.84). At the time of the second follow-up, the uterine scar was not significantly (p = 0.06) thicker if the uterus had been closed with a double layer closure 7.3 (5.7 - 9.1 mm), compared to single layer unlocked 6.4 (5.0 - 8.8 mm) or locked suturing techniques 6.8 (5.2 - 8.7 mm). Women who underwent primary or elective Cesarean delivery showed a significantly (p = 0.03, p = 0.02, "as treated") increased median scar thickness after double layer closure vs. single layer unlocked suture.  A double layer closure of the hysterotomy is associated with a thicker myometrium scar only in primary or elective Cesarean delivery patients. © Georg Thieme Verlag KG Stuttgart · New York.

Long-term outcomes of sandwich ventral hernia repair paired with hybrid vacuum-assisted closure.

PubMed

Hicks, Caitlin W; Poruk, Katherine E; Baltodano, Pablo A; Soares, Kevin C; Azoury, Said C; Cooney, Carisa M; Cornell, Peter; Eckhauser, Frederic E

2016-08-01

Sandwich ventral hernia repair (SVHR) may reduce ventral hernia recurrence rates, although with an increased risk of surgical site occurrences (SSOs) and surgical site infections (SSIs). Previously, we found that a modified negative pressure wound therapy (hybrid vacuum-assisted closure [HVAC]) system reduced SSOs and SSIs after ventral hernia repair. We aimed to describe our outcomes after SVHR paired with HVAC closure. We conducted a 4-y retrospective review of all complex SVHRs (biologic mesh underlay and synthetic mesh overlay) with HVAC closure performed at our institution by a single surgeon. All patients had fascial defects that could not be reapproximated primarily using anterior component separation. Descriptive statistics were used to report the incidence of postoperative complications and hernia recurrence. A total of 60 patients (59.3 ± 11.4 y, 58.3% male, 75% American Society of Anesthesiologists class ≥3) with complex ventral hernias being underwent sandwich repair with HVAC closure. Major postoperative morbidity (Dindo-Clavien class ≥3) occurred in 14 (23.3%) patients, but incidence of SSO (n = 13, 21.7%) and SSI (n = 4, 6.7%) was low compared with historical reports. Median follow-up time for all patients was 12 mo (interquartile range 5.8-26.5 mo). Hernia recurrence occurred in eight patients (13.3%) after a median time of 20.6 months (interquartile range 16.4- 25.4 months). Use of a dual layer sandwich repair for complex abdominal wall reconstruction is associated with low rates of hernia recurrence at 1 year postoperatively. The addition of the HVAC closure system may reduce the risk of SSOs and SSIs previously reported with this technique and deserves consideration in future prospective studies assessing optimization of ventral hernia repair approaches. Copyright © 2016 Elsevier Inc. All rights reserved.

Systematic review with meta-analysis of studies comparing primary duct closure and T-tube drainage after laparoscopic common bile duct exploration for choledocholithiasis.

PubMed

Podda, Mauro; Polignano, Francesco Maria; Luhmann, Andreas; Wilson, Michael Samuel James; Kulli, Christoph; Tait, Iain Stephen

2016-03-01

With advances in laparoscopic instrumentation and acquisition of advanced laparoscopic skills, laparoscopic common bile duct exploration (LCBDE) is technically feasible and increasingly practiced by surgeons worldwide. Traditional practice of suturing the dochotomy with T-tube drainage may be associated with T-tube-related complications. Primary duct closure (PDC) without a T-tube has been proposed as an alternative to T-tube placement (TTD) after LCBDE. The aim of this meta-analysis was to evaluate the safety and effectiveness of PDC when compared to TTD after LCBDE for choledocholithiasis. A systematic literature search was performed using PubMed, EMBASE, MEDLINE, Google Scholar, and the Cochrane Central Register of Controlled Trials databases for studies comparing primary duct closure and T-tube drainage. Studies were reviewed for the primary outcome measures: overall postoperative complications, postoperative biliary-specific complications, re-interventions, and postoperative hospital stay. Secondary outcomes assessed were: operating time, median hospital expenses, and general complications. Sixteen studies comparing PDC and TTD qualified for inclusion in our meta-analysis, with a total of 1770 patients. PDC showed significantly better results when compared to TTD in terms of postoperative biliary peritonitis (OR 0.22, 95% CI 0.06-0.76, P = 0.02), operating time (WMD, -22.27, 95% CI -33.26 to -11.28, P < 0.00001), postoperative hospital stay (WMD, -3.22; 95% CI -4.52 to -1.92, P < 0.00001), and median hospital expenses (SMD, -1.37, 95% CI -1.96 to -0.77, P < 0.00001). Postoperative hospital stay was significantly decreased in the primary duct closure with internal biliary drainage (PDC + BD) group when compared to TTD group (WMD, -2.68; 95% CI -3.23 to -2.13, P < 0.00001). This comprehensive meta-analysis demonstrates that PDC after LCBDE is feasible and associated with fewer complications than TTD. Based on these results, primary duct closure may be considered as the optimal procedure for dochotomy closure after LCBDE.

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

Internet-delivered cognitive therapy for PTSD: a development pilot series

PubMed Central

Wild, Jennifer; Warnock-Parkes, Emma; Grey, Nick; Stott, Richard; Wiedemann, Milan; Canvin, Lauren; Rankin, Harriet; Shepherd, Emma; Forkert, Ava; Clark, David M.; Ehlers, Anke

2016-01-01

Background Randomised controlled trials have established that face-to-face cognitive therapy for posttraumatic stress disorder (CT-PTSD) based on Ehlers and Clark's cognitive model of PTSD is highly effective and feasible with low rates of dropout. Access to evidence-based psychological treatments for PTSD is insufficient. Several studies have shown that therapist-assisted treatment delivery over the Internet is a promising way of improving access to cognitive behavioural therapy interventions. Objective To develop an Internet version of CT-PTSD that significantly reduces therapist contact time without compromising treatment integrity or retention rates. Methods We describe the development of an Internet version of CT-PTSD. It implements all the key procedures of face-to-face CT-PTSD, including techniques that focus on the trauma memory, such as memory updating, stimulus discrimination and revisiting the trauma site, as well as restructuring individually relevant appraisals relating to overgeneralisation of danger, guilt, shame or anger, behavioural experiments and planning activities to reclaim quality of life. A cohort of 10 patients meeting DSM-IV criteria for PTSD worked through the programme, with remote guidance from a therapist, and they were assessed at pre- and post-treatment on PTSD outcome, mood, work and social adjustment and process measures. Results No patients dropped out. Therapists facilitated the treatment with 192 min of contact time per patient, plus 57 min for reviewing the patient's progress and messages. Internet-delivered CT-PTSD was associated with very large improvements on all outcome and process measures, with 80% of patients achieving clinically significant change and remission from PTSD. Conclusions Internet-delivered cognitive therapy for PTSD (iCT-PTSD) appears to be an acceptable and efficacious treatment. Therapist time was reduced to less than 25% of time in face-to-face CT-PTSD. Randomised controlled trials are required to evaluate systematically the acceptability and efficacy of iCT-PTSD. Highlights of the article iCT-PTSD was acceptable to patients and associated with very large improvements on PTSD outcome and process measures. iCT-PTSD required substantially less therapist time than CT-PTSD. iCT-PTSD may be associated with changes in employment status. Randomised controlled trials are required to systematically evaluate the acceptability and efficacy of iCT-PTSD. PMID:27837579

Detection, attribution, and sensitivity of trends toward earlier streamflow in the Sierra Nevada

USGS Publications Warehouse

Maurer, E.P.; Stewart, I.T.; Bonfils, Celine; Duffy, P.B.; Cayan, D.

2007-01-01

Observed changes in the timing of snowmelt dominated streamflow in the western United States are often linked to anthropogenic or other external causes. We assess whether observed streamflow timing changes can be statistically attributed to external forcing, or whether they still lie within the bounds of natural (internal) variability for four large Sierra Nevada (CA) basins, at inflow points to major reservoirs. Streamflow timing is measured by "center timing" (CT), the day when half the annual flow has passed a given point. We use a physically based hydrology model driven by meteorological input from a global climate model to quantify the natural variability in CT trends. Estimated 50-year trends in CT due to natural climate variability often exceed estimated actual CT trends from 1950 to 1999. Thus, although observed trends in CT to date may be statistically significant, they cannot yet be statistically attributed to external influences on climate. We estimate that projected CT changes at the four major reservoir inflows will, with 90% confidence, exceed those from natural variability within 1-4 decades or 4-8 decades, depending on rates of future greenhouse gas emissions. To identify areas most likely to exhibit CT changes in response to rising temperatures, we calculate changes in CT under temperature increases from 1 to 5??. We find that areas with average winter temperatures between -2??C and -4??C are most likely to respond with significant CT shifts. Correspondingly, elevations from 2000 to 2800 in are most sensitive to temperature increases, with CT changes exceeding 45 days (earlier) relative to 1961-1990. Copyright 2007 by the American Geophysical Union.

T-tube drainage versus primary closure after laparoscopic common bile duct exploration.

PubMed

Gurusamy, Kurinchi Selvan; Koti, Rahul; Davidson, Brian R

2013-06-21

T-tube drainage may prevent bile leak from the biliary tract following bile duct exploration and it offers post-operative access to the bile ducts for visualisation and exploration. Use of T-tube drainage after laparoscopic common bile duct (CBD) exploration is controversial. To assess the benefits and harms of T-tube drainage versus primary closure after laparoscopic common bile duct exploration. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2013. We included all randomised clinical trials comparing T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Two of four authors independently identified the studies for inclusion and extracted data. We analysed the data with both the fixed-effect and the random-effects model meta-analyses using Review Manager (RevMan) Analysis. For each outcome we calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis. We included three trials randomising 295 participants: 147 to T-tube drainage versus 148 to primary closure. All trials had a high risk of bias. No one died during the follow-up period. There was no significant difference in the proportion of patients with serious morbidity (17/147 (weighted percentage 11.3%) in the T-tube drainage versus 9/148 (6.1%) in the primary closure group; RR 1.86; 95% CI 0.87 to 3.96; three trials), and no significant difference was found in the serious morbidity rates (weighted serious morbidity rate = 97 events per 1000 patients) in participants randomised to T-tube drainage versus serious morbidity rate = 61 events per 1000 patients in the primary closure group; RR 1.59; 95% CI 0.66 to 3.83; three trials). Quality of life was not reported in any of the trials. The operating time was significantly longer in the T-tube drainage group compared with the primary closure group (MD 21.22 minutes; 95% CI 12.44 minutes to 30.00 minutes; three trials). The hospital stay was significantly longer in the T-tube drainage group compared with the primary closure group (MD 3.26 days; 95% CI 2.49 days to 4.04 days; three trials). According to one trial, the participants randomised to T-tube drainage returned to work approximately eight days later than the participants randomised to the primary closure group (P < 0.005). T-tube drainage appears to result in significantly longer operating time and hospital stay as compared with primary closure without any evidence of benefit after laparoscopic common bile duct exploration. Based on currently available evidence, there is no justification for the routine use of T-tube drainage after laparoscopic common bile duct exploration in patients with common bile duct stones. More randomised trials comparing the effects of T-tube drainage versus primary closure after laparoscopic common bile duct exploration may be needed. Such trials should be conducted with low risk of bias, assessing the long-term beneficial and harmful effects including long-term complications such as bile stricture and recurrence of common bile duct stones.

Delayed Traumatic Intracranial Haemorrhage and Progressive Traumatic Brain Injury in a Major Referral Centre Based in a Developing Country

PubMed Central

Jeng, Toh Charng; Haspani, Mohd Saffari Mohd; Adnan, Johari Siregar; Naing, Nyi Nyi

2008-01-01

A repeat Computer Tomographic (CT) brain after 24–48 hours from the 1st scanning is usually practiced in most hospitals in South East Asia where intracranial pressure monitoring (ICP) is routinely not done. This interval for repeat CT would be shortened if there was a deterioration in Glasgow Coma Scale (GCS). Most of the time the prognosis of any intervention may be too late especially in hospitals with high patient-to-doctor ratio causing high mortality and morbidity. The purpose of this study was to determine the important predictors for early detection of Delayed Traumatic Intracranial Haemorrhage (DTICH) and Progressive Traumatic Brain Injury (PTBI) before deterioration of GCS occurred, as well as the most ideal timing of repeated CT brain for patients admitted in Malaysian hospitals. A total of 81 patients were included in this study over a period of six months. The CT scan brain was studied by comparing the first and second CT brain to diagnose the presence of DTICH/PTBI. The predictors tested were categorised into patient factors, CT brain findings and laboratory investigations. The mean age was 33.1 ± 15.7 years with a male preponderance of 6.36:1. Among them, 81.5% were patients from road traffic accidents with Glasgow Coma Scale ranging from 4 – 15 (median of 12) upon admission. The mean time interval delay between trauma and first CT brain was 179.8 ± 121.3 minutes for the PTBI group. The DTICH group, 9.9% of the patients were found to have new intracranial clots. Significant predictors detected were different referral hospitals (p=0.02), total GCS status (p=0.026), motor component of GCS (p=0.043), haemoglobin level (p<0.001), platelet count (p=0.011) and time interval between trauma and first CT brain (p=0.022). In the PTBI group, 42.0% of the patients were found to have new changes (new clot occurrence, old clot expansion and oedema) in the repeat CT brain. Univariate statistical analysis revealed that age (p=0.03), race (p=0.035), types of admission (p=0.024), GCS status (p=0.02), pupillary changes (p=0.014), number of intracranial lesion (p=0.004), haemoglobin level (p=0.038), prothrombin time (p=0.016) as the best predictors of early detection of changes. Multiple logistics regression analysis indicated that age, severity, GCS status (motor component) and GCS during admission were significantly associated with second CT scan with changes. This study showed that 9.9% of the total patients seen in the period of study had DTICH and 42% had PTBI. In the early period after traumatic head injury, the initial CT brain did not reveal the full extent of haemorrhagic injury and associated cerebral oedema. Different referral hospitals of different trauma level, GCS status, motor component of the GCS, haemoglobin level, platelet count and time interval between trauma and the first CT brain were the significant predictors for DTICH. Whereas the key determinants of PTBI were age, race, types of admission, GCS status, pupillary changes, number of intracranial bleed, haemoglobin level, prothrombin time and of course time interval between trauma and first CT brain. Any patients who had traumatic head injury in hospitals with no protocol of repeat CT scan or intracranial pressure monitoring especially in developing countries are advised to have to repeat CT brain at the appropriate quickest time . PMID:22589639

Development of CT and 3D-CT Using Flat Panel Detector Based Real-Time Digital Radiography System

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

Ravindran, V. R.; Sreelakshmi, C.; Vibin

2008-09-26

The application of Digital Radiography in the Nondestructive Evaluation (NDE) of space vehicle components is a recent development in India. A Real-time DR system based on amorphous silicon Flat Panel Detector has been developed for the NDE of solid rocket motors at Rocket Propellant Plant of VSSC in a few years back. The technique has been successfully established for the nondestructive evaluation of solid rocket motors. The DR images recorded for a few solid rocket specimens are presented in the paper. The Real-time DR system is capable of generating sufficient digital X-ray image data with object rotation for the CTmore » image reconstruction. In this paper the indigenous development of CT imaging based on the Realtime DR system for solid rocket motor is presented. Studies are also carried out to generate 3D-CT image from a set of adjacent CT images of the rocket motor. The capability of revealing the spatial location and characterisation of defect is demonstrated by the CT and 3D-CT images generated.« less

Assessment of real-time PCR cycle threshold values in Microsporum canis culture-positive and culture-negative cats in an animal shelter: a field study.

PubMed

Jacobson, Linda S; McIntyre, Lauren; Mykusz, Jenny

2018-02-01

Objectives Real-time PCR provides quantitative information, recorded as the cycle threshold (Ct) value, about the number of organisms detected in a diagnostic sample. The Ct value correlates with the number of copies of the target organism in an inversely proportional and exponential relationship. The aim of the study was to determine whether Ct values could be used to distinguish between culture-positive and culture-negative samples. Methods This was a retrospective analysis of Ct values from dermatophyte PCR results in cats with suspicious skin lesions or suspected exposure to dermatophytosis. Results One hundred and thirty-two samples were included. Using culture as the gold standard, 28 were true positives, 12 were false positives and 92 were true negatives. The area under the curve for the pretreatment time point was 96.8% (95% confidence interval [CI] 94.2-99.5) compared with 74.3% (95% CI 52.6-96.0) for pooled data during treatment. Before treatment, a Ct cut-off of <35.7 (approximate DNA count 300) provided a sensitivity of 92.3% and specificity of 95.2%. There was no reliable cut-off Ct value between culture-positive and culture-negative samples during treatment. Ct values prior to treatment differed significantly between the true-positive and false-positive groups ( P = 0.0056). There was a significant difference between the pretreatment and first and second negative culture time points ( P = 0.0002 and P <0.0001, respectively). However, there was substantial overlap between Ct values for true positives and true negatives, and for pre- and intra-treatment time points. Conclusions and relevance Ct values had limited usefulness for distinguishing between culture-positive and culture-negative cases when field study samples were analyzed. In addition, Ct values were less reliable than fungal culture for determining mycological cure.

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...

The impact of diagnostic imaging wait times on the prognosis of lung cancer.

PubMed

Byrne, Suzanne C; Barrett, Brendan; Bhatia, Rick

2015-02-01

This study was performed to determine whether gaps in patient flow from initial lung imaging to computed tomography (CT) guided lung biopsy in patients with non-small cell lung cancer (NSCLC) was associated with a change in tumour size, stage, and thus prognosis. All patients who had a CT-guided lung biopsy in 2009 (phase I) and in 2011 (phase II) with a pathologic diagnosis of primary lung cancer (NSCLC) at Eastern Health, Newfoundland, were identified. Dates of initial abnormal imaging, confirmatory CT (if performed), and CT-guided biopsy were recorded, along with tumour size and resulting T stage at each time point. In 2010, wait times for diagnostic imaging at Eastern Health were reduced. The stage and prognosis of NSCLC in 2009 was compared with 2011. In phase 1, there was a statistically significant increase in tumour size (mean difference, 0.67 cm; P < .0001) and stage (P < .0001) from initial image to biopsy. There was a moderate correlation between the time (in days) between the images and change in size (r = 0.33, P = .008) or stage (r = 0.26, P = .036). In phase II, the median wait time from initial imaging to confirmatory CT was reduced to 7.5 days (from 19 days). At this reduced wait time, there was no statistically significant increase in tumour size (mean difference, 0.02; P > .05) or stage (P > .05) from initial imaging to confirmatory CT. Delays in patient flow through diagnostic imaging resulted in an increase in tumour size and stage, with a negative impact on prognosis of NSCLC. This information contributed to the hiring of additional CT technologists and extended CT hours to decrease the wait time for diagnostic imaging. With reduced wait times, the prognosis of NSCLC was not adversely impacted as patients navigated through diagnostic imaging. Copyright © 2015 Canadian Association of Radiologists. All rights reserved.

Leveraging the NLM map from SNOMED CT to ICD-10-CM to facilitate adoption of ICD-10-CM.

PubMed

Cartagena, F Phil; Schaeffer, Molly; Rifai, Dorothy; Doroshenko, Victoria; Goldberg, Howard S

2015-05-01

Develop and test web services to retrieve and identify the most precise ICD-10-CM code(s) for a given clinical encounter. Facilitate creation of user interfaces that 1) provide an initial shortlist of candidate codes, ideally visible on a single screen; and 2) enable code refinement. To satisfy our high-level use cases, the analysis and design process involved reviewing available maps and crosswalks, designing the rule adjudication framework, determining necessary metadata, retrieving related codes, and iteratively improving the code refinement algorithm. The Partners ICD-10-CM Search and Mapping Services (PI-10 Services) are SOAP web services written using Microsoft's.NET 4.0 Framework, Windows Communications Framework, and SQL Server 2012. The services cover 96% of the Partners problem list subset of SNOMED CT codes that map to ICD-10-CM codes and can return up to 76% of the 69,823 billable ICD-10-CM codes prior to creation of custom mapping rules. We consider ways to increase 1) the coverage ratio of the Partners problem list subset of SNOMED CT codes and 2) the upper bound of returnable ICD-10-CM codes by creating custom mapping rules. Future work will investigate the utility of the transitive closure of SNOMED CT codes and other methods to assist in custom rule creation and, ultimately, to provide more complete coverage of ICD-10-CM codes. ICD-10-CM will be easier for clinicians to manage if applications display short lists of candidate codes from which clinicians can subsequently select a code for further refinement. The PI-10 Services support ICD-10 migration by implementing this paradigm and enabling users to consistently and accurately find the best ICD-10-CM code(s) without translation from ICD-9-CM. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Dealing with difficult deformations: construction of a knowledge-based deformation atlas

NASA Astrophysics Data System (ADS)

Thorup, S. S.; Darvann, T. A.; Hermann, N. V.; Larsen, P.; Ólafsdóttir, H.; Paulsen, R. R.; Kane, A. A.; Govier, D.; Lo, L.-J.; Kreiborg, S.; Larsen, R.

2010-03-01

Twenty-three Taiwanese infants with unilateral cleft lip and palate (UCLP) were CT-scanned before lip repair at the age of 3 months, and again after lip repair at the age of 12 months. In order to evaluate the surgical result, detailed point correspondence between pre- and post-surgical images was needed. We have previously demonstrated that non-rigid registration using B-splines is able to provide automated determination of point correspondences in populations of infants without cleft lip. However, this type of registration fails when applied to the task of determining the complex deformation from before to after lip closure in infants with UCLP. The purpose of the present work was to show that use of prior information about typical deformations due to lip closure, through the construction of a knowledge-based atlas of deformations, could overcome the problem. Initially, mean volumes (atlases) for the pre- and post-surgical populations, respectively, were automatically constructed by non-rigid registration. An expert placed corresponding landmarks in the cleft area in the two atlases; this provided prior information used to build a knowledge-based deformation atlas. We model the change from pre- to post-surgery using thin-plate spline warping. The registration results are convincing and represent a first move towards an automatic registration method for dealing with difficult deformations due to this type of surgery.

Personalized mitral valve closure computation and uncertainty analysis from 3D echocardiography.

PubMed

Grbic, Sasa; Easley, Thomas F; Mansi, Tommaso; Bloodworth, Charles H; Pierce, Eric L; Voigt, Ingmar; Neumann, Dominik; Krebs, Julian; Yuh, David D; Jensen, Morten O; Comaniciu, Dorin; Yoganathan, Ajit P

2017-01-01

Intervention planning is essential for successful Mitral Valve (MV) repair procedures. Finite-element models (FEM) of the MV could be used to achieve this goal, but the translation to the clinical domain is challenging. Many input parameters for the FEM models, such as tissue properties, are not known. In addition, only simplified MV geometry models can be extracted from non-invasive modalities such as echocardiography imaging, lacking major anatomical details such as the complex chordae topology. A traditional approach for FEM computation is to use a simplified model (also known as parachute model) of the chordae topology, which connects the papillary muscle tips to the free-edges and select basal points. Building on the existing parachute model a new and comprehensive MV model was developed that utilizes a novel chordae representation capable of approximating regional connectivity. In addition, a fully automated personalization approach was developed for the chordae rest length, removing the need for tedious manual parameter selection. Based on the MV model extracted during mid-diastole (open MV) the MV geometric configuration at peak systole (closed MV) was computed according to the FEM model. In this work the focus was placed on validating MV closure computation. The method is evaluated on ten in vitro ovine cases, where in addition to echocardiography imaging, high-resolution μCT imaging is available for accurate validation. Copyright © 2016 Elsevier B.V. All rights reserved.

Negative pressure wound treatment improves Acute Physiology and Chronic Health Evaluation II score in mediastinitis allowing a successful elective pectoralis muscle flap closure: six-year experience of a single protocol.

PubMed

Salica, Andrea; Weltert, Luca; Scaffa, Raffaele; Guerrieri Wolf, Lorenzo; Nardella, Saverio; Bellisario, Alessandro; De Paulis, Ruggero

2014-11-01

Optimal management of poststernotomy mediastinitis is controversial. Negative pressure wound treatment improves wound environment and sternal stability with low surgical invasiveness. Our protocol was based on negative pressure followed by delayed surgical closure. The aim of this study was to provide the results at early follow-up and to identify the risk factors for adverse outcome. In 5400 cardiac procedures, 44 consecutive patients with mediastinitis were enrolled in the study. Mediastinitis treatment was based on urgent debridement and negative pressure as the first-line approach. After wound sterilization, chest closure was achieved by elective pectoralis muscle advancement flap. Each patient's hospital data were collected prospectively. Variables included patient demographics and clinical and biological data. Acute Physiology and Chronic Health Evaluation (APACHE) II score was calculated at the time of diagnosis and 48 hours after debridement. Focus outcome measures were mediastinitis-related death and need for reintervention after pectoralis muscle closure. El Oakley type I and type IIIA mediastinitis were the most frequent types (63.6%). Methicillin-resistant Staphylococcus aureus was present in 25 patients (56.8%). Mean APACHE II score was 19.4±4 at the time of diagnosis, and 30 patients (68.2%) required intensive care unit transfer before surgical debridement. APACHE II score improved 48 hours after wound debridement and negative pressure application (mean value, 19.4±4 vs 7.2±2; P=.005) independently of any other variables included in the study. One patient in septic shock at the time of diagnosis died (2.2%). Negative pressure promotes a significant improvement in clinical status according to APACHE II score and allows a successful elective surgical closure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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...

Cone-Beam Computed Tomography (CBCT) Versus CT in Lung Ablation Procedure: Which is Faster?

PubMed

Cazzato, Roberto Luigi; Battistuzzi, Jean-Benoit; Catena, Vittorio; Grasso, Rosario Francesco; Zobel, Bruno Beomonte; Schena, Emiliano; Buy, Xavier; Palussiere, Jean

2015-10-01

To compare cone-beam CT (CBCT) versus computed tomography (CT) guidance in terms of time needed to target and place the radiofrequency ablation (RFA) electrode on lung tumours. Patients at our institution who received CBCT- or CT-guided RFA for primary or metastatic lung tumours were retrospectively included. Time required to target and place the RFA electrode within the lesion was registered and compared across the two groups. Lesions were stratified into three groups according to their size (<10, 10-20, >20 mm). Occurrences of electrode repositioning, repositioning time, RFA complications, and local recurrence after RFA were also reported. Forty tumours (22 under CT, 18 under CBCT guidance) were treated in 27 patients (19 male, 8 female, median age 67.25 ± 9.13 years). Thirty RFA sessions (16 under CBCT and 14 under CT guidance) were performed. Multivariable linear regression analysis showed that CBCT was faster than CT to target and place the electrode within the tumour independently from its size (β = -9.45, t = -3.09, p = 0.004). Electrode repositioning was required in 10/22 (45.4 %) tumours under CT guidance and 5/18 (27.8 %) tumours under CBCT guidance. Pneumothoraces occurred in 6/14 (42.8 %) sessions under CT guidance and in 6/16 (37.5 %) sessions under CBCT guidance. Two recurrences were noted for tumours receiving CBCT-guided RFA (2/17, 11.7 %) and three after CT-guided RFA (3/19, 15.8 %). CBCT with live 3D needle guidance is a useful technique for percutaneous lung ablation. Despite lesion size, CBCT allows faster lung RFA than CT.

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.

Meloxicam, 15 mg/day, spares platelet function in healthy volunteers.

PubMed

de Meijer, A; Vollaard, H; de Metz, M; Verbruggen, B; Thomas, C; Novakova, I

1999-10-01

To study the influence of meloxicam, a cyclooxygenase-2 (COX-2) preferential nonsteroidal anti-inflammatory drug, on serum thromboxane and platelet function in healthy volunteers with use of the maximum recommended daily dosage of 15 mg/day. This study used an open, randomized crossover design. Indomethacin (INN, indometacin) was given as a positive control for nonsteroidal anti-inflammatory drug-induced inhibition of platelet function. The following variables were recorded: thromboxane B2 serum concentrations by radioimmunoassay, platelet aggregation by whole blood aggregometry in response to collagen 1.1 microg/L and to arachidonic acid 0.35 mmol/L, and closure time with use of the PFA-100. Serum thromboxane B2 at baseline was 535+/-233 nmol/L (mean +/- SD) and was reduced for 95% by indomethacin to 26+/-19 nmol/L (P < .001) and for 66% by meloxicam to 183+/-62 nmol/L (P < .001). Maximal platelet aggregation in response to collagen at baseline was 18.7+/-1.6 ohms (ohms). It was reduced by indomethacin to 7.3+/-4.5 ohms (P < .001), but not by meloxicam (19+/-2.5 ohms). Platelet aggregation in response to arachidonic acid at baseline was 12.2+/-2.0 ohms. It was reduced by indomethacin in all subjects to 0 ohms, but not by meloxicam (11+/-2.4 ohms). Closure time at baseline was 128+/-24 seconds and was prolonged by indomethacin to 286+/-38 seconds (P < .001). Meloxicam caused a minor prolongation of the closure time (141+/-32 seconds; P < .05). Meloxicam, 15 mg/day caused a major reduction of maximum thromboxane production but no reduction in collagen- or arachidonic acid-induced platelet aggregation and only minor increase of the closure time.

Functional and esthetic outcome enhancement of periodontal surgery by application of plastic surgery principles.

PubMed

Hürzeler, M B; Weng, D

1999-02-01

The closure of surgical wounds in a layer-by-layer fashion, a common principle of plastic surgery, is applied in this article to the field of periodontal surgery with the introduction of a new flap design. The suggested technique is indicated with all periodontal procedures that aim for hard and soft tissue augmentation (guided bone regeneration, mucogingival surgery, or plastic periodontal surgery) where passive, tension-free wound closure is fundamental for wound healing and a successful functional and esthetic outcome. By means of a series of incisions, buccal and lingual flaps are split several times; this results in a double-partial thickness flap and a coronally positioned palatal sliding flap, respectively. Thus, several tissue layers are obtained and the passive advancement of flaps becomes possible for the coverage of augmented areas. Wound closure with microsurgical suture material is accomplished in a multilayer approach, which ensures adaptation and closure of the outer tissue layers without any tension. Two case reports demonstrate the new plastic periodontal approach.

Probing embryonic tissue mechanics with laser hole drilling

NASA Astrophysics Data System (ADS)

Ma, Xiaoyan; Lynch, Holley E.; Scully, Peter C.; Hutson, M. Shane

2009-09-01

We use laser hole drilling to assess the mechanics of an embryonic epithelium during development—in vivo and with subcellular resolution. We ablate a subcellular cylindrical hole clean through the epithelium and track the subsequent recoil of adjacent cells (on ms time scales). We investigate dorsal closure in the fruit fly with emphasis on apical constriction of amnioserosa cells. The mechanical behavior of this epithelium falls between that of a continuous sheet and a 2D cellular foam (a network of tensile interfaces). Tensile stress is carried both by cell-cell interfaces and by the cells' apical actin networks. Our results show that stress is slightly concentrated along interfaces (1.6-fold), but only in early closure. Furthermore, closure is marked by a decrease in the recoil power-law exponent, implying a transition to a more solid-like tissue. We use the site and stage dependence of the recoil kinetics to constrain how the cellular mechanics change during closure. We apply these results to test extant computational models.

[Accurate 3D free-form registration between fan-beam CT and cone-beam CT].

PubMed

Liang, Yueqiang; Xu, Hongbing; Li, Baosheng; Li, Hongsheng; Yang, Fujun

2012-06-01

Because the X-ray scatters, the CT numbers in cone-beam CT cannot exactly correspond to the electron densities. This, therefore, results in registration error when the intensity-based registration algorithm is used to register planning fan-beam CT and cone-beam CT. In order to reduce the registration error, we have developed an accurate gradient-based registration algorithm. The gradient-based deformable registration problem is described as a minimization of energy functional. Through the calculus of variations and Gauss-Seidel finite difference method, we derived the iterative formula of the deformable registration. The algorithm was implemented by GPU through OpenCL framework, with which the registration time was greatly reduced. Our experimental results showed that the proposed gradient-based registration algorithm could register more accurately the clinical cone-beam CT and fan-beam CT images compared with the intensity-based algorithm. The GPU-accelerated algorithm meets the real-time requirement in the online adaptive radiotherapy.

Zero-Echo-Time and Dixon Deep Pseudo-CT (ZeDD CT): Direct Generation of Pseudo-CT Images for Pelvic PET/MRI Attenuation Correction Using Deep Convolutional Neural Networks with Multiparametric MRI.

PubMed

Leynes, Andrew P; Yang, Jaewon; Wiesinger, Florian; Kaushik, Sandeep S; Shanbhag, Dattesh D; Seo, Youngho; Hope, Thomas A; Larson, Peder E Z

2018-05-01

Accurate quantification of uptake on PET images depends on accurate attenuation correction in reconstruction. Current MR-based attenuation correction methods for body PET use a fat and water map derived from a 2-echo Dixon MRI sequence in which bone is neglected. Ultrashort-echo-time or zero-echo-time (ZTE) pulse sequences can capture bone information. We propose the use of patient-specific multiparametric MRI consisting of Dixon MRI and proton-density-weighted ZTE MRI to directly synthesize pseudo-CT images with a deep learning model: we call this method ZTE and Dixon deep pseudo-CT (ZeDD CT). Methods: Twenty-six patients were scanned using an integrated 3-T time-of-flight PET/MRI system. Helical CT images of the patients were acquired separately. A deep convolutional neural network was trained to transform ZTE and Dixon MR images into pseudo-CT images. Ten patients were used for model training, and 16 patients were used for evaluation. Bone and soft-tissue lesions were identified, and the SUV max was measured. The root-mean-squared error (RMSE) was used to compare the MR-based attenuation correction with the ground-truth CT attenuation correction. Results: In total, 30 bone lesions and 60 soft-tissue lesions were evaluated. The RMSE in PET quantification was reduced by a factor of 4 for bone lesions (10.24% for Dixon PET and 2.68% for ZeDD PET) and by a factor of 1.5 for soft-tissue lesions (6.24% for Dixon PET and 4.07% for ZeDD PET). Conclusion: ZeDD CT produces natural-looking and quantitatively accurate pseudo-CT images and reduces error in pelvic PET/MRI attenuation correction compared with standard methods. © 2018 by the Society of Nuclear Medicine and Molecular Imaging.

Estimating sensible heat flux in agricultural screenhouses by the flux-variance and half-order time derivative methods

NASA Astrophysics Data System (ADS)

Achiman, Ori; Mekhmandarov, Yonatan; Pirkner, Moran; Tanny, Josef

2016-04-01

Previous studies have established that the eddy covariance (EC) technique is reliable for whole canopy flux measurements in agricultural crops covered by porous screens, i.e., screenhouses. Nevertheless, the eddy covariance technique remains difficult to apply in the farm due to costs, operational complexity, and post-processing of data - thereby inviting alternative techniques to be developed. The subject of this research was estimating the sensible heat flux by two turbulent transport techniques, namely, Flux-Variance (FV) and Half-order Time Derivative (HTD) whose instrumentation needs and operational demands are not as elaborate as the EC. The FV is based on the standard deviation of high frequency temperature measurements and a similarity constant CT. The HTD method requires mean air temperature and air velocity data. Measurements were carried out in two types of screenhouses: (i) a banana plantation in a light shading (8%) screenhouse; (ii) a pepper crop in a dense insect-proof (50-mesh) screenhouse. In each screenhouse an EC system was deployed for reference and high frequency air temperature measurements were conducted using miniature thermocouples installed at several levels to identify the optimal measurement height. Quality control analysis showed that turbulence development and flow stationarity conditions in the two structures were suitable for flux measurements by the EC technique. Energy balance closure slopes in the two screenhouses were larger than 0.71, in agreement with results for open fields. Regressions between sensible heat flux measured by EC and estimated by FV resulted with CT values that were usually larger than 1, the typical value for open field. In both shading and insect-proof screenhouses the CT value generally increased with height. The optimal measurement height, defined as the height with maximum R2 of the regression between EC and FV sensible heat fluxes, was just above the screen. CT value at optimal height was 2.64 and 1.52 for the shading and insect-proof screenhouses, respectively, with R2 = 0.73 in both types of structures. FV data analysis of the temperature signal at frequencies lower than 10 Hz showed that R2 of these regressions was insensitive to the data analysis frequency up to 0.5 Hz. This suggests that turbulent transport in the screenhouses was governed by large scale vortices. Regressions between EC and HTD sensible heat fluxes resulted with R2 which slightly decreased with height and had values between 0.3 and 0.4 for both screenhouses. The regression slopes also decreased with height and had values between 0.4 and 0.6. We conclude that in screenhouses the FV technique provides a more reliable estimate of the sensible heat flux than the HTD; however, the latter is simpler and more robust in terms of equipment, operation and data analysis and hence may be more attainable for day-to-day use by the growers.

Effect of film-based versus filmless operation on the productivity of CT technologists.

PubMed

Reiner, B I; Siegel, E L; Hooper, F J; Glasser, D

1998-05-01

To determine the relative time required for a technologist to perform a computed tomographic (CT) examination in a "filmless" versus a film-based environment. Time-motion studies were performed in 204 consecutive CT examinations. Images from 96 examinations were electronically transferred to a picture archiving and communication system (PACS) without being printed to film, and 108 were printed to film. The time required to obtain and electronically transfer the images or print the images to film and make the current and previous studies available to the radiologists for interpretation was recorded. The time required for a technologist to complete a CT examination was reduced by 45% with direct image transfer to the PACS compared with the time required in the film-based mode. This reduction was due to the elimination of a number of steps in the filming process, such as the printing at multiple window or level settings. The use of a PACS can result in the elimination of multiple time-intensive tasks for the CT technologist, resulting in a marked reduction in examination time. This reduction can result in increased productivity, and, hence greater cost-effectiveness with filmless operation.

Surgical complications associated with primary closure in patients with diabetic foot osteomyelitis

PubMed Central

García-Morales, Esther; Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; Cecilia-Matilla, Almudena; García-Álvarez, Yolanda; Beneit-Montesinos, Juan Vicente

2012-01-01

Background The aim of this study was to determine the incidence of complications associated with primary closure in surgical procedures performed for diabetic foot osteomyelitis compared to those healed by secondary intention. In addition, further evaluation of the surgical digital debridement for osteomyelitis with primary closure as an alternative to patients with digital amputation was also examined in our study. Methods Comparative study that included 46 patients with diabetic foot ulcerations. Surgical debridement of the infected bone was performed on all patients. Depending on the surgical technique used, primary surgical closure was performed on 34 patients (73.9%, Group 1) while the rest of the 12 patients were allowed to heal by secondary intention (26.1%, Group 2). During surgical intervention, bone samples were collected for both microbiological and histopathological analyses. Post-surgical complications were recorded in both groups during the recovery period. Results The average healing time was 9.9±SD 8.4 weeks in Group 1 and 19.1±SD 16.9 weeks in Group 2 (p=0.008). The percentage of complications was 61.8% in Group 1 and 58.3% in Group 2 (p=0.834). In all patients with digital ulcerations that were necessary for an amputation, a primary surgical closure was performed with successful outcomes. Discussion Primary surgical closure was not associated with a greater number of complications. Patients who received primary surgical closure had faster healing rates and experienced a lower percentage of exudation (p=0.05), edema (p<0.001) and reinfection, factors that determine the delay in wound healing and affect the prognosis of the surgical outcome. Further research with a greater number of patients is required to better define the cases for which primary surgical closure may be indicated at different levels of the diabetic foot. PMID:23050062

Mitigation of infectious disease at school: targeted class closure vs school closure.

PubMed

Gemmetto, Valerio; Barrat, Alain; Cattuto, Ciro

2014-12-31

School environments are thought to play an important role in the community spread of infectious diseases such as influenza because of the high mixing rates of school children. The closure of schools has therefore been proposed as an efficient mitigation strategy. Such measures come however with high associated social and economic costs, making alternative, less disruptive interventions highly desirable. The recent availability of high-resolution contact network data from school environments provides an opportunity to design models of micro-interventions and compare the outcomes of alternative mitigation measures. We model mitigation measures that involve the targeted closure of school classes or grades based on readily available information such as the number of symptomatic infectious children in a class. We focus on the specific case of a primary school for which we have high-resolution data on the close-range interactions of children and teachers. We simulate the spread of an influenza-like illness in this population by using an SEIR model with asymptomatics, and compare the outcomes of different mitigation strategies. We find that targeted class closure affords strong mitigation effects: closing a class for a fixed period of time--equal to the sum of the average infectious and latent durations--whenever two infectious individuals are detected in that class decreases the attack rate by almost 70% and significantly decreases the probability of a severe outbreak. The closure of all classes of the same grade mitigates the spread almost as much as closing the whole school. Our model of targeted class closure strategies based on readily available information on symptomatic subjects and on limited information on mixing patterns, such as the grade structure of the school, shows that these strategies might be almost as effective as whole-school closure, at a much lower cost. This may inform public health policies for the management and mitigation of influenza-like outbreaks in the community.

[Mobile CT: technical aspects of prehospital stroke imaging before intravenous thrombolysis].

PubMed

Gierhake, D; Weber, J E; Villringer, K; Ebinger, M; Audebert, H J; Fiebach, J B

2013-01-01

To reduce the time from symptom onset to treatment with tissue plasminogen activator (tPA) in ischemic stroke, an ambulance was equipped with a CT scanner. We analyzed process and image quality of CT scanning during the pilot study regarding image quality and safety issues. The pilot study of a stroke emergency mobile unit (STEMO) ran over a period of 12 weeks on 5 weekdays from 7a.m. to 6:30 p.m. A teleradiological service for the justifying indication and reporting was established. The radiographer was responsible for the performance of the CT scan on the ambulance. 64 cranial CT scans and 1 intracranial CT angiography were performed. We compared times from ambulance alarm to treatment decision (time of last brain scan) with a cohort of 50 consecutive tPA treatments before implementation of STEMO. 62 (95%) of the 65 scans performed had sufficient quality for reading. Technical quality was not optimal in 45 cases (69%) mainly caused by suboptimal positioning of patient or eye lens protection. Motion artefacts were observed in 8 exams (12%). No safety issues occurred for team or patients. 23 patients were treated with thrombolysis. Time from alarm to last CT scan was 18 minutes shorter than in the tPA cohort before STEMO implementation. A teleradiological support for primary stroke imaging by CT on-site is feasible, quality-wise of diagnostic value and has not raised safety issues. © Georg Thieme Verlag KG Stuttgart · New York.

Technical considerations for implementation of x-ray CT polymer gel dosimetry.

PubMed

Hilts, M; Jirasek, A; Duzenli, C

2005-04-21

Gel dosimetry is the most promising 3D dosimetry technique in current radiation therapy practice. X-ray CT has been shown to be a feasible method of reading out polymer gel dosimeters and, with the high accessibility of CT scanners to cancer hospitals, presents an exciting possibility for clinical implementation of gel dosimetry. In this study we report on technical considerations for implementation of x-ray CT polymer gel dosimetry. Specifically phantom design, CT imaging methods, imaging time requirements and gel dose response are investigated. Where possible, recommendations are made for optimizing parameters to enhance system performance. The dose resolution achievable with an optimized system is calculated given voxel size and imaging time constraints. Results are compared with MRI and optical CT polymer gel dosimetry results available in the literature.

Atrial septum defect closure device in a beating heart, from the perspective of a researcher in artificial organs.

PubMed

Tomizawa, Yasuko

2012-12-01

Transcatheter closure of atrial septum defect (ASD) with a closure device is increasing, but the history of clinical use of this procedure is still short, and the efficacy and long-term safety remain unproved. The total number of closure devices implanted throughout the world has not been counted accurately. Therefore, the probability of complications occurring after implantation is uncertain. Device-related complications that occur suddenly late after implantation are life-threatening, and quite often necessitate emergency surgical intervention. In Japanese medical journals, authors reporting closure devices have mentioned no complications and problems in their facilities. Detailed studies of device-related complications and device removal have not been reported in Japan. In fact, this literature search found an unexpectedly large number of reports of various adverse events from many overseas countries. When follow-up duration is short and the number of patients is small, the incidence of complications cannot be determined. Rare complications may emerge in a large series with a long observation period. Consequently, the actual number of incidents related to ASD closure devices is possibly several times higher than the number reported. Guidelines for long-term patient management for patients with an implanted closure device are necessary and post-marketing surveillance is appropriate. Development of a national database, a worldwide registration system, and continuous information disclosure will improve the quality of treatment. The devices currently available are not ideal in view of reports of late complications requiring urgent surgery and the need for life-long follow-up. An ideal device should be free from complications during life, and reliability is indispensable.

Nickel titanium springs versus stainless steel springs: A randomized clinical trial of two methods of space closure.

PubMed

Norman, Noraina Hafizan; Worthington, Helen; Chadwick, Stephen Mark

2016-09-01

To compare the clinical performance of nickel titanium (NiTi) versus stainless steel (SS) springs during orthodontic space closure. Two-centre parallel group randomized clinical trial. Orthodontic Department University of Manchester Dental Hospital and Orthodontic Department Countess of Chester Hospital, United Kingdom. Forty orthodontic patients requiring fixed appliance treatment were enrolled, each being randomly allocated into either NiTi (n = 19) or SS groups (n = 21). Study models were constructed at the start of the space closure phase (T0) and following the completion of space closure (T1). The rate of space closure achieved for each patient was calculated by taking an average measurement from the tip of the canine to the mesiobuccal groove on the first permanent molar of each quadrant. The study was terminated early due to time constraints. Only 30 patients completed, 15 in each study group. There was no statistically significant difference between the amounts of space closed (mean difference 0.17 mm (95%CI -0.99 to 1.34; P = 0.76)). The mean rate of space closure for NiTi coil springs was 0.58 mm/4 weeks (SD 0.24) and 0.85 mm/4 weeks (SD 0.36) for the stainless steel springs. There was a statistically significant difference between the two groups (P = 0.024), in favour of the stainless steel springs, when the mean values per patient were compared. Our study shows that stainless steel springs are clinically effective; these springs produce as much space closure as their more expensive rivals, the NiTi springs.

Innexin 3, a New Gene Required for Dorsal Closure in Drosophila Embryo

PubMed Central

Giuliani, Fabrizio; Giuliani, Giuliano; Bauer, Reinhard; Rabouille, Catherine

2013-01-01

Background Dorsal closure is a morphogenetic event that occurs during mid-embryogenesis in many insects including Drosophila, during which the ectoderm migrates on the extraembryonic amnioserosa to seal the embryo dorsally. The contribution of the ectoderm in this event has been known for a long time. However, amnioserosa tension and contractibility have recently been shown also to be instrumental to the closure. A critical pre-requisite for dorsal closure is integrity of these tissues that in part is mediated by cell-cell junctions and cell adhesion. In this regard, mutations impairing junction formation and/or adhesion lead to dorsal closure. However, no role for the gap junction proteins Innexins has so far been described. Results and Discussion Here, we show that Innexin 1, 2 and 3, are present in the ectoderm but also in the amnioserosa in plaques consistent with gap junctions. However, only the loss of Inx3 leads to dorsal closure defects that are completely rescued by overexpression of inx3::GFP in the whole embryo. Loss of Inx3 leads to the destabilisation of Inx1, Inx2 and DE-cadherin at the plasma membrane, suggesting that these four proteins form a complex. Accordingly, in addition to the known interaction of Inx2 with DE-cadherin, we show that Inx3 can bind to DE-cadherin. Furthermore, Inx3-GFP overexpression recruits DE-cadherin from its wildtype plasma membrane domain to typical Innexin plaques, strengthening the notion that they form a complex. Finally, we show that Inx3 stability is directly dependent on tissue tension. Taken together, we propose that Inx3 is a critical factor for dorsal closure and that it mediates the stability of Inx1, 2 and DE-cadherin by forming a complex. PMID:23894431

Fluid equations with nonlinear wave-particle resonances^

NASA Astrophysics Data System (ADS)

Mattor, Nathan

1997-11-01

We have derived fluid equations that include linear and nonlinear wave-particle resonance effects. This greatly extends previous ``Landau-fluid'' closures, which include linear Landau damping. (G.W. Hammett and F.W. Perkins, Phys. Rev. Lett. 64,) 3019 (1990).^, (Z. Chang and J. D. Callen, Phys. Fluids B 4,) 1167 (1992). The new fluid equations are derived with no approximation regarding nonlinear kinetic interaction, and so additionally include numerous nonlinear kinetic effects. The derivation starts with the electrostatic drift kinetic equation for simplicity, with a Maxwellian distribution function. Fluid closure is accomplished through a simple integration trick applied to the drift kinetic equation, using the property that the nth moment of Maxwellian distribution is related to the nth derivative. The result is a compact closure term appearing in the highest moment equation, a term which involves a plasma dispersion function of the electrostatic field and its derivatives. The new term reduces to the linear closures in appropriate limits, so both approaches retain linear Landau damping. But the nonlinearly closed equations have additional desirable properties. Unlike linear closures, the nonlinear closure retains the time-reversibility of the original kinetic equation. We have shown directly that the nonlinear closure retains at least two nonlinear resonance effects: wave-particle trapping and Compton scattering. Other nonlinear kinetic effects are currently under investigation. The new equations correct two previous discrepancies between kinetic and Landau-fluid predictions, including a propagator discrepancy (N. Mattor, Phys. Fluids B 4,) 3952 (1992). and a numerical discrepancy for the 3-mode shearless bounded slab ITG problem. (S. E. Parker et al.), Phys. Plasmas 1, 1461 (1994). ^* In collaboration with S. E. Parker, Department of Physics, University of Colorado, Boulder. ^ Work performed at LLNL under DoE contract No. W7405-ENG-48.

Relict basin closure accommodates continental convergence with minimal crustal shortening or deceleration of plate motion as inferred from detrital zircon provenance in the Caucasus

NASA Astrophysics Data System (ADS)

Cowgill, E.; Forte, A. M.; Niemi, N. A.; Avdeev, B.; Tye, A. R.; Trexler, C. C.; Javakhishvili, Z.; Elashvili, M.; Godoladze, T.

2016-12-01

Comparison of plate convergence with the timing and magnitude of upper-crustal shortening in collisional orogens indicates both shortening deficits (200-1700 km) and significant (30-40%) plate deceleration during collision, the cause(s) for which remain debated. The Greater Caucasus Mountains, which result from post-collisional Cenozoic closure of a relict Mesozoic back-arc basin on the northern margin of the Arabia-Eurasia collision zone, help reconcile these debates. Here we use U-Pb detrital zircon provenance data and the regional geology of the Caucasus to investigate the width of the now-consumed Mesozoic back-arc basin and its closure history. The provenance data record distinct southern and northern provenance domains that persisted until at least the Miocene; maximum basin width was likely 350-400 km. We propose that closure of the back-arc basin initiated at 35 Ma, coincident with initial (soft) Arabia-Eurasia collision along the Bitlis suture, eventually leading to 5 Ma (hard) collision between the Lesser Caucasus arc and the Scythian platform to form the Greater Caucasus Mountains. Final basin closure triggered deceleration of plate convergence and tectonic reorganization throughout the collision. Post-collisional subduction of such small (500-1000 km wide) relict ocean basins can account for both shortening deficits and delays in plate deceleration by accommodating convergence via subduction/underthrusting, although such shortening is easily missed if it occurs along structures hidden within flysch/slate belts. Relict-basin closure is likely typical early in continental collision at the end of a Wilson cycle due to the irregularity of colliding margins and extensive back-arc basin development during closure of long-lived ocean basins.

Priming of Early Closure: Evidence for the Lexical Boost during Sentence Comprehension

PubMed Central

Traxler, Matthew J.

2014-01-01

Two self-paced reading experiments investigated priming in sentences containing “early” vs. “late closure” ambiguities. Early closure sentences impose relatively large processing costs at the point of syntactic disambiguation (Frazier & Rayner, 1982). The current study investigated a possible way to reduce processing costs. Target sentences were temporarily ambiguous and were disambiguated towards either the preferred “late” closure analysis or the dispreferred “early” closure analysis. Each target sentence was preceded by a prime that was either structurally identical or that required a different syntactic analysis. In Experiment 1, all of the prime sentences shared the same critical verb as the target (Arai et al., 2007; Carminati et al., 2008; Tooley et al., 2009, in press; Traxler et al., in press; Weber & Indefrey, 2009). In Experiment 2, verb repetition was eliminated by reorganizing the stimuli from Experiment 1. In Experiment 1, processing of the disambiguating verb was facilitated when an “early” closure target sentence followed an “early” closure prime. In Experiment 2, there were no significant priming effects, although an overall difference in processing time favored “late closure” targets. Combined analyses verified that the pattern of results in Experiment 1 differed significantly from Experiment 2. These experiments provide the first indication that “early” closure analyses can be primed and that such priming is more robust when a critical verb appears in both the prime and the target sentence. The results add to the body of data indicating a “lexical boost” for syntactic priming effects during comprehension. They have implications for theories of syntactic representation and processing (e.g., Boland & Blodgett, 2006; Vosse & Kempen, 2009; Sag et al., 2003). PMID:25750915

Time to contact and the control of manual prehension.

PubMed

Watson, M K; Jakobson, L S

1997-11-01

In the present study, a kinematic analysis was made of unconstrained, natural prehension movements directed toward an object approaching the observer on a conveyor belt at one of three constant velocities, from one of three different directions (head-on or along the fronto-parallel plane coming either from the subject's left or right). Subjects were required to grasp the object when it reached a target located 20 cm directly in front of the hand's start position. The kinematic analysis revealed that both the transport and grasp components of the movement changed in response to the experimental manipulations, but did so in a manner that guaranteed that, for objects approaching from a given direction, hand closure would begin at a constant time prior to object contact (regardless of the object's approach speed). The kinematic analysis also revealed, however, that the onset of hand closure began earlier with objects approaching from the right than from other directions -- an effect which would not be predicted if time to contact was the key variable controlling the onset of hand closure. These results, then, lend only partial support to the theory that temporal coordination between the transport and grasp components of prehension is ensured through their common dependence on time to contact information.

Transabdominal midline reconstruction by minimally invasive surgery: technique and results.

PubMed

Costa, T N; Abdalla, R Z; Santo, M A; Tavares, R R F M; Abdalla, B M Z; Cecconello, I

2016-04-01

The introduction of the minimally invasive approach changed the way abdominal surgery was carried out. Open suture and mesh reinforcement in ventral hernia repair used to be the surgeon's choice of procedure. Although the laparoscopic approach, with defect bridging and mesh fixation, has been described since 1993, the procedure remains largely unchanged. Evidence shows that defect closure and retro-muscular mesh positioning have the best outcomes and are the best surgical practice. We therefore aimed to develop and demonstrate a procedure which combined the good results of open surgery using the Rives-Stoppa principles, particularly in terms of recurrence, with all the benefits of minimally invasive surgery. Between October 2012 and February 2014, 15 post-bariatric surgery patients underwent laparoscopic midline incisional hernia repair. The peritoneal cavity was accessed through a 5-mm optical view cannula at the superior left quadrant. A suprapubic and two right and left lower quadrant cannulas were inserted for inferior access and dissection. The defect adhesions were released. The whole midline was closed with an endoscopic linear stapler, including the defect, from the lower abdomen, 4 cm below the umbilicus, until the epigastric region, including posterior sheath mechanical suturing and cutting in the same movement. A retrorectus space was created in which a retro-muscular mesh was deployed. Fixation was done using a hernia stapler against the posterior sheath from the peritoneal cavity to the abdominal wall muscles. Selection was based on xifo-umbilical incisional midline hernias post open bariatric surgery. Pregnant women, cancer patients, or patients with clinical contraindications were excluded. The patients mean age was 51.2 years (range 39-67). Four patients were men and eleven women. Two had well-compensated fibromyalgia, four had diabetes, and five had hypertension. The mean BMI was 29.5 kg/m2 (range 23-31.6). Surgery was performed successfully in all cases through four ports; the number of incisional hernias was 3 ± 2, with a mean maximum width of 3.75 cm (range 2.1-9) and maximum length of 14 cm (7.5-20.5). The mean surgical time was 114.3 min (range 85-170), and the median hospital stay was 1.4 days. No intra-operative or immediate post-operative complication or death occurred. One patient had a seroma treated conservatively 1 week after surgery and another had a retro-muscular infection treated with percutaneous drainage. CT-Scans made before and after the procedure, showed total closure of the defect. QOL questionnaire showed satisfaction, acceptance, and no complaints. Although the study involved a small number of patients, it has proved the technique to be feasible, easy to perform, and have the combined benefits of laparoscopic and open surgery. The results, shown by CT-scan, peri-operative, and QOL findings, were good.

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...

Use of early hard palate closure using a vomer flap in cleft lip and palate patients.

PubMed

Smarius, Bram J A; Breugem, Corstiaan C

2016-08-01

The aim of the present study was to determine the influence of the vomer flap during cleft palate closure. A retrospective review was performed of all consecutive unilateral/bilateral complete cleft lip and palate (Veau III en IV) children who were treated by a simultaneous lip and hard palate closure using a vomer flap. Data were collected for sex, date of birth, syndrome, adoption, cleft palate type, type of repair, date of cleft repair, cleft width, lateral incisions, fistula and location of fistula. Ninety-one children (M = 62, F 29) were operated. Mean age at time of lip closure and vomer flap was 5.8 months (range 2.9 months to 49.2 months, SD 7.1) and the mean age at palate closure was 13.6 months (range 6.3 months to 79.9 months, SD 10.8). The mean cleft width at first assessment was 13.0 mm (range 7-22 mm) compared to 8.8 mm (range 4-15 mm) at second assessment (mean difference 4.6 mm, 95% CI 3.93-5.35, p < 0.01). One patient developed a fistula (1.1%) and required secondary surgery for closure. The vomer flap leads to a substantial decrease in cleft width, subsequently leading to a low fistula incidence (1.1%). Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Simulated spinal cerebrospinal fluid leak repair: an educational model with didactic and technical components.

PubMed

Ghobrial, George M; Anderson, Paul A; Chitale, Rohan; Campbell, Peter G; Lobel, Darlene A; Harrop, James

2013-10-01

In the era of surgical resident work hour restrictions, the traditional apprenticeship model may provide fewer hours for neurosurgical residents to hone technical skills. Spinal dura mater closure or repair is 1 skill that is infrequently encountered, and persistent cerebrospinal fluid leaks are a potential morbidity. To establish an educational curriculum to train residents in spinal dura mater closure with a novel durotomy repair model. The Congress of Neurological Surgeons has developed a simulation-based model for durotomy closure with the ongoing efforts of their simulation educational committee. The core curriculum consists of didactic training materials and a technical simulation model of dural repair for the lumbar spine. Didactic pretest scores ranged from 4/11 (36%) to 10/11 (91%). Posttest scores ranged from 8/11 (73%) to 11/11 (100%). Overall, didactic improvements were demonstrated by all participants, with a mean improvement between pre- and posttest scores of 1.17 (18.5%; P = .02). The technical component consisted of 11 durotomy closures by 6 participants, where 4 participants performed multiple durotomies. Mean time to closure of the durotomy ranged from 490 to 546 seconds in the first and second closures, respectively (P = .66), whereby the median leak rate improved from 14 to 7 (P = .34). There were also demonstrative technical improvements by all. Simulated spinal dura mater repair appears to be a potentially valuable tool in the education of neurosurgery residents. The combination of a didactic and technical assessment appears to be synergistic in terms of educational development.

Managing hospitals in turbulent times: do organizational changes improve hospital survival?

PubMed Central

Lee, S Y; Alexander, J A

1999-01-01

OBJECTIVE: To examine (1) the degree to which organizational changes affected hospital survival; (2) whether core and peripheral organizational changes affected hospital survival differently; and (3) how simultaneous organizational changes affected hospital survival. DATA SOURCES: AHA Hospital Surveys, the Area Resource File, and the AHA Hospital Guides, Part B: Multihospital Systems. STUDY DESIGN: The study employed a longitudinal panel design. We followed changes in all community hospitals in the continental United States from 1981 through 1994. The dependent variable, hospital closure, was examined as a function of multiple changes in a hospital's core and peripheral structures as well as the hospital's organizational and environmental characteristics. Cox regression models were used to test the expectations that core changes increased closure risk while peripheral changes decreased such risk, and that simultaneous core and peripheral changes would lead to higher risk of closure. PRINCIPAL FINDINGS: Results indicated more peripheral than core changes in community hospitals. Overall, findings contradicted our expectations. Change in specialty, a core change, was beneficial for hospitals, because it reduced closure risk. The two most frequent peripheral changes, downsizing and leadership change, were positively associated with closure. Simultaneous organizational changes displayed a similar pattern: multiple core changes reduced closure risk, while multiple peripheral changes increased the risk. These patterns held regardless of the level of uncertainty in hospital environments. CONCLUSIONS: Organizational changes are not all beneficial for hospitals, suggesting that hospital leaders should be both cautious and selective in their efforts to turn their hospitals around. PMID:10536977

Economic and health risk trade-offs of swim closures at a Lake Michigan beach

USGS Publications Warehouse

Rabinovici, Sharyl M.; Bernknopf, Richard L.; Wein, Anne M.; Coursey, Don L.; Whitman, Richard L.

2004-01-01

This paper presents a framework for analyzing the economic, health, and recreation implications of swim closures related to high fecal indicator bacteria (FIB) levels. The framework utilizes benefit transfer policy analysis to provide a practical procedure for estimating the effectiveness of recreational water quality policies. Evaluation criteria include the rates of intended and unintended management outcomes, whether the chosen protocols generate closures with positive net economic benefits to swimmers, and the number of predicted illnesses the policy is able to prevent. We demonstrate the framework through a case study of a Lake Michigan freshwater beach using existing water quality and visitor data from 1998 to 2001. We find that a typical closure causes a net economic loss among would-be swimmers totaling $1274-37 030/ day, depending on the value assumptions used. Unnecessary closures, caused by high indicator variability and a 24-h time delay between when samples are taken and the management decision can be made, occurred on 14 (12%) out of 118 monitored summer days. Days with high FIB levels when the swim area is open are also common but do relatively little economic harm in comparison. Also, even if the closure policy could be implemented daily and perfectly without error, only about 42% of predicted illnesses would be avoided. These conclusions were sensitive to the relative values and risk preferences that swimmers have for recreation access and avoiding health effects, suggesting a need for further study of the impacts of recreational water quality policies on individuals.

Sutureless circumcision using 2-Octyl cyanoacrylate results in more rapid and less painful procedures with excellent cosmetic satisfaction.

PubMed

Van Haute, C; Tailly, T; Klockaerts, K; Ringoir, Y

2015-06-01

Circumcision is the most common surgical procedure in male children in the world and is performed because of cultural, religious or medical reasons. Traditionally, interrupted sutures are used to close the wound, but 2-Octyl cyanoacrylate (2-OCA) tissue glue can be used as an alternative method to close the circumcision wound. To compare the use of 2-OCA with absorbable sutures in circumcision wound closure in prepubescent patients in terms of operative time, complication rate, postoperative pain and cosmetic results. We retrospectively evaluated 662 circumcision procedures using sutures and 609 procedures using 2-OCA for wound closure in prepubescent boys. All circumcision procedures were performed by 2 surgeons in a single centre. Operative time was collected from the hospital surgical software system. 62% of the patients in the suture group and 59% of the patients in the 2-OCA group presented for a postoperative check-up 6 weeks after the circumcision. Data regarding postoperative pain, need for analgesia, cosmetic satisfaction and the ease of wound care were collected through questionnaires completed by 25% of the boy's parents in the suture group and 53% of the parents in the 2-OCA group. Mean operative time was significantly shorter in the 2-OCA group (13 min) than in the suture group (17 min). Complications were comparable and mostly minor. Reintervention was only required in 3 cases. According to the parents, the degree of postoperative pain and the postoperative need for analgesics was significantly lower in the 2-OCA group. Wounds closed with 2-OCA were easier to care for. The cosmetic results after 1 day, after 1 week and after 1 month in the 2-OCA group were significantly superior than in the suture group, according to the parents' evaluation. The use of 2-OCA in circumcision wound closure has been reported before. Previous studies with mainly limited patient numbers report less pain, shorter procedure times and a higher surgeon satisfaction in terms of cosmetic results. This study is the largest study comparing the use of 2-OCA and interrupted sutures in circumcision wound closure. The retrospective character of the study, the lack of a validated questionnaire tool for the cosmetic evaluation and the use of the parent's evaluation are the limitations of this study. The use of 2-OCA in circumcision wound closure results in a shorter operative time, in less postoperative pain, in easy postoperative wound care and in excellent cosmesis when compared to interrupted absorbable sutures. 2-OCA is our current technique of choice in circumcision wound closure. Copyright © 2015 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Real-time fluoroscopic needle guidance in the interventional radiology suite using navigational software for percutaneous bone biopsies in children.

PubMed

Shellikeri, Sphoorti; Setser, Randolph M; Hwang, Tiffany J; Srinivasan, Abhay; Krishnamurthy, Ganesh; Vatsky, Seth; Girard, Erin; Zhu, Xiaowei; Keller, Marc S; Cahill, Anne Marie

2017-07-01

Navigational software provides real-time fluoroscopic needle guidance for percutaneous procedures in the Interventional Radiology (IR) suite. We describe our experience with navigational software for pediatric percutaneous bone biopsies in the IR suite and compare technical success, diagnostic accuracy, radiation dose and procedure time with that of CT-guided biopsies. Pediatric bone biopsies performed using navigational software (Syngo iGuide, Siemens Healthcare) from 2011 to 2016 were prospectively included and anatomically matched CT-guided bone biopsies from 2008 to 2016 were retrospectively reviewed with institutional review board approval. C-arm CT protocols used for navigational software-assisted cases included institution-developed low-dose (0.1/0.17 μGy/projection), regular-dose (0.36 μGy/projection), or a combination of low-dose/regular-dose protocols. Estimated effective radiation dose and procedure times were compared between software-assisted and CT-guided biopsies. Twenty-six patients (15 male; mean age: 10 years) underwent software-assisted biopsies (15 pelvic, 7 lumbar and 4 lower extremity) and 33 patients (13 male; mean age: 9 years) underwent CT-guided biopsies (22 pelvic, 7 lumbar and 4 lower extremity). Both modality biopsies resulted in a 100% technical success rate. Twenty-five of 26 (96%) software-assisted and 29/33 (88%) CT-guided biopsies were diagnostic. Overall, the effective radiation dose was significantly lower in software-assisted than CT-guided cases (3.0±3.4 vs. 6.6±7.7 mSv, P=0.02). The effective dose difference was most dramatic in software-assisted cases using low-dose C-arm CT (1.2±1.8 vs. 6.6±7.7 mSv, P=0.001) or combined low-dose/regular-dose C-arm CT (1.9±2.4 vs. 6.6±7.7 mSv, P=0.04), whereas effective dose was comparable in software-assisted cases using regular-dose C-arm CT (6.0±3.5 vs. 6.6±7.7 mSv, P=0.7). Mean procedure time was significantly lower for software-assisted cases (91±54 vs. 141±68 min, P=0.005). In our experience, navigational software technology in the IR suite is a promising alternative to CT guidance for pediatric bone biopsies providing comparable technical success and diagnostic accuracy with lower radiation dose and procedure time, in addition to providing real-time fluoroscopic needle guidance.

Diagnosing Early Ischemic Changes with the Latest-Generation Flat Detector CT: A Comparative Study with Multidetector CT.

PubMed

Maier, I L; Leyhe, J R; Tsogkas, I; Behme, D; Schregel, K; Knauth, M; Schnieder, M; Liman, J; Psychogios, M-N

2018-05-01

One-stop management of mechanical thrombectomy-eligible patients with large-vessel occlusion represents an innovative approach in acute stroke treatment. This approach reduces door-to-reperfusion times by omitting multidetector CT, using flat detector CT as pre-mechanical thrombectomy imaging. The purpose of this study was to compare the diagnostic performance of the latest-generation flat detector CT with multidetector CT. Prospectively derived data from patients with ischemic stroke with large-vessel occlusion and mechanical thrombectomy were analyzed in this monocentric study. All included patients underwent multidetector CT before referral to our comprehensive stroke center and flat detector CT in the angiography suite before mechanical thrombectomy. Diagnosis of early ischemic signs, quantified by the ASPECTS, was compared between modalities using cross tables, the Pearson correlation, and Bland-Altman plots. The predictive value of multidetector CT- and flat detector CT-derived ASPECTS for functional outcome was investigated using area under the receiver operating characteristic curve analysis. Of 25 patients, 24 (96%) had flat detector CT with sufficient diagnostic quality. Median multidetector CT and flat detector CT ASPECTSs were 7 (interquartile range, 5.5-9 and 4.25-8, respectively) with a mean period of 143.6 ± 49.5 minutes between both modalities. The overall sensitivity was 85.1% and specificity was 83.1% for flat detector CT ASPECTS compared with multidetector CT ASPECTS as the reference technique. Multidetector CT and flat detector CT ASPECTS were strongly correlated ( r = 0.849, P < .001) and moderately predicted functional outcome (area under the receiver operating characteristic curve, 0.738; P = .007 and .715; P = .069, respectively). Determination of ASPECTS on flat detector CT is feasible, showing no significant difference compared with multidetector CT ASPECTS and a similar predictive value for functional outcome. Our findings support the use of flat detector CT for emergency stroke imaging before mechanical thrombectomy to reduce door-to-groin time. © 2018 by American Journal of Neuroradiology.

Ferroelectric Fluid Flow Control Valve

NASA Technical Reports Server (NTRS)

Jalink, Antony, Jr. (Inventor); Hellbaum, Richard F. (Inventor); Rohrbach, Wayne W. (Inventor)

1999-01-01

An active valve is controlled and driven by external electrical actuation of a ferroelectric actuator to provide for improved passage of the fluid during certain time periods and to provide positive closure of the valve during other time periods. The valve provides improved passage in the direction of flow and positive closure in the direction against the flow. The actuator is a dome shaped internally prestressed ferroelectric actuator having a curvature, said dome shaped actuator having a rim and an apex. and a dome height measured from a plane through said rim said apex that varies with an electric voltage applied between an inside and an outside surface of said dome shaped actuator.

Fast parallel algorithms that compute transitive closure of a fuzzy relation

NASA Technical Reports Server (NTRS)

Kreinovich, Vladik YA.

1993-01-01

The notion of a transitive closure of a fuzzy relation is very useful for clustering in pattern recognition, for fuzzy databases, etc. The original algorithm proposed by L. Zadeh (1971) requires the computation time O(n(sup 4)), where n is the number of elements in the relation. In 1974, J. C. Dunn proposed a O(n(sup 2)) algorithm. Since we must compute n(n-1)/2 different values s(a, b) (a not equal to b) that represent the fuzzy relation, and we need at least one computational step to compute each of these values, we cannot compute all of them in less than O(n(sup 2)) steps. So, Dunn's algorithm is in this sense optimal. For small n, it is ok. However, for big n (e.g., for big databases), it is still a lot, so it would be desirable to decrease the computation time (this problem was formulated by J. Bezdek). Since this decrease cannot be done on a sequential computer, the only way to do it is to use a computer with several processors working in parallel. We show that on a parallel computer, transitive closure can be computed in time O((log(sub 2)(n))2).

Lateral thinking: 2-D interpretation of thermochronology in convergent orogenic settings

NASA Astrophysics Data System (ADS)

Batt, Geoffrey E.; Brandon, Mark T.

2002-05-01

Lateral motion of material relative to the regional thermal and kinematic frameworks is important in the interpretation of thermochronology in convergent orogens. Although cooling ages in denuded settings are commonly linked to exhumation, such data are not related to instantaneous behavior but rather to an integration of the exhumation rates experienced between the thermochronological 'closure' at depth and subsequent exposure at the surface. The short spatial wavelength variation of thermal structure and denudation rate typical of orogenic regions thus renders thermochronometers sensitive to lateral motion during exhumation. The significance of this lateral motion varies in proportion with closure temperature, which controls the depth at which isotopic closure occurs, and hence, the range of time and length scales over which such data integrate sample histories. Different chronometers thus vary in the fundamental aspects of the orogenic character to which they are sensitive. Isotopic systems with high closure temperature are more sensitive to exhumation paths and the variation in denudation and thermal structure across a region, while those of lower closure temperature constrain shorter-term behaviour and more local conditions. Discounting lateral motion through an orogenic region and interpreting cooling ages purely in terms of vertical exhumation can produce ambiguous results because variation in the cooling rate can result from either change in kinematics over time or the translation of samples through spatially varying conditions. Resolving this ambiguity requires explicit consideration of the physical and thermal framework experienced by samples during their exhumation. This can be best achieved through numerical simulations coupling kinematic deformation to thermal evolution. Such an approach allows the thermochronological implications of different kinematic scenarios to be tested, and thus provides an important means of assessing the contribution of lateral motion to orogenic evolution.

Long-term Follow-up and Outcomes in Traumatic Macular Holes.

PubMed

Miller, John B; Yonekawa, Yoshihiro; Eliott, Dean; Kim, Ivana K; Kim, Leo A; Loewenstein, John I; Sobrin, Lucia; Young, Lucy H; Mukai, Shizuo; Vavvas, Demetrios G

2015-12-01

To review presenting characteristics, clinical course, and long-term visual and anatomic outcomes of patients with traumatic macular holes at a tertiary referral center. Retrospective case series. Twenty-eight consecutive patients with traumatic macular holes at a single tertiary referral center were reviewed. In addition to visual acuities and treatments throughout the clinical course, specific dimensions of the macular hole, including diameters, height, configuration, shape, and the presence of a cuff of fluid, were examined using spectral-domain optical coherence tomography (OCT). Twenty-eight patients were identified with a mean initial visual acuity (VA) of logMAR 1.3 (20/400) and a mean follow-up of 2.2 years. Eleven holes (39.3%) closed spontaneously in median 5.7 weeks. Eleven underwent vitrectomy with a median time to intervention of 35.1 weeks. Median time to surgery for the 5 eyes with successful hole closure was 11.0 weeks vs 56.3 weeks for the 6 eyes that failed to close (P = .02). VA improved in closed holes (P < .01), whether spontaneously (P < .01) or via vitrectomy (P = .04), but VA did not improve in holes that did not close (P = .22). There was no relation between initial OCT dimensions and final hole closure status, although there was a trend, which did not reach statistical significance, toward small dimensions for those that closed spontaneously. A fairly high spontaneous closure rate was observed, with a trend toward smaller OCT dimensions. We found no relationship between hole closure and the OCT characteristics of the hole. Surgical intervention was less successful at hole closure when elected after 3 months. Copyright © 2015 Elsevier Inc. All rights reserved.

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

Does Size Matter? Atmospheric CO2 May Be a Stronger Driver of Stomatal Closing Rate Than Stomatal Size in Taxa That Diversified under Low CO2.

PubMed

Elliott-Kingston, Caroline; Haworth, Matthew; Yearsley, Jon M; Batke, Sven P; Lawson, Tracy; McElwain, Jennifer C

2016-01-01

One strategy for plants to optimize stomatal function is to open and close their stomata quickly in response to environmental signals. It is generally assumed that small stomata can alter aperture faster than large stomata. We tested the hypothesis that species with small stomata close faster than species with larger stomata in response to darkness by comparing rate of stomatal closure across an evolutionary range of species including ferns, cycads, conifers, and angiosperms under controlled ambient conditions (380 ppm CO2; 20.9% O2). The two species with fastest half-closure time and the two species with slowest half-closure time had large stomata while the remaining three species had small stomata, implying that closing rate was not correlated with stomatal size in these species. Neither was response time correlated with stomatal density, phylogeny, functional group, or life strategy. Our results suggest that past atmospheric CO2 concentration during time of taxa diversification may influence stomatal response time. We show that species which last diversified under low or declining atmospheric CO2 concentration close stomata faster than species that last diversified in a high CO2 world. Low atmospheric [CO2] during taxa diversification may have placed a selection pressure on plants to accelerate stomatal closing to maintain adequate internal CO2 and optimize water use efficiency.

Does Size Matter? Atmospheric CO2 May Be a Stronger Driver of Stomatal Closing Rate Than Stomatal Size in Taxa That Diversified under Low CO2

PubMed Central

Elliott-Kingston, Caroline; Haworth, Matthew; Yearsley, Jon M.; Batke, Sven P.; Lawson, Tracy; McElwain, Jennifer C.

2016-01-01

One strategy for plants to optimize stomatal function is to open and close their stomata quickly in response to environmental signals. It is generally assumed that small stomata can alter aperture faster than large stomata. We tested the hypothesis that species with small stomata close faster than species with larger stomata in response to darkness by comparing rate of stomatal closure across an evolutionary range of species including ferns, cycads, conifers, and angiosperms under controlled ambient conditions (380 ppm CO2; 20.9% O2). The two species with fastest half-closure time and the two species with slowest half-closure time had large stomata while the remaining three species had small stomata, implying that closing rate was not correlated with stomatal size in these species. Neither was response time correlated with stomatal density, phylogeny, functional group, or life strategy. Our results suggest that past atmospheric CO2 concentration during time of taxa diversification may influence stomatal response time. We show that species which last diversified under low or declining atmospheric CO2 concentration close stomata faster than species that last diversified in a high CO2 world. Low atmospheric [CO2] during taxa diversification may have placed a selection pressure on plants to accelerate stomatal closing to maintain adequate internal CO2 and optimize water use efficiency. PMID:27605929

Calcitonin impairs the anabolic effect of PTH in young rats and stimulates expression of sclerostin by osteocytes.

PubMed

Gooi, J H; Pompolo, S; Karsdal, M A; Kulkarni, N H; Kalajzic, I; McAhren, S H M; Han, B; Onyia, J E; Ho, P W M; Gillespie, M T; Walsh, N C; Chia, L Y; Quinn, J M W; Martin, T J; Sims, N A

2010-06-01

The therapeutic goal of increasing bone mass by co-treatment of parathyroid hormone (PTH) and an osteoclast inhibitor has been complicated by the undefined contribution of osteoclasts to the anabolic activity of PTH. To determine whether active osteoclasts are required at the time of PTH administration, we administered a low dose of the transient osteoclast inhibitor salmon calcitonin (sCT) to young rats receiving an anabolic PTH regimen. Co-administration of sCT significantly blunted the anabolic effect of PTH as measured by peripheral quantitative computer tomography (pQCT) and histomorphometry in the femur and tibia, respectively. To determine gene targets of sCT, we carried out quantitative real time PCR and microarray analysis of metaphyseal samples 1.5, 4 and 6.5h after administration of a single injection of PTH, sCT or PTH+sCT. Known targets of PTH action, IL-6, ephrinB2 and RANKL, were not modified by co-administration with sCT. Surprisingly, at all time points, we noted a significant upregulation of sclerostin mRNA by sCT treatment, as well as down-regulation of two other osteocyte gene products, MEPE and DMP1. Immunohistochemistry confirmed that sCT administration increased the percentage of osteocytes expressing sclerostin, suggesting a mechanism by which sCT reduced the anabolic effect of PTH. Neither mRNA for CT receptor (Calcr) nor labeled CT binding could be detected in sclerostin-enriched cells differentiated from primary calvarial osteoblasts. In contrast, osteocytes freshly isolated from calvariae expressed a high level of Calcr mRNA. Furthermore immunohistochemistry revealed co-localization of CT receptor (CTR) and sclerostin in some osteocytes in calvarial sections. Taken together these data indicate that co-treatment with sCT can blunt the anabolic effect of PTH and this may involve direct stimulation of sclerostin production by osteocytes. These data directly implicate calcitonin as a negative regulator of bone formation through a previously unsuspected mechanism. Copyright 2010 Elsevier Inc. All rights reserved.

40 CFR 264.146 - Use of a mechanism for financial assurance of both closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... assurance of both closure and post-closure care. 264.146 Section 264.146 Protection of Environment... mechanism for financial assurance of both closure and post-closure care. An owner or operator may satisfy the requirements for financial assurance for both closure and post-closure care for one or more...

What is Computed Tomography?

MedlinePlus

... CT Imaging System back to top Advances in Technology and Clinical Practice Today most CT systems are ... in relatively less time. Another advancement in the technology is electron beam CT, also known as EBCT. ...

Evaluation of the Diagnostic Accuracy of Conventional 2-Dimensional and 3-Dimensional Computed Tomography for Assessing Canine Sacral and Pelvic Fractures by Radiologists, Orthopedic Surgeons, and Veterinary Medical Students.

PubMed

Stieger-Vanegas, Susanne M; Senthirajah, Sri Kumar Jamie; Nemanic, Sarah; Baltzer, Wendy; Warnock, Jennifer; Hollars, Katelyn; Lee, Scott S; Bobe, Gerd

2015-08-01

To determine, using 3 groups of evaluators of varying experience reading orthopedic CT studies, if 3-dimensional computed tomography (3D-CT) provides a more accurate and time efficient method for diagnosis of canine sacral and pelvic fractures, and displacements of the sacroiliac and coxofemoral joints compared with 2-dimensional computed tomography (2D-CT). Retrospective clinical and prospective study. Dogs (n = 23): 12 dogs with traumatic pelvic fractures, 11 canine cadavers with pelvic trauma induced by a lateral impactor. All dogs had a 2D-CT exam of the pelvis and subsequent 3D-CT reconstructions from the 2D-CT images. Both 2D-CT and 3D-CT studies were anonymized and randomly presented to 2 veterinary radiologists, 2 veterinary orthopedic surgeons, and 2 veterinary medical students. Evaluators classified fractures using a confidence scale and recorded the duration of evaluation for each modality and case. 3D-CT was a more time-efficient technique for evaluation of traumatic sacral and pelvic injuries compared with 2D-CT in all evaluator groups irrespective of experience level reading orthopedic CT studies. However, for radiologists and surgeons, 2D-CT was the more accurate technique for evaluating sacral and pelvic fractures. 3D-CT improves sacral and pelvic fracture diagnosis when added to 2D-CT; however, 3D-CT has a reduced accuracy for evaluation of sacral and pelvic fractures if used without concurrent evaluation of 2D-CT images. © Copyright 2014 by The American College of Veterinary Surgeons.

Base Closure: A Road Map for Completion

DTIC Science & Technology

1991-03-22

leadership . At the same time, he should issue written press releases. Selected senior leaders from the base should be briefed separately from key community...they will hold with other agencies on base. These matters should be the commander’s call; they will reflect his style of leadership and preference for...base closure. He alone must foresee what can most likely go wrong as well as what should go right in this arduous process. DCNSIZING AN ORGANIZATIN The

BRAC, What Will it Cost

DTIC Science & Technology

1992-04-10

Devens - Fort Huachuca FY 91 FY 95 Fort McClellan FY 92 FY 96 Fort Chaffee FY 92 FY 97 Cameron Station FY 91 FY 95 53 Stand Alone Housing Sites FY 90 FY...Army, Headquarters Forces Command, &as Realianment and Closure Implementation Plan - Fort Devens Closure Package, Implementation Plan, Fort McPherson, GA...Classification) RAC , What Will It Cost? 12. PERSONAL AUTHOR(S) TLIN, Robert B. LTC, USA 13. TYPE OF REPORT 13b. TIME COVERED 14. DATE OF REPORT (Year

Wound Closure and Outcome in Extensively Burned Patients Treated with Cultured Autologous Keratinocytes,

DTIC Science & Technology

1993-05-01

long-term joint consequently has exerted no demonstrable effect on the contractures could be expected. Was any increase noted in this outcome of...ELECTE . , AD-A268 707 THE JOURNAL or TRAUMA so AU 3 019934 N Copyright 1993 by Wils & Printed in U.S.A. WOUND CLOSLRE AND OUTCOME IN EXTENSIVELY...Ultimate patient outcome remains dependent upon ocytes has prompted many investigators to assess the early, timely closure of the burn wound, typically

Treatment Strategies in 135 Consecutive Patients with Enterocutaneous Fistulas

PubMed Central

Visschers, Ruben G. J.; Damink, Steven W. M. Olde; Winkens, Bjorn; Soeters, Peter B.

2008-01-01

Background Enterocutaneous fistulas (ECF) pose a major challenge to every gastrointestinal (GI) surgeon. Based on earlier studies, a standardized treatment guideline was implemented. The focus of the present study was to assess that guideline and determine prognostic factors for outcome of patients with ECF, and to define a more detailed therapeutic approach including the convalescence time before restorative surgery. Methods All patients with ECF treated between 1990 and 2005 were included. Management consisted of controlling Sepsis, Optimization of nutritional state, Wound care, assessment of fistula Anatomy, Timing of surgery, and Surgical strategy (the SOWATS guideline). Prognostic factors were assessed by way of multiple logistic regression analysis. Results A total of 135 patients were treated at our unit. Overall closure was achieved in 118 patients (87.4%). Restorative operations for fistula closure were performed after a median of 53 days (range: 4–270 days). Restorative operations were successful in 97/107 patients (90.7%). Thirteen patients (9.6%) died. An abdominal wall defect was the most predominant negative prognostic factor for spontaneous closure (odds ratio [OR] = 0.195, confidence interval [CI] 0.052–0.726, p = 0.015). A strong relation was found between preoperative albumin level and surgical closure (p < 0.001) and mortality (p < 0.001). Conclusions Application of the SOWATS guideline allowed a favorable outcome after a short convalescence period. Abdominal wall defects and preoperative hypoalbuminemia are important prognostic variables. PMID:18175171

Treatment strategies in 135 consecutive patients with enterocutaneous fistulas.

PubMed

Visschers, Ruben G J; Olde Damink, Steven W M; Winkens, Bjorn; Soeters, Peter B; van Gemert, Wim G

2008-03-01

Enterocutaneous fistulas (ECF) pose a major challenge to every gastrointestinal (GI) surgeon. Based on earlier studies, a standardized treatment guideline was implemented. The focus of the present study was to assess that guideline and determine prognostic factors for outcome of patients with ECF, and to define a more detailed therapeutic approach including the convalescence time before restorative surgery. All patients with ECF treated between 1990 and 2005 were included. Management consisted of controlling Sepsis, Optimization of nutritional state, Wound care, assessment of fistula Anatomy, Timing of surgery, and Surgical strategy (the SOWATS guideline). Prognostic factors were assessed by way of multiple logistic regression analysis. A total of 135 patients were treated at our unit. Overall closure was achieved in 118 patients (87.4%). Restorative operations for fistula closure were performed after a median of 53 days (range: 4-270 days). Restorative operations were successful in 97/107 patients (90.7%). Thirteen patients (9.6%) died. An abdominal wall defect was the most predominant negative prognostic factor for spontaneous closure (odds ratio [OR]=0.195, confidence interval [CI] 0.052-0.726, p=0.015). A strong relation was found between preoperative albumin level and surgical closure (p<0.001) and mortality (p<0.001). Application of the SOWATS guideline allowed a favorable outcome after a short convalescence period. Abdominal wall defects and preoperative hypoalbuminemia are important prognostic variables.

Closed-chest transthoracic magnetic resonance imaging-guided ventricular septal defect closure in swine.

PubMed

Ratnayaka, Kanishka; Saikus, Christina E; Faranesh, Anthony Z; Bell, Jamie A; Barbash, Israel M; Kocaturk, Ozgur; Reyes, Christine A; Sonmez, Merdim; Schenke, William H; Wright, Victor J; Hansen, Michael S; Slack, Michael C; Lederman, Robert J

2011-12-01

The aim of this study was to close ventricular septal defects (VSDs) directly through the chest wall using magnetic resonance imaging (MRI) guidance, without cardiopulmonary bypass, sternotomy, or radiation exposure. Surgical, percutaneous, and hybrid management of VSD each have limitations and known morbidity. Percutaneous muscular VSDs were created in 10 naive Yorkshire swine using a transjugular laser catheter. Under real-time MRI guidance, a direct transthoracic vascular access sheath was introduced through the chest into the heart along a trajectory suitable for VSD access and closure. Through this transthoracic sheath, muscular VSDs were occluded using a commercial nitinol device. Finally, the right ventricular free wall was closed using a commercial collagen plug intended for arterial closure. Anterior, posterior, and mid-muscular VSDs (6.8 ± 1.8 mm) were created. VSDs were closed successfully in all animals. The transthoracic access sheath was displaced in 2, both fatal. Thereafter, we tested an intracameral retention sheath to prevent this complication. Right ventricular access ports were closed successfully in all, and after as many as 30 days, healed successfully. Real-time MRI guidance allowed closed-chest transthoracic perventricular muscular VSD closure in a clinically meaningful animal model. Once applied to patients, this approach may avoid traditional surgical, percutaneous, or open-chest transcatheter ("hybrid") risks. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Closed-Chest Transthoracic Magnetic Resonance Imaging-Guided Ventricular Septal Defect Closure in Swine

PubMed Central

Ratnayaka, Kanishka; Saikus, Christina E.; Faranesh, Anthony Z.; Bell, Jamie A.; Barbash, Israel M.; Kocaturk, Ozgur; Reyes, Christine A.; Sonmez, Merdim; Schenke, William H.; Wright, Victor J.; Hansen, Michael S.; Slack, Michael C.; Lederman, Robert J.

2012-01-01

Objectives The aim of this study was to close ventricular septal defects (VSDs) directly through the chest wall using magnetic resonance imaging (MRI) guidance, without cardiopulmonary bypass, sternotomy, or radiation exposure. Background Surgical, percutaneous, and hybrid management of VSD each have limitations and known morbidity. Methods Percutaneous muscular VSDs were created in 10 naive Yorkshire swine using a transjugular laser catheter. Under real-time MRI guidance, a direct transthoracic vascular access sheath was introduced through the chest into the heart along a trajectory suitable for VSD access and closure. Through this transthoracic sheath, muscular VSDs were occluded using a commercial nitinol device. Finally, the right ventricular free wall was closed using a commercial collagen plug intended for arterial closure. Results Anterior, posterior, and mid-muscular VSDs (6.8 ± 1.8 mm) were created. VSDs were closed successfully in all animals. The transthoracic access sheath was displaced in 2, both fatal. Thereafter, we tested an intracameral retention sheath to prevent this complication. Right ventricular access ports were closed successfully in all, and after as many as 30 days, healed successfully. Conclusions Real-time MRI guidance allowed closed-chest transthoracic perventricular muscular VSD closure in a clinically meaningful animal model. Once applied to patients, this approach may avoid traditional surgical, percutaneous, or open-chest transcatheter (“hybrid”) risks. PMID:22192373

Closure of skin incision by dual wavelength (980 and 1064 nm) laser application.

PubMed

Uba, Abdullahi Ibrahim; Tabakoglu, Haşim Ozgur; Abdullahi, Umar Aliyu; Sani, Musbahu Muhammad

2017-04-01

Thermal effect of dual wavelength (980 and 1064 nm) laser application in skin incision closure was assessed on 18 male and female Wister rats. 1-cm-long incisions were made on the shaved dorsal region of 220-250 g animals. The incisions were closed by laser irradiation at 1 W and exposure time, 5 seconds in continuous-wave mode (CW) and 1 W and exposure time, 10 seconds in pulsed mode to deliver total energies of 5 J and 10 J per spot onto the incisions, respectively. Animals from each group were sacrificed at 0th, 4th, and 7th days and the skin samples of the weld area were excised for histological analysis using Hematoxylin and Eosin (H & E) stain. Mean thermally altered area (TAA) of CW-mode laser-treated groups was found to increase significantly (p < 0.05) compared with pulsed mode laser treated group at 0th and 4th days post-irradiation while no significant difference (p > 0.05) was statistically found at 7th day post-irradiation. Moreover, tighter closure was observed with CW group at 7th day post-irradiation. We thus conclude that 1 W, 5 J for 5 seconds CW mode laser application of 980 and 1064 nm combined beam form in skin incision closure was found to have absolute wound healing capability with minimal thermal alteration.

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.

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

Laser tissue melding: use of 1.32-μm computerized Nd:YAG laser, results of leak/burst strength studies in microsurgical procedures

NASA Astrophysics Data System (ADS)

Anderson, Dallas W.; Hsu, Tung M.; Halpern, Steven J.; Honaker, Arnold

1993-07-01

The ProClosureTM System (PCS) consists of a low power 1.32micrometers Nd:YAG laser coupled to a handheld disposable fiber optic device. The system has been designed to perform a wide range of tissue welding applications such as cosmetic skin closure,vascular surgery, and minimally invasive surgical procedures normally performed with sutures and staples. Utilizing a wavelength for tissue fusion that is least distracted by medium in the surgical field coupled with a computerized delivery system allows for a more precise application (+/- 5%) of laser energy to the tissue. The study design involved the micro-surgical anastomosis of twenty Sprague-Dawley rats (vas deferens) and twenty-one Sprague-Dawley rats (femoral arteries). Each rat is its own contralateral control. Laser repair time is approximately one-third that of conventional suturing. Postoperative dissection and burst strength testing was conducted at day 0, 1, 7, and 14. At each postoperative interval, the mean leak/burst strength for laser-assisted closure v. control, was markedly higher. The precise application of energy fluence resulting from ProClosure's computerized system yields an initial strength and a fluid static seal that is superior to conventional suture closure.

40 CFR 265.146 - Use of a mechanism for financial assurance of both closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... assurance of both closure and post-closure care. 265.146 Section 265.146 Protection of Environment... Use of a mechanism for financial assurance of both closure and post-closure care. An owner or operator may satisfy the requirements for financial assurance for both closure and post-closure care for one or...

Validation study of an interpolation method for calculating whole lung volumes and masses from reduced numbers of CT-images in ponies.

PubMed

Reich, H; Moens, Y; Braun, C; Kneissl, S; Noreikat, K; Reske, A

2014-12-01

Quantitative computer tomographic analysis (qCTA) is an accurate but time intensive method used to quantify volume, mass and aeration of the lungs. The aim of this study was to validate a time efficient interpolation technique for application of qCTA in ponies. Forty-one thoracic computer tomographic (CT) scans obtained from eight anaesthetised ponies positioned in dorsal recumbency were included. Total lung volume and mass and their distribution into four compartments (non-aerated, poorly aerated, normally aerated and hyperaerated; defined based on the attenuation in Hounsfield Units) were determined for the entire lung from all 5 mm thick CT-images, 59 (55-66) per animal. An interpolation technique validated for use in humans was then applied to calculate qCTA results for lung volumes and masses from only 10, 12, and 14 selected CT-images per scan. The time required for both procedures was recorded. Results were compared statistically using the Bland-Altman approach. The bias ± 2 SD for total lung volume calculated from interpolation of 10, 12, and 14 CT-images was -1.2 ± 5.8%, 0.1 ± 3.5%, and 0.0 ± 2.5%, respectively. The corresponding results for total lung mass were -1.1 ± 5.9%, 0.0 ± 3.5%, and 0.0 ± 3.0%. The average time for analysis of one thoracic CT-scan using the interpolation method was 1.5-2 h compared to 8 h for analysis of all images of one complete thoracic CT-scan. The calculation of pulmonary qCTA data by interpolation from 12 CT-images was applicable for equine lung CT-scans and reduced the time required for analysis by 75%. Copyright © 2014 Elsevier Ltd. All rights reserved.

Automatic radiation dose monitoring for CT of trauma patients with different protocols: feasibility and accuracy.

PubMed

Higashigaito, K; Becker, A S; Sprengel, K; Simmen, H-P; Wanner, G; Alkadhi, H

2016-09-01

To demonstrate the feasibility and accuracy of automatic radiation dose monitoring software for computed tomography (CT) of trauma patients in a clinical setting over time, and to evaluate the potential of radiation dose reduction using iterative reconstruction (IR). In a time period of 18 months, data from 378 consecutive thoraco-abdominal CT examinations of trauma patients were extracted using automatic radiation dose monitoring software, and patients were split into three cohorts: cohort 1, 64-section CT with filtered back projection, 200 mAs tube current-time product; cohort 2, 128-section CT with IR and identical imaging protocol; cohort 3, 128-section CT with IR, 150 mAs tube current-time product. Radiation dose parameters from the software were compared with the individual patient protocols. Image noise was measured and image quality was semi-quantitatively determined. Automatic extraction of radiation dose metrics was feasible and accurate in all (100%) patients. All CT examinations were of diagnostic quality. There were no differences between cohorts 1 and 2 regarding volume CT dose index (CTDIvol; p=0.62), dose-length product (DLP), and effective dose (ED, both p=0.95), while noise was significantly lower (chest and abdomen, both -38%, p<0.017). Compared to cohort 1, CTDIvol, DLP, and ED in cohort 3 were significantly lower (all -25%, p<0.017), similar to the noise in the chest (-32%) and abdomen (-27%, both p<0.017). Compared to cohort 2, CTDIvol (-28%), DLP, and ED (both -26%) in cohort 3 was significantly lower (all, p<0.017), while noise in the chest (+9%) and abdomen (+18%) was significantly higher (all, p<0.017). Automatic radiation dose monitoring software is feasible and accurate, and can be implemented in a clinical setting for evaluating the effects of lowering radiation doses of CT protocols over time. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Giant pseudomeningocele causing urinary obstruction in a patient with Marfan syndrome.

PubMed

Stone, Jeremy G; Bergmann, Liisa L; Takamori, Ryan; Donovan, Daniel J

2015-07-01

Defective collagen biosynthesis in Marfan syndrome predisposes to dural defects such as dural ectasia, meningocele, and pseudomeningocele; thus, an increased index of suspicion for these conditions should be present in the clinical setting of Marfan syndrome. The authors describe a young woman with Marfan syndrome who was being treated with anticoagulants for a prosthetic heart valve and who presented with a spontaneous retroperitoneal hemorrhage requiring surgical evacuation. No CSF leak was encountered at surgery, but she developed progressively more severe positional headaches over the following year. She then experienced the sudden onset of acute urinary obstruction, at which time CT revealed a 17 × 15 × 13-cm presacral pseudomeningocele communicating with the thecal sac through a sacral bone defect. An anterior surgical approach was used for drainage of the pseudomeningocele as well as for primary closure of the dural defect with a bovine pericardial patch and autologous subcutaneous fat graft. After a short period of lumbar subarachnoid drainage of the CSF, the patient was able to resume normal activity without recurrent symptoms. To the authors' knowledge, such a pseudomeningocele in a patient with Marfan syndrome has been reported only twice, and this case features the largest pseudomeningocele to date. They also review the pertinent literature regarding presentation, diagnosis, and management of these lesions.

[Injuries to the duodenum and pancreas in 42 operated cases].

PubMed

Kiss, L; Remescu, A

2001-01-01

42 consecutive patients who sustained injuries to the duodenum or/and pancreas were admitted to our hospital. Over a twenty year period 32 blunt injuries and 10 penetrating injuries were encountered. Penetrating injuries were always suspected and treated by time: following blunt injury diagnostic delay was encountered in 14 patients and insufficient surgical procedure because of intra-operative misinterpretation in 2 patients. Most of the patients had associated intra-abdominal organ injuries. Adjusts to diagnosis such as abdominal roentgenograms, serum amylase levels and gastroduodenography was not helpful. CT scan and ultrasound allowed to confirm the suspected diagnosis in 3 cases only. Intraoperative diagnosis was also challenging. Complete mobilization of the strictures surrounding the duodenum and the pancreas to provide entire exposure was necessary in 12 patients treated first in a peripheral hospital, diagnosis of the injury have been missed at first laparotomy and reoperation was necessary in all of them. Suture closure of the duodenum and drainage of the pancreatic region wee the most common reparative techniques used. More complicated procedures with pancreatic and/or duodenal resection were performed in 12 patients. Overall mortality in patients surviving more than 24 hours was 14%. Suture live dehiscence after delayed operation (4) and 2 deaths due to brain injury.

Barbed suture material technique for wound closure and concomitant tube placement in uniportal VATS for pneumothorax

PubMed Central

2017-01-01

Background Uniportal video-assisted thoracoscopic surgery (VATS) is an alternative modality for treatment of primary spontaneous pneumothorax (PSP) with its less invasiveness and acceptable surgical outcomes. However, a few reports have been introduced for wound management to achieve better cosmetic wound healing and for placement of the chest tube in uniportal VATS. Thus, we aimed to evaluate the feasibility of our novel method for wound closure and concomitant tube placement using continuous barbed suture material in uniportal VATS for PSP. Methods Between July 2012 and December 2015, consecutive 31 patients (22 males) underwent uniportal VATS to treat PSP. Bilateral approaches were performed in four patients, thus total 35 cases were enrolled. We divided them into two groups with one group of 17 (48.5%) cases (group A), using barbed absorbable wound closure device for knotless continuous wound closure and subsequent chest tube anchoring, and the other group of 18 (51.4%) cases (group B), using conventional suture anchoring after skin closure using absorbable suture device. Postoperative surgical outcomes were compared to assess the feasibility of this technique. Results Demographic data demonstrate no significant difference in both groups. There was no significant difference in length of hospital stay (3.7±1.2 vs. 4.1±1.2 days, P=0.267) and in median chest tube indwelling time (2.4±0.9 vs. 3.1±1.2 days, P=0.066), respectively. Operation time in group A was shorter than in group B but there was no significant difference (41.7±11.8 vs. 45.6±16.0 minutes, P=0.415). There was neither conversion to two or three port VATS in all cases. In group A, all chest tubes were removed with concomitant sealing the tube removal site by pulling the thread. Residual knots do not exist that stitch out procedure is not required. There was no wound complication in both groups during the median follow-up period of 18 months. Conclusions Knotless, barbed suture material technique for continuous wound closure with concomitant chest tube placement achieved equivocal outcomes in comparison to the conventional suture anchoring method. We suggest this simple technique for wound closure and easy tube removal with cosmetic wound healing in uniportal VATS for PSP. PMID:28616277

Tissue adhesives for closure of surgical incisions.

PubMed

Dumville, Jo C; Coulthard, Paul; Worthington, Helen V; Riley, Philip; Patel, Neil; Darcey, James; Esposito, Marco; van der Elst, Maarten; van Waes, Oscar J F

2014-11-28

Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of an absence of risk of needlestick injury and no requirement to remove sutures later. Initially, tissue adhesives were used primarily in emergency room settings, but this review looks at the use of tissue adhesives in the operating room/theatre where surgeons are using them increasingly for the closure of surgical skin incisions. To determine the effects of various tissue adhesives compared with conventional skin closure techniques for the closure of surgical wounds. In March 2014 for this second update we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We did not restrict the search and study selection with respect to language, date of publication or study setting. Only randomised controlled trials were eligible for inclusion. We conducted screening of eligible studies, data extraction and risk of bias assessment independently and in duplicate. We expressed results as random-effects models using mean difference for continuous outcomes and risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes. We investigated heterogeneity, including both clinical and methodological factors. This second update of the review identified 19 additional eligible trials resulting in a total of 33 studies (2793 participants) that met the inclusion criteria. There was low quality evidence that sutures were significantly better than tissue adhesives for reducing the risk of wound breakdown (dehiscence; RR 3.35; 95% CI 1.53 to 7.33; 10 trials, 736 participants that contributed data to the meta-analysis). The number needed to treat for an additional harmful outcome was calculated as 43. For all other outcomes - infection, patient and operator satisfaction and cost - there was no evidence of a difference for either sutures or tissue adhesives. No evidence of differences was found between tissue adhesives and tapes for minimising dehiscence, infection, patients' assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However there was evidence in favour of using tape for surgeons' assessment of cosmetic appearance (mean difference (VAS 0 to 100) 9.56 (95% CI 4.74 to 14.37; 2 trials, 139 participants). One trial compared tissue adhesives with a variety of methods of wound closure and found both patients and clinicians were significantly more satisfied with the alternative closure methods than the adhesives. There appeared to be little difference in outcome for different types of tissue adhesives. One study that compared high viscosity with low viscosity adhesives found that high viscosity adhesives were less time-consuming to use than low viscosity tissue adhesives, but the time difference was small. Sutures are significantly better than tissue adhesives for minimising dehiscence. In some cases tissue adhesives may be quicker to apply than sutures. Although surgeons may consider the use of tissue adhesives as an alternative to other methods of surgical site closure in the operating theatre, they need to be aware that sutures minimise dehiscence. There is a need for more well designed randomised controlled trials comparing tissue adhesives with alternative methods of closure. These trials should include people whose health may interfere with wound healing and surgical sites of high tension.

SU-E-J-187: Individually Optimized Contrast-Enhancement 4D-CT for Pancreatic Adenocarcinoma in Radiotherapy Simulation

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

Xue, M; Patel, K; Regine, W

2014-06-01

Purpose: To study the feasibility of individually optimized contrastenhancement (CE) 4D-CT for pancreatic adenocarcinoma (PDA) in radiotherapy simulation. To evaluate the image quality and contrast enhancement of tumor in the CE 4D-CT, compared to the clinical standard of CE 3D-CT and 4D-CT. Methods: In this IRB-approved study, each of the 7 PDA patients enrolled underwent 3 CT scans: a free-breathing 3D-CT with contrast (CE 3D-CT) followed by a 4D-CT without contrast (4D-CT) in the first study session, and a 4D-CT with individually synchronized contrast injection (CE 4D-CT) in the second study session. In CE 4D-CT, the time of full contrastmore » injection was determined based on the time of peak enhancement for the test injection, injection rate, table speed, and longitudinal location and span of the pancreatic region. Physicians contoured both the tumor (T) and the normal pancreatic parenchyma (P) on the three CTs (end-of-exhalation for 4D-CT). The contrast between the tumor and normal pancreatic tissue was computed as the difference of the mean enhancement level of three 1 cm3 regions of interests in T and P, respectively. Wilcoxon rank sum test was used to statistically compare the scores and contrasts. Results: In qualitative evaluations, both CE 3D-CT and CE 4D-CT scored significantly better than 4D-CT (4.0 and 3.6 vs. 2.6). There was no significant difference between CE 3D-CT and CE 4D-CT. In quantitative evaluations, the contrasts between the tumor and the normal pancreatic parenchyma were 0.6±23.4, −2.1±8.0, and −19.6±28.8 HU, in CE 3D-CT, 4D-CT, and CE 4D-CT, respectively. Although not statistically significant, CE 4D-CT achieved better contrast enhancement between the tumor and the normal pancreatic parenchyma than both CE 3D-CT and 4DCT. Conclusion: CE 4D-CT achieved equivalent image quality and better contrast enhancement between tumor and normal pancreatic parenchyma than the clinical standard of CE 3D-CT and 4D-CT. This study was supported in part by Philips Healthcare.« less

Silver-coated nylon dressing plus active DC microcurrent for healing of autogenous skin donor sites.

PubMed

Malin, Edward W; Galin, Chaya M; Lairet, Kimberley F; Huzar, Todd F; Williams, James F; Renz, Evan M; Wolf, Steven E; Cancio, Leopoldo C

2013-11-01

Burn wounds are a significant cause of morbidity and mortality, and improved outcomes are demonstrated with early closure of both primary burn wounds and skin donor sites. Thus, technology that decreases the healing time of burns and donor sites would be potentially lifesaving. We present the results of a single-center, prospective, double-blinded, randomized controlled trial to evaluate the efficacy of silver-coated dressing with active microcurrent in comparison to silver-coated dressing with sham microcurrent on wound-closure time for autogenous skin donor sites. Four hundred five patients were screened for treatment of their donor sites using a silver-coated nylon dressing with either sham or active microcurrent stimulation. Thirty patients were enrolled in the study and then randomized. Of these, 5 patients were removed from analysis due to protocol deviations. Differences in time-to-closure were analyzed using Kaplan-Meier analysis and the proportional hazard regression model. Subjective verbal pain rating scores (0-10; 0, no pain; 10, worst pain) were also recorded. All devices were blinded and programmed at an outside facility, so that every patient had either an active or sham device. The study was unblinded only after the final patient's donor site had healed. All patients achieved donor-site healing before postoperative day 20. The 14 patients in the active microcurrent group [mean, 10.8 (2.9) days; range, 7-15 days] experienced no difference in time to wound healing as compared to the remaining patients in the sham microcurrent group [mean, 11.1 (2.0) days; range, 8-14 days; P = 0.75]. There were no differences in pain from one group compared to the other. None of the donor sites exhibited clinical signs of infection. In a sample size of 25 burn patients, the addition of direct microcurrent to silver-nylon dressings did not decrease time to wound closure of skin donor sites, and it did not show a difference in reported pain levels.

Post-traumatic pseudoaneurysm of the common hepatic artery with duodenal fistula

PubMed Central

Matsumoto, Cal; Wayne, Michael; Schwartz, Myron E

2002-01-01

Background Post-traumatic pseudoaneurysm of the hepatic artery is rare, especially after blunt abdominal trauma; an even more rare occurrence is enteric fistulisation. Case outline A 29-year-old man was admitted with an acute episode of upper gastrointestinal bleeding three months after blunt abdominal trauma and was found to have an hepatic artery pseudoaneurysm with duodenal fistula. Surgical treatment was by ligature of the artery and duodenal closure with omental patch. Discussion There is one previous case report of hepatic artery pseudoaneurysm as a delayed complication of blunt abdominal trauma. The presence of a haematoma in the hepatoduodenal ligament after blunt trauma should raise the suspicion of hepatic artery injury, and surgical exploration may prevent the subsequent development of pseudoaneurysm. CT scan has become an important instrument both in diagnosis and in surgical planning. PMID:18332952

Ex vivo evaluation of 4 different viscoelastic assays for detecting moderate to severe coagulopathy during liver transplantation.

PubMed

Abuelkasem, Ezeldeen; Mazzeffi, Michael A; Lu, Shu Yang; Planinsic, Raymond M; Sakai, Tetsuro; Tanaka, Kenichi A

2016-04-01

Prolonged prothrombin time (PT) and its ratio are routinely used for the assessment of candidates for liver transplantation (LT), but intraoperative coagulation management of transfusion is hindered by its long turnaround time. Abnormal reaction time (R time) on thromboelastography (TEG) or clotting time (CT) of rotational thromboelastometry (ROTEM) are presumably an alternative, but there is a paucity of clinical data on abnormal R time/CT values compared to PT during LT. After receiving institutional review board approval and informed consent, we obtained blood samples from 36 LT patients for international normalized ratio (INR), factor (F) X level, and viscoelastic tests (EXTEM/INTEM and kaolin/rapid TEG) at baseline and 30 minutes after graft reperfusion. Receiver operating characteristic (ROC) curves were calculated for INR > 1.5 and viscoelastic R time/CT thresholds to assess the ability to diagnose FX deficiency at the moderate (<50%) or severe (<35%) level. The FX deficiency data were calculated using cutoff values of INR (>1.5) and abnormal R time/CT for TEG and ROTEM. Tissue factor (TF)-activated INR and EXTEM-CT performed well in diagnosing FX below 50%, but rapid TEG with combined TF and kaolin activators failed. Improved performance of INTEM-CT in diagnosing FX below 35% underlies multifactorial deficiency involving both intrinsic and common pathways. In conclusion, the differences among different viscoelastic tests and clinical situations should be carefully considered when they are used to guide transfusion during LT. © 2015 American Association for the Study of Liver Diseases.

Metastases to the Liver from Neuroendocrine Tumors: Effect of Duration of Scan Acquisition on CT Perfusion Values

PubMed Central

Hobbs, Brian P.; Chandler, Adam G.; Anderson, Ella F.; Herron, Delise H.; Charnsangavej, Chusilp; Yao, James

2013-01-01

Purpose To assess the effects of acquisition duration on computed tomographic (CT) perfusion parameter values in neuroendocrine liver metastases and normal liver tissue. Materials and Methods This retrospective study was institutional review board approved, with waiver of informed consent. CT perfusion studies in 16 patients (median age, 57.5 years; range, 42.0–69.7 years), including six men (median, 54.1 years; range, 42.0–69.7), and 10 women (median, 59.3 years; range 43.6–66.3), with neuroendocrine liver metastases were analyzed by means of distributed parametric modeling to determine tissue blood flow, blood volume, mean transit time, permeability, and hepatic arterial fraction for tumors and normal liver tissue. Analyses were undertaken with acquisition time of 12–590 seconds. Nonparameteric regression analyses were used to evaluate the functional relationships between CT perfusion parameters and acquisition duration. Evidence for time invariance was evaluated for each parameter at multiple time points by inferring the fitted derivative to assess its proximity to zero as a function of acquisition time by using equivalence tests with three levels of confidence (20%, 70%, and 90%). Results CT perfusion parameter values varied, approaching stable values with increasing acquisition duration. Acquisition duration greater than 160 seconds was required to obtain at least low confidence stability in any of the CT perfusion parameters. At 160 seconds of acquisition, all five CT perfusion parameters stabilized with low confidence in tumor and normal tissues, with the exception of hepatic arterial fraction in tumors. After 220 seconds of acquisition, there was stabilization with moderate confidence for blood flow, blood volume, and hepatic arterial fraction in tumors and normal tissue, and for mean transit time in tumors; however, permeability values did not satisfy the moderate stabilization criteria in both tumors and normal tissue until 360 seconds of acquisition. Blood flow, mean transit time, permeability, and hepatic arterial fraction were significantly different between tumor and normal tissue at 360 seconds (P < .001). Conclusion CT perfusion parameter values are affected by acquisition duration and approach progressively stable values with increasing acquisition times. © RSNA, 2013 Online supplemental material is available for this article. PMID:23824990

Use of gadoxetic acid for computed tomographic cholangiography in healthy dogs.

PubMed

Chau, Jennifer; Podadera, Juan M; Young, Alex C; Makara, Mariano A

2017-07-01

OBJECTIVE To evaluate the effect of gadoxetic acid (contrast) dose on biliary tract enhancement, determine the optimal time after contrast injection for CT image acquisition, and assess the feasibility of CT cholangiography in sedated dogs. ANIMALS 8 healthy dogs. PROCEDURES The study had 2 parts. In part 1, 4 dogs were anesthetized and underwent CT cholangiography twice. Gadoxetic acid was administered IV at a low dose (0.025 mmol/kg) for the first procedure and high dose (0.3 mmol/kg) for the second procedure. Serial CT scans were obtained at predetermined times after contrast injection. In part 2, 4 dogs were sedated and underwent CT angiography 85 minutes after IV administration of the high contrast dose. Contrast enhancement of the biliary tract on all scans was objectively assessed by measurement of CT attenuation and qualitatively assessed by use of a subjective 4-point scoring system by 3 independent reviewers. All measurements were compared over time and between contrast doses for the dogs of part 1. Subjective measurements were compared between the sedated dogs of part 2 and anesthetized dogs of part 1. RESULTS Enhancement of the biliary tract was positively associated with contrast dose and time after contrast injection. Optimal enhancement was achieved 65 minutes after contrast injection. Subjective visualization of most biliary structures did not differ significantly between sedated and anesthetized dogs. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated CT cholangiography with gadoxetic acid was feasible in sedated dogs. The high contrast dose provided better visualization of biliary structures than the low dose; CT scans should be obtained 65 minutes after contrast injection.

Amplatzer angled duct occluder for closure of patent ductus arteriosus larger than the aorta in an infant.

PubMed

Vijayalakshmi, I B; Chitra, N; Rajasri, R; Prabhudeva, A N

2005-01-01

Transcatheter closure of patent ductus arteriosus (PDA) by Amplatzer duct occluder is the treatment of choice. However, closure of very large ducts in infants with low weight is a challenge for the interventionalist because a large device may obstruct the aorta or left pulmonary artery. Difficulty is also encountered in advancing the device around the curve of the right ventricular outflow tract toward the pulmonary artery; this curve is tight, more or less at a right angle in infants, leading to kinking of the sheath, which increases fluoroscopic time. This is the first reported case of a very large PDA (8.7 mm), larger than the aorta (8.2 mm), successfully closed by an Amplatzer angled duct occluder in an infant weighing 5 kg.

Does the time between CT scan and chemotherapy increase the risk of acute adverse reactions to iodinated contrast media in cancer patients?

PubMed

Farolfi, Alberto; Carretta, Elisa; Luna, Corradina Della; Ragazzini, Angela; Gentili, Nicola; Casadei, Carla; Barone, Domenico; Minguzzi, Martina; Amadori, Dino; Nanni, Oriana; Gavelli, Giampaolo

2014-10-31

Cancer patients undergo routine computed-tomography (CT) scans and, therefore, iodinated contrast media (ICM) administration. It is not known whether a time-dependent correlation exists between chemotherapy administration, contrast enhanced CT and onset of acute ICM-related adverse reactions (ARs). All consecutive contrast-enhanced CTs performed from 1 January 2010 to 31 December 2012 within 30 days of the last chemotherapy administration were retrospectively reviewed. Episodes of acute ICM-related ARs were reported to the pharmacovigilance officer. We analyzed time to CT evaluation calculated as the time elapsed from the date of the CT performed to the date of the last chemotherapy administration. Patients were classified into 4 groups based on the antineoplastic treatment: platinum-based, taxane-based, platinum plus taxane and other group. Out of 10,472 contrast-enhanced CTs performed, 3,945 carried out on 1,878 patients were considered for the study. Forty acute ICM-related ARs (1.01%; 95% CI, 0.70-1.33) were reported. No differences were seen among immediate (within 10 days of the last chemotherapy administration), early (11-20 days) and delayed (21-30 days) CTs. Median time to CT in patients who experienced an acute ICM-related AR by treatment group was not statistically different: 20 days (range 6-30), 17 days (range 5-22), 13 days (range 8-17), 13 days (range (2-29) for the platinum, taxane, platinum plus taxane and other group, respectively (P =0.251). Our results did not reveal any correlation between time to CT and risk of acute ICM-related ARs in cancer patients.

CT fluoroscopy-guided robotically-assisted lung biopsy

NASA Astrophysics Data System (ADS)

Xu, Sheng; Fichtinger, Gabor; Taylor, Russell H.; Banovac, Filip; Cleary, Kevin

2006-03-01

Lung biopsy is a common interventional radiology procedure. One of the difficulties in performing the lung biopsy is that lesions move with respiration. This paper presents a new robotically assisted lung biopsy system for CT fluoroscopy that can automatically compensate for the respiratory motion during the intervention. The system consists of a needle placement robot to hold the needle on the CT scan plane, a radiolucent Z-frame for registration of the CT and robot coordinate systems, and a frame grabber to obtain the CT fluoroscopy image in real-time. The CT fluoroscopy images are used to noninvasively track the motion of a pulmonary lesion in real-time. The position of the lesion in the images is automatically determined by the image processing software and the motion of the robot is controlled to compensate for the lesion motion. The system was validated under CT fluoroscopy using a respiratory motion simulator. A swine study was also done to show the feasibility of the technique in a respiring animal.

Fast image-based mitral valve simulation from individualized geometry.

PubMed

Villard, Pierre-Frederic; Hammer, Peter E; Perrin, Douglas P; Del Nido, Pedro J; Howe, Robert D

2018-04-01

Common surgical procedures on the mitral valve of the heart include modifications to the chordae tendineae. Such interventions are used when there is extensive leaflet prolapse caused by chordae rupture or elongation. Understanding the role of individual chordae tendineae before operating could be helpful to predict whether the mitral valve will be competent at peak systole. Biomechanical modelling and simulation can achieve this goal. We present a method to semi-automatically build a computational model of a mitral valve from micro CT (computed tomography) scans: after manually picking chordae fiducial points, the leaflets are segmented and the boundary conditions as well as the loading conditions are automatically defined. Fast finite element method (FEM) simulation is carried out using Simulation Open Framework Architecture (SOFA) to reproduce leaflet closure at peak systole. We develop three metrics to evaluate simulation results: (i) point-to-surface error with the ground truth reference extracted from the CT image, (ii) coaptation surface area of the leaflets and (iii) an indication of whether the simulated closed leaflets leak. We validate our method on three explanted porcine hearts and show that our model predicts the closed valve surface with point-to-surface error of approximately 1 mm, a reasonable coaptation surface area, and absence of any leak at peak systole (maximum closed pressure). We also evaluate the sensitivity of our model to changes in various parameters (tissue elasticity, mesh accuracy, and the transformation matrix used for CT scan registration). We also measure the influence of the positions of the chordae tendineae on simulation results and show that marginal chordae have a greater influence on the final shape than intermediate chordae. The mitral valve simulation can help the surgeon understand valve behaviour and anticipate the outcome of a procedure. Copyright © 2018 John Wiley & Sons, Ltd.

Occult Radiographically Evident Port-Site Hernia After Robot-Assisted Urologic Surgery: Incidence and Risk Factors.

PubMed

Christie, Matthew C; Manger, Jules P; Khiyami, Abdulaziz M; Ornan, Afshan A; Wheeler, Karen M; Schenkman, Noah S

2016-01-01

Laparoscopic trocar-site hernias (TSH) are rare, with a reported incidence of 1% or less. The incidence of occult radiographically evident hernias has not been described after robot-assisted urologic surgery. We evaluated the incidence and risk factors of this problem. A single-institution retrospective review of robot-assisted urologic surgery was performed from April 2009 to December 2012. Patients with preoperative and postoperative CT were included for analysis. Imaging was reviewed by two radiologists and one urologist. One hundred four cases were identified, including 60 partial nephrectomy, 38 prostatectomy, and 6 cystectomy. Mean age was 58 years and mean body mass index (BMI) was 29 kg/m(2). The cohort was 77% male. Ten total hernias were identified by CT in 8 patients, 2 of which were clinically evident hernias. Excluding these two hernias, occult port-site hernias were identified radiographically in seven patients. Per-patient incidence of occult TSH was 6.7% (7/104), and per-port incidence was 1.4% (8/564). All hernias were midline and 30% contained bowel. Eight of the 10 occurred at 12 mm sites (p = 0.0065) and 3 of the 10 occurred at extended incisions. Age, gender, BMI, smoking status, diabetes mellitus, immunosuppressive drug therapy, ASA score, procedure, blood loss, prior abdominal surgery, and history of hernia were not significant risk factors. Specimen size >40 g (p = 0.024) and wound infection (p = 0.0052) were significant risk factors. While the incidence of clinically evident port-site hernia remains low in robot-assisted urologic surgery, the incidence of CT-detected occult hernia was 6.7% in this series. These occurred most often in sites extended for specimen extraction and at larger port sites. This suggests more attention should be paid to fascial closure at these sites.

The importance of Tc-MAA SPECT/CT for therapy planning of radioembolization in a patient treated with bevacizumab.

PubMed

Ahmadzadehfar, Hojjat; Sabet, Amir; Meyer, Carsten; Habibi, Elham; Biersack, Hans-Jürgen; Ezziddin, Samer

2012-11-01

A 76-year-old man with colorectal cancer and hepatic metastases was referred to us for radioembolization of the liver. Angiography with 99mTc-MAA SPECT/CT was performed 8 weeks after the discontinuation of bevacizumab. 99mTc-MAA SPECT/CT showed a diffused intrahepatic tracer distribution with no focally accentuated accumulation in the tumorous region. The test was repeated 6 weeks later and Tc-MAA SPECT/CT showed this time a tumor accentuated tracer accumulation in the liver. Subsequently, the patient was treated with resin microspheres. Tc-MAA SPECT/CT allows a better evaluation of intrahepatic tracer accumulation of Tc-MAA and facilitates the determination of the most appropriate treatment time.

Substitute CT generation from a single ultra short time echo MRI sequence: preliminary study

NASA Astrophysics Data System (ADS)

Ghose, Soumya; Dowling, Jason A.; Rai, Robba; Liney, Gary P.

2017-04-01

In MR guided radiation therapy planning both MR and CT images for a patient are acquired and co-registered to obtain a tissue specific HU map. Generation of the HU map directly from the MRI would eliminate the CT acquisition and may improve radiation therapy planning. In this preliminary study of substitute CT (sCT) generation, two porcine leg phantoms were scanned using a 3D ultrashort echo time (PETRA) sequence and co-registered to corresponding CT images to build tissue specific regression models. The model was created from one co-registered CT-PETRA pair to generate the sCT for the other PETRA image. An expectation maximization based clustering was performed on the co-registered PETRA image to identify the soft tissues, dense bone and air class membership probabilities. A tissue specific non linear regression model was built from one registered CT-PETRA pair dataset to predict the sCT of the second PETRA image in a two-fold cross validation schema. A complete substitute CT is generated in 3 min. The mean absolute HU error for air was 0.3 HU, bone was 95 HU, fat was 30 HU and for muscle it was 10 HU. The mean surface reconstruction error for the bone was 1.3 mm. The PETRA sequence enabled a low mean absolute surface distance for the bone and a low HU error for other classes. The sCT generated from a single PETRA sequence shows promise for the generation of fast sCT for MRI based radiation therapy planning.

Determination of enoxaparin with rotational thrombelastometry using the prothrombinase-induced clotting time reagent.

PubMed

Schaden, Eva; Schober, Andreas; Hacker, Stefan; Spiss, Christian; Chiari, Astrid; Kozek-Langenecker, Sibylle

2010-04-01

Drug monitoring of low molecular weight heparin is generally not recommended, but could be reasonable in critically ill patients, whose risk for bleeding or thrombosis shows a high interpatient variability. Anti-Xa assays are not available around the clock even in central hospitals, whereas rotational thrombelastometry (ROTEM) becomes increasingly used at the bedside. Prothrombinase-induced clotting time (PiCT) reagent allows determination of factor Xa-inhibition in plasma. The aim of our study was to evaluate enoxaparin determination in whole blood with the ROTEM using specific test modifications, including PiCT. After ethics committee's approval, citrated whole blood obtained from overall 16 healthy volunteers was incubated with enoxaparin at 16 different anti-Xa concentrations. Main endpoint was the clotting time (CT) in ROTEM representing initial activation of clot formation. CT was determined in the new PiCT-ROTEM test, in a low-tissue factor-activated modification (LowTF-ROTEM) as well as in the commercially available heparin-sensitive ROTEM assays (HEPTEM and INTEM). In the absence of enoxaparin, CT values were 168.6 +/- 6.1 s (PiCT-ROTEM), 247.3 +/- 18.6 s (LowTF-ROTEM), and -6.2 +/- 7.9 s (INTEM-HEPTEM). A linear dependency (P < 0.01) between anti-Xa concentration and CT was found for PiCT-ROTEM, LowTF-ROTEM, and for INTEM-HEPTEM with correlation coefficients of 0.93 for PiCT-ROTEM, 0.94 for LowTF-ROTEM, and 0.81 for INTEM-HEPTEM. This in-vitro experiment demonstrates a strong correlation between enoxaparin anti-Xa concentrations and specific ROTEM tests. These promising assays should be further evaluated for monitoring anticoagulation in high-risk patients in clinical studies.

With "big data" comes big responsibility: outreach to North Carolina Medicaid patients with 10 or more computed tomography scans in 12 months.

PubMed

Biola, Holly; Best, Randall M; Lahlou, Rita M; Burke, Lauren M; Dewar, Charles; Jackson, Carlos T; Broder, Joshua; Grey, Linda; Semelka, Richard C; Dobson, Allen

2014-01-01

Patients are being exposed to increasing levels of ionizing radiation, much of it from computed tomography (CT) scans. Adults without a cancer diagnosis who received 10 or more CT scans in 2010 were identified from North Carolina Medicaid claims data and were sent a letter in July 2011 informing them of their radiation exposure; those who had undergone 20 or more CT scans in 2010 were also telephoned. The CT scan exposure of these high-exposure patients during the 12 months following these interventions was compared with that of adult Medicaid patients without cancer who had at least 1 CT scan but were not in the intervention population. The average number of CT scans per month for the high-exposure population decreased over time, but most of that reduction occurred 6-9 months before our interventions took place. At about the same time, the number of CT scans per month also decreased in adult Medicaid patients without cancer who had at least 1 CT scan but were not in the intervention population. Our data do not include information about CT scans that may have been performed during times when patients were not covered by Medicaid. Some of our letters may not have been received or understood. Some high-exposure patients were unintentionally excluded from our study because organization of data on Medicaid claims varies by setting of care. Our patient education intervention was not temporally associated with significant decreases in subsequent CT exposure. Effecting behavior change to reduce exposure to ionizing radiation requires more than an educational letter or telephone call.

Cine CT technique for dynamic airway studies

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

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

1985-07-01

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

Computations of turbulent lean premixed combustion using conditional moment closure

NASA Astrophysics Data System (ADS)

Amzin, Shokri; Swaminathan, Nedunchezhian

2013-12-01

Conditional Moment Closure (CMC) is a suitable method for predicting scalars such as carbon monoxide with slow chemical time scales in turbulent combustion. Although this method has been successfully applied to non-premixed combustion, its application to lean premixed combustion is rare. In this study the CMC method is used to compute piloted lean premixed combustion in a distributed combustion regime. The conditional scalar dissipation rate of the conditioning scalar, the progress variable, is closed using an algebraic model and turbulence is modelled using the standard k-ɛ model. The conditional mean reaction rate is closed using a first order CMC closure with the GRI-3.0 chemical mechanism to represent the chemical kinetics of methane oxidation. The PDF of the progress variable is obtained using a presumed shape with the Beta function. The computed results are compared with the experimental measurements and earlier computations using the transported PDF approach. The results show reasonable agreement with the experimental measurements and are consistent with the transported PDF computations. When the compounded effects of shear-turbulence and flame are strong, second order closures may be required for the CMC.

A variational approach to moment-closure approximations for the kinetics of biomolecular reaction networks

NASA Astrophysics Data System (ADS)

Bronstein, Leo; Koeppl, Heinz

2018-01-01

Approximate solutions of the chemical master equation and the chemical Fokker-Planck equation are an important tool in the analysis of biomolecular reaction networks. Previous studies have highlighted a number of problems with the moment-closure approach used to obtain such approximations, calling it an ad hoc method. In this article, we give a new variational derivation of moment-closure equations which provides us with an intuitive understanding of their properties and failure modes and allows us to correct some of these problems. We use mixtures of product-Poisson distributions to obtain a flexible parametric family which solves the commonly observed problem of divergences at low system sizes. We also extend the recently introduced entropic matching approach to arbitrary ansatz distributions and Markov processes, demonstrating that it is a special case of variational moment closure. This provides us with a particularly principled approximation method. Finally, we extend the above approaches to cover the approximation of multi-time joint distributions, resulting in a viable alternative to process-level approximations which are often intractable.

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

DNA denaturation bubbles: free-energy landscape and nucleation/closure rates.

PubMed

Sicard, François; Destainville, Nicolas; Manghi, Manoel

2015-01-21

The issue of the nucleation and slow closure mechanisms of non-superhelical stress-induced denaturation bubbles in DNA is tackled using coarse-grained MetaDynamics and Brownian simulations. A minimal mesoscopic model is used where the double helix is made of two interacting bead-spring rotating strands with a prescribed torsional modulus in the duplex state. We demonstrate that timescales for the nucleation (respectively, closure) of an approximately 10 base-pair bubble, in agreement with experiments, are associated with the crossing of a free-energy barrier of 22 kBT (respectively, 13 kBT) at room temperature T. MetaDynamics allows us to reconstruct accurately the free-energy landscape, to show that the free-energy barriers come from the difference in torsional energy between the bubble and duplex states, and thus to highlight the limiting step, a collective twisting, that controls the nucleation/closure mechanism, and to access opening time scales on the millisecond range. Contrary to small breathing bubbles, those more than 4 base-pair bubbles are of biological relevance, for example, when a pre-existing state of denaturation is required by specific DNA-binding proteins.

Extreme Precipitation and Beach Closures in the Great Lakes Region: Evaluating Risk among the Elderly

PubMed Central

Bush, Kathleen F.; Fossani, Cheryl L.; Li, Shi; Mukherjee, Bhramar; Gronlund, Carina J.; O’Neill, Marie S.

2014-01-01

As a result of climate change, extreme precipitation events are expected to increase in frequency and intensity. Runoff from these extreme events poses threats to water quality and human health. We investigated the impact of extreme precipitation and beach closings on the risk of gastrointestinal illness (GI)-related hospital admissions among individuals 65 and older in 12 Great Lakes cities from 2000 to 2006. Poisson regression models were fit in each city, controlling for temperature and long-term time trends. City-specific estimates were combined to form an overall regional risk estimate. Approximately 40,000 GI-related hospital admissions and over 100 beach closure days were recorded from May through September during the study period. Extreme precipitation (≥90th percentile) occurring the previous day (lag 1) is significantly associated with beach closures in 8 of the 12 cities (p < 0.05). However, no association was observed between beach closures and GI-related hospital admissions. These results support previous work linking extreme precipitation to compromised recreational water quality. PMID:24534768

High risk of fistula formation in vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis-a retrospective analysis.

PubMed

Mintziras, Ioannis; Miligkos, Michael; Bartsch, Detlef Klaus

2016-08-01

The aim of this study was to evaluate the efficacy of vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis and to identify possible risk factors of fistula formation. The hospital OPS-database (time period 2005-2014) was searched to identify patients treated with an open abdomen due to secondary peritonitis, who underwent vacuum-assisted closure therapy. Medical records were retrospectively analyzed for patients' characteristics, cause of peritonitis, duration of vacuum therapy, number of relaparotomies, fascial closure rates, and risk factors of fistula formation. Forty-three patients (19 male, 24 female) with a median age of 65 years (range 24-90 years) were identified. The major cause of secondary peritonitis was anastomotic leakage after intestinal anastomosis or bowel perforation, the median APACHE II score was 11. Median duration of VAC treatment was 12 days (range 3-88 days). Twenty of 43 (47 %) patients died from septic complications. Delayed fascial closure was obtained by suturing in 20 of 43 patients (47 %). Overall 16 of 43 (37 %) patients developed enteroatmospheric fistulas. Re-explorations after starting VAC treatment and duration of VAC therapy were significantly associated with the occurrence of enteroatmospheric fistulas (p < 0.001). ROC curve analysis determined the optimal duration of VAC therapy to reduce the risk of fistula formation at 13 days. Long-term VAC treatment of patients with an open abdomen due to secondary peritonitis results in a relatively low fascial closure rate and a high risk of fistula formation.

The recovery of online drug markets following law enforcement and other disruptions.

PubMed

Van Buskirk, Joe; Bruno, Raimondo; Dobbins, Timothy; Breen, Courtney; Burns, Lucinda; Naicker, Sundresan; Roxburgh, Amanda

2017-04-01

Online drug markets operating on the 'darknet' ('cryptomarkets') facilitate the trade of illicit substances at an international level. The present study assessed the longitudinal impact on cryptomarket trading of two major disruptions: a large international law enforcement operation, 'Operation Onymous'; and the closure of the largest cryptomarket, Evolution. Almost 1150 weekly snapshots of a total of 39 cryptomarkets were collected between October 2013 and November 2015. Data were collapsed by month and the number of unique vendor aliases operating across markets was assessed using interrupted time series regression. Following both Operation Onymous and the closure of Evolution, significant drops of 627 (p=0.014) and 910 vendors (p<0.001) were observed, respectively. However, neither disruption significantly affected the rate at which vendor numbers increased overall. Operation Onymous and the closure of Evolution were associated with considerable, though temporary, reductions in the number of vendors operating across cryptomarkets. Vendor numbers, however, recovered at a constant rate. While these disruptions likely impacted cryptomarket trading at the time, these markets appear resilient to disruption long-term. Copyright © 2017 Elsevier B.V. All rights reserved.

Data-driven non-Markovian closure models

NASA Astrophysics Data System (ADS)

Kondrashov, Dmitri; Chekroun, Mickaël D.; Ghil, Michael

2015-03-01

This paper has two interrelated foci: (i) obtaining stable and efficient data-driven closure models by using a multivariate time series of partial observations from a large-dimensional system; and (ii) comparing these closure models with the optimal closures predicted by the Mori-Zwanzig (MZ) formalism of statistical physics. Multilayer stochastic models (MSMs) are introduced as both a generalization and a time-continuous limit of existing multilevel, regression-based approaches to closure in a data-driven setting; these approaches include empirical model reduction (EMR), as well as more recent multi-layer modeling. It is shown that the multilayer structure of MSMs can provide a natural Markov approximation to the generalized Langevin equation (GLE) of the MZ formalism. A simple correlation-based stopping criterion for an EMR-MSM model is derived to assess how well it approximates the GLE solution. Sufficient conditions are derived on the structure of the nonlinear cross-interactions between the constitutive layers of a given MSM to guarantee the existence of a global random attractor. This existence ensures that no blow-up can occur for a broad class of MSM applications, a class that includes non-polynomial predictors and nonlinearities that do not necessarily preserve quadratic energy invariants. The EMR-MSM methodology is first applied to a conceptual, nonlinear, stochastic climate model of coupled slow and fast variables, in which only slow variables are observed. It is shown that the resulting closure model with energy-conserving nonlinearities efficiently captures the main statistical features of the slow variables, even when there is no formal scale separation and the fast variables are quite energetic. Second, an MSM is shown to successfully reproduce the statistics of a partially observed, generalized Lotka-Volterra model of population dynamics in its chaotic regime. The challenges here include the rarity of strange attractors in the model's parameter space and the existence of multiple attractor basins with fractal boundaries. The positivity constraint on the solutions' components replaces here the quadratic-energy-preserving constraint of fluid-flow problems and it successfully prevents blow-up.

Comparison of conventional ultrasonography and ultrasonography-computed tomography fusion imaging for target identification using digital/real hybrid phantoms: a preliminary study.

PubMed

Soyama, Takeshi; Sakuhara, Yusuke; Kudo, Kohsuke; Abo, Daisuke; Wang, Jeff; Ito, Yoichi M; Hasegawa, Yu; Shirato, Hiroki

2016-07-01

This preliminary study compared ultrasonography-computed tomography (US-CT) fusion imaging and conventional ultrasonography (US) for accuracy and time required for target identification using a combination of real phantoms and sets of digitally modified computed tomography (CT) images (digital/real hybrid phantoms). In this randomized prospective study, 27 spheres visible on B-mode US were placed at depths of 3.5, 8.5, and 13.5 cm (nine spheres each). All 27 spheres were digitally erased from the CT images, and a radiopaque sphere was digitally placed at each of the 27 locations to create 27 different sets of CT images. Twenty clinicians were instructed to identify the sphere target using US alone and fusion imaging. The accuracy of target identification of the two methods was compared using McNemar's test. The mean time required for target identification and error distances were compared using paired t tests. At all three depths, target identification was more accurate and the mean time required for target identification was significantly less with US-CT fusion imaging than with US alone, and the mean error distances were also shorter with US-CT fusion imaging. US-CT fusion imaging was superior to US alone in terms of accurate and rapid identification of target lesions.

Defining Appropriate Temperature for Perfect Erection Time of Steel Arch Bridge Closure to Minimize the Effect of the Thermal Stress. Case Study: The New Kutai Kartenagara Bridge, Indonesia

NASA Astrophysics Data System (ADS)

Sugihardjo, H.; Tavio; Prasetya, D.; Achmad, N. I.

2017-11-01

The impact of temperature change could govern the final stress of structural elements in the long-span steel bridges. The study was conducted to investigate the effect of temperature change during the construction of a new steel arch bridge, namely the Kutai Kartanegara Bridge. The main bridge has a total spanning length of 470 meters. The erection method of the bridge was the cantilever method with temporary towers, mast cranes, and stay cables. The deflections and internal forces of the steel elements were analyzed using the Midas Civil software. The study focuses on the effort to find the perfect erection time for the closure with regards to the temperature. By measuring the temperatures of the steel elements during the construction, it was found that they varied between 19 and 64 degrees Celsius. From the results of the analyses with various temperatures, it can be concluded that the recommended temperature for the closure erection was 44.6 degrees Celsius. This temperature is similar with the air temperature between either 6 AM and 12 noon or 12 noon and 6 PM. During this periods of time, the effect of thermal stress on the final internal forces in the bridge elements was found much lesser than those obtained during any other period of time.

Directly ventricular septal defect closure without using arteriovenous wire loop: Our adult case series using transarterial retrograde approach

PubMed Central

Pekel, Nihat; Ercan, Ertuğrul; Özpelit, Mehmet Emre; Özyurtlu, Ferhat; Yılmaz, Akar; Topaloğlu, Caner; Saygı, Serkan; Yakan, Serkan; Tengiz, İstemihan

2017-01-01

Objective: The standard transcatheter ventricular septal defects (VSD) closure procedure is established with arteriovenous (AV) loop and is called as antegrade approach. The directly retrograde transarterial VSD closure without using AV loop might be better option as shortens the procedure time and decreases radiation exposure. Methods: Our series consist of twelve sequential adult cases with congenital VSDs (seven with perimembranous, four with muscular, one with postoperative residuel VSD). The mean age was 26.9 (Range 18–58), the mean height was 168.75 cm (Range 155–185cm), and the mean body mass index was 23.4 (Range 17.3–28.4). Maximum and minimum defect sizes were 10 and 5 mm and the mean defect size was 6.24 mm. The procedure was performed with left heart catheterization and advancing the delivery sheath over the stiff exchange wire then VSD occlusion from left side. Results: The defects were successfully closed with this technique in eleven patients. In sixth patient, the defect could not be cannulated by the delivery sheath, as the tip of the sheath did not reach the defect and VSD was closed with same sheath by standard transvenous approach using AV loop. We didn’t encounter any complication releated to semilunar or atrioventricular valves. Atrioventricular conduction system was not affected by the procedure in any patients. The median procedure and fluoroscopy times were 66 and 16.5 minutes respectively. Conclusion: Transarterial retrograde VSD closure without using AV loop simplifies the procedure, decreases the radiation exposure, and shortens the procedure time. The only limitation in adult patients is delivery sheath length. PMID:28315566

Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial.

PubMed

Fujimaki, Yoko; Tsunoda, Koichi; Kobayashi, Rika; Tonghyo, Chong; Tanaka, Fujinobu; Kuroda, Hiroyuki; Numata, Tsutomu; Ishii, Toyota; Kuroda, Reiko; Masuda, Sawako; Hashimoto, Sho; Misawa, Hayato; Shindo, Naoko; Mori, Takahiro; Mori, Hiroko; Uchiyama, Naoki; Kamei, Yuichirou; Tanaka, Masashi; Hamaya, Hironobu; Funatsuki, Shingo; Usui, Satoko; Ito, Ikuno; Hamada, Kohei; Shindo, Akihito; Tokumaru, Yutaka; Morita, Yoko; Ueha, Rumi; Nito, Takaharu; Kikuta, Shu; Sekimoto, Sotaro; Kondo, Kenji; Sakamoto, Takashi; Itoh, Kenji; Yamasoba, Tatsuya; Matsumoto, Sumio

2017-08-01

To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency. Parallel-arm, individual randomized controlled trial. Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups. Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly ( p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference ( p < 0.001). The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly. gov Identifier-UMIN000015567.

Clinical Characteristics of Adult Dogs More Than 5 Years of Age at Presentation for Patent Ductus Arteriosus.

PubMed

Boutet, B G; Saunders, A B; Gordon, S G

2017-05-01

The median age at presentation for dogs with patent ductus arteriosus (PDA) is <6 months of age, and closure is associated with a decrease in heart size and increased survival time, which are not well described in older dogs. To describe the clinical characteristics of dogs with PDA ≥5 years of age at the time of presentation to a veterinary referral hospital. 35 client-owned dogs. Retrospective case series. PDA was diagnosed at a median age of 7.4 years (range, 5.1-12.3 years). Females represented 23/35 (65.7%) of the patients. Concurrent heart disease included degenerative mitral valve disease (DMVD; 13), arrhythmias (11), pulmonary hypertension (7), and other congenital defects (2). Cardiomegaly was documented in the majority of dogs consisting of left ventricular enlargement (91%) and left atrial enlargement (86%). Median vertebral heart size in 24 dogs was 12.9 (range, 10.7-18.2). The PDA shunt direction was left-to-right in 33 and bidirectional in 2 dogs. Closure was performed in 26 dogs, including 4 with pulmonary hypertension. In 10 dogs receiving furosemide pre-operatively for management of heart failure, furosemide was discontinued (8) or the dosage decreased (2) at the time of discharge. Adult dogs can present with a left-to-right shunting PDA that results in cardiomegaly and clinical signs that can improve or resolve with PDA closure. This improvement is also apparent in dogs with PDA complicated by DMVD. Pulmonary hypertension that does not result in complete right-to-left shunting should not be considered a contraindication to closure. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Time to CT head in adult patients with suspected traumatic brain injury: Association with the 'Shorter Stays in Emergency Departments' health target in Aotearoa New Zealand.

PubMed

Jones, Peter; Athaullah, Waheedah; Harper, Alana; Wells, Susan; LeFevre, James; Stewart, Joanna; Curtis, Elana; Reid, Papaarangi; Ameratunga, Shanthi

2018-05-21

A national health target for length of stay in emergency departments (ED) was introduced in 2009 to reduce crowding and improve quality of care. We aimed to determine whether the target was associated with changes in time to CT and appropriateness of CT imaging, as markers of care quality for suspected acute traumatic brain injury (TBI). We undertook a retrospective review of the case records of a random sample of people aged ≥15 years presenting to the ED with TBI from 2006 to 2013. General linear models were used to investigate changes in outcomes along with routine process times before and after the introduction of the target. Among 501 eligible cases the median (IQR) time to CT was 136 (76-247) pre target versus 119 (59-209) minutes post target, p = 0.014. The proportion of appropriate imaging was similar between periods: 77.9% (95% CI 71-83%) versus 76.6% (95%CI 72-81%), p = 0.825. Interactions suggested that the time to CT and appropriateness of imaging before and after the introduction of the target varied by ethnicity, although the changes were not clinically important. Time to assessment and length of stay did not change importantly. We found no evidence of a clinically important change in time to CT or appropriateness of imaging for suspected TBI in association with the introduction of the SSED time target. Additional research with larger cohorts of Māori and Pacific participants is recommended to understand our observed patterns by ethnicity. Copyright © 2018 Elsevier Ltd. All rights reserved.

Tissue adhesives for closure of surgical incisions.

PubMed

Coulthard, Paul; Esposito, Marco; Worthington, Helen V; van der Elst, Maarten; van Waes, Oscar J F; Darcey, James

2010-05-12

Sutures, staples and adhesive tapes are the traditional methods of wound closure, whilst tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables meticulous closure, but they may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of no risk of needlestick injury and no requirement to remove sutures later. Tissue adhesives have been used primarily in emergency rooms but this review looks at the use of tissue adhesives in the operating room where surgeons are increasingly using these for the closure of surgical skin incisions. To determine the relative effects of various tissue adhesives and conventional skin closure techniques on the healing of surgical wounds. For this update we searched the Cochrane Wounds Group Specialised Register (Searched 17/11/09); The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 4 2009; Ovid MEDLINE - 1950 to November Week 1 2009; Ovid EMBASE - 1980 to 2009 Week 46; EBSCO CINAHL - 1982 to 17 November 20098. No date or language restrictions were applied. Only randomised controlled clinical trials were eligible for inclusion. Screening of eligible studies and data extraction were conducted independently and in triplicate whilst assessment of the methodological quality of the trials was conducted independently and in duplicate. Results were expressed as random effects models using mean difference for continuous outcomes and relative risks with 95% confidence intervals for dichotomous outcomes. Heterogeneity was investigated including both clinical and methodological factors. This update identified an additional six trials resulting in a total of fourteen RCTs (1152 patients) which met the inclusion criteria. Sutures were significantly better than tissue adhesives for minimising dehiscence (10 trials). Sutures were also found to be significantly faster to use. For all other analyses of infection, patient and operator satisfaction and cost there was no significant difference between sutures and tissue adhesives. No differences were found between tissue adhesives and tapes (2 trials) for minimising dehiscence, infection, patients assessment of cosmetic appearance, patient satisfaction or surgeon satisfaction. However a statistically significant difference in favour of using tape was found for surgeons' assessment of cosmetic appearance (mean difference 13, 95% CI 5 to 21). Tapes were also demonstrated to be significantly faster to use than tissue adhesives as were staples (1 trial). No other outcome measures were analysed in this group. One trial compared tissue adhesives with a variety of methods of wound closure and found both patients and clinicians were significantly more satisfied with the alternative closure methods than the adhesives. In this same trial tissue adhesives were significantly less time consuming to use. For the remaining outcomes of dehiscence and infection no difference was observed between groups. This trial also compared high viscosity with low viscosity adhesives and found that high viscosity adhesives were less time consuming to use than low viscosity tissue adhesives. For all other outcomes of dehiscence, infection, patient satisfaction and operator satisfaction there was no statistically significant difference between high and low viscosity adhesives. Sutures were significantly better than tissue adhesives for minimising dehiscence and were found to be significantly faster to use. Although surgeons may consider the use of tissue adhesives as an alternative to other methods of surgical site closure in the operating theatre they must be aware that adhesives may take more time to apply and that if higher tension is needed upon an incision, sutures may minimise dehiscence. There is a need for more well designed randomised controlled trials comparing tissue adhesives and alternative methods of closure. These trials should include people whose health may interfere with wound healing and surgical sites of high tension.

Helical 4D CT and Comparison with Cine 4D CT

NASA Astrophysics Data System (ADS)

Pan, Tinsu

4D CT was one of the most important developments in radiation oncology in the last decade. Its early development in single slice CT and commercialization in multi-slice CT has radically changed our practice in radiation treatment of lung cancer, and has enabled the stereotactic radiosurgery of early stage lung cancer. In this chapter, we will document the history of 4D CT development, detail the data sufficiency condition governing the 4D CT data collection; present the design of the commercial helical 4D CTs from Philips and Siemens; compare the differences between the helical 4D CT and the GE cine 4D CT in data acquisition, slice thickness, acquisition time and work flow; review the respiratory monitoring devices; and understand the causes of image artifacts in 4D CT.

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...

Analytical and phenomenological studies of rotating turbulence

NASA Technical Reports Server (NTRS)

Mahalov, Alex; Zhou, YE

1995-01-01

A framework, which combines mathematical analysis, closure theory, and phenomenological treatment, is developed to study the spectral transfer process and reduction of dimensionality in turbulent flows that are subject to rotation. First, we outline a mathematical procedure that is particularly appropriate for problems with two disparate time scales. The approach which is based on the Green's method leads to the Poincare velocity variables and the Poincare transformation when applied to rotating turbulence. The effects of the rotation are now reflected in the modifications to the convolution of a nonlinear term. The Poincare transformed equations are used to obtain a time-dependent analog of the Taylor-Proudman theorem valid in the asymptotic limit when the non-dimensional parameter mu is identical to Omega(t) approaches infinity (Omega is the rotation rate and t is the time). The 'split' of the energy transfer in both direct and inverse directions is established. Secondly, we apply the Eddy-Damped-Quasinormal-Markovian (EDQNM) closure to the Poincare transformed Euler/Navier-Stokes equations. This closure leads to expressions for the spectral energy transfer. In particular, an unique triple velocity decorrelation time is derived with an explicit dependence on the rotation rate. This provides an important input for applying the phenomenological treatment of Zhou. In order to characterize the relative strength of rotation, another non-dimensional number, a spectral Rossby number, which is defined as the ratio of rotation and turbulence time scales, is introduced. Finally, the energy spectrum and the spectral eddy viscosity are deduced.

Viscoelastic blood coagulation measurement with Sonoclot predicts postoperative bleeding in cardiac surgery after heparin reversal.

PubMed

Bischof, Dominique B; Ganter, Michael T; Shore-Lesserson, Linda; Hartnack, Sonja; Klaghofer, Richard; Graves, Kirk; Genoni, Michele; Hofer, Christoph K

2015-01-01

The aim of the study was to determine if Sonoclot with its sensitive glass bead-activated, viscoelastic test can predict postoperative bleeding in patients undergoing cardiac surgery at predefined time points. A prospective, observational clinical study. A teaching hospital, single center. Consecutive patients undergoing cardiac surgery (N = 300). Besides routine laboratory coagulation studies and heparin management with standard (kaolin) activated clotting time, additional native blood samples were analyzed on a Sonoclot using glass bead-activated tests. Glass bead-activated clotting time, clot rate, and platelet function were recorded immediately before anesthesia induction and at the end of surgery after heparin reversal but before chest closure. Primary outcome was postoperative blood loss (chest tube drainage at 4, 8, and 12 hours postoperatively). Secondary outcome parameters were transfusion requirements, need for surgical re-exploration, time of mechanical ventilation, length of intensive care unit and hospital stay, and hospital morbidity and mortality. Patients were categorized into "bleeders" and "nonbleeders." Patient characteristics, operations, preoperative standard laboratory parameters, and procedural times were comparable between bleeders and nonbleeders except for sex and age. Bleeders had higher rates of transfusions, surgical re-explorations, and complications. Only glass bead measurements by Sonoclot after heparin reversal before chest closure but not preoperatively were predictive for increased postoperative bleeding. Sonoclot with its glass bead-activated tests may predict the risk for postoperative bleeding in patients undergoing cardiac surgery at the end of surgery after heparin reversal but before chest closure. Copyright © 2015 Elsevier Inc. All rights reserved.

Systematic review on the value of CT scanning in the diagnosis of anastomotic leakage after colorectal surgery.

PubMed

Kornmann, Verena N N; Treskes, Nikki; Hoonhout, Lilian H F; Bollen, Thomas L; van Ramshorst, Bert; Boerma, Djamila

2013-04-01

Timely diagnosis of anastomotic leakage after colorectal surgery and adequate treatment is important to reduce morbidity and mortality. Abdominal computed tomography (CT) scanning is the diagnostic tool of preference, but its value may be questionable in the early postoperative period. The accuracy of CT scanning for the detection of anastomotic leakage and its role in timing of intervention was evaluated. A systematic literature search was performed. Relevant publications were identified from four electronic databases between 1990 and 2011. Inclusion criteria were human studies, studies published in English or Dutch, colorectal surgery with primary anastomosis, and abdominal CT scan with reported outcome for the detection of anastomotic leakage. Exclusion criteria were cohort of fewer than five patients, other gastrointestinal surgery, no anastomosis, and radiological imaging other than CT. Eight studies, including 221 abdominal CT scans, fulfilled the inclusion criteria. Overall, the methodological quality of the studies was poor. The overall sensitivity of CT scanning to diagnose leakage was 0.68 (95 % confidence interval 0.59-0.75) for colonic resection. Data on the sequelae of false-negative CT scanning was not available. There is limited good-quality evidence to determine the value of CT scans in the detection of anastomotic leakage. To prevent delay in diagnosis and appropriate treatment of anastomotic leakage, the relatively low sensitivity of CT scanning must be taken into account.

Research notes : alternate method for pothole patching.

DOT National Transportation Integrated Search

1998-09-01

Typically, throw and roll pothole patches will likely fail before the pavement is resurfaced or rehabilitated. Alternatively, semi-permanent repairs are time consuming and require more people and added lane closure time. An alternate method is spray ...

Measuring Evapotranspiration of five Alley Cropping systems in Germany using the Eddy-Covariance- and Bowen-Ratio Energy-Balance methods

NASA Astrophysics Data System (ADS)

Markwitz, Christian; Knohl, Alexander; Siebicke, Lukas

2017-04-01

The inclusion of trees into the agricultural landscape of Europe is gaining popularity as a source for energy production. Fast growing tree species such as poplar or willow are included as short rotation coppice or alley cropping systems, which consist of tree alleys interleaved by annual rotating crops or perennial grasslands. Estimating turbulent fluxes of those systems using the eddy-covariance- (ECEB) and bowen-ratio energy-balance (BREB) method is challenging due to the methods limitation to horizontally homogeneous terrain and steady state conditions. As the conditions are not fulfilled for those systems the energy-balance is commonly not fully closed, with the non-closure being site specific. An underestimation of measured heat fluxes leads to an overestimation of the latent heat fluxes inferred from the ECEB method. The aim of our study is to 1) quantify the site specific non-closure of the energy-balance and 2) characterize the performance of both methods, compared to direct eddy-covariance measurements using a high frequency infra-red gas analyzer (LI-7200, Licor Inc.). To assess continuous evapotranspiration (ET) rates on a 30-minute time scale we installed a combined ECEB and BREB system at five alley cropping and five agricultural reference sites across Germany. For time periods of four weeks we performed direct eddy covariance flux measurements for H2O and CO2 over one crop- and one grassland alley cropping- and their respective reference systems during the growing season of 2016. We found a non-closure between 21 and 26 % for all sites, considering all day- and night-time data. The residual energy was highest during the morning and lowest in the afternoon. Related to that the energy-balance ratio (EBR), i.e. the ratio between the turbulent heat fluxes and available energy, was below one in the morning hours and increased slightly during the day up to 1.8, until the EBR decreased sharply after sunset. The EBR correlated to the daily cycle of solar radiation, the main driver of turbulent fluxes. Corresponding, we found an increasing EBR with increasing friction velocity, indicating, that under turbulent condition the energy-balance closure improves. Further, we found that the turbulent fluxes estimated by the BREB method compared well with direct eddy-covariance measurements and that the accuracy improved with increasing sensor distance. We conclude, when calculating ET rates on a 30-minute time scale using the ECEB method the site specific non-closure should be assessed beforehand by eddy-covariance. In the current study, ignoring the non-closure would have lead to an overestimation of the latent heat flux of about 25 % for the ECEB method. For a longer averaging period of one day the overestimation was reduced to less than 5 %.

Evidence for the Role of Proton Shell Closure in Quasifission Reactions from X-Ray Fluorescence of Mass-Identified Fragments

NASA Astrophysics Data System (ADS)

Morjean, M.; Hinde, D. J.; Simenel, C.; Jeung, D. Y.; Airiau, M.; Cook, K. J.; Dasgupta, M.; Drouart, A.; Jacquet, D.; Kalkal, S.; Palshetkar, C. S.; Prasad, E.; Rafferty, D.; Simpson, E. C.; Tassan-Got, L.; Vo-Phuoc, K.; Williams, E.

2017-12-01

The atomic numbers and the masses of fragments formed in quasifission reactions are simultaneously measured at scission in 48Ti + 238U reactions at a laboratory energy of 286 MeV. The atomic numbers are determined from measured characteristic fluorescence x rays, whereas the masses are obtained from the emission angles and times of flight of the two emerging fragments. For the first time, thanks to this full identification of the quasifission fragments on a broad angular range, the important role of the proton shell closure at Z =82 is evidenced by the associated maximum production yield, a maximum predicted by time-dependent Hartree-Fock calculations. This new experimental approach gives now access to precise studies of the time dependence of the N /Z (neutron over proton ratios of the fragments) evolution in quasifission reactions.