76 FR 59703 - Notice of Intent To Award Affordable Care Act (ACA) Funding, RFA-TP-08-001

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-27

... Intent To Award Affordable Care Act (ACA) Funding, RFA- TP-08-001 AGENCY: Centers for Disease Control and... of Intent to award Affordable Care Act (ACA) funding to Preparedness and Emergency Response Research... continuation application under Funding Opportunity Announcement RFA-TP- 08-001, ``Preparedness and Emergency...

76 FR 54774 - Notice of Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-02

... Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA-DP10-1014 AGENCY... Funding Opportunity CDC-RFA- DP10-1014. It is the intent of CDC to provide continuation funding to one (1... published in the above referenced REACH CORE Funding Opportunity Announcement (FOA). Award Information...

Recurrence of Esophageal Intestinal Metaplasia After Endoscopic Mucosal Resection and Radiofrequency Ablation of Barrett’s Esophagus: Results From a US Multicenter Consortium Recurrence of Barrett’s Esophagus after EMR and RFA

PubMed Central

Gupta, Milli; Iyer, Prasad G.; Lutzke, Lori; Gorospe, Emmanuel C.; Abrams, Julian A.; Falk, Gary W.; Ginsberg, Gregory G.; Rustgi, Anil K.; Lightdale, Charles J.; Wang, Timothy C.; Fudman, David I.; Poneros, John M.; Wang, Kenneth K.

2013-01-01

BACKGROUND & AIMS Radiofrequency ablation (RFA) is an established treatment for dysplastic Barrett’s esophagus (BE). Although short-term endpoints of ablation have been ascertained, there have been concerns about recurrence of intestinal metaplasia (IM) after ablation. We aimed to estimate the incidence and identify factors that predicted the recurrence of IM after successful RFA. METHODS We analyzed data from 592 patients with BE treated with RFA from 2003 through 2011 at 3 tertiary referral centers. Complete remission of intestinal metaplasia (CRIM) was defined as eradication of IM (in esophageal and gastro esophageal junction biopsies), documented by 2 consecutive endoscopies. Recurrence was defined as presence of IM or dysplasia after CRIM in surveillance biopsies. Two experienced gastrointestinal pathologists confirmed pathology findings. RESULTS Based on histology analysis, before RFA, 71% of patients had high-grade dysplasia or esophageal adenocarcinoma, 15% had low-grade dysplasia, and 14% had non-dysplastic BE. Of patients treated, 448 (76%) were assessed following RFA. 55% of patients underwent endoscopic mucosal resection before RFA. The median time to CRIM was 22 months, with 56% of patients in CRIM by 24 months. Increasing age and length of BE segment were associated with a longer times to CRIM. Twenty-four months after CRIM, the incidence of recurrence was 33%; 22% of all recurrences observed were dysplastic BE. There were no demographic or endoscopic factors associated with recurrence. Complications developed in 6.5% of subjects treated with RFA; strictures were the most common complication. CONCLUSION Of patients with BE treated by RFA, 56% are in complete remission after 24 months. However, 33% of these patients have disease recurrence within the next 2 years. Most recurrences were non-dysplastic and endoscopically manageable, but continued surveillance after RFA is essential. PMID:23499759

Image-Guided Radiofrequency Ablation (RFA) of Unresectable Hepatic Tumors Using a Triple-Spiral-Shaped Electrode Needle: Initial Experience in 34 Patients

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

Thanos, Loukas; Poulou, Loukia S., E-mail: ploukia@hotmail.co; Ziakas, Panayiotis D.

We evaluated the safety and efficacy of image-guided radiofrequency ablation (RFA) using a triple-spiral-shaped electrode needle for unresectable primary or metastatic hepatic tumors. Thirty-four patients with 46 index tumors were treated. Ablation zone, morbidity, and complications were assessed. The lesions were completely ablated with an ablative margin of about 1 cm. Five patients (14.7%) with a lesion larger than 4.5 cm had local tumor progression after 1 month and were retreated. Hemothorax, as a major complication, occurred in 1 of 34 patients (3.0%) or 1 of 46 lesions ablated (2.2%). RFA using this new electrode needle can be effective inmore » the treatment of large unresectable hepatic tumors.« less

RFA-cut: Semi-automatic segmentation of radiofrequency ablation zones with and without needles via optimal s-t-cuts.

PubMed

Egger, Jan; Busse, Harald; Brandmaier, Philipp; Seider, Daniel; Gawlitza, Matthias; Strocka, Steffen; Voglreiter, Philip; Dokter, Mark; Hofmann, Michael; Kainz, Bernhard; Chen, Xiaojun; Hann, Alexander; Boechat, Pedro; Yu, Wei; Freisleben, Bernd; Alhonnoro, Tuomas; Pollari, Mika; Moche, Michael; Schmalstieg, Dieter

2015-01-01

In this contribution, we present a semi-automatic segmentation algorithm for radiofrequency ablation (RFA) zones via optimal s-t-cuts. Our interactive graph-based approach builds upon a polyhedron to construct the graph and was specifically designed for computed tomography (CT) acquisitions from patients that had RFA treatments of Hepatocellular Carcinomas (HCC). For evaluation, we used twelve post-interventional CT datasets from the clinical routine and as evaluation metric we utilized the Dice Similarity Coefficient (DSC), which is commonly accepted for judging computer aided medical segmentation tasks. Compared with pure manual slice-by-slice expert segmentations from interventional radiologists, we were able to achieve a DSC of about eighty percent, which is sufficient for our clinical needs. Moreover, our approach was able to handle images containing (DSC=75.9%) and not containing (78.1%) the RFA needles still in place. Additionally, we found no statistically significant difference (p<;0.423) between the segmentation results of the subgroups for a Mann-Whitney test. Finally, to the best of our knowledge, this is the first time a segmentation approach for CT scans including the RFA needles is reported and we show why another state-of-the-art segmentation method fails for these cases. Intraoperative scans including an RFA probe are very critical in the clinical practice and need a very careful segmentation and inspection to avoid under-treatment, which may result in tumor recurrence (up to 40%). If the decision can be made during the intervention, an additional ablation can be performed without removing the entire needle. This decreases the patient stress and associated risks and costs of a separate intervention at a later date. Ultimately, the segmented ablation zone containing the RFA needle can be used for a precise ablation simulation as the real needle position is known.

[Comparative analysis of TACE alone or plus RFA in the treatment of 167 cases of intermediate and advanced staged primary hepatocellular carcinoma].

PubMed

Zhao, Ming; Wang, Jian-peng; Wu, Pei-hong; Zhang, Fu-jun; Huang, Zi-lin; Li, Wang; Zhang, Liang; Pan, Chang-chuan; Li, Chuan-xing; Jiang, Yong

2010-11-09

To evaluate the clinical efficacy and survival rate of transarterial chemoembolization (TACE) alone or plus radiofrequency ablation (RFA) in patients with intermediate or advanced stage primary hepatocellular carcinoma (HCC). In this retrospective study, 467 cases received RFA or TACE plus RFA. Among them, 167 cases with strict clinical procedure (TACE alone or plus RFA) and complete follow-up data were included. Eighty-seven cases received TACE and 80 cases had TACE plus RFA between January 2000 and December 2006. Hierarchical analyses were performed using log-rank tests and survival curve was estimated by Kaplan-Meier method. A total of 167 patients received TACE alone or plus RFA for a follow-up period of 1 to 89 months. In the TACE alone group, the time-to-progression (TTP) was an average of 3.6 months. The median survival was 13 months, one-year survival rate 52.9%, three-year survival rate 11.5% and five-year survival rate 4.6%. In the TACE plus RFA group, the TTP time was an average of 10.8 months. The median survival time was 30 months, one-year survival rate 85.0%, three-year survival rate 45.0% and five-year survival rate 11.3%. In the TACE alone group, the median survival of intermediate stage HCC was 14 months, one-year survival rate 62.2%, three-year survival rate 13.3% and five-year survival rate 4.4%; In the TACE plus RFA group, the median survival of intermediate stage HCC was 14 months, one-year survival rate 90.1%, three-year survival rate 52.9% and five-year survival rate 13.7%. All differences of two groups has statistical significance (P < 0.05). In intermediate stage HCC, the median survival of TACE alone group was 14 months, one-year survival rate 62.2%, three-year survival rate 13.3%, five-year survival rate 4.4% versus 32 months, 90.1%, 52.9%, 13.7% in the TACE plus RFA group respectively. For the advanced stage HCC, the median survival time was 12 months, one-year survival rate 35%, three-year survival rate 7.1% and five-year survival rate

Towards a Teleoperated Needle Driver Robot with Haptic Feedback for RFA of Breast Tumors under Continuous MRI1

PubMed Central

Kokes, Rebecca; Lister, Kevin; Gullapalli, Rao; Zhang, Bao; MacMillan, Alan; Richard, Howard; Desai, Jaydev P.

2009-01-01

Objective The purpose of this paper is to explore the feasibility of developing a MRI-compatible needle driver system for radiofrequency ablation (RFA) of breast tumors under continuous MRI imaging while being teleoperated by a haptic feedback device from outside the scanning room. The developed needle driver prototype was designed and tested for both tumor targeting capability as well as RFA. Methods The single degree-of-freedom (DOF) prototype was interfaced with a PHANToM haptic device controlled from outside the scanning room. Experiments were performed to demonstrate MRI-compatibility and position control accuracy with hydraulic actuation, along with an experiment to determine the PHANToM’s ability to guide the RFA tool to a tumor nodule within a phantom breast tissue model while continuously imaging within the MRI and receiving force feedback from the RFA tool. Results Hydraulic actuation is shown to be a feasible actuation technique for operation in an MRI environment. The design is MRI-compatible in all aspects except for force sensing in the directions perpendicular to the direction of motion. Experiments confirm that the user is able to detect healthy vs. cancerous tissue in a phantom model when provided with both visual (imaging) feedback and haptic feedback. Conclusion The teleoperated 1-DOF needle driver system presented in this paper demonstrates the feasibility of implementing a MRI-compatible robot for RFA of breast tumors with haptic feedback capability. PMID:19303805

[Endoscopic mucosal resection (EMR) followed by radiofrequency ablation (RFA) in neoplastic Barrett's esophagus or Barrett early cancer is also economically superior to sole radical endoscopic resection].

PubMed

Wilke, M; Rathmayer, M; Schenker, M; Schepp, W

2016-05-01

Neoplastic changes (mild or high grade intraepithelial neoplasia (L- or HGIEN) or early cancer) in Barrett esophagus are treated with various methods. This study compares clinical-economical aspects of sole stepwise radical endoscopic resection (SRER) against combination treatment with EMR (Endoscopic mucosal resection) and RFA (radiofrequency ablation). Based on clinical data from a randomized controlled trial 1 we developed an economic model for costs of treatment according to the German Hospital Remuneration System (G-DRG). Our calculating incorporated initial treatment costs and the cost of treating complications (both paid via G-DRG). Medical and economically, the treatment with EMR + RFA advantages over sole SRER treatment 1. The successful complete resection or destruction of neoplastic intestinal metaplastic tissue is similar in both procedures. Acute complications (24 vs. 13 % in SRER EMR + RFA) and late complications (88 vs. 13 % in SRER EMR + RFA) are significantly more likely in sole SRER than in the EMR + RFA. While SRER initially appears more cost-effective as a sole therapy, cost levels move significantly above EMR+RFA due to higher complication rates and following procedures costs. Overall, the costs of treatment was € 13 272.11 in the SRER group and € 11 389.33 in the EMR + RFA group. The EMR + RFA group thus achieved a cost advantage of € 1882.78. The study shows that the treatment of neoplastic Barrett esophagus with EMR + RFA is also appropriate in economic terms. © Georg Thieme Verlag KG Stuttgart · New York.

GPU-based RFA simulation for minimally invasive cancer treatment of liver tumours.

PubMed

Mariappan, Panchatcharam; Weir, Phil; Flanagan, Ronan; Voglreiter, Philip; Alhonnoro, Tuomas; Pollari, Mika; Moche, Michael; Busse, Harald; Futterer, Jurgen; Portugaller, Horst Rupert; Sequeiros, Roberto Blanco; Kolesnik, Marina

2017-01-01

Radiofrequency ablation (RFA) is one of the most popular and well-standardized minimally invasive cancer treatments (MICT) for liver tumours, employed where surgical resection has been contraindicated. Less-experienced interventional radiologists (IRs) require an appropriate planning tool for the treatment to help avoid incomplete treatment and so reduce the tumour recurrence risk. Although a few tools are available to predict the ablation lesion geometry, the process is computationally expensive. Also, in our implementation, a few patient-specific parameters are used to improve the accuracy of the lesion prediction. Advanced heterogeneous computing using personal computers, incorporating the graphics processing unit (GPU) and the central processing unit (CPU), is proposed to predict the ablation lesion geometry. The most recent GPU technology is used to accelerate the finite element approximation of Penne's bioheat equation and a three state cell model. Patient-specific input parameters are used in the bioheat model to improve accuracy of the predicted lesion. A fast GPU-based RFA solver is developed to predict the lesion by doing most of the computational tasks in the GPU, while reserving the CPU for concurrent tasks such as lesion extraction based on the heat deposition at each finite element node. The solver takes less than 3 min for a treatment duration of 26 min. When the model receives patient-specific input parameters, the deviation between real and predicted lesion is below 3 mm. A multi-centre retrospective study indicates that the fast RFA solver is capable of providing the IR with the predicted lesion in the short time period before the intervention begins when the patient has been clinically prepared for the treatment.

RFA Guardian: Comprehensive Simulation of Radiofrequency Ablation Treatment of Liver Tumors.

PubMed

Voglreiter, Philip; Mariappan, Panchatcharam; Pollari, Mika; Flanagan, Ronan; Blanco Sequeiros, Roberto; Portugaller, Rupert Horst; Fütterer, Jurgen; Schmalstieg, Dieter; Kolesnik, Marina; Moche, Michael

2018-01-15

The RFA Guardian is a comprehensive application for high-performance patient-specific simulation of radiofrequency ablation of liver tumors. We address a wide range of usage scenarios. These include pre-interventional planning, sampling of the parameter space for uncertainty estimation, treatment evaluation and, in the worst case, failure analysis. The RFA Guardian is the first of its kind that exhibits sufficient performance for simulating treatment outcomes during the intervention. We achieve this by combining a large number of high-performance image processing, biomechanical simulation and visualization techniques into a generalized technical workflow. Further, we wrap the feature set into a single, integrated application, which exploits all available resources of standard consumer hardware, including massively parallel computing on graphics processing units. This allows us to predict or reproduce treatment outcomes on a single personal computer with high computational performance and high accuracy. The resulting low demand for infrastructure enables easy and cost-efficient integration into the clinical routine. We present a number of evaluation cases from the clinical practice where users performed the whole technical workflow from patient-specific modeling to final validation and highlight the opportunities arising from our fast, accurate prediction techniques.

Novel temperature-controlled RFA probe for treatment of blocked metal biliary stents in patients with pancreaticobiliary cancers: initial experience.

PubMed

Nayar, Manu K; Oppong, Kofi W; Bekkali, Noor L H; Leeds, John S

2018-05-01

 Radiofrequency ablation (RFA) is used to treat blocked biliary stents in patients with pancreaticobiliary (PB) tumors with varying results. We report our experience with a novel temperature-controlled probe for treatment of blocked metal stents.  Patients with histologically proven PB cancers and a blocked biliary stents were treated using ELRATM electrode (Taewoong Medical) under fluoroscopic guidance. Demographics, clinical outcome, stricture diameter improvements, complications and mortality at 30 days were prospectively recorded.  Nine procedures were performed on seven patients (4 male, 3 female); mean age 65.33 (range 56 - 82 years). Mean stricture diameter prior to RFA was 1.13 mm (SD ± 0.54) and 4.42 mm (SD ± 1.54) following RFA ( P  < 0.0001). Five of seven patients (71 %) required additional stents to ensure optimal drainage. There were no procedure-related complications. Mean follow-up was 193.55 days (range 31 - 540) and three of nine patients (33 %) died due to terminal cancer. These are the first reported data on use of a temperature-controlled RFA catheter in humans to treat blocked metal biliary stents. The device is safe but further randomized trials are required to establish the efficacy and survival benefits of this probe.

An rfaH Mutant of Salmonella enterica Serovar Typhimurium is Attenuated in Swine and Reduces Intestinal Colonization, Fecal Shedding, and Disease Severity Due to Virulent Salmonella Typhimurium

PubMed Central

Bearson, Bradley L.; Bearson, Shawn M. D.; Kich, Jalusa D.; Lee, In Soo

2014-01-01

Swine are often asymptomatic carriers of Salmonella spp., and interventions are needed to limit colonization of swine to enhance food safety and reduce environmental contamination. We evaluated the attenuation and potential vaccine use in pigs of a Salmonella enterica serovar Typhimurium mutant of rfaH, the gene encoding the RfaH antiterminator that prevents premature termination of long mRNA transcripts. Pigs inoculated with wild-type S. Typhimurium exhibited a significant elevation in average body temperature (fever) at 1 and 2 days post-inoculation; rfaH-inoculated pigs did not (n = 5/group). During the 7-day trial, a significant reduction of Salmonella in the feces, tonsils, and cecum were observed in the rfaH-inoculated pigs compared to wild-type inoculated pigs. To determine whether vaccination with the rfaH mutant could provide protection against wild-type S. Typhimurium challenge, two groups of pigs (n = 14/group) were intranasally inoculated with either the rfaH mutant or a PBS placebo at 6 and 8 weeks of age and challenged with the parental, wild-type S. Typhimurium at 11 weeks of age. The average body temperature was significantly elevated in the mock-vaccinated pigs at 1 and 2 days post-challenge, but not in the rfaH-vaccinated pigs. Fecal shedding at 2 and 3 days post-challenge and colonization of intestinal tract tissues at 7 days post-challenge by wild-type S. Typhimurium was significantly reduced in the rfaH-vaccinated pigs compared to mock-vaccinated pigs. Serological analysis using the IDEXX HerdChek Swine Salmonella Test Kit indicated that vaccination with the rfaH mutant did not stimulate an immune response against LPS. These results indicate that vaccination of swine with the attenuated rfaH mutant confers protection against challenge with virulent S. Typhimurium but does not interfere with herd level monitoring for Salmonella spp., thereby allowing for differentiation of infected from vaccinated animals (DIVA). PMID

Interdomain Contacts Control Native State Switching of RfaH on a Dual-Funneled Landscape

PubMed Central

Ramírez-Sarmiento, César A.; Noel, Jeffrey K.; Valenzuela, Sandro L.; Artsimovitch, Irina

2015-01-01

RfaH is a virulence factor from Escherichia coli whose C-terminal domain (CTD) undergoes a dramatic α-to-β conformational transformation. The CTD in its α-helical fold is stabilized by interactions with the N-terminal domain (NTD), masking an RNA polymerase binding site until a specific recruitment site is encountered. Domain dissociation is triggered upon binding to DNA, allowing the NTD to interact with RNA polymerase to facilitate transcription while the CTD refolds into the β-barrel conformation that interacts with the ribosome to activate translation. However, structural details of this transformation process in the context of the full protein remain to be elucidated. Here, we explore the mechanism of the α-to-β conformational transition of RfaH in the full-length protein using a dual-basin structure-based model. Our simulations capture several features described experimentally, such as the requirement of disruption of interdomain contacts to trigger the α-to-β transformation, confirms the roles of previously indicated residues E48 and R138, and suggests a new important role for F130, in the stability of the interdomain interaction. These native basins are connected through an intermediate state that builds up upon binding to the NTD and shares features from both folds, in agreement with previous in silico studies of the isolated CTD. We also examine the effect of RNA polymerase binding on the stabilization of the β fold. Our study shows that native-biased models are appropriate for interrogating the detailed mechanisms of structural rearrangements during the dramatic transformation process of RfaH. PMID:26230837

The relation between temperature distribution for lung RFA and electromagnetic wave frequency dependence of electrical conductivity with changing a lung's internal air volumes.

PubMed

Yamazaki, Nozomu; Watanabe, Hiroki; Lu, Xiaowei; Isobe, Yosuke; Kobayashi, Yo; Miyashita, Tomoyuki; Fujie, Masakatsu G

2013-01-01

Radio frequency ablation (RFA) for lung cancer has increasingly been used over the past few years because it is a minimally invasive treatment. As a feature of RFA for lung cancer, lung contains air during operation. Air is low thermal and electrical conductivity. Therefore, RFA for this cancer has the advantage that only the cancer is coagulated, and it is difficult for operators to control the precise formation of coagulation lesion. In order to overcome this limitation, we previously proposed a model-based robotic ablation system using finite element method. Creating an accurate thermo physical model and constructing thermal control method were a challenging problem because the thermal properties of the organ are complex. In this study, we measured electromagnetic wave frequency dependence of lung's electrical conductivity that was based on lung's internal air volumes dependence with in vitro experiment. In addition, we validated the electromagnetic wave frequency dependence of lung's electrical conductivity using temperature distribution simulator. From the results of this study, it is confirmed that the electromagnetic wave frequency dependence of lung's electrical conductivity effects on heat generation of RFA.

Final voluntary release assessment/corrective action report

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

NONE

1996-11-12

The US Department of Energy, Carlsbad Area Office (DOE-CAO) has completed a voluntary release assessment sampling program at selected Solid Waste Management Units (SWMUs) at the Waste Isolation Pilot Plant (WIPP). This Voluntary Release Assessment/Corrective Action (RA/CA) report has been prepared for final submittal to the Environmental protection Agency (EPA) Region 6, Hazardous Waste Management Division and the New Mexico Environment Department (NMED) Hazardous and Radioactive Materials Bureau to describe the results of voluntary release assessment sampling and proposed corrective actions at the SWMU sites. The Voluntary RA/CA Program is intended to be the first phase in implementing the Resourcemore » Conservation and Recovery Act (RCRA) Facility Investigation (RFI) and corrective action process at the WIPP. Data generated as part of this sampling program are intended to update the RCRA Facility Assessment (RFA) for the WIPP (Assessment of Solid Waste Management Units at the Waste Isolation Pilot Plant), NMED/DOE/AIP 94/1. This Final Voluntary RA/CA Report documents the results of release assessment sampling at 11 SWMUs identified in the RFA. With this submittal, DOE formally requests a No Further Action determination for these SWMUs. Additionally, this report provides information to support DOE`s request for No Further Action at the Brinderson and Construction landfill SWMUs, and to support DOE`s request for approval of proposed corrective actions at three other SWMUs (the Badger Unit Drill Pad, the Cotton Baby Drill Pad, and the DOE-1 Drill Pad). This information is provided to document the results of the Voluntary RA/CA activities submitted to the EPA and NMED in August 1995.« less

Electronic Rapid Fitness Assessment: A Novel Tool for Preoperative Evaluation of the Geriatric Oncology Patient

PubMed Central

Shahrokni, Armin; Tin, Amy; Downey, Robert J.; Strong, Vivian; Mahmoudzadeh, Sanam; Boparai, Manpreet K.; McMillan, Sincere; Vickers, Andrew; Korc-Grodzicki, Beatriz

2017-01-01

Background The American College of Surgeons and American Geriatrics Society recommend performing a geriatric assessment (GA) in the preoperative evaluation of older patients. To address this, we developed an electronic GA; the Electronic Rapid Fitness Assessment (eRFA). We reviewed the feasibility and clinical utility of the eRFA in the preoperative evaluation of geriatric patients. Methods We performed a retrospective review of our experience using the eRFA in the preoperative assessment of geriatric patients. The rate of and time to completion of the eRFA were recorded. The first 50 patients who completed the assessment were asked additional questions to assess their satisfaction. Descriptive statistics of patient-reported geriatric-related data were used for analysis. Results In 2015, 636 older cancer patients (median age, 80 years) completed the eRFA during preoperative evaluation. The median time to completion was 11 minutes (95% CI, 11 to 12 minutes). Only 13% of patients needed someone else to complete the assessment for them. Of the first 50 patients, 90% (95% CI, 75% to 98%) responded that answering questions by using eRFA was easy. Geriatric syndromes were commonly identified through the performance of the GA: 16% of patients had a positive screening for cognitive impairment, 22% (95% CI, 19% to 26%) needed a cane to ambulate, and 26% (95% CI, 23% to 30%) had fallen at least once during the previous year. Conclusion Implementation of the eRFA was feasible. The eRFA identified relevant geriatric syndromes in the preoperative setting that, if addressed, could lead to improved outcomes. PMID:28188187

A study on the measurement of the core body temperature change after radiofrequency ablation (RFA) through MR temperature mapping

NASA Astrophysics Data System (ADS)

Kim, Chang-Bok; Dong, Kyung-Rae; Yu, Young; Chung, Woon-Kwan; Cho, Jae-Hwan; Joo, Kyu-Ji

2013-09-01

This study examined the change in the heat generated during radiofrequency ablation (RFA) using a self-manufactured phantom and used magnetic resonance imaging (MRI) to analyze the change in the temperature of the core body and the tissues surrounding the phantom. In this experiment, the image and the phase image were obtained simultaneously from a gradient echo-based sequence using 1.5-Tesla MRI equipment and a 12-channel head coil. The temperature mapping technique was used to calculate the change in temperature. The regions of interest (ROIs) (ROI 1 - ROI 6) were set with a focus on the area where the RFA was performed, according to the temperature distribution, before monitoring the temperature change for one hour in time intervals of five minutes. The results showed that the temperature change in the ROI with time was largest in the ROI 1 and smallest in the ROI 5. In addition, after the RFA procedure, the temperature decreased from the initial value to 0 °C in one hour. The temperature changes in the core body and the surrounding tissues were confirmed by MRI temperature mapping, which is a noninvasive method.

The synergistic effects of radiofrequency ablation (RFA) with glycated chitosan for inhibiting the metastasis of breast cancer

NASA Astrophysics Data System (ADS)

Chiu, Hsin-Yu; Leu, Jyh-Der; Chen, Wei R.; Lee, Yi-Jang

2016-03-01

Breast cancer is increasing with years in Taiwan because of dietary style, life behavior and several social-physiological factors. According to the record of Bureau of Health Promotion in Taiwan, the incidence of breast cancer is top one, and the mortality of that is top one cancer type in women. Compared with USA, most of breast cancer cases found in Taiwanese women have reached to stage 2 or 3. Current therapeutic strategies for breast cancer include surgery, radiation therapy, chemotherapy, hormone therapy and targeted therapy. However, these methods used for curing the late-stage breast cancer remains rare. Because the metastasis is the major problem of late-stage breast cancer, it is of interest to investigate whether a systemic therapy can reduce the symptoms of cancer. The immunotherapy, particularly an induction of autoimmune system, is probably important for the treatment of late-stage breast cancer. Glycated chitosan (GC) is derived from chitosan, a linear polysaccharide composed of D-glucosamine and N-acetyl-D-glucosamine through β-(1-4) linkage. Several lines of evidence have shown that GC is an immunoadjuvant that can target on primary and metastatic tumors formed in animal and human patients. In our previous data, GC was demonstrated to decrease the motility and invasion of mammalian breast cancer cells in vitro and in vivo. Radiofrequency ablation (RFA) is dependent on a small generator that delivers high frequency alternating electric current directly to burn a tumor lesion. Therefore, the temperature may reach up to above 60 °C. In this study, we used 4T1 mouse breast cancer cell that is the approximately equal to stage 4 of human breast cancer. And triple modality reporter gene (3R) was delivered into the cells using transfected piggyBac, a transposable element for observation of tumor growth and metastasis in vivo. Data showed that growth and metastasis of tumors smaller than 500mm3 were entirely suppressed by RFA-GC combination treatment

76 FR 54772 - Notice of Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-02

... applications under the Nutrition, Physical Activity, and Obesity Program. These applications have been..., Physical Activity, and Obesity Program Funding Opportunity Announcement (FOA). Award Information... based on methodology published in the Nutrition, Physical Activity, and Obesity Program CDC-RFA-DP08-805...

Assessing the security vulnerabilities of correctional facilities

NASA Astrophysics Data System (ADS)

Spencer, Debra D.; Morrison, G. Steve

1998-12-01

The National Institute of Justice has tasked their satellite facility at Sandia National Laboratories and their Southeast Regional Technology Center in Charleston, South Carolina to devise new procedures and tools for helping correctional facilities to assess their security vulnerabilities. Thus, a team is visiting selected correctional facilities and performing vulnerability assessments. A vulnerability assessment helps identify the easiest paths for inmate escape, for introduction of contraband such as drugs or weapons, for unexpected intrusion from outside of the facility, and for the perpetration of violent acts on other inmates and correctional employees. In addition, the vulnerability assessment helps to quantify the security risks for the facility. From these assessments will come better procedures for performing vulnerability assessments in general at other correctional facilities, as well as the development of tools to assist with the performance of such vulnerability assessments.

76 FR 54774 - Notice of Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-02

... Intent To Award Affordable Care Act Funding, Funding Opportunity Announcement CDC-RFA-DP09-905 AGENCY: Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS). ACTION: Notice. SUMMARY: This notice provides notice of CDC's intent to fund continuation cooperative agreement...

Life Sciences Centrifuge Facility assessment

NASA Technical Reports Server (NTRS)

Benson, Robert H.

1994-01-01

This report provides an assessment of the status of the Centrifuge Facility being developed by ARC for flight on the International Space Station Alpha. The assessment includes technical status, schedules, budgets, project management, performance of facility relative to science requirements, and identifies risks and issues that need to be considered in future development activities.

Notice of Changes to RFA-CA-15-022 and Pre-Application Webinar | Office of Cancer Clinical Proteomics Research

Cancer.gov

The National Cancer Institute will hold a public Pre-Application webinar on Wednesday, January 13, 2016 at 12:00 p.m. (EST) for the Funding Opportunity Announcement (FOA) RFA-CA-15-022 entitled “Proteogenomic Translational Research Centers for Clinical Proteomic Tumor Analysis Consortium (U01).”

33 CFR 105.305 - Facility Security Assessment (FSA) requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Facility Security Assessment (FSA... SECURITY MARITIME SECURITY MARITIME SECURITY: FACILITIES Facility Security Assessment (FSA) § 105.305 Facility Security Assessment (FSA) requirements. (a) Background. The facility owner or operator must ensure...

33 CFR 105.305 - Facility Security Assessment (FSA) requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Facility Security Assessment (FSA... SECURITY MARITIME SECURITY MARITIME SECURITY: FACILITIES Facility Security Assessment (FSA) § 105.305 Facility Security Assessment (FSA) requirements. (a) Background. The facility owner or operator must ensure...

33 CFR 105.305 - Facility Security Assessment (FSA) requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Facility Security Assessment (FSA... SECURITY MARITIME SECURITY MARITIME SECURITY: FACILITIES Facility Security Assessment (FSA) § 105.305 Facility Security Assessment (FSA) requirements. (a) Background. The facility owner or operator must ensure...

33 CFR 105.305 - Facility Security Assessment (FSA) requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Facility Security Assessment (FSA... SECURITY MARITIME SECURITY MARITIME SECURITY: FACILITIES Facility Security Assessment (FSA) § 105.305 Facility Security Assessment (FSA) requirements. (a) Background. The facility owner or operator must ensure...

33 CFR 105.305 - Facility Security Assessment (FSA) requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Facility Security Assessment (FSA... SECURITY MARITIME SECURITY MARITIME SECURITY: FACILITIES Facility Security Assessment (FSA) § 105.305 Facility Security Assessment (FSA) requirements. (a) Background. The facility owner or operator must ensure...

The Benefits of Guided Facility Self-Assessments

ERIC Educational Resources Information Center

O'Leary, Keith

2012-01-01

A growing number of educational institutions have discovered that a guided self-assessment solution helps them to consistently and cost-effectively obtain facility condition information and make better-informed capital planning decisions. Facility self-assessment employs a consistent, repeatable process for internal staff to quickly assess assets…

RFA-based 589-nm guide star lasers for ESO VLT: a paradigm shift in performance, operational simplicity, reliability, and maintenance

NASA Astrophysics Data System (ADS)

Friedenauer, Axel; Karpov, Vladimir; Wei, Daoping; Hager, Manfred; Ernstberger, Bernhard; Clements, Wallace R. L.; Kaenders, Wilhelm G.

2012-07-01

Large telescopes equipped with adaptive optics require 20-25W CW 589-nm sources with emission linewidths of ~5 MHz. These Guide Star (GS) lasers should also be highly reliable and simple to operate and maintain for many years at the top of a mountain facility. Under contract from ESO, industrial partners TOPTICA and MPBC are nearing completion of the development of GS lasers for the ESO VLT, with delivery of the first of four units scheduled for December 2012. We report on the design and performance of the fully-engineered Pre-Production Unit (PPU), including system reliability/availability analysis, the successfully-concluded qualification testing, long-term component and system level tests and long-term maintenance and support planning. The chosen approach is based on ESO's patented narrow-band Raman Fiber Amplifier (EFRA) technology. A master oscillator signal from a linearly-polarized TOPTICA 20-mW, 1178-nm CW diode laser, with stabilized emission frequency and controllable linewidth up to a few MHz, is amplified in an MPBC polarization-maintaining (PM) RFA pumped by a high-power 1120-nm PM fiber laser. With efficient stimulated Brillouin scattering suppression, an unprecedented 40W of narrow-band RFA output has been obtained. This is then mode-matched into a resonant-cavity doubler with a free-spectral-range matching the sodium D2a to D2b separation, allowing simultaneous generation of an additional frequency component (D2b line) to re-pump the sodium atom electronic population. With this technique, the return flux can be increased without having to resort to electro-optical modulators and without the risk of introducing optical wave front distortions. The demonstrated output powers with doubling efficiencies >80% at 589 nm easily exceed the 20W design goal and require less than 700 W of electrical power. In summary, the fiber-based guide star lasers provide excellent beam quality and are modular, turn-key, maintenance-free, reliable, efficient, and ruggedized

Facility Condition Assessment from A to Z

ERIC Educational Resources Information Center

Kaleba, Frank

2013-01-01

This article will provide an overview of the options for performing facility condition assessments. Quite often, the facility manager will choose a condition assessment method without deliberate examination of what type of assessment is best suited to the needs of the organization. In addition, the needs of diverse audiences usually differ--for…

Kauai Test Facility hazards assessment document

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

Swihart, A

1995-05-01

The Department of Energy Order 55003A requires facility-specific hazards assessment be prepared, maintained, and used for emergency planning purposes. This hazards assessment document describes the chemical and radiological hazards associated with the Kauai Test Facility, Barking Sands, Kauai, Hawaii. The Kauai Test Facility`s chemical and radiological inventories were screened according to potential airborne impact to onsite and offsite individuals. The air dispersion model, ALOHA, estimated pollutant concentrations downwind from the source of a release, taking into consideration the toxicological and physical characteristics of the release site, the atmospheric conditions, and the circumstances of the release. The greatest distance to themore » Early Severe Health Effects threshold is 4.2 kilometers. The highest emergency classification is a General Emergency at the {open_quotes}Main Complex{close_quotes} and a Site Area Emergency at the Kokole Point Launch Site. The Emergency Planning Zone for the {open_quotes}Main Complex{close_quotes} is 5 kilometers. The Emergency Planning Zone for the Kokole Point Launch Site is the Pacific Missile Range Facility`s site boundary.« less

FY11 Facility Assessment Study for Aeronautics Test Program

NASA Technical Reports Server (NTRS)

Loboda, John A.; Sydnor, George H.

2013-01-01

This paper presents the approach and results for the Aeronautics Test Program (ATP) FY11 Facility Assessment Project. ATP commissioned assessments in FY07 and FY11 to aid in the understanding of the current condition and reliability of its facilities and their ability to meet current and future (five year horizon) test requirements. The principle output of the assessment was a database of facility unique, prioritized investments projects with budgetary cost estimates. This database was also used to identify trends for the condition of facility systems.

WASTE OPPORTUNITY ASSESSMENT: A PHOTOFINISHING FACILITY

EPA Science Inventory

A waste minimization opportunity assessment was performed which identified areas for waste reduction at a photofinishing facility. The study followed procedures in the EPA Waste Minimization Opportunity Assessment Manual. The report identifies potential options to achieve further...

Chemical facility vulnerability assessment project.

PubMed

Jaeger, Calvin D

2003-11-14

Sandia National Laboratories, under the direction of the Office of Science and Technology, National Institute of Justice, conducted the chemical facility vulnerability assessment (CFVA) project. The primary objective of this project was to develop, test and validate a vulnerability assessment methodology (VAM) for determining the security of chemical facilities against terrorist or criminal attacks (VAM-CF). The project also included a report to the Department of Justice for Congress that in addition to describing the VAM-CF also addressed general observations related to security practices, threats and risks at chemical facilities and chemical transport. In the development of the VAM-CF Sandia leveraged the experience gained from the use and development of VAs in other areas and the input from the chemical industry and Federal agencies. The VAM-CF is a systematic, risk-based approach where risk is a function of the severity of consequences of an undesired event, the attack potential, and the likelihood of adversary success in causing the undesired event. For the purpose of the VAM-CF analyses Risk is a function of S, L(A), and L(AS), where S is the severity of consequence of an event, L(A) is the attack potential and L(AS) likelihood of adversary success in causing a catastrophic event. The VAM-CF consists of 13 basic steps. It involves an initial screening step, which helps to identify and prioritize facilities for further analysis. This step is similar to the prioritization approach developed by the American Chemistry Council (ACC). Other steps help to determine the components of the risk equation and ultimately the risk. The VAM-CF process involves identifying the hazardous chemicals and processes at a chemical facility. It helps chemical facilities to focus their attention on the most critical areas. The VAM-CF is not a quantitative analysis but, rather, compares relative security risks. If the risks are deemed too high, recommendations are developed for

Aberdeen area fire training area hydrologic assessment, Aberdeen Proving Ground. Final report, September 1989-July 1991

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

Whitten, C.B.; Miller, S.P.; Derryberry, N.A.

1992-12-01

In 1986, the US Environmental Protection Agency (EPA) issued a Hazardous Waste Management Permit to Aberdeen Proving Ground (APG), Maryland. The permit required a Resource Conservation and Recovery Act (RCRA) Facility Assessment (RFA) of sites in the Aberdeen Area (AA) of APG. Recommendations from a draft RFA report suggested further investigations at the Fire Training Area (FTA). This study is in response to the recommendations. Three soil borings and twelve groundwater monitor wells were installed. Three rounds of groundwater sampling and analyses were conducted. APG lies in the Coastal Plain Physiographic Province which is underlain by sediments consisting of threemore » major units, the Potomac Group, the Talbot Formation, and Recent (Holocene) sediments. The Lower Cretaceous sediments of the Potomac Group lie unconformably on the older Precambrian rocks. In the early 1960's fire training was initiated and training has been conducted as often as once a week. Trenches were ignited after being filled with oil and water. The exercises concluded in 1989. During the RFA shallow boring soil gas surveys were conducted for volatile organic compound (VOC) contamination at the FTA. Deeper borings were conducted for monitor wells and geologic mapping. Sampling and monitoring of groundwater, surface water, and soils was conducted. Analyses of groundwater from the monitor wells and two supply wells indicate the AFTA is contributing chemical contaminants to the upper aquifer, which is at a depth of approximately 30 feet below ground surface. ....Aberdeen Proving Ground, Maryland, Hydrogeology, Groundwater, Site characterization, Groundwater contamination.« less

Assessment of the radiofrequency ablation dynamics of esophageal tissue with optical coherence tomography

NASA Astrophysics Data System (ADS)

Lee, Hsiang-Chieh; Ahsen, Osman O.; Liu, Jonathan J.; Tsai, Tsung-Han; Huang, Qin; Mashimo, Hiroshi; Fujimoto, James G.

2017-07-01

Radiofrequency ablation (RFA) is widely used for the eradication of dysplasia and the treatment of early stage esophageal carcinoma in patients with Barrett's esophagus (BE). However, there are several factors, such as variation of BE epithelium (EP) thickness among individual patients and varying RFA catheter-tissue contact, which may compromise RFA efficacy. We used a high-speed optical coherence tomography (OCT) system to identify and monitor changes in the esophageal tissue architecture from RFA. Two different OCT imaging/RFA application protocols were performed using an ex vivo swine esophagus model: (1) post-RFA volumetric OCT imaging for quantitative analysis of the coagulum formation using RFA applications with different energy settings, and (2) M-mode OCT imaging for monitoring the dynamics of tissue architectural changes in real time during RFA application. Post-RFA volumetric OCT measurements showed an increase in the coagulum thickness with respect to the increasing RFA energies. Using a subset of the specimens, OCT measurements of coagulum and coagulum + residual EP thickness were shown to agree with histology, which accounted for specimen shrinkage during histological processing. In addition, we demonstrated the feasibility of OCT for real-time visualization of the architectural changes during RFA application with different energy settings. Results suggest feasibility of using OCT for RFA treatment planning and guidance.

Trends in Facility Management Technology: The Emergence of the Internet, GIS, and Facility Assessment Decision Support.

ERIC Educational Resources Information Center

Teicholz, Eric

1997-01-01

Reports research on trends in computer-aided facilities management using the Internet and geographic information system (GIS) technology for space utilization research. Proposes that facility assessment software holds promise for supporting facility management decision making, and outlines four areas for its use: inventory; evaluation; reporting;…

40 CFR 256.41 - Recommendations for assessing the need for facilities.

Code of Federal Regulations, 2013 CFR

2013-07-01

... facilities and practices and the need for new or expanded facilities and practices. (1) The needs assessment... require new capacity development, based on the needs assessment. ... 40 Protection of Environment 26 2013-07-01 2013-07-01 false Recommendations for assessing the need...

40 CFR 256.41 - Recommendations for assessing the need for facilities.

Code of Federal Regulations, 2012 CFR

2012-07-01

... facilities and practices and the need for new or expanded facilities and practices. (1) The needs assessment... require new capacity development, based on the needs assessment. ... 40 Protection of Environment 26 2012-07-01 2011-07-01 true Recommendations for assessing the need...

40 CFR 256.41 - Recommendations for assessing the need for facilities.

Code of Federal Regulations, 2014 CFR

2014-07-01

... facilities and practices and the need for new or expanded facilities and practices. (1) The needs assessment... require new capacity development, based on the needs assessment. ... 40 Protection of Environment 25 2014-07-01 2014-07-01 false Recommendations for assessing the need...

33 CFR 106.305 - Facility Security Assessment (FSA) requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., including computer systems and networks; (vi) Existing agreements with private security companies; (vii) Any... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Facility Security Assessment (FSA... SECURITY MARITIME SECURITY MARINE SECURITY: OUTER CONTINENTAL SHELF (OCS) FACILITIES Outer Continental...

33 CFR 106.305 - Facility Security Assessment (FSA) requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., including computer systems and networks; (vi) Existing agreements with private security companies; (vii) Any... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Facility Security Assessment (FSA... SECURITY MARITIME SECURITY MARINE SECURITY: OUTER CONTINENTAL SHELF (OCS) FACILITIES Outer Continental...

33 CFR 106.305 - Facility Security Assessment (FSA) requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., including computer systems and networks; (vi) Existing agreements with private security companies; (vii) Any... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Facility Security Assessment (FSA... SECURITY MARITIME SECURITY MARINE SECURITY: OUTER CONTINENTAL SHELF (OCS) FACILITIES Outer Continental...

33 CFR 106.305 - Facility Security Assessment (FSA) requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., including computer systems and networks; (vi) Existing agreements with private security companies; (vii) Any... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Facility Security Assessment (FSA... SECURITY MARITIME SECURITY MARINE SECURITY: OUTER CONTINENTAL SHELF (OCS) FACILITIES Outer Continental...

Aeronautical facilities assessment

NASA Technical Reports Server (NTRS)

Penaranda, F. E. (Compiler)

1985-01-01

A survey of the free world's aeronautical facilities was undertaken and an evaluation made on where the relative strengths and weaknesses exist. Special emphasis is given to NASA's own capabilities and needs. The types of facilities surveyed are: Wind Tunnels; Airbreathing Propulsion Facilities; and Flight Simulators

Underwater Facilities Inspection and Assessment at Magnetic Silencing Facility, Naval Submarine Base, Trident Support Site, Bangor, Washington.

DTIC Science & Technology

1980-10-01

failure was noted in any other area of the facility. :’.. - . - ..- UNDERWATER FACILITI ES INSPECTION AND ASSESSMENT AT S- MAGNETIC SILENCING FACILITY...piling were found to be in excellent condition. No damage or failure was noted in any other * area of the facility. EXECUTIVE SUI’IARY TABLE U Piling...5-1 LEGEND TO TABLES. .... ........... ........ T-1 - -TABLE 1: REMAINING CROSS-SECTIONAL AREA AND DESCRIPTION OF DAMAGE TO

40 CFR 256.41 - Recommendations for assessing the need for facilities.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 25 2011-07-01 2011-07-01 false Recommendations for assessing the need for facilities. 256.41 Section 256.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... their impact on facility needs should be assessed. (3) Current and projected movement of solid and...

40 CFR 256.41 - Recommendations for assessing the need for facilities.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Recommendations for assessing the need for facilities. 256.41 Section 256.41 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... their impact on facility needs should be assessed. (3) Current and projected movement of solid and...

Quality of antenatal care service provision in health facilities across sub-Saharan Africa: Evidence from nationally representative health facility assessments.

PubMed

Kanyangarara, Mufaro; Munos, Melinda K; Walker, Neff

2017-12-01

Utilization of antenatal care (ANC) services has increased over the past two decades. Continued gains in maternal and newborn health will require an understanding of both access and quality of ANC services. We linked health facility and household survey data to examine the quality of service provision for five ANC interventions across health facilities in sub-Saharan Africa. Using data from 20 nationally representative health facility assessments - the Service Provision Assessment (SPA) and the Service Availability and Readiness Assessment (SARA), we estimated facility level readiness to deliver five ANC interventions: tetanus toxoid vaccine for pregnant women, intermittent preventive treatment for malaria in pregnancy (IPTp), syphilis detection and treatment in pregnancy, iron supplementation and hypertensive disease case management. Facility level indicators were stratified by health facility type, managing authority and location, then linked to estimates of ANC utilization in that stratum from the corresponding Demographic and Health Surveys (DHS) to generate population level estimates of the 'likelihood of appropriate care'. Finally, the association between estimates of the 'likelihood of appropriate care' from the linking approach and estimates of coverage levels from the DHS were assessed. A total of 10 534 health facilities were surveyed in the 20 health facility assessments, of which 8742 reported offering ANC services and were included in the analysis. Health facility readiness to deliver IPTp, iron supplementation, and tetanus toxoid vaccination was higher (median: 84.1%, 84.9% and 82.8% respectively) than readiness to deliver hypertensive disease case management and syphilis detection and treatment (median: 23.0% and 19.9% respectively). Coverage of at least 4 ANC visits ranged from 24.8% to 75.8%. Estimates of the likelihood of appropriate care derived from linking health facility and household survey data showed marked gaps for all interventions

LV dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging in patients with Wolff-Parkinson-White syndrome.

PubMed

Chen, Chun; Li, Dianfu; Miao, Changqing; Feng, Jianlin; Zhou, Yanli; Cao, Kejiang; Lloyd, Michael S; Chen, Ji

2012-07-01

The purpose of this study was to evaluate left ventricular (LV) mechanical dyssynchrony in patients with Wolff-Parkinson-White (WPW) syndrome pre- and post-radiofrequency catheter ablation (RFA) using phase analysis of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Forty-five WPW patients were enrolled and had gated SPECT MPI pre- and 2-3 days post-RFA. Electrophysiological study (EPS) was used to locate accessory pathways (APs) and categorize the patients according to the AP locations (septal, left and right free wall). Electrocardiography (ECG) was performed pre- and post-RFA to confirm successful elimination of the APs. Phase analysis of gated SPECT MPI was used to assess LV dyssynchrony pre- and post-RFA. Among the 45 patients, 3 had gating errors, and thus 42 had SPECT phase analysis. Twenty-two patients (52.4%) had baseline LV dyssynchrony. Baseline LV dyssynchrony was more prominent in the patients with septal APs than in the patients with left or right APs (p < 0.05). RFA improved LV synchrony in the entire cohort and in the patients with septal APs (p < 0.01). Phase analysis of gated SPECT MPI demonstrated that LV mechanical dyssynchrony can be present in patients with WPW syndrome. Septal APs result in the greatest degree of LV mechanical dyssynchrony and afford the most benefit after RFA. This study supports further investigation in the relationship between electrical and mechanical activation using EPS and phase analysis of gated SPECT MPI.

RCRA Facility Investigation/Remedial Investigation Report for Gunsite 720 Rubble Pit Unit (631-16G) - March 1996

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

Palmer, E.

1996-03-01

Gunsite 720 Rubble Pit Unit is located on the west side of SRS. In the early to mid 1980`s, while work was being performed in this area, nine empty, partially buried drums, labeled `du Pont Freon 11`, were found. As a result, Gunsite 720 became one of the original waste units specified in the SRS RCRA Facility Assessment (RFA). The drums were excavated on July 30, 1987 and placed on a pallet at the unit. Both the drums and pallet were removed and disposed of in October 1989. The area around the drums was screened during the excavation and themore » liquid (rainwater) that collected in the excavated drums was sampled prior to disposal. No evidence of hazardous materials was found. Based on the review of the analytical data and screening techniques used to evaluate all the chemicals of potential concern at Gunsite 720 Rubble Pit Unit, it is recommended that no further remedial action be performed at this unit.« less

Quality of antenatal care service provision in health facilities across sub–Saharan Africa: Evidence from nationally representative health facility assessments

PubMed Central

Kanyangarara, Mufaro; Munos, Melinda K; Walker, Neff

2017-01-01

Background Utilization of antenatal care (ANC) services has increased over the past two decades. Continued gains in maternal and newborn health will require an understanding of both access and quality of ANC services. We linked health facility and household survey data to examine the quality of service provision for five ANC interventions across health facilities in sub–Saharan Africa. Methods Using data from 20 nationally representative health facility assessments – the Service Provision Assessment (SPA) and the Service Availability and Readiness Assessment (SARA), we estimated facility level readiness to deliver five ANC interventions: tetanus toxoid vaccine for pregnant women, intermittent preventive treatment for malaria in pregnancy (IPTp), syphilis detection and treatment in pregnancy, iron supplementation and hypertensive disease case management. Facility level indicators were stratified by health facility type, managing authority and location, then linked to estimates of ANC utilization in that stratum from the corresponding Demographic and Health Surveys (DHS) to generate population level estimates of the ‘likelihood of appropriate care’. Finally, the association between estimates of the ‘likelihood of appropriate care’ from the linking approach and estimates of coverage levels from the DHS were assessed. Findings A total of 10 534 health facilities were surveyed in the 20 health facility assessments, of which 8742 reported offering ANC services and were included in the analysis. Health facility readiness to deliver IPTp, iron supplementation, and tetanus toxoid vaccination was higher (median: 84.1%, 84.9% and 82.8% respectively) than readiness to deliver hypertensive disease case management and syphilis detection and treatment (median: 23.0% and 19.9% respectively). Coverage of at least 4 ANC visits ranged from 24.8% to 75.8%. Estimates of the likelihood of appropriate care derived from linking health facility and household survey data

Using Facility Condition Assessments to Identify Actions Related to Infrastructure

NASA Technical Reports Server (NTRS)

Rubert, Kennedy F.

2010-01-01

To support cost effective, quality research it is essential that laboratory and testing facilities are maintained in a continuous and reliable state of availability at all times. NASA Langley Research Center (LaRC) and its maintenance contractor, Jacobs Technology, Inc. Research Operations, Maintenance, and Engineering (ROME) group, are in the process of implementing a combined Facility Condition Assessment (FCA) and Reliability Centered Maintenance (RCM) program to improve asset management and overall reliability of testing equipment in facilities such as wind tunnels. Specific areas are being identified for improvement, the deferred maintenance cost is being estimated, and priority is being assigned against facilities where conditions have been allowed to deteriorate. This assessment serves to assist in determining where to commit available funds on the Center. RCM methodologies are being reviewed and enhanced to assure that appropriate preventive, predictive, and facilities/equipment acceptance techniques are incorporated to prolong lifecycle availability and assure reliability at minimum cost. The results from the program have been favorable, better enabling LaRC to manage assets prudently.

LV dyssynchrony as assessed by phase analysis of gated SPECT myocardial perfusion imaging in patients with Wolff-Parkinson-White syndrome

PubMed Central

Chen, Chun; Miao, Changqing; Feng, Jianlin; Zhou, Yanli; Cao, Kejiang; Lloyd, Michael S.; Chen, Ji

2013-01-01

Purpose The purpose of this study was to evaluate left ventricular (LV) mechanical dyssynchrony in patients with Wolff-Parkinson-White (WPW) syndrome pre- and post-radiofrequency catheter ablation (RFA) using phase analysis of gated single photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). Methods Forty-five WPW patients were enrolled and had gated SPECT MPI pre- and 2–3 days post-RFA. Electrophysiological study (EPS) was used to locate accessory pathways (APs) and categorize the patients according to the AP locations (septal, left and right free wall). Electrocardiography (ECG) was performed pre- and post-RFA to confirm successful elimination of the APs. Phase analysis of gated SPECT MPI was used to assess LV dyssynchrony pre- and post-RFA. Results Among the 45 patients, 3 had gating errors, and thus 42 had SPECT phase analysis. Twenty-two patients (52.4 %) had baseline LV dyssynchrony. Baseline LV dyssynchrony was more prominent in the patients with septal APs than in the patients with left or right APs (p<0.05). RFA improved LV synchrony in the entire cohort and in the patients with septal APs (p<0.01). Conclusion Phase analysis of gated SPECT MPI demonstrated that LV mechanical dyssynchrony can be present in patients with WPW syndrome. Septal APs result in the greatest degree of LV mechanical dyssynchrony and afford the most benefit after RFA. This study supports further investigation in the relationship between electrical and mechanical activation using EPS and phase analysis of gated SPECT MPI. PMID:22532253

Proposal for a new categorization of aseptic processing facilities based on risk assessment scores.

PubMed

Katayama, Hirohito; Toda, Atsushi; Tokunaga, Yuji; Katoh, Shigeo

2008-01-01

Risk assessment of aseptic processing facilities was performed using two published risk assessment tools. Calculated risk scores were compared with experimental test results, including environmental monitoring and media fill run results, in three different types of facilities. The two risk assessment tools used gave a generally similar outcome. However, depending on the tool used, variations were observed in the relative scores between the facilities. For the facility yielding the lowest risk scores, the corresponding experimental test results showed no contamination, indicating that these ordinal testing methods are insufficient to evaluate this kind of facility. A conventional facility having acceptable aseptic processing lines gave relatively high risk scores. The facility showing a rather high risk score demonstrated the usefulness of conventional microbiological test methods. Considering the significant gaps observed in calculated risk scores and in the ordinal microbiological test results between advanced and conventional facilities, we propose a facility categorization based on risk assessment. The most important risk factor in aseptic processing is human intervention. When human intervention is eliminated from the process by advanced hardware design, the aseptic processing facility can be classified into a new risk category that is better suited for assuring sterility based on a new set of criteria rather than on currently used microbiological analysis. To fully benefit from advanced technologies, we propose three risk categories for these aseptic facilities.

WTP Pretreatment Facility Potential Design Deficiencies--Sliding Bed and Sliding Bed Erosion Assessment

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

Hansen, E. K.

2015-05-06

This assessment is based on readily available literature and discusses both Newtonian and non-Newtonian slurries with respect to sliding beds and erosion due to sliding beds. This report does not quantify the size of the sliding beds or erosion rates due to sliding beds, but only assesses if they could be present. This assessment addresses process pipelines in the Pretreatment (PT) facility and the high level waste (HLW) transfer lines leaving the PT facility to the HLW vitrification facility concentrate receipt vessel.

Environmental assessment of the Carlsbad Environmental Monitoring and Research Center Facility

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

NONE

1995-10-01

This Environmental Assessment has been prepared to determine if the Carlsbad Environmental Monitoring and Research Center (the Center), or its alternatives would have significant environmental impacts that must be analyzed in an Environmental Impact Statement. DOE`s proposed action is to continue funding the Center. While DOE is not funding construction of the planned Center facility, operation of that facility is dependent upon continued funding. To implement the proposed action, the Center would initially construct a facility of approximately 2,300 square meters (25,000 square feet). The Phase 1 laboratory facilities and parking lot will occupy approximately 1.2 hectares (3 acres) ofmore » approximately 8.9 hectares (22 acres) of land which were donated to New Mexico State University (NMSU) for this purpose. The facility would contain laboratories to analyze chemical and radioactive materials typical of potential contaminants that could occur in the environment in the vicinity of the DOE Waste Isolation Pilot Plant (WIPP) site or other locations. The facility also would have bioassay facilities to measure radionuclide levels in the general population and in employees of the WIPP. Operation of the Center would meet the DOE requirement for independent monitoring and assessment of environmental impacts associated with the planned disposal of transuranic waste at the WIPP.« less

Cost-effectiveness of Stereotactic Body Radiation Therapy versus Radiofrequency Ablation for Hepatocellular Carcinoma: A Markov Modeling Study.

PubMed

Pollom, Erqi L; Lee, Kyueun; Durkee, Ben Y; Grade, Madeline; Mokhtari, Daniel A; Wahl, Daniel R; Feng, Mary; Kothary, Nishita; Koong, Albert C; Owens, Douglas K; Goldhaber-Fiebert, Jeremy; Chang, Daniel T

2017-05-01

Purpose To assess the cost-effectiveness of stereotactic body radiation therapy (SBRT) versus radiofrequency ablation (RFA) for patients with inoperable localized hepatocellular carcinoma (HCC) who are eligible for both SBRT and RFA. Materials and Methods A decision-analytic Markov model was developed for patients with inoperable, localized HCC who were eligible for both RFA and SBRT to evaluate the cost-effectiveness of the following treatment strategies: (a) SBRT as initial treatment followed by SBRT for local progression (SBRT-SBRT), (b) RFA followed by RFA for local progression (RFA-RFA), (c) SBRT followed by RFA for local progression (SBRT-RFA), and (d) RFA followed by SBRT for local progression (RFA-SBRT). Probabilities of disease progression, treatment characteristics, and mortality were derived from published studies. Outcomes included health benefits expressed as discounted quality-adjusted life years (QALYs), costs in U.S. dollars, and cost-effectiveness expressed as an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analysis was performed to assess the robustness of the findings. Results In the base case, SBRT-SBRT yielded the most QALYs (1.565) and cost $197 557. RFA-SBRT yielded 1.558 QALYs and cost $193 288. SBRT-SBRT was not cost-effective, at $558 679 per QALY gained relative to RFA-SBRT. RFA-SBRT was the preferred strategy, because RFA-RFA and SBRT-RFA were less effective and more costly. In all evaluated scenarios, SBRT was preferred as salvage therapy for local progression after RFA. Probabilistic sensitivity analysis showed that at a willingness-to-pay threshold of $100 000 per QALY gained, RFA-SBRT was preferred in 65.8% of simulations. Conclusion SBRT for initial treatment of localized, inoperable HCC is not cost-effective. However, SBRT is the preferred salvage therapy for local progression after RFA. © RSNA, 2017 Online supplemental material is available for this article.

Cost-effectiveness of Stereotactic Body Radiation Therapy versus Radiofrequency Ablation for Hepatocellular Carcinoma: A Markov Modeling Study

PubMed Central

Lee, Kyueun; Durkee, Ben Y.; Grade, Madeline; Mokhtari, Daniel A.; Wahl, Daniel R.; Feng, Mary; Kothary, Nishita; Koong, Albert C.; Owens, Douglas K.; Goldhaber-Fiebert, Jeremy; Chang, Daniel T.

2017-01-01

Purpose To assess the cost-effectiveness of stereotactic body radiation therapy (SBRT) versus radiofrequency ablation (RFA) for patients with inoperable localized hepatocellular carcinoma (HCC) who are eligible for both SBRT and RFA. Materials and Methods A decision-analytic Markov model was developed for patients with inoperable, localized HCC who were eligible for both RFA and SBRT to evaluate the cost-effectiveness of the following treatment strategies: (a) SBRT as initial treatment followed by SBRT for local progression (SBRT-SBRT), (b) RFA followed by RFA for local progression (RFA-RFA), (c) SBRT followed by RFA for local progression (SBRT-RFA), and (d) RFA followed by SBRT for local progression (RFA-SBRT). Probabilities of disease progression, treatment characteristics, and mortality were derived from published studies. Outcomes included health benefits expressed as discounted quality-adjusted life years (QALYs), costs in U.S. dollars, and cost-effectiveness expressed as an incremental cost-effectiveness ratio. Deterministic and probabilistic sensitivity analysis was performed to assess the robustness of the findings. Results In the base case, SBRT-SBRT yielded the most QALYs (1.565) and cost $197 557. RFA-SBRT yielded 1.558 QALYs and cost $193 288. SBRT-SBRT was not cost-effective, at $558 679 per QALY gained relative to RFA-SBRT. RFA-SBRT was the preferred strategy, because RFA-RFA and SBRT-RFA were less effective and more costly. In all evaluated scenarios, SBRT was preferred as salvage therapy for local progression after RFA. Probabilistic sensitivity analysis showed that at a willingness-to-pay threshold of $100 000 per QALY gained, RFA-SBRT was preferred in 65.8% of simulations. Conclusion SBRT for initial treatment of localized, inoperable HCC is not cost-effective. However, SBRT is the preferred salvage therapy for local progression after RFA. © RSNA, 2017 Online supplemental material is available for this article. PMID:28045603

78 FR 63128 - Dried Prunes Produced in California; Increased Assessment Rate

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-23

...; Increased Assessment Rate AGENCY: Agricultural Marketing Service, USDA. ACTION: Proposed rule. SUMMARY: This... the Regulatory Flexibility Act (RFA) (5 U.S.C. 601-612), the Agricultural Marketing Service (AMS) has... prunes. Dated: October 17, 2013. Rex A. Barnes, Associate Administrator, Agricultural Marketing Service...

RCRA Facility Investigation/Remedial Investigation Report with Baseline Risk Assessment for the Fire Department Hose Training Facility (904-113G)

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

Palmer, E.

1997-04-01

This report documents the Resource Conservation and Recovery Act (RCRA) Facility Investigation/Remedial Investigation/Baseline Risk Assessment (RFI/RI/BRA) for the Fire Department Hose Training Facility (FDTF) (904-113G).

Percutaneous radiofrequency ablation for hepatic tumors abutting the diaphragm: clinical assessment of the heat-sink effect of artificial ascites.

PubMed

Nam, Sang Yu; Rhim, Hyunchul; Kang, Tae Wook; Lee, Min Woo; Kim, Young-Sun; Choi, Dongil; Lee, Won Jae; Park, Yulri; Chang, Ilsoo; Lim, Hyo K

2010-02-01

This study was designed to assess whether artificial ascites has a heat-sink effect on the ablation zone for percutaneous radiofrequency ablation (RFA) of hepatic tumors abutting the diaphragm. We retrospectively assessed 28 patients who underwent percutaneous RFA for the treatment of a single nodular hepatic tumor that abutted the diaphragm from July 2000 to December 2006. All patients underwent ultrasound-guided RFA using internally cooled electrodes. A single ablation for 12 minutes was applied using 3-cm active-tip electrodes. We divided patients into two groups on the basis of whether artificial ascites was introduced before RFA: Group A consisted of patients who received artificial ascites with a mean of 760 mL of a 5% dextrose in water solution (n = 15) and group B consisted of patients who did not receive artificial ascites (n = 13). The volume of the ablation zone was measured on CT images obtained immediately after the ablation procedure, and imaging findings were compared for both groups using the Student's t test. We also compared the local tumor progression rate between both groups using the chi-square test (mean follow-up, 37.4 months). There was no significant difference between the two patient groups with regard to age, sex, Child-Pugh class, or tumor location (p > 0.05). The tumors were significantly smaller in group A patients (mean +/- SD, 1.6 +/- 0.5 cm) than in group B patients (2.1 +/- 0.7 cm) (p = 0.019). The mean volume of the RFA zone was 31.6 +/- 11.9 cm(3) in group A patients and 30.9 +/- 11.0 cm(3) in group B patients. There was no significant difference between the groups in the ablation volume (p = 0.871). Local tumor progression was noted in four patients (26.7%) in group A and in three patients (23.1%) in group B. There was no significant difference in the local tumor progression rate between the two groups (p = 0.83). Artificial ascites did not show a heat-sink effect on the volume of the ablation zone after percutaneous RFA for the

Assessment of radiofrequency ablation margin by MRI-MRI image fusion in hepatocellular carcinoma.

PubMed

Wang, Xiao-Li; Li, Kai; Su, Zhong-Zhen; Huang, Ze-Ping; Wang, Ping; Zheng, Rong-Qin

2015-05-07

To investigate the feasibility and clinical value of magnetic resonance imaging (MRI)-MRI image fusion in assessing the ablative margin (AM) for hepatocellular carcinoma (HCC). A newly developed ultrasound workstation for MRI-MRI image fusion was used to evaluate the AM of 62 tumors in 52 HCC patients after radiofrequency ablation (RFA). The lesions were divided into two groups: group A, in which the tumor was completely ablated and 5 mm AM was achieved (n = 32); and group B, in which the tumor was completely ablated but 5 mm AM was not achieved (n = 29). To detect local tumor progression (LTP), all patients were followed every two months by contrast-enhanced ultrasound, contrast-enhanced MRI or computed tomography (CT) in the first year after RFA. Then, the follow-up interval was prolonged to every three months after the first year. Of the 62 tumors, MRI-MRI image fusion was successful in 61 (98.4%); the remaining case had significant deformation of the liver and massive ascites after RFA. The time required for creating image fusion and AM evaluation was 15.5 ± 5.5 min (range: 8-22 min) and 9.6 ± 3.2 min (range: 6-14 min), respectively. The follow-up period ranged from 1-23 mo (14.2 ± 5.4 mo). In group A, no LTP was detected in 32 lesions, whereas in group B, LTP was detected in 4 of 29 tumors, which occurred at 2, 7, 9, and 15 mo after RFA. The frequency of LTP in group B (13.8%; 4/29) was significantly higher than that in group A (0/32, P = 0.046). All of the LTPs occurred in the area in which the 5 mm AM was not achieved. The MRI-MRI image fusion using an ultrasound workstation is feasible and useful for evaluating the AM after RFA for HCC.

Torsional resonance frequency analysis: a novel method for assessment of dental implant stability.

PubMed

Tang, Yu-Long; Li, Bing; Jin, Wei; Li, De-Hua

2015-06-01

To establish and experimentally validate a novel resonance frequency analysis (RFA) method for measurement of dental implant stability by analyzing torsional resonance frequency (TRF). A numerical study and in vitro measurements were performed to evaluate the feasibility and reliability of the method of torsional RFA (T-RFA) using a T-shaped bilateral cantilever beam transducer. The sensitivity of this method was assessed by measuring the TRFs of dental implants with 8 sizes of T-shaped transducers during polymerization, which simulated the process of bone healing around an implant. The TRFs of the test implants detected using this new method and the bending resonance frequencies (BRFs) measured by Osstell(®) ISQ were compared. TRFs and BRFs on implant models in polymethyl methacrylate (PMMA) blocks with three exposure heights were also measured to assess the specificity of this method. Finite element analysis showed two bending modes (5333 and 6008 Hz) following a torsional mode (8992 Hz) in the lower rank frequency. During in vitro measurements, a bending formant (mean 6075 Hz) and a torsional formant (mean 10225 Hz) appeared, which were verified by multipoint measurement with invariable excitation frequency in the laboratory. In the self-curing resin experiments, the average growth rate at all time points of TRFs using the new method with Transducer II was 2.36% and that of BRFs using Osstell(®) ISQ was 1.97%. In the implant exposure height tests, the mean declined rate of TRFs was 2.06% and that of BRFs using Osstell(®) ISQ was 12.34%. A novel method for assessment of implant stability through TRF was established using a T-shape transducer, which showed high reliability and sensibility. The method alleviated the effects of implant exposure height on the measurements compared with Osstell(®) ISQ. The application of T-RFA represents another way in the investigation of dental implant osseointegration. © 2014 John Wiley & Sons A/S. Published by John Wiley

Vulnerability Assessments and Resilience Planning at Federal Facilities. Preliminary Synthesis of Project

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

Moss, R. H.; Blohm, A. J.; Delgado, A.

2015-08-15

U.S. government agencies are now directed to assess the vulnerability of their operations and facilities to climate change and to develop adaptation plans to increase their resilience. Specific guidance on methods is still evolving based on the many different available frameworks. Agencies have been experimenting with these frameworks and approaches. This technical paper synthesizes lessons and insights from a series of research case studies conducted by the investigators at facilities of the U.S. Department of Energy and the Department of Defense. The purpose of the paper is to solicit comments and feedback from interested program managers and analysts before finalmore » conclusions are published. The paper describes the characteristics of a systematic process for prioritizing needs for adaptation planning at individual facilities and examines requirements and methods needed. It then suggests a framework of steps for vulnerability assessments at Federal facilities and elaborates on three sets of methods required for assessments, regardless of the detailed framework used. In a concluding section, the paper suggests a roadmap to further develop methods to support agencies in preparing for climate change. The case studies point to several preliminary conclusions; (1) Vulnerability assessments are needed to translate potential changes in climate exposure to estimates of impacts and evaluation of their significance for operations and mission attainment, in other words into information that is related to and useful in ongoing planning, management, and decision-making processes; (2) To increase the relevance and utility of vulnerability assessments to site personnel, the assessment process needs to emphasize the characteristics of the site infrastructure, not just climate change; (3) A multi-tiered framework that includes screening, vulnerability assessments at the most vulnerable installations, and adaptation design will efficiently target high-risk sites and

Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

PubMed

Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

2015-05-01

Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

Characterizing and Optimizing the TITAN facility from Energy Spread Determinations with a Retarding Energy Field Analyzer

NASA Astrophysics Data System (ADS)

Champagne, Christian

The TITAN (TRIUMF's Ion Trap for Atomic and Nuclear science) experiment uses a Measurement Penning Trap (MPET) to perform high precision mass measurements (deltam/m ≈ 10--8) on short-lived (t1/2 ≈ 10 ms) isotopes. The ISAC (Isotope Separation and ACceleration) facility provides a 60 keV rare isotope beam to the experiments. A Radio-Frequency Quadrupole (RFQ) ion trap cools and bunches the incoming radioactive beam. An Electron Beam Ion Trap (EBIT) charge breeds the ions to a high charged state q. Since the MPET mass resolution is proportional to the charge state q, an improvement up to two orders of magnitude can be achieved. Further enhancements are obtained by the reduction of the uncertainty on the MPET measurements, such as from the ion bunch longitudinal kinetic energy spread. A Retarding Field energy Analyzer (RFA) was designed and constructed to measure this uncertainty. An energy resolution DeltaE/E ≈ 10--3 was expected from to simulated RFQ ion extraction longitudinal energy spread measurements. An experimental energy resolution DeltaE/E = 2.4x10--3 was obtained. Suggestions to improve the energy resolution are provided. Two testing sessions were undertaken using the RFQ and TITAN ion source to provide a singly charged pulsed ion beam. The first session used a 6Li+ beam with a 1--4 keV energy range. The RFA collimating slits were removed to insure the beam entered the RFA, increasing the energy resolution to DeltaE/E = 5 x 10 --3. An energy resolution DeltaE/E = (1.4 +/- 0.5) x 10--2 was obtained from the longitudinal energy spread measurements as a function of the beam energy. No correlation between the RFQ buffer gas pressure and the longitudinal energy spread was observed. The second session used 6,7Li, 23Na, 39,41K beams with a 1--5 keV energy range and the slits were reincorporated. A linear correlation with the RFQ extraction potentials magnitude is visible with both 2.5 keV 7Li+ and 23Na+ beams. No correlations between the RFQ buffer gas

The Maximum standardized uptake value is more reliable than size measurement in early follow-up to evaluate potential pulmonary malignancies following radiofrequency ablation.

PubMed

Alafate, Aierken; Shinya, Takayoshi; Okumura, Yoshihiro; Sato, Shuhei; Hiraki, Takao; Ishii, Hiroaki; Gobara, Hideo; Kato, Katsuya; Fujiwara, Toshiyoshi; Miyoshi, Shinichiro; Kaji, Mitsumasa; Kanazawa, Susumu

2013-01-01

We retrospectively evaluated the accumulation of fluorodeoxy glucose (FDG) in pulmonary malignancies without local recurrence during 2-year follow-up on positron emission tomography (PET)/computed tomography (CT) after radiofrequency ablation (RFA). Thirty tumors in 25 patients were studied (10 non-small cell lung cancers;20 pulmonary metastatic tumors). PET/CT was performed before RFA, 3 months after RFA, and 6 months after RFA. We assessed the FDG accumulation with the maximum standardized uptake value (SUVmax) compared with the diameters of the lesions. The SUVmax had a decreasing tendency in the first 6 months and, at 6 months post-ablation, FDG accumulation was less affected by inflammatory changes than at 3 months post-RFA. The diameter of the ablated lesion exceeded that of the initial tumor at 3 months post-RFA and shrank to pre-ablation dimensions by 6 months post-RFA. SUVmax was more reliable than the size measurements by CT in the first 6 months after RFA, and PET/CT at 6 months post-RFA may be more appropriate for the assessment of FDG accumulation than that at 3 months post-RFA.

Decision support tool to assess importance of transportation facilities.

DOT National Transportation Integrated Search

2008-01-01

Assessing the importance of transportation facilities is an increasingly growing topic of interest to federal and state transportation agencies. This work proposes an optimization based model that uses concepts and techniques of complex networks scie...

Primary stability and self-tapping blades: biomechanical assessment of dental implants in medium-density bone.

PubMed

Kim, Yung-Soo; Lim, Young-Jun

2011-10-01

The aim of this biomechanical study was to assess the influence of self-tapping blades in terms of primary implant stability between implants with self-tapping blades and implants without self-tapping blades using five different analytic methods, especially in medium-density bone. Two different types of dental implants (4 × 10 mm) were tested: self-tapping and non-self-tapping. The fixture design including thread profiles was exactly the same between the two groups; the only difference was the presence of cutting blades on one half of the apical portion of the implant body. Solid rigid polyurethane blocks with corresponding densities were selected to simulate medium-density bone. Five mechanical assessments (insertion torque, resonance frequency analysis [RFA], reverse torque, pull-out and push in test) were performed for primary stability. Implants without self-tapping blades showed significantly higher values (P<0.001) in four biomechanical assessments, except RFA (P=0.684). However, a statistically significant correlation could not be detected between insertion torque values with the four different outcome variables (P>0.05). The outcomes of the present study indicate that the implant body design without self-tapping blades has a good primary stability compared with that with self-tapping blades in medium-density bone. Considering the RFA, a distinct layer of cortical bone on marginal bone will yield implant stability quotient values similar to those in medium-bone density when implants have the same diameter. © 2011 John Wiley & Sons A/S.

A preliminary identification of Rf*-A619, a novel restorer gene for CMS-C in maize (Zea mays L.).

PubMed

Yongming, Liu; Zhuofan, Zhao; Yanli, Lu; Chuan, Li; Jing, Wang; Boxiao, Dong; Bing, Liang; Tao, Qiu; Wenbing, Zeng; Moju, Cao

2016-01-01

C-type cytoplasmic male sterility (CMS-C) is widely utilized for hybrid maize seed production. However, genetic mechanisms underlying the fertility restoration are very complicated. At present, there is a divergence on the number of fertility restorer genes in maize inbred line A619 for CMS-C. To further elucidate the restoring mechanism of A619, we used genetic analysis and molecular markers to confirm the restorer genes of maize inbred line A619 for C-type male sterile line C48-2 in this study. Firstly, the fertility segregations of (C48-2 × A619)F 2 populations were investigated under three environments during 2013-2015. The segregation ratio of fertile and sterile plants in the F 2 population fit to 15:1 via chi-square test and this result suggested that there are two dominant restorer genes in A619 for CMS-C, i.e., Rf4 and a novel gene named Rf*-A619 . Next, based on the sequence differences between Rf4 and its recessive allelic rf4 , a novel dominant marker F2/R2 was developed and validated to genotyping Rf4 in the F 2 population. Through genotypic analysis, we found that there were a certain amount of fertile individuals without Rf4 which accounted for 3/16 in the F 2 population via chi-square test at the 0.05 level. These results provided another proof to sustain that the inbred line A619 contains one additional restorer gene for CMS-C fertility restoration except Rf4 . At last, we used one SSR marker which is tightly linked with the dominant restorer gene Rf5 to analyze those fertile plants without Rf4 in the F 2 population. The PCR amplification results showed that Rf*-A619 is not allelic to Rf5 but a novel restorer gene for CMS-C. These results not only provide a basis for the mapping and characterization of a novel restorer gene but also give a new insight into the mechanism of CMS-C fertility restoration.

Diagnostic accuracy of 18F-FDG PET/CT for assessing response to radiofrequency ablation treatment in lung metastases: a multicentre prospective study.

PubMed

Bonichon, Françoise; Palussière, Jean; Godbert, Yann; Pulido, Marina; Descat, Edouard; Devillers, Anne; Meunier, Catherine; Leboulleux, Sophie; de Baère, Thierry; Galy-Lacour, Claire; Lagoarde-Segot, Laurent; Cazeau, Anne-Laure

2013-12-01

To assess diagnostic accuracy of (18)F-FDG PET/CT at 3 months for the detection of local recurrence after radiofrequency ablation (RFA) of lung metastases. The PET/CT scan at 3 months was compared with a baseline PET/CT scan from a maximum of 2 months before RFA, with the reference standard as recurrence diagnosed by CT during a 12-month follow-up. Local recurrence was diagnosed on the PET/CT scan if lesional uptake was greater than the mediastinal background. Maximum standardized uptake values (SUVmax) were recorded. ROC curve analysis for SUVmax was performed. Overall survival (OS) and time to local relapse were computed from the date of RFA using the Kaplan-Meier method (www.clinicaltrials.gov: NCT 00382252). Between 2005 and 2009, 89 patients (mean age 65 years) underwent RFA for 115 lung metastases (mean size 16.2 ± 6.9 mm). The median SUVmax before RFA was 5.8 ± 4. PET/CT at 3 months and the reference standard were available in 77 patients and 100 lesions. Accuracy was 66.00% (95% CI 55.85-75.18%), sensitivity 90.91% (95 % CI 58.72-99.77 %), specificity 62.92% (95% CI 52.03-72.93%), PPV 23.26% (95% CI 11.76-38.63%), and NPV 98.25% (95% CI 90.61-99.96%). One-year OS was 94.2% (95% CI 86.6-97.5%) and the probability of being free of local recurrence 1 year after RFA was 84.6% (95% CI 75.0-90.8%). The specificity of PET/CT at 3 months is low because of persistent inflammation, especially when the lesion is close to the pleura. This technique is useful for its negative predictive value, but positive findings need to be confirmed by histology before new treatment is planned.

Alcoa: Plant-Wide Energy Assessment Finds Potential Savings at Aluminum Extrusion Facility

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

None

2003-09-01

Alcoa completed an energy assessment of its Engineered Products aluminum extrusion facility in Plant City, Florida, in 2001. The company identified energy conservation opportunities throughout the plant and prepared a report as an example for performing energy assessments at similar Alcoa facilities. If implemented, the cost of energy for the plant would be reduced by more than $800,000 per year by conserving 3 million kWh of electricity and 150,000 MMBtu of natural gas.

Homologous overexpression of rfaH in E. coli K4 improves the production of chondroitin-like capsular polysaccharide

PubMed Central

2013-01-01

Background Glycosaminoglycans, such as hyaluronic acid, heparin, and chondroitin sulfate, are among the top ranked products in industrial biotechnology for biomedical applications, with a growing world market of billion dollars per year. Recently a remarkable progress has been made in the development of tailor-made strains as sources for the manufacturing of such products. The genetic modification of E. coli K4, a natural producer of chondroitin sulfate precursor, is challenging considering the lack of detailed information on its genome, as well as its mobilome. Chondroitin sulfate is currently used as nutraceutical for the treatment of osteoarthritis, and several new therapeutic applications, spanning from the development of skin substitutes to live attenuated vaccines, are under evaluation. Results E. coli K4 was used as host for the overexpression of RfaH, a positive regulator that controls expression of the polysaccharide biosynthesis genes and other genes necessary for the virulence of E. coli K4. Various engineering strategies were compared to investigate different types of expression systems (plasmid vs integrative cassettes) and integration sites (genome vs endogenous mobile element). All strains analysed in shake flasks on different media showed a capsular polysaccharide production improved by 40 to 140%, compared to the wild type, with respect to the final product titer. A DO-stat fed-batch process on the 2L scale was also developed for the best performing integrative strain, EcK4r3, yielding 5.3 g∙L-1 of K4 polysaccharide. The effect of rfaH overexpression in EcK4r3 affected the production of lipopolysaccharide and the expression of genes involved in the polysaccharide biosynthesis pathway (kfoC and kfoA), as expected. An alteration of cellular metabolism was revealed by changes of intracellular pools of UDP-sugars which are used as precursors for polysaccharide biosynthesis. Conclusions The present study describes the identification of a gene target

Homologous overexpression of RfaH in E. coli K4 improves the production of chondroitin-like capsular polysaccharide.

PubMed

Cimini, Donatella; De Rosa, Mario; Carlino, Elisabetta; Ruggiero, Alessandro; Schiraldi, Chiara

2013-05-09

Glycosaminoglycans, such as hyaluronic acid, heparin, and chondroitin sulfate, are among the top ranked products in industrial biotechnology for biomedical applications, with a growing world market of billion dollars per year. Recently a remarkable progress has been made in the development of tailor-made strains as sources for the manufacturing of such products. The genetic modification of E. coli K4, a natural producer of chondroitin sulfate precursor, is challenging considering the lack of detailed information on its genome, as well as its mobilome. Chondroitin sulfate is currently used as nutraceutical for the treatment of osteoarthritis, and several new therapeutic applications, spanning from the development of skin substitutes to live attenuated vaccines, are under evaluation. E. coli K4 was used as host for the overexpression of RfaH, a positive regulator that controls expression of the polysaccharide biosynthesis genes and other genes necessary for the virulence of E. coli K4. Various engineering strategies were compared to investigate different types of expression systems (plasmid vs integrative cassettes) and integration sites (genome vs endogenous mobile element). All strains analysed in shake flasks on different media showed a capsular polysaccharide production improved by 40 to 140%, compared to the wild type, with respect to the final product titer. A DO-stat fed-batch process on the 2L scale was also developed for the best performing integrative strain, EcK4r3, yielding 5.3 g ∙ L(-1) of K4 polysaccharide. The effect of rfaH overexpression in EcK4r3 affected the production of lipopolysaccharide and the expression of genes involved in the polysaccharide biosynthesis pathway (kfoC and kfoA), as expected. An alteration of cellular metabolism was revealed by changes of intracellular pools of UDP-sugars which are used as precursors for polysaccharide biosynthesis. The present study describes the identification of a gene target and the application of a

Network Performance Evaluation Model for assessing the impacts of high-occupancy vehicle facilities

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

Janson, B.N.; Zozaya-Gorostiza, C.; Southworth, F.

1986-09-01

A model to assess the impacts of major high-occupancy vehicle (HOV) facilities on regional levels of energy consumption and vehicle air pollution emissions in urban aeas is developed and applied. This model can be used to forecast and compare the impacts of alternative HOV facility design and operation plans on traffic patterns, travel costs, model choice, travel demand, energy consumption and vehicle emissions. The model is designed to show differences in the overall impacts of alternative HOV facility types, locations and operation plans rather than to serve as a tool for detailed engineering design and traffic planning studies. The Networkmore » Performance Evaluation Model (NETPEM) combines several urban transportation planning models within a multi-modal network equilibrium framework including modules with which to define the type, location and use policy of the HOV facility to be tested, and to assess the impacts of this facility.« less

Assessing post-abortion care in health facilities in Afghanistan: a cross-sectional study.

PubMed

Ansari, Nasratullah; Zainullah, Partamin; Kim, Young Mi; Tappis, Hannah; Kols, Adrienne; Currie, Sheena; Haver, Jaime; van Roosmalen, Jos; Broerse, Jacqueline E W; Stekelenburg, Jelle

2015-02-03

Complications of abortion are one of the leading causes of maternal mortality worldwide, along with hemorrhage, sepsis, and hypertensive diseases of pregnancy. In Afghanistan little data exist on the capacity of the health system to provide post-abortion care (PAC). This paper presents findings from a national emergency obstetric and neonatal care needs assessment related to PAC, with the aim of providing insight into the current situation and recommendations for improvement of PAC services. A national Emergency Obstetric and Neonatal Care Needs Assessment was conducted from December 2009 through February 2010 at 78 of the 127 facilities designated to provide emergency obstetric and neonatal care services in Afghanistan. Research tools were adapted from the Averting Maternal Death and Disability Program Needs Assessment Toolkit and national midwifery education assessment tools. Descriptive statistics were used to summarize facility characteristics, and linear regression models were used to assess the factors associated with providers' PAC knowledge and skills. The average number of women receiving PAC in the past year in each facility was 244, with no significant difference across facility types. All facilities had at least one staff member who provided PAC services. Overall, 70% of providers reported having been trained in PAC and 68% felt confident in their ability to perform these services. On average, providers were able to identify 66% of the most common complications of unsafe or incomplete abortion and 57% of the steps to take in examining and managing women with these complications. Providers correctly demonstrated an average of 31% of the tasks required for PAC during a simulated procedure. Training was significantly associated with PAC knowledge and skills in multivariate regression models, but other provider and facility characteristics were not. While designated emergency obstetric facilities in Afghanistan generally have most supplies and equipment for

Metrics for Success: Strategies for Enabling Core Facility Performance and Assessing Outcomes

PubMed Central

Hockberger, Philip E.; Meyn, Susan M.; Nicklin, Connie; Tabarini, Diane; Auger, Julie A.

2016-01-01

Core Facilities are key elements in the research portfolio of academic and private research institutions. Administrators overseeing core facilities (core administrators) require assessment tools for evaluating the need and effectiveness of these facilities at their institutions. This article discusses ways to promote best practices in core facilities as well as ways to evaluate their performance across 8 of the following categories: general management, research and technical staff, financial management, customer base and satisfaction, resource management, communications, institutional impact, and strategic planning. For each category, we provide lessons learned that we believe contribute to the effective and efficient overall management of core facilities. If done well, we believe that encouraging best practices and evaluating performance in core facilities will demonstrate and reinforce the importance of core facilities in the research and educational mission of institutions. It will also increase job satisfaction of those working in core facilities and improve the likelihood of sustainability of both facilities and personnel. PMID:26848284

Metrics for Success: Strategies for Enabling Core Facility Performance and Assessing Outcomes.

PubMed

Turpen, Paula B; Hockberger, Philip E; Meyn, Susan M; Nicklin, Connie; Tabarini, Diane; Auger, Julie A

2016-04-01

Core Facilities are key elements in the research portfolio of academic and private research institutions. Administrators overseeing core facilities (core administrators) require assessment tools for evaluating the need and effectiveness of these facilities at their institutions. This article discusses ways to promote best practices in core facilities as well as ways to evaluate their performance across 8 of the following categories: general management, research and technical staff, financial management, customer base and satisfaction, resource management, communications, institutional impact, and strategic planning. For each category, we provide lessons learned that we believe contribute to the effective and efficient overall management of core facilities. If done well, we believe that encouraging best practices and evaluating performance in core facilities will demonstrate and reinforce the importance of core facilities in the research and educational mission of institutions. It will also increase job satisfaction of those working in core facilities and improve the likelihood of sustainability of both facilities and personnel.

Remote video assessment for missile launch facilities

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

Wagner, G.G.; Stewart, W.A.

1995-07-01

The widely dispersed, unmanned launch facilities (LFs) for land-based ICBMs (intercontinental ballistic missiles) currently do not have visual assessment capability for existing intrusion alarms. The security response force currently must assess each alarm on-site. Remote assessment will enhance manpower, safety, and security efforts. Sandia National Laboratories was tasked by the USAF Electronic Systems Center to research, recommend, and demonstrate a cost-effective remote video assessment capability at missile LFs. The project`s charter was to provide: system concepts; market survey analysis; technology search recommendations; and operational hardware demonstrations for remote video assessment from a missile LF to a remote security center viamore » a cost-effective transmission medium and without using visible, on-site lighting. The technical challenges of this project were to: analyze various video transmission media and emphasize using the existing missile system copper line which can be as long as 30 miles; accentuate and extremely low-cost system because of the many sites requiring system installation; integrate the video assessment system with the current LF alarm system; and provide video assessment at the remote sites with non-visible lighting.« less

Assessment of radiofrequency ablation margin by MRI-MRI image fusion in hepatocellular carcinoma

PubMed Central

Wang, Xiao-Li; Li, Kai; Su, Zhong-Zhen; Huang, Ze-Ping; Wang, Ping; Zheng, Rong-Qin

2015-01-01

AIM: To investigate the feasibility and clinical value of magnetic resonance imaging (MRI)-MRI image fusion in assessing the ablative margin (AM) for hepatocellular carcinoma (HCC). METHODS: A newly developed ultrasound workstation for MRI-MRI image fusion was used to evaluate the AM of 62 tumors in 52 HCC patients after radiofrequency ablation (RFA). The lesions were divided into two groups: group A, in which the tumor was completely ablated and 5 mm AM was achieved (n = 32); and group B, in which the tumor was completely ablated but 5 mm AM was not achieved (n = 29). To detect local tumor progression (LTP), all patients were followed every two months by contrast-enhanced ultrasound, contrast-enhanced MRI or computed tomography (CT) in the first year after RFA. Then, the follow-up interval was prolonged to every three months after the first year. RESULTS: Of the 62 tumors, MRI-MRI image fusion was successful in 61 (98.4%); the remaining case had significant deformation of the liver and massive ascites after RFA. The time required for creating image fusion and AM evaluation was 15.5 ± 5.5 min (range: 8-22 min) and 9.6 ± 3.2 min (range: 6-14 min), respectively. The follow-up period ranged from 1-23 mo (14.2 ± 5.4 mo). In group A, no LTP was detected in 32 lesions, whereas in group B, LTP was detected in 4 of 29 tumors, which occurred at 2, 7, 9, and 15 mo after RFA. The frequency of LTP in group B (13.8%; 4/29) was significantly higher than that in group A (0/32, P = 0.046). All of the LTPs occurred in the area in which the 5 mm AM was not achieved. CONCLUSION: The MRI-MRI image fusion using an ultrasound workstation is feasible and useful for evaluating the AM after RFA for HCC. PMID:25954109

Assessing the Congregate Disaster Shelter: Using Shelter Facility Assessment Data for Evaluating Potential Hazards to Occupants During Disasters.

PubMed

Cruz, Miguel A; Garcia, Stephanie; Chowdhury, Muhammad A B; Malilay, Josephine; Perea, Nancy; Williams, O Dale

Disaster shelter assessments are environmental health assessments conducted during disaster situations to evaluate the living environment of shelters for hygiene, sanitation, and safety conditions. We conducted a secondary data analysis of shelter assessment records available (n = 108) on ice storms, floods, and tornado events from 1 state jurisdiction. Descriptive statistics were used to analyze results of environmental health deficiencies found in the facilities. The greater numbers of environmental health deficiencies were associated with sanitation (26%), facility physical issues (19%), and food areas (17%). Most deficiencies were reported following ice storms, tornadoes, and flood events. This report describes the first analysis of environmental health deficiencies found in disaster shelters across a spectrum of disaster events. Although the number of records analyzed for this project was small and results may not be generalizable, this new insight into the living environment in shelter facilities offers the first analysis of deficiencies of the shelter operation and living environment that have great potential to affect the safety and health of shelter occupants.

Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

PubMed

Berendes, Sima; Lako, Richard L; Whitson, Donald; Gould, Simon; Valadez, Joseph J

2014-10-01

We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states. © 2014 John Wiley & Sons Ltd.

Radiological performance assessment for the E-Area Vaults Disposal Facility

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

Cook, J.R.

This report is the first revision to ``Radiological Performance Assessment for the E-Area Vaults Disposal Facility, Revision 0'', which was issued in April 1994 and received conditional DOE approval in September 1994. The title of this report has been changed to conform to the current name of the facility. The revision incorporates improved groundwater modeling methodology, which includes a large data base of site specific geotechnical data, and special Analyses on disposal of cement-based wasteforms and naval wastes, issued after publication of Revision 0.

Software-assisted post-interventional assessment of radiofrequency ablation

NASA Astrophysics Data System (ADS)

Rieder, Christian; Geisler, Benjamin; Bruners, Philipp; Isfort, Peter; Na, Hong-Sik; Mahnken, Andreas H.; Hahn, Horst K.

2014-03-01

Radiofrequency ablation (RFA) is becoming a standard procedure for minimally invasive tumor treatment in clinical practice. Due to its common technical procedure, low complication rate, and low cost, RFA has become an alternative to surgical resection in the liver. To evaluate the therapy success of RFA, thorough follow-up imaging is essential. Conventionally, shape, size, and position of tumor and coagulation are visually compared in a side-by-side manner using pre- and post-interventional images. To objectify the verification of the treatment success, a novel software assistant allowing for fast and accurate comparison of tumor and coagulation is proposed. In this work, the clinical value of the proposed assessment software is evaluated. In a retrospective clinical study, 39 cases of hepatic tumor ablation are evaluated using the prototype software and conventional image comparison by four radiologists with different levels of experience. The cases are randomized and evaluated in two sessions to avoid any recall-bias. Self-confidence of correct diagnosis (local recurrence vs. no local recurrence) on a six-point scale is given for each case by the radiologists. Sensitivity, specificity, positive and negative predictive values as well as receiver operating curves are calculated for both methods. It is shown that the software-assisted method allows physicians to correctly identify local tumor recurrence with a higher percentage than the conventional method (sensitivity: 0.6 vs. 0.35), whereas the percentage of correctly identified successful ablations is slightly reduced (specificity: 0.83 vs. 0.89).

Comparative evaluation of three-dimensional Gd-EOB-DTPA-enhanced MR fusion imaging with CT fusion imaging in the assessment of treatment effect of radiofrequency ablation of hepatocellular carcinoma.

PubMed

Makino, Yuki; Imai, Yasuharu; Igura, Takumi; Hori, Masatoshi; Fukuda, Kazuto; Sawai, Yoshiyuki; Kogita, Sachiyo; Fujita, Norihiko; Takehara, Tetsuo; Murakami, Takamichi

2015-01-01

To assess the feasibility of fusion of pre- and post-ablation gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-MRI) to evaluate the effects of radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC), compared with similarly fused CT images This retrospective study included 67 patients with 92 HCCs treated with RFA. Fusion images of pre- and post-RFA dynamic CT, and pre- and post-RFA Gd-EOB-DTPA-MRI were created, using a rigid registration method. The minimal ablative margin measured on fusion imaging was categorized into three groups: (1) tumor protruding outside the ablation zone boundary, (2) ablative margin 0-<5.0 mm beyond the tumor boundary, and (3) ablative margin ≥5.0 mm beyond the tumor boundary. The categorization of minimal ablative margins was compared between CT and MR fusion images. In 57 (62.0%) HCCs, treatment evaluation was possible both on CT and MR fusion images, and the overall agreement between them for the categorization of minimal ablative margin was good (κ coefficient = 0.676, P < 0.01). MR fusion imaging enabled treatment evaluation in a significantly larger number of HCCs than CT fusion imaging (86/92 [93.5%] vs. 62/92 [67.4%], P < 0.05). Fusion of pre- and post-ablation Gd-EOB-DTPA-MRI is feasible for treatment evaluation after RFA. It may enable accurate treatment evaluation in cases where CT fusion imaging is not helpful.

30 CFR 285.825 - When must I assess my facilities?

Code of Federal Regulations, 2011 CFR

2011-07-01

... Section 285.825 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, REGULATION, AND ENFORCEMENT... CONTINENTAL SHELF Environmental and Safety Management, Inspections, and Facility Assessments for Activities... and Constructing Fixed Offshore Platforms—Working Stress Design (incorporated by reference, as...

A security vulnerabilities assessment tool for interim storage facilities of low-level radioactive wastes.

PubMed

Bible, J; Emery, R J; Williams, T; Wang, S

2006-11-01

Limited permanent low-level radioactive waste (LLRW) disposal capacity and correspondingly high disposal costs have resulted in the creation of numerous interim storage facilities for either decay-in-storage operations or longer term accumulation efforts. These facilities, which may be near the site of waste generation or in distal locations, often were not originally designed for the purpose of LLRW storage, particularly with regard to security. Facility security has become particularly important in light of the domestic terrorist acts of 2001, wherein LLRW, along with many other sources of radioactivity, became recognized commodities to those wishing to create disruption through the purposeful dissemination of radioactive materials. Since some LLRW materials may be in facilities that may exhibit varying degrees of security control sophistication, a security vulnerabilities assessment tool grounded in accepted criminal justice theory and security practice has been developed. The tool, which includes dedicated sections on general security, target hardening, criminalization benefits, and the presence of guardians, can be used by those not formally schooled in the security profession to assess the level of protection afforded to their respective facilities. The tool equips radiation safety practitioners with the ability to methodically and systematically assess the presence or relative status of various facility security aspects, many of which may not be considered by individuals from outside the security profession. For example, radiation safety professionals might not ordinarily consider facility lighting aspects, which is a staple for the security profession since it is widely known that crime disproportionately occurs more frequently at night or in poorly lit circumstances. Likewise, the means and associated time dimensions for detecting inventory discrepancies may not be commonly considered. The tool provides a simple means for radiation safety professionals to

Life-Cycle Assessments of Selected NASA Ground-Based Test Facilities

NASA Technical Reports Server (NTRS)

Sydnor, George Honeycutt

2012-01-01

In the past two years, two separate facility-specific life cycle assessments (LCAs) have been performed as summer student projects. The first project focused on 13 facilities managed by NASA s Aeronautics Test Program (ATP), an organization responsible for large, high-energy ground test facilities that accomplish the nation s most advanced aerospace research. A facility inventory was created for each facility, and the operational-phase carbon footprint and environmental impact were calculated. The largest impacts stemmed from electricity and natural gas used directly at the facility and to generate support processes such as compressed air and steam. However, in specialized facilities that use unique inputs like R-134a, R-14, jet fuels, or nitrogen gas, these sometimes had a considerable effect on the facility s overall environmental impact. The second LCA project was conducted on the NASA Ames Arc Jet Complex and also involved creating a facility inventory and calculating the carbon footprint and environmental impact. In addition, operational alternatives were analyzed for their effectiveness at reducing impact. Overall, the Arc Jet Complex impact is dominated by the natural-gas fired boiler producing steam on-site, but alternatives were provided that could reduce the impact of the boiler operation, some of which are already being implemented. The data and results provided by these LCA projects are beneficial to both the individual facilities and NASA as a whole; the results have already been used in a proposal to reduce carbon footprint at Ames Research Center. To help future life cycle projects, several lessons learned have been recommended as simple and effective infrastructure improvements to NASA, including better utility metering and data recording and standardization of modeling choices and methods. These studies also increased sensitivity to and appreciation for quantifying the impact of NASA s activities.

Bioaerosol releases from compost facilities: Evaluating passive and active source terms at a green waste facility for improved risk assessments

NASA Astrophysics Data System (ADS)

Taha, M. P. M.; Drew, G. H.; Longhurst, P. J.; Smith, R.; Pollard, S. J. T.

The passive and active release of bioaerosols during green waste composting, measured at source is reported for a commercial composting facility in South East (SE) England as part of a research programme focused on improving risk assessments at composting facilities. Aspergillus fumigatus and actinomycetes concentrations of 9.8-36.8×10 6 and 18.9-36.0×10 6 cfu m -3, respectively, measured during the active turning of green waste compost, were typically 3-log higher than previously reported concentrations from static compost windrows. Source depletion curves constructed for A. fumigatus during compost turning and modelled using SCREEN3 suggest that bioaerosol concentrations could reduce to background concentrations of 10 3 cfu m -3 within 100 m of this site. Authentic source term data produced from this study will help to refine the risk assessment methodologies that support improved permitting of compost facilities.

Effects of Lugol staining on stenosis formation induced by radiofrequency ablation of esophageal squamous epithelium: a study in a porcine model.

PubMed

Schölvinck, D W; Alvarez Herrero, L; Visser, M; Bergman, J J G H M; Weusten, B L A M

2015-10-01

Preliminary data show higher stricture rates after radiofrequency ablation (RFA) for early esophageal squamous neoplasia compared with Barrett's esophagus. We studied the effects of Lugol stain (LS) directly prior to RFA on stricture formation in squamous epithelium. Of 16 pigs, the distal half of the esophagus was LS, followed by circumferential RFA (single application 12 J/cm(2) ) in the unstained and stained esophagus. Pigs were euthanized at day 0 (n = 4), 3 (n = 4), or 28 (n = 8). Histology was evaluated in four areas: blank-control (no RFA, no LS), blank-RFA (no LS), LS+RFA, and LS-control (no RFA). Stenosis severity in LS+RFA and blank-RFA at 28 days was assessed by the ratio of the mucosal diameter at the RFA area to the diameter 2 cm proximal of this zone. Histology showed submucosal edema in 50% of LS+RFA versus 0% in blank-RFA. Severity and depth of inflammation (day 3) was equal in LS+RFA and blank-RFA. Severity and depth of fibrosis (day 28) appeared more severe in LS+RFA. Consequently, stenosis was present in 100% (LS+RFA) versus 12.5% (blank-RFA). The stenosis-severity ratio was 0.40 (interquartile range 0.29-0.45) in LS+RFA versus 0.73 (interquartile range 0.64-0.78) in blank-RFA (P = 0.012). Limitations of this study were the difference in uptake of LS between pigs and humans, the difference in esophageal anatomy between pigs and humans, and between the proximal and distal esophagus within pigs. In conclusion, in the porcine squamous esophagus, stenosis rate and severity after RFA increased when preceded by LS. LS may be contributing in the altered response of squamous epithelium to RFA as compared with Barrett's esophagus. © 2014 International Society for Diseases of the Esophagus.

30 CFR 285.825 - When must I assess my facilities?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 285.825 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE... Safety Management, Inspections, and Facility Assessments for Activities Conducted Under SAPs, COPs and... Offshore Platforms—Working Stress Design (incorporated by reference, as specified in § 285.115). (b) You...

The contemporary role of ablative treatment approaches in the management of renal cell carcinoma (RCC): focus on radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU), and cryoablation.

PubMed

Klatte, Tobias; Kroeger, Nils; Zimmermann, Uwe; Burchardt, Martin; Belldegrun, Arie S; Pantuck, Allan J

2014-06-01

Currently, most of renal tumors are small, low grade, with a slow growth rate, a low metastatic potential, and with up to 30 % of these tumors being benign on the final pathology. Moreover, they are often diagnosed in elderly patients with preexisting medical comorbidities in whom the underlying medical conditions may pose a greater risk of death than the small renal mass. Concerns regarding overdiagnosis and overtreatment of patients with indolent small renal tumors have led to an increasing interest in minimally invasive, ablative as an alternative to extirpative interventions for selected patients. To provide an overview about the state of the art in radiofrequency ablation (RFA), high-intensity focused ultrasound, and cryoablation in the clinical management of renal cell carcinoma. A PubMed wide the literature search of was conducted. International consensus panels recommend ablative techniques in patients who are unfit for surgery, who are not considered candidates for or elect against elective surveillance, and who have small renal masses. The most often used techniques are cryoablation and RFA. These ablative techniques offer potentially curative outcomes while conferring several advantages over extirpative surgery, including improved patient procedural tolerance, faster recovery, preservation of renal function, and reduction in the risk of intraoperative and postsurgical complications. While it is likely that outcomes associated with ablative modalities will improve with further advances in technology, their application will expand to more elective indications as longer-term efficacy data become available. Ablative techniques pose a valid treatment option in selected patients.

Ethiopia's assessment of emergency obstetric and newborn care: setting the gold standard for national facility-based assessments.

PubMed

Keyes, Emily B; Haile-Mariam, Abonesh; Belayneh, Neghist T; Gobezie, Wasihun A; Pearson, Luwei; Abdullah, Muna; Kebede, Henok

2011-10-01

To describe the methods used to implement Ethiopia's 2008 emergency obstetric and newborn care services (EmONC) assessment; highlight how the collaborative process contributed to immediate integration of results into national and subnational planning; and explain how the experience informed the development of a set of tools providing best practices and guidelines for other countries conducting similar assessments. A team of maternal and newborn health experts from the Federal Ministry of Health (FMOH), the United Nations Children's Fund (UNICEF), the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), together with representatives from the Ethiopian Society of Obstetricians and Gynecologists, provided technical guidance for the 18-month process and facilitated demand for and use of the assessment results. Eighty-four trained data collectors administered 9 data collection modules in 806 public and private facilities. Field work and data were managed by a private firm who, together with the core team, implemented a multi-layered plan for data quality. Columbia University's Averting Maternal Death and Disability Program provided technical assistance. Results were published in national and regional reports and in 1-page facility factsheets informing subnational planning activities. Assessment results-which have been published in journal articles-informed water infrastructure improvements, efforts to expand access to magnesium sulfate, and FMOH and UN planning documents. The assessment also established a permanent database for future monitoring of the health system, including geographic locations of surveyed facilities. Ethiopia's assessment was successful largely because of active local leadership, a collaborative process, ample financial and technical support, and rapid integration of results into health system planning. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

30 CFR 585.825 - When must I assess my facilities?

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 585.825 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE... Safety Management, Inspections, and Facility Assessments for Activities Conducted Under SAPs, COPs and... Offshore Platforms—Working Stress Design (as incorporated by reference in § 585.115). (b) You must initiate...

30 CFR 585.825 - When must I assess my facilities?

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 585.825 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE... Safety Management, Inspections, and Facility Assessments for Activities Conducted Under SAPs, COPs and... Offshore Platforms—Working Stress Design (as incorporated by reference in § 585.115). (b) You must initiate...

30 CFR 585.825 - When must I assess my facilities?

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 585.825 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE... Safety Management, Inspections, and Facility Assessments for Activities Conducted Under SAPs, COPs and... Offshore Platforms—Working Stress Design (as incorporated by reference in § 585.115). (b) You must initiate...

Fire Hazard Assessment in Supporting Fire Protection System Design of a Chemical Process Facility

DTIC Science & Technology

1996-08-01

CSDP/Studies/FireHaz –i– 3/28/97 FIRE HAZARD ASSESSMENT IN SUPPORTING FIRE PROTECTION SYSTEM DESIGN OF A CHEMICAL PROCESS FACILITY Ali Pezeshk...Joseph Chang, Dwight Hunt, and Peter Jahn Parsons Infrastructure & Technology Group, Inc. Pasadena, California 91124 ABSTRACT Because fires in a chemical ...Assessment in Supporting Fire Protection System Design of a Chemical Process Facility 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6

Operational Phase Life Cycle Assessment of Select NASA Ground Test Facilities

NASA Technical Reports Server (NTRS)

Sydnor, George H.; Marshall, Timothy J.; McGinnis, Sean

2011-01-01

NASA's Aeronautics Test Program (ATP) is responsible for many large, high-energy ground test facilities that accomplish the nation s most advanced aerospace research. In order to accomplish these national objectives, significant energy and resources are consumed. A select group of facilities was analyzed using life-cycle assessment (LCA) to determine carbon footprint and environmental impacts. Most of these impacts stem from electricity and natural gas consumption, used directly at the facility and to generate support processes such as compressed air and steam. Other activities were analyzed but determined to be smaller in scale and frequency with relatively negligible environmental impacts. More specialized facilities use R-134a, R-14, jet fuels, or nitrogen gas, and these unique inputs can have a considerable effect on a facility s overall environmental impact. The results of this LCA will be useful to ATP and NASA as the nation looks to identify its top energy consumers and NASA looks to maximize research output and minimize environmental impact. Keywords: NASA, Aeronautics, Wind tunnel, Keyword 4, Keyword 5

Clinical usefulness of the ablative margin assessed by magnetic resonance imaging with Gd-EOB-DTPA for radiofrequency ablation of hepatocellular carcinoma.

PubMed

Koda, Masahiko; Tokunaga, Shiho; Okamoto, Toshiaki; Hodozuka, Masanori; Miyoshi, Kennichi; Kishina, Manabu; Fujise, Yuki; Kato, Jun; Matono, Tomomitsu; Sugihara, Takaaki; Oyama, Kenji; Hosho, Keiko; Okano, Jun-ichi; Murawaki, Yoshikazu; Kakite, Suguru; Yamashita, Eijiro

2015-12-01

The aim of this study was to investigate the feasibility of ablative margin (AM) grading by magnetic resonance imaging (MRI) with Gd-EOB-DTPA administered prior to radiofrequency ablation (RFA), and to identify factors for achieving a sufficient AM and predictors for local tumor progression. A total of 124 hepatocellular carcinomas (HCCs) were treated by RFA after Gd-EOB-DTPA administration. MRI and enhanced CT were performed within seven hours and one month after RFA. The AM assessment was categorized using three grades: AM (+), low-intensity area with continuous high-intensity rim; AM zero, low-intensity area with discontinuous high-intensity rim; and AM (-), low-intensity area extends beyond the high-intensity rim. Patients were followed and local tumor progression was observed. AM (+), AM zero, AM (-), and indeterminate were found in 34, 33, 26, and 31 nodules, respectively. The overall agreement rate between MRI and enhanced CT for the diagnosis of AM was 56.8%. The κ coefficient was 0.326 (p<0.001), indicating moderate agreement. Multivariate logistic regression analysis showed that a significant factor for the achievement of AM (+) on MRI was no contiguous vessels. The cumulative local tumor progression rates (0% at 1, 2, and 3 years) in 33 AM (+) nodules were significantly lower than those (3.6%, 11.5%, and 18.3% at 1, 2, and 3 years respectively) in 32 AM zero nodules. A multivariate Cox proportional hazards model identified tumor size as an independent predictor for local tumor progression. Gd-EOB-DTPA-MRI enabled an early assessment of RFA effectiveness in the majority ofHCC nodules. Local tumor progression was not detected in AM (+) nodules during the follow-up. Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Environmental Assessment for Developing Renewable Energy Enhanced Use Lease Facilities at Robins Air Force Base

DTIC Science & Technology

2013-12-15

Blufftown is underlain by igneous and metamorphic rocks which are equivalent to those of the Georgia Piedmont. Potable and process waters are produced...Final Environmental Assessment for Developing Renewable Energy Enhanced Use Lease Facilities at Robins Air Force Base...TITLE AND SUBTITLE Final Environmental Assessment for Developing Renewable Energy Enhanced Use Lease Facilities at Robins Air Force Base 5a. CONTRACT

Assessment of environmental consequences of the normal operations of the ESS facility

NASA Astrophysics Data System (ADS)

Ene, D.; Avila, R.; Hjerpe, T.; Bugay, D.; Stenberg, K.

2018-06-01

As other accelerator based facilities, the European Spallation Source ESS facility will interact with the environment. The Swedish legislation requires a demonstration that the sum of the doses resulting from the exposure of any member of the public to ionizing radiation dose does not exceed the specified limit of 50 μSv/year. A radiological assessment has been produced to provide that demonstration. This evaluation was based upon the actual status of the ESS design. A graded approach was adopted through over the assessment allowing estimating dose for all radionuclides and exposure pathways, but the degree of detail in the assessment depend upon their relative radiological importance. The total dose was obtained making the sum of the contribution of all-important radionuclides treated realistically with that of all screened out radionuclides, derived by means a conservative method.

Outcome assessment of hemiparesis due to intracerebral hemorrhage using diffusion tensor fractional anisotropy.

PubMed

Koyama, Tetsuo; Marumoto, Kohei; Uchiyama, Yuki; Miyake, Hiroji; Domen, Kazuhisa

2015-04-01

This study aimed to evaluate the prognostic efficacy of magnetic resonance diffusion tensor fractional anisotropy (FA) for patients with hemiparesis due to intracerebral hemorrhage. Diffusion tensor FA brain images were acquired 14-21 days after putaminal and/or thalamic hemorrhage. The ratio of FA values within the cerebral peduncles of the affected and unaffected hemispheres (rFA) was calculated for each patient (n = 40) and assessed for correlation with Brunnstrom stage (BRS, 1-6), motor component of the functional independence measure (FIM-motor, 13-91), and the total length of stay (LOS) until discharge from rehabilitation (P < .05). Ordinal logistic regression analyses were conducted to determine the relationships between rFA and specific outcomes as measured by BRS range (poor, BRS 1 or 2; moderate, BRS 3 or 4; and good, BRS 5 or 6; P < .05). The rFA values were .571-1.043 (median, .856) and BRS scores were 1-6 (median, 4) for shoulder/elbow/forearm, 1-6 (median, 4) for hand, and 2-6 (median, 4) for lower extremities. FIM-motor scores were 58-86 (median, 78) and LOS ranged from 42 to 225 days (median, 175.5 days). Correlation coefficients were statistically significant between rFA and shoulder/elbow/forearm BRS (.696), hand BRS (.779), lower extremity BRS (.631), FIM-motor (.442), and LOS (-.598). Logistic model fit was moderate for shoulder/elbow/forearm BRS (R(2) = .221) and lower extremity BRS (R(2) = .277), but was much higher for hand BRS (R(2) = .441). Diffusion tensor FA values are predictive of clinical outcome from hemiparesis due to putaminal and/or thalamic hemorrhage, particularly hand function recovery. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

CFD-CAA Coupled Calculations of a Tandem Cylinder Configuration to Assess Facility Installation Effects

NASA Technical Reports Server (NTRS)

Redonnet, Stephane; Lockard, David P.; Khorrami, Mehdi R.; Choudhari, Meelan M.

2011-01-01

This paper presents a numerical assessment of acoustic installation effects in the tandem cylinder (TC) experiments conducted in the NASA Langley Quiet Flow Facility (QFF), an open-jet, anechoic wind tunnel. Calculations that couple the Computational Fluid Dynamics (CFD) and Computational Aeroacoustics (CAA) of the TC configuration within the QFF are conducted using the CFD simulation results previously obtained at NASA LaRC. The coupled simulations enable the assessment of installation effects associated with several specific features in the QFF facility that may have impacted the measured acoustic signature during the experiment. The CFD-CAA coupling is based on CFD data along a suitably chosen surface, and employs a technique that was recently improved to account for installed configurations involving acoustic backscatter into the CFD domain. First, a CFD-CAA calculation is conducted for an isolated TC configuration to assess the coupling approach, as well as to generate a reference solution for subsequent assessments of QFF installation effects. Direct comparisons between the CFD-CAA calculations associated with the various installed configurations allow the assessment of the effects of each component (nozzle, collector, etc.) or feature (confined vs. free jet flow, etc.) characterizing the NASA LaRC QFF facility.

Hydrocode simulations of air and water shocks for facility vulnerability assessments.

PubMed

Clutter, J Keith; Stahl, Michael

2004-01-02

Hydrocodes are widely used in the study of explosive systems but their use in routine facility vulnerability assessments has been limited due to the computational resources typically required. These requirements are due to the fact that the majority of hydrocodes have been developed primarily for the simulation of weapon-scale phenomena. It is not practical to use these same numerical frameworks on the large domains found in facility vulnerability studies. Here, a hydrocode formulated specifically for facility vulnerability assessments is reviewed. Techniques used to accurately represent the explosive source while maintaining computational efficiency are described. Submodels for addressing other issues found in typical terrorist attack scenarios are presented. In terrorist attack scenarios, loads produced by shocks play an important role in vulnerability. Due to the difference in the material properties of water and air and interface phenomena, there exists significant contrast in wave propagation phenomena in these two medium. These physical variations also require special attention be paid to the mathematical and numerical models used in the hydrocodes. Simulations for a variety of air and water shock scenarios are presented to validate the computational models used in the hydrocode and highlight the phenomenological issues.

78 FR 1763 - Oranges and Grapefruit Grown in Lower Rio Grande Valley in Texas; Increased Assessment Rate

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-09

... the adoption of the final rules. #0; #0; #0; #0;#0;Federal Register / Vol. 78, No. 6 / Wednesday... Grande Valley in Texas; Increased Assessment Rate AGENCY: Agricultural Marketing Service, USDA. ACTION... Regulatory Flexibility Act (RFA) (5 U.S.C. 601-612), the Agricultural Marketing Service (AMS) has considered...

Annual Summary of the Integrated Disposal Facility Performance Assessment 2011

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

Lehman, L. L.

2012-03-12

An annual summary of the adequacy of the Hanford Immobilized Low-Activity Waste (ILAW) Performance Assessment (PA) is required each year (DOE O 435.1 Chg 1,1 DOE M 435.1-1 Chg 1,2 DOE/ORP-2000-013). The most recently approved PA is DOE/ORP-2000-24.4 The ILAW PA evaluated the adequacy of the ILAW disposal facility, now referred to as the Integrated Disposal Facility (IDF), for the safe disposal of vitrified Hanford Site tank waste. More recently, a preliminary evaluation for the disposal of offsite low-level waste and mixed low-level waste was considered in RPP-1583.

General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh.

PubMed

Shawon, Md Shajedur Rahman; Adhikary, Gourab; Ali, Md Wazed; Shamsuzzaman, Md; Ahmed, Shahabuddin; Alam, Nurul; Shackelford, Katya A; Woldeab, Alexander; Lim, Stephen S; Levine, Aubrey; Gakidou, Emmanuela; Uddin, Md Jasim

2018-01-25

Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation. A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities. The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of

Impact of Breast Density Legislation on Breast Cancer Risk Assessment and Supplemental Screening: A Survey of 110 Radiology Facilities.

PubMed

Nayak, Lina; Miyake, Kanae K; Leung, Jessica W T; Price, Elissa R; Liu, Yueyi I; Joe, Bonnie N; Sickles, Edward A; Thomas, William R; Lipson, Jafi A; Daniel, Bruce L; Hargreaves, Jonathan; Brenner, R James; Bassett, Lawrence W; Ojeda-Fournier, Haydee; Lindfors, Karen K; Feig, Stephen A; Ikeda, Debra M

2016-09-01

Breast density notification laws, passed in 19 states as of October 2014, mandate that patients be informed of their breast density. The purpose of this study is to assess the impact of this legislation on radiology practices, including performance of breast cancer risk assessment and supplemental screening studies. A 20-question anonymous web-based survey was emailed to radiologists in the Society of Breast Imaging between August 2013 and March 2014. Statistical analysis was performed using Fisher's exact test. Around 121 radiologists from 110 facilities in 34 USA states and 1 Canadian site responded. About 50% (55/110) of facilities had breast density legislation, 36% of facilities (39/109) performed breast cancer risk assessment (one facility did not respond). Risk assessment was performed as a new task in response to density legislation in 40% (6/15) of facilities in states with notification laws. However, there was no significant difference in performing risk assessment between facilities in states with a law and those without (p < 0.831). In anticipation of breast density legislation, 33% (16/48), 6% (3/48), and 6% (3/48) of facilities in states with laws implemented handheld whole breast ultrasound (WBUS), automated WBUS, and tomosynthesis, respectively. The ratio of facilities offering handheld WBUS was significantly higher in states with a law than in states without (p < 0.001). In response to breast density legislation, more than 33% of facilities are offering supplemental screening with WBUS and tomosynthesis, and many are performing formal risk assessment for determining patient management. © 2016 Wiley Periodicals, Inc.

Facility target insert shielding assessment

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

Mocko, Michal

2015-10-06

Main objective of this report is to assess the basic shielding requirements for the vertical target insert and retrieval port. We used the baseline design for the vertical target insert in our calculations. The insert sits in the 12”-diameter cylindrical shaft extending from the service alley in the top floor of the facility all the way down to the target location. The target retrieval mechanism is a long rod with the target assembly attached and running the entire length of the vertical shaft. The insert also houses the helium cooling supply and return lines each with 2” diameter. In themore » present study we focused on calculating the neutron and photon dose rate fields on top of the target insert/retrieval mechanism in the service alley. Additionally, we studied a few prototypical configurations of the shielding layers in the vertical insert as well as on the top.« less

Dual time-point (18)F-FDG PET/CT to assess response to radiofrequency ablation of lung metastases.

PubMed

Lafuente, S; Fuster, D; Arguis, P; Granados, U; Perlaza, P; Paredes, P; Vollmer, I; Sánchez, M; Lomeña, F

2016-01-01

To establish the usefulness of dual time-point PET/CT imaging in determining the response to radiofrequency ablation (RFA) of solitary lung metastases from gastrointestinal cancer. This prospective study included 18 cases (3 female, 15 male, mean age 71±15 yrs) with solitary lung metastases from malignant digestive tract tumors candidates for RFA. PET/CT images 1h after injection of 4.07MBq/kg of (18)F-FDG (standard images) were performed at baseline, 1 month, and 3 months after RFA. PET/CT images 2h after injection centered in the thorax at 1 month after RFA were also performed (delayed images). A retention index (RI) of dual time-point images was calculated as follows: RI=(SUVmax delayed image-SUVmax standard image/SUVmax standard image)*100. Pathological confirmation of residual tumor by histology of the treated lesion was considered as local recurrence. A negative imaging follow-up was considered as complete response. Local recurrence was found in 6/18 lesions, and complete response in the remaining 12. The mean percentage change in SUVmax at 1 month and at 3 months showed a sensitivity and specificity for PET/CT of 50% and 33%, and 67% and 92%, respectively. The RI at 1 month after RFA showed a sensitivity and specificity of 83% and 92%, respectively. Dual time point PET/CT can predict the outcome at one month after RFA in lung metastases from digestive tract cancers. The RI can be used to indicate the need for further procedures to rule out persistent tumor due to incomplete RFA. Copyright © 2015 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

Monitoring the ability to deliver care in low- and middle-income countries: a systematic review of health facility assessment tools

PubMed Central

Nickerson, Jason W; Adams, Orvill; Attaran, Amir; Hatcher-Roberts, Janet; Tugwell, Peter

2015-01-01

Introduction Health facilities assessments are an essential instrument for health system strengthening in low- and middle-income countries. These assessments are used to conduct health facility censuses to assess the capacity of the health system to deliver health care and to identify gaps in the coverage of health services. Despite the valuable role of these assessments, there are currently no minimum standards or frameworks for these tools. Methods We used a structured keyword search of the MEDLINE, EMBASE and HealthStar databases and searched the websites of the World Health Organization, the World Bank and the International Health Facilities Assessment Network to locate all available health facilities assessment tools intended for use in low- and middle-income countries. We parsed the various assessment tools to identify similarities between them, which we catalogued into a framework comprising 41 assessment domains. Results We identified 10 health facility assessment tools meeting our inclusion criteria, all of which were included in our analysis. We found substantial variation in the comprehensiveness of the included tools, with the assessments containing indicators in 13 to 33 (median: 25.5) of the 41 assessment domains included in our framework. None of the tools collected data on all 41 of the assessment domains we identified. Conclusions Not only do a large number of health facility assessment tools exist, but the data they collect and methods they employ are very different. This certainly limits the comparability of the data between different countries’ health systems and probably creates blind spots that impede efforts to strengthen those systems. Agreement is needed on the essential elements of health facility assessments to guide the development of specific indicators and for refining existing instruments. PMID:24895350

Development of Safety Assessment Code for Decommissioning of Nuclear Facilities

NASA Astrophysics Data System (ADS)

Shimada, Taro; Ohshima, Soichiro; Sukegawa, Takenori

A safety assessment code, DecDose, for decommissioning of nuclear facilities has been developed, based on the experiences of the decommissioning project of Japan Power Demonstration Reactor (JPDR) at Japan Atomic Energy Research Institute (currently JAEA). DecDose evaluates the annual exposure dose of the public and workers according to the progress of decommissioning, and also evaluates the public dose at accidental situations including fire and explosion. As for the public, both the internal and the external doses are calculated by considering inhalation, ingestion, direct radiation from radioactive aerosols and radioactive depositions, and skyshine radiation from waste containers. For external dose for workers, the dose rate from contaminated components and structures to be dismantled is calculated. Internal dose for workers is calculated by considering dismantling conditions, e.g. cutting speed, cutting length of the components and exhaust velocity. Estimation models for dose rate and staying time were verified by comparison with the actual external dose of workers which were acquired during JPDR decommissioning project. DecDose code is expected to contribute the safety assessment for decommissioning of nuclear facilities.

An Integrated Assessment of Location-Dependent Scaling for Microalgae Biofuel Production Facilities

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

Coleman, Andre M.; Abodeely, Jared; Skaggs, Richard

Successful development of a large-scale microalgae-based biofuels industry requires comprehensive analysis and understanding of the feedstock supply chain—from facility siting/design through processing/upgrading of the feedstock to a fuel product. The evolution from pilot-scale production facilities to energy-scale operations presents many multi-disciplinary challenges, including a sustainable supply of water and nutrients, operational and infrastructure logistics, and economic competitiveness with petroleum-based fuels. These challenges are addressed in part by applying the Integrated Assessment Framework (IAF)—an integrated multi-scale modeling, analysis, and data management suite—to address key issues in developing and operating an open-pond facility by analyzing how variability and uncertainty in space andmore » time affect algal feedstock production rates, and determining the site-specific “optimum” facility scale to minimize capital and operational expenses. This approach explicitly and systematically assesses the interdependence of biofuel production potential, associated resource requirements, and production system design trade-offs. The IAF was applied to a set of sites previously identified as having the potential to cumulatively produce 5 billion-gallons/year in the southeastern U.S. and results indicate costs can be reduced by selecting the most effective processing technology pathway and scaling downstream processing capabilities to fit site-specific growing conditions, available resources, and algal strains.« less

An integrated assessment of location-dependent scaling for microalgae biofuel production facilities

DOE PAGES

Coleman, André M.; Abodeely, Jared M.; Skaggs, Richard L.; ...

2014-06-19

Successful development of a large-scale microalgae-based biofuels industry requires comprehensive analysis and understanding of the feedstock supply chain—from facility siting and design through processing and upgrading of the feedstock to a fuel product. The evolution from pilot-scale production facilities to energy-scale operations presents many multi-disciplinary challenges, including a sustainable supply of water and nutrients, operational and infrastructure logistics, and economic competitiveness with petroleum-based fuels. These challenges are partially addressed by applying the Integrated Assessment Framework (IAF) – an integrated multi-scale modeling, analysis, and data management suite – to address key issues in developing and operating an open-pond microalgae production facility.more » This is done by analyzing how variability and uncertainty over space and through time affect feedstock production rates, and determining the site-specific “optimum” facility scale to minimize capital and operational expenses. This approach explicitly and systematically assesses the interdependence of biofuel production potential, associated resource requirements, and production system design trade-offs. To provide a baseline analysis, the IAF was applied in this paper to a set of sites in the southeastern U.S. with the potential to cumulatively produce 5 billion gallons per year. Finally, the results indicate costs can be reduced by scaling downstream processing capabilities to fit site-specific growing conditions, available and economically viable resources, and specific microalgal strains.« less

Renal Cell Carcinoma Perfusion before and after Radiofrequency Ablation Measured with Dynamic Contrast Enhanced MRI: A Pilot Study.

PubMed

Wah, Tze Min; Sourbron, Steven; Wilson, Daniel Jonathan; Magee, Derek; Gregory, Walter Martin; Selby, Peter John; Buckley, David L

2018-01-08

To investigate if the early treatment effects of radiofrequency ablation (RFA) on renal cell carcinoma (RCC) can be detected with dynamic contrast enhanced (DCE)-MRI and to correlate RCC perfusion with RFA treatment time. 20 patients undergoing RFA of their 21 RCCs were evaluated with DCE-MRI before and at one month after RFA treatment. Perfusion was estimated using the maximum slope technique at two independent sittings. Total RCC blood flow was correlated with total RFA treatment time, tumour location, size and histology. DCE-MRI examinations were successfully evaluated for 21 RCCs (size from 1.3 to 4 cm). Perfusion of the RCCs decreased significantly ( p < 0.0001) from a mean of 203 (±80) mL/min/100 mL before RFA to 8.1 (±3.1) mL/min/100 mL after RFA with low intra-observer variability ( r ≥ 0.99, p < 0.0001). There was an excellent correlation ( r = 0.95) between time to complete ablation and pre-treatment total RCC blood flow. Tumours with an exophytic location exhibit the lowest mean RFA treatment time. DCE-MRI can detect early treatment effects by measuring RCC perfusion before and after RFA. Perfusion significantly decreases in the zone of ablation, suggesting that it may be useful for the assessment of treatment efficacy. Pre-RFA RCC blood flow may be used to predict RFA treatment time.

Joint Assessment of Renewable Energy and Water Desalination Research Center (REWDC) Program Capabilities and Facilities In Radioactive Waste Management

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

Bissani, M; Fischer, R; Kidd, S

2006-04-03

The primary goal of this visit was to perform a joint assessment of the Renewable Energy and Water Desalination Center's (REWDC) program in radioactive waste management. The visit represented the fourth technical and scientific interaction with Libya under the DOE/NNSA Sister Laboratory Arrangement. Specific topics addressed during the visit focused on Action Sheet P-05-5, ''Radioactive Waste Management''. The Team, comprised of Mo Bissani (Team Lead), Robert Fischer, Scott Kidd, and Jim Merrigan, consulted with REWDC management and staff. The team collected information, discussed particulars of the technical collaboration and toured the Tajura facility. The tour included the waste treatment facility,more » waste storage/disposal facility, research reactor facility, hot cells and analytical labs. The assessment team conducted the first phase of Task A for Action Sheet 5, which involved a joint assessment of the Radioactive Waste Management Program. The assessment included review of the facilities dedicated to the management of radioactive waste at the Tourja site, the waste management practices, proposed projects for the facility and potential impacts on waste generation and management.« less

GEWEX-RFA Land-Ocean Mask

Atmospheric Science Data Center

2017-05-25

... for the Radiative Flux Assessment. It can be used as a filter for creating global, regional, or zonal time series for land or ocean. ... where coastal pixels have at least 10% of both land and water. Download file . ...

Diagnostic accuracy of contrast-enhanced ultrasound in assessing the therapeutic response to radio frequency ablation for liver tumors: systematic review and meta-analysis.

PubMed

Xuan, Min; Zhou, Fengsheng; Ding, Yan; Zhu, Qiaoying; Dong, Ji; Zhou, Hao; Cheng, Jun; Jiang, Xiao; Wu, Pengxi

2018-04-01

To review the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) used to detect residual or recurrent liver tumors after radiofrequency ablation (RFA). This technique uses contrast-enhanced computer tomography or/and contrast-enhanced magnetic resonance imaging as the gold standard of investigation. MEDLINE, EMBASE, and COCHRANE were systematically searched for all potentially eligible studies comparing CEUS with the reference standard that follows RFA. Risk of bias and applicability concerns were addressed by adopting the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Pooled point estimates for sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratios (DOR) with 95% CI were computed before plotting the sROC (summary receiver operating characteristic) curve. Meta-regression and subgroup analysis were used to identify the source of the heterogeneity that was detected. Publication bias was evaluated using Deeks' funnel plot asymmetry test. Ten eligible studies on 1162 lesions that occurred between 2001 and 2016 were included in the final analysis. The quality of the included studies assessed by the QUADAS-2 tool was considered reasonable. The pooled sensitivity and specificity of CEUS in detecting residual or recurrent liver tumors had the following values: 0.90 (95% CI 0.85-0.94) and 1.00 (95% CI 0.99-1.00), respectively. Overall DOR was 420.10 (95% CI 142.30-1240.20). The sources of heterogeneity could not be precisely identified by meta-regression or subgroup analysis. No evidence of publication bias was found. This study confirmed that CEUS exhibits high sensitivity and specificity in assessing therapeutic responses to RFA for liver tumors.

Value of Nonrigid Registration of Pre-Procedure MR with Post-Procedure CT After Radiofrequency Ablation for Hepatocellular Carcinoma

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

Park, Juil; Lee, Jeong Min, E-mail: jmlshy2000@gmail.com, E-mail: jmsh@snu.ac.kr; Lee, Dong Ho

PurposeTo evaluate the value of pre-radiofrequency ablation (RFA) MR and post-RFA CT registration for the assessment of the therapeutic response of hepatocellular carcinoma (HCC).Materials and MethodsA total of 178 patients with single HCC who received RFA as an initial treatment and had available pre-RFA MR and post-RFA CT images were included in this retrospective study. Two independent readers (one experienced radiologist, one inexperienced radiologist) scored the ablative margin (AM) of treated tumors on a four-point scale (1, residual tumor; 2, incomplete AM; 3, borderline AM; 4, sufficient AM), in two separate sessions: (1) visual comparison between pre-and post-RFA images; (2)more » with addition of nonrigid registration for pre- and post-RFA images. Local tumor progression (LTP) rates between low-risk (response score, 3–4) and high-risk groups (1–2) were analyzed using the Kaplan–Meier method at each interpretation session.ResultsThe patients’ reassignments after using the registered images were statistically significant for inexperienced reader (p < 0.001). In the inexperienced reader, LTP rates of low- and high-risk groups were significantly different with addition of registered images (session 2) (p < 0.001), but not significantly different in session 1 (p = 0.101). However, in the experienced reader, LTP rates of low- and high-risk groups were significantly different in both interpretation sessions (p < 0.001). Using the registered images, the cumulative incidence of LTP at 2 years was 3.0–6.6%, for the low-risk group, and 18.6–27.8% for the high-risk group.ConclusionRegistration between pre-RFA MR and post-RFA CT images may allow better assessment of the therapeutic response of HCC after RFA, especially for inexperienced radiologists, helping in the risk stratification for LTP.« less

A retrospective tiered environmental assessment of the Mount Storm Wind Energy Facility, West Virginia,USA

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

Efroymson, Rebecca Ann; Day, Robin; Strickland, M. Dale

Bird and bat fatalities from wind energy projects are an environmental and public concern, with post-construction fatalities sometimes differing from predictions. Siting facilities in this context can be a challenge. In March 2012 the U.S. Fish and Wildlife Service (USFWS) released Land-based Wind Energy Guidelines to assess collision fatalities and other potential impacts to species of concern and their habitats to aid in siting and management. The Guidelines recommend a tiered approach for assessing risk to wildlife, including a preliminary site evaluation that may evaluate alternative sites, a site characterization, field studies to document wildlife and habitat and to predictmore » project impacts, post construction studies to estimate impacts, and other post construction studies. We applied the tiered assessment framework to a case study site, the Mount Storm Wind Energy Facility in Grant County, West Virginia, USA, to demonstrate the use of the USFWS assessment approach, to indicate how the use of a tiered assessment framework might have altered outputs of wildlife assessments previously undertaken for the case study site, and to assess benefits of a tiered ecological assessment framework for siting wind energy facilities. The conclusions of this tiered assessment for birds are similar to those of previous environmental assessments for Mount Storm. This assessment found risk to individual migratory tree-roosting bats that was not emphasized in previous preconstruction assessments. Differences compared to previous environmental assessments are more related to knowledge accrued in the past 10 years rather than to the tiered structure of the Guidelines. Benefits of the tiered assessment framework include good communication among stakeholders, clear decision points, a standard assessment trajectory, narrowing the list of species of concern, improving study protocols, promoting consideration of population-level effects, promoting adaptive management through post

Histopathology of breast cancer after magnetic resonance-guided high-intensity focused ultrasound and radiofrequency ablation.

PubMed

Knuttel, Floortje M; Waaijer, Laurien; Merckel, Laura G; van den Bosch, Maurice A A J; Witkamp, Arjen J; Deckers, Roel; van Diest, Paul J

2016-08-01

Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation and radiofrequency ablation (RFA) are being researched as possible substitutes for surgery in breast cancer patients. The histopathological appearance of ablated tissue has not been studied in great detail. This study aimed to compare histopathological features of breast cancer after MR-HIFU ablation and RFA. MR-HIFU ablation and RFA were performed in- and ex-vivo. Tumours in six mastectomy specimens were partially ablated with RFA or MR-HIFU. In-vivo MR-HIFU ablation was performed 3-6 days before excision; RFA was performed in the operation room. Tissue was fixed in formalin and processed to haematoxylin and eosin (H&E) and cytokeratin-8 (CK-8)-stained slides. Morphology and cell viability were assessed. Ex-vivo ablation resulted in clear morphological changes after RFA versus subtle differences after MR-HIFU. CK-8 staining was decreased or absent. H&E tended to underestimate the size of thermal damage. In-vivo MR-HIFU resulted in necrotic-like changes. Surprisingly, some ablated lesions were CK-8-positive. Histopathology after in-vivo RFA resembled ex-vivo RFA, with hyper-eosinophilic stroma and elongated nuclei. Lesion borders were sharp after MR-HIFU and indistinct after RFA. Histopathological differences between MR-HIFU-ablated tissue and RF-ablated tissue were demonstrated. CK-8 was more reliable for cell viability assessment than H&E when used directly after ablation, while H&E was more reliable in ablated tissue left in situ for a few days. Our results contribute to improved understanding of histopathological features in breast cancer lesions treated with minimally invasive ablative techniques. © 2016 John Wiley & Sons Ltd.

Practical Approaches for Assessment of Daily and Post-discharge Room Disinfection in Healthcare Facilities.

PubMed

Deshpande, Abhishek; Donskey, Curtis J

2017-09-01

Cleaning and disinfection in healthcare facilities is essential to ensure patient safety. This review examines practical strategies used to assess and improve the effectiveness of daily and post-discharge manual cleaning in healthcare facilities. Effective implementation of cleaning interventions requires objective monitoring of staff performance with regular feedback on performance. Use of fluorescent markers to assess thoroughness of cleaning and measurement of residual ATP can provide rapid and objective feedback to personnel and have been associated with improved cleaning. Direct observation of cleaning and interviews with front-line staff are useful to identify variations and deficiencies in practice that may not be detected by other methods. Although not recommended for routine monitoring, cultures can be helpful for outbreak investigations. Monitoring and feedback can be effective in improving cleaning and disinfection in healthcare facilities. Ongoing commitment within institutions is needed to sustain successful cleaning and disinfection programs.

Radiofrequency ablation of the pancreas with and without intraluminal duodenal cooling in a porcine model.

PubMed

Fegrachi, Samira; Molenaar, I Quintus; Klaessens, John H; Besselink, Marc G; Offerhaus, Johan A; van Hillegersberg, Richard

2013-10-01

To determine the short-term outcome of radiofrequency ablation (RFA) of pancreatic tissue near the duodenum and portomesenteric vessels (PMV) in a porcine model with and without intraluminal duodenal cooling. RFA has been proposed as a new treatment strategy in patients with unresectable locally advanced pancreatic cancer. RFA may cause thermal damage to the duodenum and vascular structures, but these risks and potential protective measures have never been systematically addressed. Intraluminal duodenal cooling during RFA could prevent thermal damage to the duodenum. RFA was performed in 11 pigs during laparotomy with a bipolar probe of 30 mm active length at a power of 30 W until a total energy of 15 kJ was administered. The RFA probe was inserted in the pancreas at 5 or 15 mm from the duodenum, PMV, and in the pancreatic tail. RFA near the duodenum was performed with and without intraluminal duodenal cooling using 100 mL/min saline of 5°C. Histopathologic assessment was performed. The maximum RFA-induced temperature was 92°C. RFA with one single probe induced adequate ablation lesions with a diameter of 20 mm over a length of 30 mm. Without duodenal cooling, RFA induced duodenal thermal damage, whereas with duodenal cooling, no damage was observed. RFA at 15 mm from the PMV resulted in minimal superficial focal vascular damage, without thrombosis or hemorrhage. RFA provides adequate ablation zones in the pancreas of the porcine. Thermal damage to the duodenum can be prevented by intraluminal duodenal cooling without loss of ablation effectivity. Copyright © 2013 Elsevier Inc. All rights reserved.

Site specific risk assessment of an energy-from-waste thermal treatment facility in Durham Region, Ontario, Canada. Part A: Human health risk assessment.

PubMed

Ollson, Christopher A; Knopper, Loren D; Whitfield Aslund, Melissa L; Jayasinghe, Ruwan

2014-01-01

The regions of Durham and York in Ontario, Canada have partnered to construct an energy-from-waste thermal treatment facility as part of a long term strategy for the management of their municipal solid waste. This paper presents the results of a comprehensive human health risk assessment for this facility. This assessment was based on extensive sampling of baseline environmental conditions (e.g., collection and analysis of air, soil, water, and biota samples) as well as detailed site specific modeling to predict facility-related emissions of 87 identified contaminants of potential concern. Emissions were estimated for both the approved initial operating design capacity of the facility (140,000 tonnes per year) and for the maximum design capacity (400,000 tonnes per year). For the 140,000 tonnes per year scenario, this assessment indicated that facility-related emissions are unlikely to cause adverse health risks to local residents, farmers, or other receptors (e.g., recreational users). For the 400,000 tonnes per year scenarios, slightly elevated risks were noted with respect to inhalation (hydrogen chloride) and infant consumption of breast milk (dioxins and furans), but only during predicted 'upset conditions' (i.e. facility start-up, shutdown, and loss of air pollution control) that represent unusual and/or transient occurrences. However, current provincial regulations require that additional environmental screening would be mandatory prior to expansion of the facility beyond the initial approved capacity (140,000 tonnes per year). Therefore, the potential risks due to upset conditions for the 400,000 tonnes per year scenario should be more closely investigated if future expansion is pursued. © 2013.

Assessment of the National Transonic Facility for Laminar Flow Testing

NASA Technical Reports Server (NTRS)

Crouch, Jeffrey D.; Sutanto, Mary I.; Witkowski, David P.; Watkins, A. Neal; Rivers, Melissa B.; Campbell, Richard L.

2010-01-01

A transonic wing, designed to accentuate key transition physics, is tested at cryogenic conditions at the National Transonic Facility at NASA Langley. The collaborative test between Boeing and NASA is aimed at assessing the facility for high-Reynolds number testing of configurations with significant regions of laminar flow. The test shows a unit Reynolds number upper limit of 26 M/ft for achieving natural transition. At higher Reynolds numbers turbulent wedges emanating from the leading edge bypass the natural transition process and destroy the laminar flow. At lower Reynolds numbers, the transition location is well correlated with the Tollmien-Schlichting-wave N-factor. The low-Reynolds number results suggest that the flow quality is acceptable for laminar flow testing if the loss of laminar flow due to bypass transition can be avoided.

Assessment of health facility capacity to provide newborn care in Bangladesh, Haiti, Malawi, Senegal, and Tanzania

PubMed Central

Winter, Rebecca; Yourkavitch, Jennifer; Wang, Wenjuan; Mallick, Lindsay

2017-01-01

Background Despite the importance of health facility capacity to provide comprehensive care, the most widely used indicators for global monitoring of maternal and child health remain contact measures which assess women’s use of services only and not the capacity of health facilities to provide those services; there is a gap in monitoring health facilities’ capacity to provide newborn care services in low and middle income countries. Methods In this study we demonstrate a measurable framework for assessing health facility capacity to provide newborn care using open access, nationally–representative Service Provision Assessment (SPA) data from the Demographic Health Surveys Program. In particular, we examine whether key newborn–related services are available at the facility (ie, service availability, measured by the availability of basic emergency obstetric care (BEmOC) signal functions, newborn signal functions, and routine perinatal services), and whether the facility has the equipment, medications, training and knowledge necessary to provide those services (ie, service readiness, measured by general facility requirements, equipment, medicines and commodities, and guidelines and staffing) in five countries with high levels of neonatal mortality and recent SPA data: Bangladesh, Haiti, Malawi, Senegal, and Tanzania. Findings In each country, we find that key services and commodities needed for comprehensive delivery and newborn care are missing from a large percentage of facilities with delivery services. Of three domains of service availability examined, scores for routine care availability are highest, while scores for newborn signal function availability are lowest. Of four domains of service readiness examined, scores for general requirements and equipment are highest, while scores for guidelines and staffing are lowest. Conclusions Both service availability and readiness tend to be highest in hospitals and facilities in urban areas, pointing to

78 FR 7334 - Port Authority Access to Facility Vulnerability Assessments and the Integration of Security Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-01

... to Facility Vulnerability Assessments and the Integration of Security Systems AGENCY: Coast Guard...-sharing measures. Security System Integration Alternatives Require each MTSA-regulated facility owner or... other forms of security system integration. Information Requested 1. We request comments on the...

Alcoa: Plant-Wide Energy Assessment Finds Potential Savings at Aluminum Extrusion Facility. Industrial Technologies Program, Aluminum BestPractices Plant-Wide Assessment Case Study.

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

Not Available

2003-09-01

Alcoa completed an energy assessment of its Engineered Products aluminum extrusion facility in Plant City, Florida, in 2001. The company identified energy conservation opportunities throughout the plant and prepared a report as an example for performing energy assessments at similar Alcoa facilities. If implemented, the cost of energy for the plant would be reduced by more than$800,000 per year by conserving 3 million kWh of electricity and 150,000 MMBtu of natural gas.

Epicardial Radiofrequency Ablation Failure During Ablation Procedures for Ventricular Arrhythmias: Reasons and Implications for Outcomes.

PubMed

Baldinger, Samuel H; Kumar, Saurabh; Barbhaiya, Chirag R; Mahida, Saagar; Epstein, Laurence M; Michaud, Gregory F; John, Roy; Tedrow, Usha B; Stevenson, William G

2015-12-01

Radiofrequency ablation (RFA) from the epicardial space for ventricular arrhythmias is limited or impossible in some cases. Reasons for epicardial ablation failure and the effect on outcome have not been systematically analyzed. We assessed reasons for epicardial RFA failure relative to the anatomic target area and the type of heart disease and assessed the effect of failed epicardial RFA on outcome after ablation procedures for ventricular arrhythmias in a large single-center cohort. Epicardial access was attempted during 309 ablation procedures in 277 patients and was achieved in 291 procedures (94%). Unlimited ablation in an identified target region could be performed in 181 cases (59%), limited ablation was possible in 22 cases (7%), and epicardial ablation was deemed not feasible in 88 cases (28%). Reasons for failed or limited ablation were unsuccessful epicardial access (6%), failure to identify an epicardial target (15%), proximity to a coronary artery (13%), proximity to the phrenic nerve (6%), and complications (<1%). Epicardial RFA was impeded in the majority of cases targeting the left ventricular summit region. Acute complications occurred in 9%. The risk for acute ablation failure was 8.3× higher (4.5-15.0; P<0.001) after no or limited epicardial RFA compared with unlimited RFA, and patients with unlimited epicardial RFA had better recurrence-free survival rates (P<0.001). Epicardial RFA for ventricular arrhythmias is often limited even when pericardial access is successful. Variability of success is dependent on the target area, and the presence of factors limiting ablation is associated with worse outcomes. © 2015 American Heart Association, Inc.

POLLUTION PREVENTION OPPORTUNITY ASSESSMENT: GENERAL MAIL AND VEHICLE MAINTENANCE FACILITY, UNITED STATES POSTAL SERVICE, BUFFALO, NY

EPA Science Inventory

The Pollution Prevention Opportunity Assessment (PPOA) summarized here was conducted at a U.S.Postal Service (USPS) Facility in Buffalo, NY. The PPOA documented and quantified waste generation at the General Mail Facility (GMF) where mail is processed, and at the Vehicle Maintena...

Optically-based Sensor System for Critical Nuclear Facilities Post-Event Seismic Structural Assessment

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

McCallen, David; Petrone, Floriana; Buckle, Ian

The U.S. Department of Energy (DOE) has ownership and operational responsibility for a large enterprise of nuclear facilities that provide essential functions to DOE missions ranging from national security to discovery science and energy research. These facilities support a number of DOE programs and offices including the National Nuclear Security Administration, Office of Science, and Office of Environmental Management. With many unique and “one of a kind” functions, these facilities represent a tremendous national investment, and assuring their safety and integrity is fundamental to the success of a breadth of DOE programs. Many DOE critical facilities are located in regionsmore » with significant natural phenomenon hazards including major earthquakes and DOE has been a leader in developing standards for the seismic analysis of nuclear facilities. Attaining and sustaining excellence in nuclear facility design and management must be a core competency of the DOE. An important part of nuclear facility management is the ability to monitor facilities and rapidly assess the response and integrity of the facilities after any major upset event. Experience in the western U.S. has shown that understanding facility integrity after a major earthquake is a significant challenge which, lacking key data, can require extensive effort and significant time. In the work described in the attached report, a transformational approach to earthquake monitoring of facilities is described and demonstrated. An entirely new type of optically-based sensor that can directly and accurately measure the earthquake-induced deformations of a critical facility has been developed and tested. This report summarizes large-scale shake table testing of the sensor concept on a representative steel frame building structure, and provides quantitative data on the accuracy of the sensor measurements.« less

Optimal siting of solid waste-to-value-added facilities through a GIS-based assessment.

PubMed

Khan, Md Mohib-Ul-Haque; Vaezi, Mahdi; Kumar, Amit

2018-01-01

Siting a solid waste conversion facility requires an assessment of solid waste availability as well as ensuring compliance with environmental, social, and economic factors. The main idea behind this study was to develop a methodology to locate suitable locations for waste conversion facilities considering waste availability as well as environmental and social constraints. A geographic information system (GIS) spatial analysis was used to identify the most suitable areas and to screen out unsuitable lands. The analytic hierarchy process (AHP) was used for a multi-criteria evaluation of relative preferences of different environmental and social factors. A case study was conducted for Alberta, a western province in Canada, by performing a province-wide waste availability assessment. The total available waste considered in this study was 4,077,514tonnes/year for 19 census divisions collected from 79 landfills. Finally, a location-allocation analysis was performed to determine suitable locations for 10 waste conversion facilities across the province. Copyright © 2017 Elsevier B.V. All rights reserved.

A National Survey of Mental Health Screening and Assessment Practices in Juvenile Correctional Facilities

ERIC Educational Resources Information Center

Swank, Jacqueline M.; Gagnon, Joseph C.

2017-01-01

Background: Mental health screening and assessment is crucial within juvenile correctional facilities (JC). However, limited information is available about the current screening and assessment procedures specifically within JC. Objective: The purpose of the current study was to obtain information about the mental health screening and assessment…

Memorandum : feasibility assessment, bicycle or bicycle/pedestrian (multi-user) facility at Appomattox Court house NHP

DOT National Transportation Integrated Search

2007-10-12

This memorandum provides a preliminary feasibility assessment for a bicycle or combined bicycle/pedestrian (i.e., multi-user) facility at Appomattox Court House National Historical Park (NHP). This assessment is based on discussions with park staff, ...

Feasibility study: Assess the feasibility of siting a monitored retrievable storage facility. Phase 1

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

King, J.W.

1993-08-01

The purpose of phase one of this study are: To understand the waste management system and a monitored retrievable storage facility; and to determine whether the applicant has real interest in pursuing the feasibility assessment process. Contents of this report are: Generating electric power; facts about exposure to radiation; handling storage, and transportation techniques; description of a proposed monitored retrievable storage facility; and benefits to be received by host jurisdiction.

Acoustic radiation force impulse imaging for real-time observation of lesion development during radiofrequency ablation procedures

NASA Astrophysics Data System (ADS)

Fahey, Brian J.; Trahey, Gregg E.

2005-04-01

When performing radiofrequency ablation (RFA) procedures, physicians currently have little or no feedback concerning the success of the treatment until follow-up assessments are made days to weeks later. To be successful, RFA must induce a thermal lesion of sufficient volume to completely destroy a target tumor or completely isolate an aberrant cardiac pathway. Although ultrasound, computed tomography (CT), and CT-based fluoroscopy have found use in guiding RFA treatments, they are deficient in giving accurate assessments of lesion size or boundaries during procedures. As induced thermal lesion size can vary considerably from patient to patient, the current lack of real-time feedback during RFA procedures is troublesome. We have developed a technique for real-time monitoring of thermal lesion size during RFA procedures utilizing acoustic radiation force impulse (ARFI) imaging. In both ex vivo and in vivo tissues, ARFI imaging provided better thermal lesion contrast and better overall appreciation for lesion size and boundaries relative to conventional sonography. The thermal safety of ARFI imaging for use at clinically realistic depths was also verified through the use of finite element method models. As ARFI imaging is implemented entirely on a diagnostic ultrasound scanner, it is a convenient, inexpensive, and promising modality for monitoring RFA procedures in vivo.

Ultrasound-ultrasound image overlay fusion improves real-time control of radiofrequency ablation margin in the treatment of hepatocellular carcinoma.

PubMed

Minami, Yasunori; Minami, Tomohiro; Hagiwara, Satoru; Ida, Hiroshi; Ueshima, Kazuomi; Nishida, Naoshi; Murakami, Takamichi; Kudo, Masatoshi

2018-05-01

To assess the clinical feasibility of US-US image overlay fusion with evaluation of the ablative margin in radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). Fifty-three patients with 68 HCCs measuring 0.9-4.0 cm who underwent RFA guided by US-US overlay image fusion were included in this retrospective study. By an overlay of pre-/postoperative US, the tumor image could be projected onto the ablative hyperechoic zone. Therefore, the ablative margin three-dimensionally could be shown during the RFA procedure. US-US image overlay was compared to dynamic CT a few days after RFA for assessment of early treatment response. Accuracy of graded response was calculated, and the performance of US-US image overlay fusion was compared with that of CT using a Kappa agreement test. Technically effective ablation was achieved in a single session, and 59 HCCs (86.8 %) succeeded in obtaining a 5-mm margin on CT. The response with US-US image overlay correctly predicted early CT evaluation with an accuracy of 92.6 % (63/68) (k = 0.67; 95 % CI: 0.39-0.95). US-US image overlay fusion can be proposed as a feasible guidance in RFA with a safety margin and predicts early response of treatment assessment with high accuracy. • US-US image overlay fusion visualizes the ablative margin during RFA procedure. • Visualizing the margin during the procedure can prompt immediate complementary treatment. • US image fusion correlates with the results of early evaluation CT.

Associations between Moderate-to-Vigorous Physical Activity and Neighbourhood Recreational Facilities: The Features of the Facilities Matter

PubMed Central

Lee, Ka Yiu; Lee, Paul H.; Macfarlane, Duncan

2014-01-01

Objectives: To examine the associations between objectively-assessed moderate-to-vigorous physical activity (MVPA) and perceived/objective measures of neighbourhood recreational facilities categorized into indoor or outdoor, public, residential or commercial facilities. The associations between facility perceptions and objectively-assessed numbers of recreational facilities were also examined. Method: A questionnaire was used on 480 adults to measure local facility perceptions, with 154 participants wearing ActiGraph accelerometers for ≥4 days. The objectively-assessed number of neighbourhood recreational facilities were examined using direct observations and Geographical Information System data. Results: Both positive and negative associations were found between MVPA and perceived/objective measures of recreational facilities. Some associations depended on whether the recreational facilities were indoor or outdoor, public or residential facilities. The objectively-assessed number of most public recreational facilities was associated with the corresponding facility perceptions, but the size of effect was generally lower than for residential recreational facilities. Conclusions: The objectively-assessed number of residential outdoor table tennis courts and public indoor swimming pools, the objectively-assessed presence of tennis courts and swimming pools, and the perceived presence of bike lanes and swimming pools were positive determinants of MVPA. It is suggested to categorize the recreational facilities into smaller divisions in order to identify unique associations with MVPA. PMID:25485980

Development of Army Facility Functionality Assessment Criteria and Procedures

DTIC Science & Technology

2010-09-01

critical facility types: the Tactical Equipment Main- tenance Facility (TEMF), the Company Operations Facility (COF), the Bat- talion Headquarters...Criteria for Company Operations Facilities (COF) ................ 56 Appendix G: Army Standard Design Criteria for Tactical Equipment Maintenance...1 mission-critical facility types: the Tactical Equipment Mainten- ance Facility (TEMF), the Company Operations Facility (COF), the Batta- lion

Assessment of accessible facilities for disabled passenger movement in aerodrome terminals in Klang Valley

NASA Astrophysics Data System (ADS)

Ramli, M. Z.; Hasnol., J. N. E.; Hamid, N. B.; Ismail, N.; Zawawi, M. H.; Zainal, M. Z.

2017-09-01

The effectiveness of accessibility in public transport has prompted a great deal of weakness and confines many disabled from moving around unreservedly. As far as the built-up environment is concerned, it is important that it should be barrier-free and adapted to fulfill the needs of all people equally. The consideration of equal accessibility to outdoor environments is still lacking. These cause the problems with poor accessibility, the disabled people face more challenges and difficulties while travelling and using the public transport. Therefore, the aim of the study is to evaluate the performance of accessible facilities for disabled movement in aerodrome terminals in Klang Valley. An assessment rating was developed from an established guideline to assess the disabled facilities provided in the Aerodrome Terminal 1 and Aerodrome Terminal 2 by using manual observation and measurement technique. Based on the results obtained, the facility for disabled people in both aerodrome terminals are moderate. Aerodrome Terminal 1 is averagely 63.46% while for Aerodrome Terminal 2 is 67.31%. Results demonstrated that effort is needed by the respective agencies and there was a demand on re-designing the current facility, so that disabled people will not face any difficulty while traveling through public transport stations or terminals.

Quality Assessment of Family Planning Sterilization Services at Health Care Facilities: Case Record Audit.

PubMed

Mathur, Medha; Goyal, Ram Chandra; Mathur, Navgeet

2017-05-01

Quality of sterilization services is a matter of concern in India because population control is a necessity. Family Planning Sterilization (FPS) services provided at public health care facilities need to be as per Standard Operating Procedures. To assess the quality of FPS services by audit of case records at selected health care facilities. This cross-sectional study was conducted for two and a half year duration at selected public health care facilities of central India by simple random sampling where FPS services were provided. As per the standards of Government of India, case records were audited and compliance was calculated to assess the quality of services. Results of record audit were satisfactory but important criteria like previous contraceptive history and postoperative counselling were found to be deviated from standards. At Primary Health Centres (PHCs) only 89.5% and at Community Health Centres (CHCs) 58.7% of records were having details of previous contraceptive history. Other criteria like mental illness (only 70% at CHCs) assessment were also inadequate. Although informed consent was found to be having 100% compliance in all records. Quality of care in FPS services is the matter of concern in present scenario for better quality of services. This study may enlighten the policy makers regarding improvements needed for providing quality care.

Defense Facility Condition: Revised Guidance Needed to Improve Oversight of Assessments and Ratings

DTIC Science & Technology

2016-06-01

are to implement the standardized process in part by assessing the condition of buildings, pavement , and rail using the same set of software tools...facility to current standards; costs for labor, equipment, materials, and currency exchange rates overseas; costs for project planning and design ...example, the services are to assess the condition of buildings, pavement , and rail using Sustainment Management System software tools developed by the

Engendering a conducive environment for university students with physical disabilities: assessing availability of assistive facilities in Nigeria.

PubMed

Ijadunola, Macellina Y; Ojo, Temitope O; Akintan, Florence O; Adeyemo, Ayoade O; Afolayan, Ademola S; Akanji, Olakunle G

2018-03-12

This study assessed awareness and availability of assistive facilities in a Nigerian public university. Study was conducted in Obafemi Awolowo University (OAU), Ile Ife Nigeria using a mixed methods approach. Fifty two students with disability (SWD) were interviewed with a semistructured, self-administered questionnaire. A checklist was used to assess assistive facilities on campus while in-depth interviews (IDI) were conducted with university officials, to assess their perspectives about the availability and use of assistive facilities in the university. Almost three-thirds (57.7%) of SWD were male while more than two-thirds were aged between 21 and 30 years. About seven in 10 (71.1%) respondents, had mobility impairment, while two-fifth had visual impairment (40.8%) and a few had hearing impairment. Only the university's administrative building had a functioning elevator. Slightly more than half (54.5%) of the lecture theatres have public address systems, while only two have special entrances and exits with ramps for SWD. Almost all respondents were unaware of facilities that aid learning (96.2%) and facilities for library use (90.4%). University officials were aware of assistive facilities for SWD but do not know the actual number of SWD. Assistive facilities for SWD on campus are limited. More assistive facilities need to be provided alongside increased awareness about these facilities and a disability register should be open for students on campus. Assistive facilities to aid learning and make SWD more comfortable are required. Implications for Rehabilitation Universities should have an official policy on students with disabilities and implement it, such a policy should address special considerations for disabled students, such as having an updated register for students with disability, having examination questions in large fonts for students with visual disabilities, giving them extra time for examinations and providing special counselling services for

Source term model evaluations for the low-level waste facility performance assessment

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

Yim, M.S.; Su, S.I.

1995-12-31

The estimation of release of radionuclides from various waste forms to the bottom boundary of the waste disposal facility (source term) is one of the most important aspects of LLW facility performance assessment. In this work, several currently used source term models are comparatively evaluated for the release of carbon-14 based on a test case problem. The models compared include PRESTO-EPA-CPG, IMPACTS, DUST and NEFTRAN-II. Major differences in assumptions and approaches between the models are described and key parameters are identified through sensitivity analysis. The source term results from different models are compared and other concerns or suggestions are discussed.

Assessment of radiological protection systems among diagnostic radiology facilities in North East India.

PubMed

Singh, Thokchom Dewan; Jayaraman, T; Arunkumar Sharma, B

2017-03-01

This study aims to assess the adequacy level of radiological protection systems available in the diagnostic radiology facilities located in three capital cities of North East (NE) India. It further attempts to understand, using a multi-disciplinary approach, how the safety codes/standards in diagnostic radiology framed by the Atomic Energy Regulatory Board (AERB) and the International Atomic Energy Agency (IAEA) to achieve adequate radiological protection in facilities, have been perceived, conceptualized, and applied accordingly in these facilities. About 30 diagnostic radiology facilities were randomly selected from three capitals of states in NE India; namely Imphal (Manipur), Shillong (Meghalaya) and Guwahati (Assam). A semi-structured questionnaire developed based on a multi-disciplinary approach was used for this study. It was observed that radiological practices undertaken in these facilities were not exactly in line with safety codes/standards in diagnostic radiology of the AERB and the IAEA. About 50% of the facilities had registered/licensed x-ray equipment with the AERB. More than 80% of the workers did not use radiation protective devices, although these devices were available in the facilities. About 85% of facilities had no institutional risk management system. About 70% of the facilities did not carry out periodic quality assurance testing of their x-ray equipment or surveys of radiation leakage around the x-ray room, and did not display radiation safety indicators in the x-ray rooms. Workers in these facilities exhibited low risk perception about the risks associated with these practices. The majority of diagnostic radiology facilities in NE India did not comply with the radiological safety codes/standards framed by the AERB and IAEA. The study found inadequate levels of radiological protection systems in the majority of facilities. This study suggests a need to establish firm measures that comply with the radiological safety codes/standards of the

Thermal Versus Impedance-Based Ablation of Renal Cell Carcinoma: A Meta-analysis

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

Modabber, Milad, E-mail: mmodabber@gmail.com; Martin, Jason, E-mail: jason.martin@medportal.ca; Athreya, Sriharsha, E-mail: sathreya@stjosham.on.ca

2013-10-04

BackgroundPercutaneous radiofrequency ablation (RFA) of renal carcinoma has become an established treatment modality. However, thermal (TB) versus impedance-based (IB)-RF generators have not been previously compared.MethodsA literature search on the application of RFA for renal masses using TB or IB-RF generators was performed. The safety, efficacy, and long-term outcomes of TB versus IB-based RFA were assessed using the outcome measures of technical success, local recurrence rate, complications, and preservation of renal function.ResultsAcross the 27 included studies, pooled results suggested comparable results for technical success (TB-RFA 98.53 % vs. IB-RFA 98.78 %, P = 0.9813). Clinical efficacy results were also similar across both generators (91.0 % TB-RFAmore » vs. 91.5 % IB-RFA; P = 0.73). At follow-up, no differences in renal function (relative risk [RR] 0.5, 95 % confidence interval [CI] 0.45–5.48), and local recurrence (RR 0.717, 95 % CI 0.49–1.50) were observed. The pooled proportion of overall complication rates was 13.1 % for TB-RFA and 11.5 % for IB-RFA.ConclusionNo differences in the observed parameters were found either during surgery or at follow-up.« less

Assessment of facility readiness and provider preparedness for dealing with postpartum haemorrhage and pre-eclampsia/eclampsia in public and private health facilities of northern Karnataka, India: a cross-sectional study.

PubMed

Jayanna, Krishnamurthy; Mony, Prem; B M, Ramesh; Thomas, Annamma; Gaikwad, Ajay; H L, Mohan; Blanchard, James F; Moses, Stephen; Avery, Lisa

2014-09-04

The maternal mortality ratio in India has been declining over the past decade, but remains unacceptably high at 212 per 100,000 live births. Postpartum haemorrhage (PPH) and pre- eclampsia/eclampsia contribute to 40% of all maternal deaths. We assessed facility readiness and provider preparedness to deal with these two maternal complications in public and private health facilities of northern Karnataka state, south India. We undertook a cross-sectional study of 131 primary health centres (PHCs) and 148 higher referral facilities (74 public and 74 private) in eight districts of the region. Facility infrastructure and providers' knowledge related to screening and management of complications were assessed using facility checklists and test cases, respectively. We also attempted an audit of case sheets to assess provider practice in the management of complications. Chi square tests were used for comparing proportions. 84.5% and 62.9% of all facilities had atleast one doctor and three nurses, respectively; only 13% of higher facilities had specialists. Magnesium sulphate, the drug of choice to control convulsions in eclampsia was available in 18% of PHCs, 48% of higher public facilities and 70% of private facilities. In response to the test case on eclampsia, 54.1% and 65.1% of providers would administer anti-hypertensives and magnesium sulphate, respectively; 24% would administer oxygen and only 18% would monitor for magnesium sulphate toxicity. For the test case on PPH, only 37.7% of the providers would assess for uterine tone, and 40% correctly defined early PPH. Specialists were better informed than the other cadres, and the differences were statistically significant. We experienced generally poor response rates for audits due to non-availability and non-maintenance of case sheets. Addressing gaps in facility readiness and provider competencies for emergency obstetric care, alongside improving coverage of institutional deliveries, is critical to improve maternal

Immune Adjuvant Activity of Pre-Resectional Radiofrequency Ablation Protects against Local and Systemic Recurrence in Aggressive Murine Colorectal Cancer.

PubMed

Ito, Fumito; Ku, Amy W; Bucsek, Mark J; Muhitch, Jason B; Vardam-Kaur, Trupti; Kim, Minhyung; Fisher, Daniel T; Camoriano, Marta; Khoury, Thaer; Skitzki, Joseph J; Gollnick, Sandra O; Evans, Sharon S

2015-01-01

While surgical resection is a cornerstone of cancer treatment, local and distant recurrences continue to adversely affect outcome in a significant proportion of patients. Evidence that an alternative debulking strategy involving radiofrequency ablation (RFA) induces antitumor immunity prompted the current investigation of the efficacy of performing RFA prior to surgical resection (pre-resectional RFA) in a preclinical mouse model. Therapeutic efficacy and systemic immune responses were assessed following pre-resectional RFA treatment of murine CT26 colon adenocarcinoma. Treatment with pre-resectional RFA significantly delayed tumor growth and improved overall survival compared to sham surgery, RFA, or resection alone. Mice in the pre-resectional RFA group that achieved a complete response demonstrated durable antitumor immunity upon tumor re-challenge. Failure to achieve a therapeutic benefit in immunodeficient mice confirmed that tumor control by pre-resectional RFA depends on an intact adaptive immune response rather than changes in physical parameters that make ablated tumors more amenable to a complete surgical excision. RFA causes a marked increase in intratumoral CD8+ T lymphocyte infiltration, thus substantially enhancing the ratio of CD8+ effector T cells: FoxP3+ regulatory T cells. Importantly, pre-resectional RFA significantly increases the number of antigen-specific CD8+ T cells within the tumor microenvironment and tumor-draining lymph node but had no impact on infiltration by myeloid-derived suppressor cells, M1 macrophages or M2 macrophages at tumor sites or in peripheral lymphoid organs (i.e., spleen). Finally, pre-resectional RFA of primary tumors delayed growth of distant tumors through a mechanism that depends on systemic CD8+ T cell-mediated antitumor immunity. Improved survival and antitumor systemic immunity elicited by pre-resectional RFA support the translational potential of this neoadjuvant treatment for cancer patients with high-risk of

Facility Energy Decision System (FEDS) Assessment Report for Fort Buchanan, Puerto Rico

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

Chvala, William D.; Solana, Amy E.; Dixon, Douglas R.

2005-02-01

This report documents the findings of the Facility Energy Decision System (FEDS) assessment at Fort Buchanan, Puerto Rico, by a team of PNNL engineers under contract to the Installation Management Agency (IMA) Southeast Region Office (SERO). Funding support was also provided by the Department of Energy's Federal Energy Management Program. The purpose of the assessment was to determine how energy is consumed at Fort Buchanan, identify the most cost-effective energy retrofit measures, and calculate the potential energy and cost savings.

Assessment of Volatile Organic Compounds (VOCs) in indooor parking facilities at Houston, Texas

NASA Astrophysics Data System (ADS)

Kristanto, Gabriel Andari

This dissertation identified the types, magnitudes, sources, and assessed risk exposure of VOCs in different types of indoor parking facilities. VOCs are ones of major pollutants emitted from automobiles. The indoor parking facilities included were attached garages, grounds, and underground parking. Modification of method TO15 by EPA had been applied for identifying types and magnitudes of VOCs. Results of these identifications are presented. Eight most abundant VOCs could be identified in every sampling location with toluene as the most abundant compound followed by m,p-xylene, ethylbenzene and benzene. Compare to ground and underground parking, attached garages have the highest concentration of TVOCs. For sources identification, BTEX, m,p-xylene and benzene, and toluene and benzene ratios are calculated. BTEX ratios for ground and underground parking are similar compare to attached garage due to the similar pattern of driving speed and the content of gasoline fuel. On the other hand the ratios of m,p-xylene and benzene and toluene and benzene in attached garage are higher compare to the same ratios for ground and underground parking due to other significant contributor of VOCs such as solvent, household cleanings stored. Cancer and noncancer risk assessment were also calculated. Results showed that cancer and noncancer risk due human exposures to VOC in indoor parking facilities were relatively low. However the risk of the human exposure to VOCs from indoor parking facilities has to be considered as a part of total risks of VOC exposures on human during their daily activities. When people in Houston have already exposed to high VOC concentrations from outdoor environment activities such as traffic and refineries and petrochemical facilities, additional activities causing VOC exposures will add the risk significantly.

41 CFR 102-80.60 - Are Federal agencies responsible for performing facility assessments?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT REGULATION REAL PROPERTY 80-SAFETY AND ENVIRONMENTAL MANAGEMENT Safety and Environmental Management Facility Assessments... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Are Federal agencies...

Environmental Assessment for Developing Renewable Energy Enhanced Use Lease Facilities at Robins Air Force Base

DTIC Science & Technology

2013-12-15

underlain by igneous and metamorphic rocks which are equivalent to those of the Georgia Piedmont. Potable and process waters are produced from the...Final Environmental Assessment for Developing Renewable Energy Enhanced Use Lease Facilities at Robins Air Force Base...RENEWABLE ENERGY ENHANCED USE LEASE FACILITIES AT ROBINS AIR FORCE BASE In accordance with the National Environmental Policy Act (NEPA) of 1969 (42 U.S

Monitored retrievable storage submission to Congress: Volume 2, Environmental assessment for a monitored retrievable storage facility. [Contains glossary

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

None

1986-02-01

This Environmental Assessment (EA) supports the DOE proposal to Congress to construct and operate a facility for monitored retrievable storage (MRS) of spent fuel at a site on the Clinch River in the Roane County portion of Oak Ridge, Tennessee. The first part of this document is an assessment of the value of, need for, and feasibility of an MRS facility as an integral component of the waste management system. The second part is an assessment and comparison of the potential environmental impacts projected for each of six site-design combinations. The MRS facility would be centrally located with respect tomore » existing reactors, and would receive and canister spent fuel in preparation for shipment to and disposal in a geologic repository. 207 refs., 57 figs., 132 tabs.« less

Site specific risk assessment of an energy-from-waste/thermal treatment facility in Durham Region, Ontario, Canada. Part B: Ecological risk assessment.

PubMed

Ollson, Christopher A; Whitfield Aslund, Melissa L; Knopper, Loren D; Dan, Tereza

2014-01-01

The regions of Durham and York in Ontario, Canada have partnered to construct an energy-from-waste (EFW) thermal treatment facility as part of a long term strategy for the management of their municipal solid waste. In this paper we present the results of a comprehensive ecological risk assessment (ERA) for this planned facility, based on baseline sampling and site specific modeling to predict facility-related emissions, which was subsequently accepted by regulatory authorities. Emissions were estimated for both the approved initial operating design capacity of the facility (140,000 tonnes per year) and the maximum design capacity (400,000 tonnes per year). In general, calculated ecological hazard quotients (EHQs) and screening ratios (SRs) for receptors did not exceed the benchmark value (1.0). The only exceedances noted were generally due to existing baseline media concentrations, which did not differ from those expected for similar unimpacted sites in Ontario. This suggests that these exceedances reflect conservative assumptions applied in the risk assessment rather than actual potential risk. However, under predicted upset conditions at 400,000 tonnes per year (i.e., facility start-up, shutdown, and loss of air pollution control), a potential unacceptable risk was estimated for freshwater receptors with respect to benzo(g,h,i)perylene (SR=1.1), which could not be attributed to baseline conditions. Although this slight exceedance reflects a conservative worst-case scenario (upset conditions coinciding with worst-case meteorological conditions), further investigation of potential ecological risk should be performed if this facility is expanded to the maximum operating capacity in the future. © 2013.

Use of a geographic information system to assess accessibility to health facilities providing emergency obstetric and newborn care in Bangladesh.

PubMed

Chowdhury, Mahbub E; Biswas, Taposh K; Rahman, Monjur; Pasha, Kamal; Hossain, Mollah A

2017-08-01

To use a geographic information system (GIS) to determine accessibility to health facilities for emergency obstetric and newborn care (EmONC) and compare coverage with that stipulated by UN guidelines (5 EmONC facilities per 500 000 individuals, ≥1 comprehensive). A cross-sectional study was undertaken of all public facilities providing EmONC in 24 districts of Bangladesh from March to October 2012. Accessibility to each facility was assessed by applying GIS to estimate the proportion of catchment population (comprehensive 500 000; basic 100 000) able to reach the nearest facility within 2 hours and 1 hour of travel time, respectively, by existing road networks. The minimum number of public facilities providing comprehensive and basic EmONC services (1 and 5 per 500 000 individuals, respectively) was reached in 16 and 3 districts, respectively. However, after applying GIS, in no district did 100% of the catchment population have access to these services. A minimum of 75% and 50% of the population had accessibility to comprehensive services in 11 and 5 districts, respectively. For basic services, accessibility was much lower. Assessing only the number of EmONC facilities does not ensure universal coverage; accessibility should be assessed when planning health systems. © 2017 International Federation of Gynecology and Obstetrics.

Human Engineering Operations and Habitability Assessment: A Process for Advanced Life Support Ground Facility Testbeds

NASA Technical Reports Server (NTRS)

Connolly, Janis H.; Arch, M.; Elfezouaty, Eileen Schultz; Novak, Jennifer Blume; Bond, Robert L. (Technical Monitor)

1999-01-01

Design and Human Engineering (HE) processes strive to ensure that the human-machine interface is designed for optimal performance throughout the system life cycle. Each component can be tested and assessed independently to assure optimal performance, but it is not until full integration that the system and the inherent interactions between the system components can be assessed as a whole. HE processes (which are defining/app lying requirements for human interaction with missions/systems) are included in space flight activities, but also need to be included in ground activities and specifically, ground facility testbeds such as Bio-Plex. A unique aspect of the Bio-Plex Facility is the integral issue of Habitability which includes qualities of the environment that allow humans to work and live. HE is a process by which Habitability and system performance can be assessed.

High-order motor cortex in rats receives somatosensory inputs from the primary motor cortex via cortico-cortical pathways.

PubMed

Kunori, Nobuo; Takashima, Ichiro

2016-12-01

The motor cortex of rats contains two forelimb motor areas; the caudal forelimb area (CFA) and the rostral forelimb area (RFA). Although the RFA is thought to correspond to the premotor and/or supplementary motor cortices of primates, which are higher-order motor areas that receive somatosensory inputs, it is unknown whether the RFA of rats receives somatosensory inputs in the same manner. To investigate this issue, voltage-sensitive dye (VSD) imaging was used to assess the motor cortex in rats following a brief electrical stimulation of the forelimb. This procedure was followed by intracortical microstimulation (ICMS) mapping to identify the motor representations in the imaged cortex. The combined use of VSD imaging and ICMS revealed that both the CFA and RFA received excitatory synaptic inputs after forelimb stimulation. Further evaluation of the sensory input pathway to the RFA revealed that the forelimb-evoked RFA response was abolished either by the pharmacological inactivation of the CFA or a cortical transection between the CFA and RFA. These results suggest that forelimb-related sensory inputs would be transmitted to the RFA from the CFA via the cortico-cortical pathway. Thus, the present findings imply that sensory information processed in the RFA may be used for the generation of coordinated forelimb movements, which would be similar to the function of the higher-order motor cortex in primates. © 2016 Federation of European Neuroscience Societies and John Wiley & Sons Ltd.

Proliferation resistance assessments during the design phase of a recycling facility as a means of reducing proliferation risks

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

Lindell, M.A.; Grape, S.; Haekansson, A.

The sustainability criterion for Gen IV nuclear energy systems inherently presumes the availability of efficient fuel recycling capabilities. One area for research on advanced fuel recycling concerns safeguards aspects of this type of facilities. Since a recycling facility may be considered as sensitive from a non-proliferation perspective, it is important to address these issues early in the design process, according to the principle of Safeguards By Design. Presented in this paper is a mode of procedure, where assessments of the proliferation resistance (PR) of a recycling facility for fast reactor fuel have been performed so as to identify the weakestmore » barriers to proliferation of nuclear material. Two supplementing established methodologies have been applied; TOPS (Technological Opportunities to increase Proliferation resistance of nuclear power Systems) and PR-PP (Proliferation Resistance and Physical Protection evaluation methodology). The chosen fuel recycling facility belongs to a small Gen IV lead-cooled fast reactor system that is under study in Sweden. A schematic design of the recycling facility, where actinides are separated using solvent extraction, has been examined. The PR assessment methodologies make it possible to pinpoint areas in which the facility can be improved in order to reduce the risk of diversion. The initial facility design may then be slightly modified and/or safeguards measures may be introduced to reduce the total identified proliferation risk. After each modification of design and/or safeguards implementation, a new PR assessment of the revised system can then be carried out. This way, each modification can be evaluated and new ways to further enhance the proliferation resistance can be identified. This type of iterative procedure may support Safeguards By Design in the planning of new recycling plants and other nuclear facilities. (authors)« less

24 CFR 1710.114 - Recreational facilities.

Code of Federal Regulations, 2014 CFR

2014-04-01

...'s annual cost or assessments (1) Facility. Identify each recreational facility. Identify closely... chart state “none”. (6) Buyer's annual cost or assessments. State the lot buyer's annual cost or assessments for using the facility. These costs should include any applicable property owners' association...

24 CFR 1710.114 - Recreational facilities.

Code of Federal Regulations, 2011 CFR

2011-04-01

...'s annual cost or assessments (1) Facility. Identify each recreational facility. Identify closely... chart state “none”. (6) Buyer's annual cost or assessments. State the lot buyer's annual cost or assessments for using the facility. These costs should include any applicable property owners' association...

24 CFR 1710.114 - Recreational facilities.

Code of Federal Regulations, 2012 CFR

2012-04-01

...'s annual cost or assessments (1) Facility. Identify each recreational facility. Identify closely... chart state “none”. (6) Buyer's annual cost or assessments. State the lot buyer's annual cost or assessments for using the facility. These costs should include any applicable property owners' association...

24 CFR 1710.114 - Recreational facilities.

Code of Federal Regulations, 2010 CFR

2010-04-01

...'s annual cost or assessments (1) Facility. Identify each recreational facility. Identify closely... chart state “none”. (6) Buyer's annual cost or assessments. State the lot buyer's annual cost or assessments for using the facility. These costs should include any applicable property owners' association...

24 CFR 1710.114 - Recreational facilities.

Code of Federal Regulations, 2013 CFR

2013-04-01

...'s annual cost or assessments (1) Facility. Identify each recreational facility. Identify closely... chart state “none”. (6) Buyer's annual cost or assessments. State the lot buyer's annual cost or assessments for using the facility. These costs should include any applicable property owners' association...

Remedial investigation work plan for Bear Creek Valley Operable Unit 2 (Rust Spoil Area, SY-200 Yard, Spoil Area 1) at the Oak Ridge Y-12 Plant, Oak Ridge, Tennessee. Environmental Restoration Program

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

Not Available

1993-05-01

The enactment of the Resource Conservation and Recovery Act (RCRA) in 1976 and the Hazardous and Solid Waste Amendments (HSWA) to RCRA in 1984 created management requirements for hazardous waste facilities. The facilities within the Oak Ridge Reservation (ORR) were in the process of meeting the RCRA requirements when ORR was placed on the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) National Priorities List (NPL) on November 21, 1989. Under RCRA, the actions typically follow the RCRA Facility Assessment (RFA)/RCRA Facility Investigation (RFI)/Corrective Measures Study (CMS)/Corrective Measures implementation process. Under CERCLA the actions follow the PA/SI/Remedial Investigation (RI)/Feasibility Studymore » (FS)/Remedial Design/Remedial Action process. The development of this document will incorporate requirements under both RCRA and CERCLA into an RI work plan for the characterization of Bear Creek Valley (BCV) Operable Unit (OU) 2.« less

Emergency and urgent care capacity in a resource-limited setting: an assessment of health facilities in western Kenya

PubMed Central

Burke, Thomas F; Hines, Rosemary; Ahn, Roy; Walters, Michelle; Young, David; Anderson, Rachel Eleanor; Tom, Sabrina M; Clark, Rachel; Obita, Walter; Nelson, Brett D

2014-01-01

Objective Injuries, trauma and non-communicable diseases are responsible for a rising proportion of death and disability in low-income and middle-income countries. Delivering effective emergency and urgent healthcare for these and other conditions in resource-limited settings is challenging. In this study, we sought to examine and characterise emergency and urgent care capacity in a resource-limited setting. Methods We conducted an assessment within all 30 primary and secondary hospitals and within a stratified random sampling of 30 dispensaries and health centres in western Kenya. The key informants were the most senior facility healthcare provider and manager available. Emergency physician researchers utilised a semistructured assessment tool, and data were analysed using descriptive statistics and thematic coding. Results No lower level facilities and 30% of higher level facilities reported having a defined, organised approach to trauma. 43% of higher level facilities had access to an anaesthetist. The majority of lower level facilities had suture and wound care supplies and gloves but typically lacked other basic trauma supplies. For cardiac care, 50% of higher level facilities had morphine, but a minority had functioning ECG, sublingual nitroglycerine or a defibrillator. Only 20% of lower level facilities had glucometers, and only 33% of higher level facilities could care for diabetic emergencies. No facilities had sepsis clinical guidelines. Conclusions Large gaps in essential emergency care capabilities were identified at all facility levels in western Kenya. There are great opportunities for a universally deployed basic emergency care package, an advanced emergency care package and facility designation scheme, and a reliable prehospital care transportation and communications system in resource-limited settings. PMID:25260371

Systems Check: Community Colleges Turn to Facilities Assessments to Plan Capital Projects and Avoid Expensive Emergency Repairs

ERIC Educational Resources Information Center

Joch, Alan

2014-01-01

With an emphasis on planning and cutting costs to make better use of resources, facilities managers at community colleges across the nation have undertaken facilities audits usually with the help of outside engineers. Such assessments analyze the history and structural integrity of buildings and core components on campus, including heating…

Risk assessment associated to possible concrete degradation of a near surface disposal facility

NASA Astrophysics Data System (ADS)

Capra, B.; Billard, Y.; Wacquier, W.; Gens, R.

2013-07-01

This article outlines a risk analysis of possible concrete degradation performed in the framework of the preparation of the Safety Report of ONDRAF/NIRAS, the Belgian Agency for Radioactive Waste and Enriched Fissile Materials, for the construction and operation of a near surface disposal facility of category A waste - short-lived low and intermediate level waste - in Dessel. The main degradation mechanism considered is the carbonation of different concrete components over different periods (from the building phase up to 2000 years), which induces corrosion of the rebars. A dedicated methodology mixing risk analysis and numerical modeling of concrete carbonation has been developed to assess the critical risks of the disposal facility at different periods. According to the results obtained, risk mapping was used to assess the impact of carbonation of concrete on the different components at the different stages. The most important risk is related to an extreme situation with complete removal of the earth cover and side embankment.

Performance Assessment Program for the Savannah River Site Liquid Waste Facilities - 13610

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

Rosenberger, Kent H.

2013-07-01

The Liquid Waste facilities at the U.S. Department of Energy's (DOE) Savannah River Site (SRS) are operated by Liquid Waste Operations contractor Savannah River Remediation LLC (SRR). A separate Performance Assessment (PA) is prepared to support disposal operations at the Saltstone Disposal Facility and closure evaluations for the two liquid waste tank farm facilities at SRS, F-Tank Farm and H-Tank Farm. A PA provides the technical basis and results to be used in subsequent documents to demonstrate compliance with the pertinent requirements identified in operations and closure regulatory guidance. The Saltstone Disposal Facility is subject to a State of Southmore » Carolina industrial solid waste landfill permit and the tank farms are subject to a state industrial waste water permit. The three Liquid Waste facilities are also subject to a Federal Facility Agreement approved by the State, DOE and the Environmental Protection Agency (EPA). Due to the regulatory structure, a PA is a key technical document reviewed by the DOE, the State of South Carolina and the EPA. As the waste material disposed of in the Saltstone Disposal Facility and the residual material in the closed tank farms is also subject to reclassification prior to closure via a waste determination pursuant to Section 3116 of the Ronald W. Reagan National Defense Authorization Act of Fiscal Year 2005, the U.S. Nuclear Regulatory Commission (NRC) is also a reviewing agency for the PAs. Pursuant to the Act, the NRC also has a continuing role to monitor disposal actions to assess compliance with stated performance objectives. The Liquid Waste PA program at SRS represents a continual process over the life of the disposal and closure operations. When the need for a PA or PA revision is identified, the first step is to develop a conceptual model to best represent the facility conditions. The conceptual model will include physical dimensions of the closed system, both the engineered and natural system, and

Percutaneous Intraductal Radiofrequency Ablation for Extrahepatic Distal Cholangiocarcinoma: A Method for Prolonging Stent Patency and Achieving Better Functional Status and Quality of Life

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

Wu, Tian-tian, E-mail: matthewwu1979@hotmail.com; Li, Wei-min, E-mail: weimin-li-surgery@126.com; Li, Hu-cheng, E-mail: hucheng-li-surgery@126.com

PurposeThe clinical efficacy of intraductal radiofrequency ablation (RFA) with Habib™ EndoHPB catheter, a newly developed intervention for malignant extrahepatic biliary obstruction, remains uncertain. The aim of this study was to investigate the clinical efficacy of intraductal RFA.MethodsData from 71 patients with extrahepatic distal cholangiocarcinoma were retrospectively analyzed. The study patients were divided into RFA and control groups. The RFA group had undergone percutaneous transhepatic intraductal RFA with a Habib™ EndoHPB catheter, followed by placement of covered or uncovered biliary self-expandable metallic stents (SEMs) whereas the control group had undergone percutaneous transhepatic covered or uncovered SEMs placement. Procedure-related complications, stent patency,more » patient survival, and postoperative serum bilirubin concentrations were compared between the two groups. The Functional Assessment of Cancer Therapy-Hepatobiliary (FACT-Hep) questionnaire was administered to evaluate functional status, improvement in clinical manifestations, and quality of life.ResultsThe RFA group had a longer median stent patency than the control group (p = 0.001 for uncovered SEMs placement). Higher functional well-being, hepatobiliary-specific cancer subscale, Trial Outcome Index, and total FACT-Hep scores were observed during post-procedure follow-up in the RFA group. However, median survival did not differ significantly between the two groups (p > 0.05).ConclusionsProlongation of stent patency and better functional status and quality of life, which are all important clinical endpoints, were observed in patients treated with intraductal RFA. Prospective randomized controlled clinical trials are necessary to further investigate the clinical efficacy and long-term benefits of intraductal RFA.« less

Initial experience of EUS-guided radiofrequency ablation of unresectable pancreatic cancer.

PubMed

Song, Tae Jun; Seo, Dong Wan; Lakhtakia, Sundeep; Reddy, Nageshwar; Oh, Dong Wook; Park, Do Hyun; Lee, Sang Soo; Lee, Sung Koo; Kim, Myung-Hwan

2016-02-01

Radiofrequency ablation (RFA) has been used as a valuable treatment modality for various unresectable malignancies. EUS-guided radiofrequency ablation (EUS-RFA) of the porcine pancreas was reported to be feasible and safe in our previous study, suggesting that EUS-RFA may be applicable as an adjunct and effective alternative treatment method for unresectable pancreatic cancer. This study aimed to assess the technical feasibility and safety of EUS-RFA for unresectable pancreatic cancer. An 18-gauge endoscopic RFA electrode and a radiofrequency generator were used for the procedure. The length of the exposed tip of the RFA electrode was 10 mm. After insertion of the RFA electrode into the mass, the radiofrequency generator was activated to deliver 20 to 50 W ablation power for 10 seconds. Depending on tumor size, the procedure was repeated to sufficiently cover the tumor. EUS-RFA was performed successfully in all 6 patients (median age 62 years, range 43-73 years). Pancreatic cancer was located in the head (n = 4) or body (n = 2) of the pancreas. The median diameter of masses was 3.8 cm (range 3cm-9cm). Four patients had stage 3 disease, and 2 patients had stage 4 disease. After the procedure, 2 patients experienced mild abdominal pain, but there were no other adverse events such as pancreatitis or bleeding. EUS-RFA could be a technically feasible and safe option for patients with unresectable pancreatic cancer. Copyright © 2016 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Consequence assessment for Airborne Releases of SO{sub 2} from the Y-12 Pilot Dechlorination Facility

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

Pendergrass, W.R.

The Atmospheric Turbulence and Diffusion Division was requested by the Department of Energy`s Oak Ridge Operations Office to conduct a consequence assessment for potential atmospheric releases of SO{sub 2} from the Y-12 Pilot Dechlorination Facility. The focus of the assessment was to identify ``worst`` case meteorology which posed the highest concentration exposure potential for both on-site as well as off-site populations. A series of plausible SO{sub 2} release scenarios were provided by Y-12 for the consequence assessment. Each scenario was evaluated for predictions of downwind concentration, estimates of a five-minute time weighted average, and estimate of the dimension of themore » puff. The highest hazard potential was associated with Scenario 1, in which a total of eight SO{sub 2} cylinders are released internally to the Pilot Facility and exhausted through the emergency venting system. A companion effort was also conducted to evaluate the potential for impact of releases of SO{sub 2} from the Pilot Facility on the population of Oak Ridge. While specific transport trajectory data is not available for the Pilot Facility, extrapolations based on the Oak Ridge Site Survey and climatological records from the Y-12 meteorological program does not indicate the potential for impact on the city of Oak Ridge. Steering by the local topographical features severely limits the potential impact ares. Due to the lack of specific observational data, both tracer and meteorological, only inferences can be made concerning impact zones. It is recommended tat the Department of Energy Oak Ridge Operations examine the potential for off-site impact and develop the background data to prepare impact zones for releases of hazardous materials from the Y-12 facility.« less

Minimal vascular flows cause strong heat sink effects in hepatic radiofrequency ablation ex vivo.

PubMed

Lehmann, Kai S; Poch, Franz G M; Rieder, Christian; Schenk, Andrea; Stroux, Andrea; Frericks, Bernd B; Gemeinhardt, Ole; Holmer, Christoph; Kreis, Martin E; Ritz, Jörg P; Zurbuchen, Urte

2016-08-01

The present paper aims to assess the lower threshold of vascular flow rate on the heat sink effect in bipolar radiofrequency ablation (RFA) ex vivo. Glass tubes (vessels) of 3.4 mm inner diameter were introduced in parallel to bipolar RFA applicators into porcine liver ex vivo. Vessels were perfused with flow rates of 0 to 1,500 ml/min. RFA (30 W power, 15 kJ energy input) was carried out at room temperature and 37°C. Heat sink effects were assessed in RFA cross sections by the decrease in ablation radius, area and by a high-resolution sector planimetry. Flow rates of 1 ml/min already caused a significant cooling effect (P ≤ 0.001). The heat sink effect reached a maximum at 10 ml/min (18.4 mm/s) and remained stable for flow rates up to 1,500 ml/min. Minimal vascular flows of ≥1 ml/min cause a significant heat sink effect in hepatic RFA ex vivo. A lower limit for volumetric flow rate was not found. The maximum of the heat sink effect was reached at a flow rate of 10 ml/min and remained stable for flow rates up to 1,500 ml/min. Hepatic inflow occlusion should be considered in RFA close to hepatic vessels. © 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Percutaneous Image-guided Radiofrequency Ablation of Tumors in Inoperable Patients - Immediate Complications and Overall Safety.

PubMed

Sahay, Anubha; Sahay, Nishant; Kapoor, Ashok; Kapoor, Jyoti; Chatterjee, Abhishek

2016-01-01

Percutaneous destruction of cancer cells using a radiofrequency energy source has become an accepted part of the modern armamentarium for managing malignancies. Radiofrequency ablation (RFA) is a relatively novel procedure for treating recurrent and metastatic tumors. It is used for debulking tumors and as adjuvant therapy for palliative care apart from its role as a pain management tool. Its use in the third world countries is limited by various factors such as cost and expertise. In the remotest parts of India, where economic development has been slow, abject poverty with poor health care facilities advanced malignancies present a challenge to health care providers. We undertook this study to assess the safety of the percutaneous RFA tumor ablation as a therapeutic or palliative measure in patients where surgery was not possible. We observed that RFA may be an effective, alternative therapeutic modality for some inoperable tumors where other therapeutic modalities cannot be considered. Palliative and therapeutic image-guided RFAs of tumors may be the only treatment option in patients who are inoperable for a variety of reasons. To assess the safety and complications of RFA in such a patient population is important before embarking upon any interventions given their physically, mentally, and socially compromised status in a country such as India. To assess the safety of percutaneous image-guided radiofrequency tumor ablation and to note the various immediate and early complications of the intervention. This was a prospective, observational study conducted in Tata Main Hospital, Jamshedpur, Jharkhand, India. After approval by the Hospital Approval Committee all patients who consented for percutaneous RFA of their tumor admitted in the hospital were included after taking fully informed consent from patient/close relative keeping the following criteria in view. Patients who were likely to derive a direct benefit in the survival or as a palliative measure for relief

Prevalence and facility level correlates of need for wheelchair seating assessment among long-term care residents.

PubMed

Giesbrecht, Edward M; Mortenson, W Ben; Miller, William C

2012-01-01

Wheelchairs are frequently prescribed for residents with mobility impairments in long-term care. Many residents receive poorly fitting wheelchairs, compromising functional independence and mobility, and contributing to subsequent health issues such as pressure ulcers. The extent of this problem and the factors that predict poor fit are poorly understood; such evidence would contribute greatly to effective and efficient clinical practice in long-term care. To identify the prevalence of need for wheelchair seating intervention among residents in long-term care facilities in Vancouver and explore the relationship between the need for seating intervention and facility level factors. Logistic regression analysis using secondary data from a cross-sectional study exploring predictors of resident mobility. A total of 263 residents (183 females and 80 males) were randomly selected from 11 long-term care facilities in the Vancouver health region (mean age 84.2 ± 8.6 years). The Seating Identification Tool was used to establish subject need for wheelchair seating intervention. Individual item frequency was calculated. Six contextual variables were measured at each facility including occupational therapy staffing, funding source, policies regarding wheelchair-related equipment, and decision-making philosophy. The overall prevalence rate of inappropriate seating was 58.6% (95% CI 52.6-64.5), ranging from 30.4 to 81.8% among the individual facilities. Discomfort, poor positioning and mobility, and skin integrity were the most common issues. Two facility level variables were significant predictors of need for seating assessment: ratio of occupational therapists per 100 residents [OR 0.11 (CI 0.04, 0.31)] and expectation that residents purchase wheelchair equipment beyond the basic level [OR 2.78 (1.11, 6.97)]. A negative association between facility prevalence rate and ratio of occupational therapists (r(p) = -0.684, CI -0.143 to -0.910) was found. Prevalence of need for seating

Availability and distribution of safe abortion services in rural areas: a facility assessment study in Madhya Pradesh, India

PubMed Central

Chaturvedi, Sarika; Ali, Sayyed; Randive, Bharat; Sabde, Yogesh; Diwan, Vishal; De Costa, Ayesha

2015-01-01

Background Unsafe abortion contributes to a significant portion of maternal mortality in India. Access to safe abortion care is known to reduce maternal mortality. Availability and distribution of abortion care facilities can influence women's access to these services, especially in rural areas. Objectives To assess the availability and distribution of abortion care at facilities providing childbirth care in three districts of Madhya Pradesh (MP) province of India. Design Three socio demographically heterogeneous districts of MP were selected for this study. Facilities conducting at least 10 deliveries a month were surveyed to assess availability and provision of abortion services using UN signal functions for emergency obstetric care. Geographical Information System was used for visualisation of the distribution of facilities. Results The three districts had 99 facilities that conducted >10 deliveries a month: 74 in public and 25 in private sector. Overall, 48% of facilities reported an ability to provide safe surgical abortion service. Of public centres, 32% reported the ability compared to 100% among private centres while 18% of public centres and 77% of private centres had performed an abortion in the last 3 months. The availability of abortion services was higher at higher facility levels with better equipped and skilled personnel availability, in urban areas and in private sector facilities. Conclusions Findings showed that availability of safe abortion care is limited especially in rural areas. More emphasis on providing safe abortion services, particularly at primary care level, is important to more significantly dent maternal mortality in India. PMID:25797220

A low cost solution for post-biopsy complications using available RFA generator and coaxial core biopsy needle.

PubMed

Azlan, C A; Mohd Nasir, N F; Saifizul, A A; Faizul, M S; Ng, K H; Abdullah, B J J

2007-12-01

Percutaneous image-guided needle biopsy is typically performed in highly vascular organs or in tumours with rich macroscopic and microscopic blood supply. The main risks related to this procedure are haemorrhage and implantation of tumour cells in the needle tract after the biopsy needle is withdrawn. From numerous conducted studies, it was found that heating the needle tract using alternating current in radiofrequency (RF) range has a potential to minimize these effects. However, this solution requires the use of specially designed needles, which would make the procedure relatively expensive and complicated. Thus, we propose a simple solution by using readily available coaxial core biopsy needles connected to a radiofrequency ablation (RFA) generator. In order to do so, we have designed and developed an adapter to interface between these two devices. For evaluation purpose, we used a bovine liver as a sample tissue. The experimental procedure was done to study the effect of different parameter settings on the size of coagulation necrosis caused by the RF current heating on the subject. The delivery of the RF energy was varied by changing the values for delivered power, power delivery duration, and insertion depth. The results showed that the size of the coagulation necrosis is affected by all of the parameters tested. In general, the size of the region is enlarged with higher delivery of RF power, longer duration of power delivery, and shallower needle insertion and become relatively constant after a certain value. We also found that the solution proposed provides a low cost and practical way to minimizes unwanted post-biopsy effects.

Acoustic Radiation Force Impulse Elastography for Efficacy Evaluation after Hepatocellular Carcinoma Radiofrequency Ablation: A Comparative Study with Contrast-Enhanced Ultrasound

PubMed Central

Xu, Xiaohong; Luo, Liangping; Chen, Jiexin; Wang, Jiexin; Zhou, Honglian; Li, Mingyi; Jin, Zhanqiang; Chen, Nianping; Miao, Huilai; Lin, Manzhou; Dai, Wei; Ahuja, Anil T.; Wang, Yi-Xiang J.

2014-01-01

Aim. To explore acoustic radiation force impulse (ARFI) elastography in assessing residual tumors of hepatocellular carcinoma (HCC) after radiofrequency ablation (RFA). Materials and Methods. There were 83 HCC lesions among 72 patients. All patients were examined with ARFI, contrast enhanced ultrasound (CEUS), and CT or MRI. Tumor brightness on virtual touch tissue imaging (VTI) and shear wave velocity (SWV) were assessed before and approximately one month after RFA. Results. There were 14 residual tumors after RFA. VTI showed that all the tumors were darker after RFA. VTI was not able to distinguish the ablated lesions and the residual tumors. 13 residual tumor lesions were detected by CEUS. All completely ablated nodules had SWV demonstration of x.xx., while with those residual nodules, 6 tumors had x.xx measurement and 8 tumors had measurable SWV. nine lesions with residual tumors occurred in cirrhosis subjects and 5 lesions with residual tumors occurred in fibrosis subjects; there was no residual tumor in the normal liver subjects. Conclusion. VTI technique cannot demonstrate residual tumor post RFA. While SWV measurement of less than x.xx is likely associated with residual tumors, measurement of less than x.xx cannot exclude residual tumors. Liver cirrhosis is associated with decreased chance of a complete ablation. PMID:24895624

External quality assessment of malaria microscopy diagnosis in selected health facilities in Western Oromia, Ethiopia.

PubMed

Sori, Getachew; Zewdie, Olifan; Tadele, Geletta; Samuel, Abdi

2018-06-18

Accurate early diagnosis and prompt treatment are one of the key strategies to control and prevent malaria disease. External quality assessment is the most effective method for evaluation of the quality of malaria microscopy diagnosis. The aim of this study was to assess the quality of malaria microscopy diagnosis and its associated factors in selected public health facility laboratories in East Wollega Zone, Western Ethiopia. Facility-based cross-sectional study design was conducted in 30 randomly selected public health facility laboratories from November 2014 to January 2015 in East Wollega Zone, Western Ethiopia. Ten validated stained malaria panel slides with known Plasmodium species, developmental stage and parasite density were distributed. Data were captured; cleaned and analyzed using SPSS version 20 statistical software-multivariate logistic regressions and the agreement in reading between the peripheral diagnostic centers and the reference laboratory were done using kappa statistics. A total of 30 health facility laboratories were involved in the study and the overall quality of malaria microscopy diagnosis was poor (62.3%). The associated predictors of quality in this diagnosis were in-service training [(AOR = 16, 95% CI (1.3, 1.96)], smearing quality [(AOR = 24, 95% CI (1.8, 3.13)], staining quality [(AOR = 15, 95% CI (2.35, 8.61), parasite detection [(AOR = 9, 95% CI (1.1, 8.52)] and identification skills [(AOR = 8.6, 95% CI (1.21, 1.63)]. Eighteen (60%) of health facility laboratories had in-service trained laboratory professionals on malaria microscopy diagnosis. Overall quality of malaria microscopy diagnosis was poor and a significant gap in this service was observed that could impact on its diagnostic services.

Developing International Guidelines on Volcanic Hazard Assessments for Nuclear Facilities

NASA Astrophysics Data System (ADS)

Connor, Charles

2014-05-01

Worldwide, tremendous progress has been made in recent decades in forecasting volcanic events, such as episodes of volcanic unrest, eruptions, and the potential impacts of eruptions. Generally these forecasts are divided into two categories. Short-term forecasts are prepared in response to unrest at volcanoes, rely on geophysical monitoring and related observations, and have the goal of forecasting events on timescales of hours to weeks to provide time for evacuation of people, shutdown of facilities, and implementation of related safety measures. Long-term forecasts are prepared to better understand the potential impacts of volcanism in the future and to plan for potential volcanic activity. Long-term forecasts are particularly useful to better understand and communicate the potential consequences of volcanic events for populated areas around volcanoes and for siting critical infrastructure, such as nuclear facilities. Recent work by an international team, through the auspices of the International Atomic Energy Agency, has focused on developing guidelines for long-term volcanic hazard assessments. These guidelines have now been implemented for hazard assessment for nuclear facilities in nations including Indonesia, the Philippines, Armenia, Chile, and the United States. One any time scale, all volcanic hazard assessments rely on a geologically reasonable conceptual model of volcanism. Such conceptual models are usually built upon years or decades of geological studies of specific volcanic systems, analogous systems, and development of a process-level understanding of volcanic activity. Conceptual models are used to bound potential rates of volcanic activity, potential magnitudes of eruptions, and to understand temporal and spatial trends in volcanic activity. It is these conceptual models that provide essential justification for assumptions made in statistical model development and the application of numerical models to generate quantitative forecasts. It is a

Assessment of management policies and practices for occupational exposure to bloodborne pathogens in dialysis facilities.

PubMed

Mbaeyi, Chukwuma; Panlilio, Adelisa L; Hobbs, Cynthia; Patel, Priti R; Kuhar, David T

2012-10-01

Occupational exposure management is an important element in preventing the transmission of bloodborne pathogens in health care settings. In 2008, the US Centers for Disease Control and Prevention conducted a survey to assess procedures for managing occupational bloodborne pathogen exposures in outpatient dialysis facilities in the United States. A cross-sectional survey of randomly selected outpatient dialysis facilities. 339 outpatient dialysis facilities drawn from the 2006 US end-stage renal disease database. Hospital affiliation (free-standing vs hospital-based facilities), profit status (for-profit vs not-for-profit facilities), and number of health care personnel (≥100 vs <100 health care personnel). Exposures to hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV); provision of HBV and HIV postexposure prophylaxis. We calculated the proportion of facilities reporting occupational bloodborne pathogen exposures and offering occupational exposure management services. We analyzed bloodborne pathogen exposures and provision of postexposure prophylaxis by facility type. Nearly all respondents (99.7%) had written policies and 95% provided occupational exposure management services to health care personnel during the daytime on weekdays, but services were provided infrequently during other periods of the week. Approximately 10%-15% of facilities reported having HIV, HBV, or HCV exposures in health care personnel in the 12 months prior to the survey, but inconsistencies were noted in procedures for managing such exposures. Despite 86% of facilities providing HIV prophylaxis for exposed health care personnel, only 37% designated a primary HIV postexposure prophylaxis regimen. For-profit and free-standing facilities reported fewer exposures, but did not as reliably offer HBV prophylaxis or have a primary HIV postexposure prophylaxis regimen relative to not-for-profit and hospital-based facilities. The survey response rate was low

Final Environmental Assessment: Proposed Composite Aircraft Inspection Facilities, Hill Air Force Base, Utah

DTIC Science & Technology

2008-10-02

radiography . Two large inspection bays would each accommodate one F-22 aircraft and robotic x-ray inspection equipment. Six smaller bays would accommodate...large aircraft components (two ultrasonic inspection bays, two laser shearography inspection bays, and two digital radiography inspection bays...Hill Air Force Base, Utah Final Environmental Assessment: Proposed Composite Aircraft Inspection Facilities, Hill Air Force Base, Utah

Final Assessment: U.S. Virgin Islands Industrial Development Park and Adjacent Facilities Energy-Efficiency and Micro-Grid Infrastructure

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

Petersen, Joseph M.; Boyd, Paul A.; Dahowski, Robert T.

The purpose of this assessment was to undertake an assessment and analysis of cost-effective options for energy-efficiency improvements and the deployment of a micro-grid to increase the energy resilience at the U.S. Virgin Islands Industrial Development Park (IDP) and adjacent facilities in St. Croix, Virgin Islands. The Economic Development Authority sought assistance from the U.S. Department of Energy to undertake this assessment undertaken by Pacific Northwest National Laboratory. The assessment included 18 buildings plus the perimeter security lighting at the Virgin Islands Bureau of Correctional Facility, four buildings plus exterior lighting at the IDP, and five buildings (one of whichmore » is to be constructed) at the Virgin Islands Police Department for a total of 27 buildings with a total of nearly 323,000 square feet.« less

Guidelines for the evaluation and assessment of the sustainable use of resources and of wastes management at healthcare facilities.

PubMed

Townend, William K; Cheeseman, Christopher R

2005-10-01

This paper presents guidelines that can be used by managers of healthcare facilities to evaluate and assess the quality of resources and waste management at their facilities and enabling the principles of sustainable development to be addressed. The guidelines include the following key aspects which need to be considered when completing an assessment. They are: (a) general management; (b) social issues; (c) health and safety; (d) energy and water use; (e) purchasing and supply; (f) waste management (responsibility, segregation, storage and packaging); (g) waste transport; (h) recycling and re-use; (i) waste treatment; and (j) final disposal. They identify actions required to achieve a higher level of performance which can readily be applied to any healthcare facility, irrespective of the local level of social, economic and environmental development. The guidelines are presented, and the characteristics of facilities associated with sustainable (level 4) and unsustainable (level 0) healthcare resource and wastes management are outlined. They have been used to assess a major London hospital, and this highlighted a number of deficiencies in current practice, including a lack of control over purchasing and supply, and very low rates of segregation of municipal solid waste from hazardous healthcare waste.

An Assessment of South Carolina Higher Education Facilities Conditions & Measuring Deferred Maintenance. Special Report

ERIC Educational Resources Information Center

South Carolina Commission on Higher Education, 2007

2007-01-01

For the current study, institutions evaluated education and general (E&G) buildings on their campuses using an assessment format established in the original deferred maintenance study conducted in 1994. The joint study, "Deferred Maintenance, An Analysis of South Carolina's Facilities Portfolio," conducted by the Commission on Higher…

POLLUTION PREVENTION OPPORTUNITY ASSESSMENT OF THE U.S. ARMY CORPS OF ENGINEERS CIVIL WORKS FACILITIES

EPA Science Inventory

The Pollution Prevention Opportunity Assessments (PPOA) summarized here were conducted at the following representative Army Corps of Engineers (USAGE) Civil Works facilities: Pittsburgh Engineering Warehouse and Repair Station (PEWARS) and Emsworth Locks and Dams in Pittsburgh, P...

Environmental Assessment for decommissioning the Strategic Petroleum Reserve Weeks Island Facility, Iberia Parish, Louisiana

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

NONE

1995-12-01

The Strategic Petroleum Reserve (SPR) Weeks Island site is one of five underground salt dome crude oils storage facilities operated by the Department of Energy (DOE). It is located in Iberia Parish, Louisiana. The purpose of the proposed action is to decommission the Weeks Island crude oil storage after the oil inventory has been transferred to other SPR facilities. Water intrusion into the salt dome storage chambers and the development of two sinkholes located near the aboveground facilities has created uncertain geophysical conditions. This Environmental Assessment describes the proposed decommissioning operation, its alternatives, and potential environmental impacts. Based on thismore » analyses, DOE has determined that the proposed action is not a major Federal action significantly affecting the quality of the human environment within the meaning of the National Environmental Policy Act (NEPA) and has issued the Finding of No Significant Impact (FONSI).« less

Using health-facility data to assess subnational coverage of maternal and child health indicators, Kenya.

PubMed

Maina, Isabella; Wanjala, Pepela; Soti, David; Kipruto, Hillary; Droti, Benson; Boerma, Ties

2017-10-01

To develop a systematic approach to obtain the best possible national and subnational statistics for maternal and child health coverage indicators from routine health-facility data. Our approach aimed to obtain improved numerators and denominators for calculating coverage at the subnational level from health-facility data. This involved assessing data quality and determining adjustment factors for incomplete reporting by facilities, then estimating local target populations based on interventions with near-universal coverage (first antenatal visit and first dose of pentavalent vaccine). We applied the method to Kenya at the county level, where routine electronic reporting by facilities is in place via the district health information software system. Reporting completeness for facility data were well above 80% in all 47 counties and the consistency of data over time was good. Coverage of the first dose of pentavalent vaccine, adjusted for facility reporting completeness, was used to obtain estimates of the county target populations for maternal and child health indicators. The country and national statistics for the four-year period 2012/13 to 2015/16 showed good consistency with results of the 2014 Kenya demographic and health survey. Our results indicated a stagnation of immunization coverage in almost all counties, a rapid increase of facility-based deliveries and caesarean sections and limited progress in antenatal care coverage. While surveys will continue to be necessary to provide population-based data, web-based information systems for health facility reporting provide an opportunity for more frequent, local monitoring of progress, in maternal and child health.

Radiofrequency Ablation of Renal Tumors with an Expandable Multitined Electrode: Results, Complications, and Pilot Evaluation of Cooled Pyeloperfusion for Collecting System Protection

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

Rouviere, Olivier; Badet, Lionel; Murat, Francois Joseph

2008-05-15

The objective of this study was to retrospectively evaluate the results of radiofrequency ablation (RFA) of renal tumors with an impedance-based system using an expandable multitined electrode. Twenty-two patients (30 tumors) were treated with RFA over a 7-year period, percutaneously (16 tumors) or intraoperatively (14 tumors). Follow-up imaging was performed at 1-3, 6, and 12 months and yearly thereafter. Twenty-seven of 30 tumors (19/22 patients) showed no residual tumor on the first imaging control. Two residual tumors were successfully ablated by a second RFA procedure. Our mean follow-up period was 35 months (range, 3-84 months). Two tumors that had beenmore » completely ablated based on imaging criteria recurred 11 and 48 months after RFA. One was treated by partial nephrectomy. The other one was not treated because the patient developed bone metastases. One patient had nephrectomy because of an RFA-induced ureteropelvic junction stricture. Nine patients (11 sessions) had a pyeloperfusion of cooled saline during RFA. None developed symptomatic complications, even though in three patients the ablation zone extended to the closest calyx (3-5 mm from the tumor). We conclude that RFA of renal tumors is promising, but serious complications to the collecting system must be taken into consideration. Prophylactic per-procedural cooling of the collecting system is feasible but needs further assessment.« less

In vivo immunological antitumor effect of OK-432-stimulated dendritic cell transfer after radiofrequency ablation.

PubMed

Nakagawa, Hidetoshi; Mizukoshi, Eishiro; Iida, Noriho; Terashima, Takeshi; Kitahara, Masaaki; Marukawa, Yohei; Kitamura, Kazuya; Nakamoto, Yasunari; Hiroishi, Kazumasa; Imawari, Michio; Kaneko, Shuichi

2014-04-01

Radiofrequency ablation therapy (RFA) is a radical treatment for liver cancers and induces tumor antigen-specific immune responses. In the present study, we examined the antitumor effects of focal OK-432-stimulated dendritic cell (DC) transfer combined with RFA and analyzed the functional mechanisms involved using a murine model. C57BL/6 mice were injected subcutaneously with colon cancer cells (MC38) in their bilateral flanks. After the establishment of tumors, the subcutaneous tumor on one flank was treated using RFA, and then OK-432-stimulated DCs were injected locally. The antitumor effect of the treatment was evaluated by measuring the size of the tumor on the opposite flank, and the immunological responses were assessed using tumor-infiltrating lymphocytes, splenocytes and draining lymph nodes. Tumor growth was strongly inhibited in mice that exhibited efficient DC migration after RFA and OK-432-stimulated DC transfer, as compared to mice treated with RFA alone or treatment involving immature DC transfer. We also demonstrated that the antitumor effect of this treatment depended on both CD8-positive and CD4-positive cells. On the basis of our findings, we believe that combination therapy for metastatic liver cancer consisting of OK-432-stimulated DCs in combination with RFA can proceed to clinical trials, and it is anticipated to be markedly superior to RFA single therapy.

Assessment and Mitigation of Radiation, EMP, Debris & Shrapnel Impacts at Megajoule-Class Laser Facilities

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

Eder, D C; Anderson, R W; Bailey, D S

2009-10-05

The generation of neutron/gamma radiation, electromagnetic pulses (EMP), debris and shrapnel at mega-Joule class laser facilities (NIF and LMJ) impacts experiments conducted at these facilities. The complex 3D numerical codes used to assess these impacts range from an established code that required minor modifications (MCNP - calculates neutron and gamma radiation levels in complex geometries), through a code that required significant modifications to treat new phenomena (EMSolve - calculates EMP from electrons escaping from laser targets), to a new code, ALE-AMR, that is being developed through a joint collaboration between LLNL, CEA, and UC (UCSD, UCLA, and LBL) for debrismore » and shrapnel modelling.« less

[A pilot study on pain assessment among elderly with severe dementia
in residential aged care facilities of Reggio Emilia district].

PubMed

Bargellini, Annalisa; Mastrangelo, Stefano; Cervi, Monica; Bagnasco, Michele; Reghizzi, Jlenia; Coriani, Sandra

2017-01-01

. A pilot study on pain assessment among elderly with severe dementia in residential aged care facilities of Reggio Emilia district. Despite the availability of pain assessment tools and best practice recommendations for the assessment and management of pain in people with severe dementia, pain in residential aged care facilities is still undetected or misinterpreted. To assess pain prevalence and analgesic load medication in people with severe cognitive impairment admitted to residential aged care facilities of Reggio Emilia (Italy) province. A pilot cross-sectional study was conducted on 84 elderly patients affected by severe dementia and resident in aged care facilities. Pain was assessed with the PAINAD observational scale, both at rest and during routine procedures: positioning in bed, from bed to standing position, from bed to chair or during the medication of a pressure sore (under challenge). 33.4% of patients had pain at rest, mainly mild, and 86.9 % under challenge. During routine interventions, in 64 patients (76.2%) pain increased compared to at rest condition (for 39, 2/3, moderate-severe); although 46 of them were prescribed as-required analgesic medication, none had received the drug. Also patients with analgesics on regular basis experienced more pain during routine procedures. Many patients experienced pain during routine procedures. The regular use of pain assessment tools and adequate training of all healthcare professionals are essential requirements for an effective pain control.

Assessing the effectiveness of safeguards at a medium-sized spent-fuel reprocessing facility

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

Higinbotham, W.; Fishbone, L.G.; Suda, S.

1983-01-01

In order to evaluate carefully and systematically the effectiveness of safeguards at nuclear-fuel-cycle facilities, the International Atomic Energy Agency has adopted a safeguards effectiveness assessment methodology. The methodology has been applied to a well-characterized, medium-sized, spent-fuel reprocessing plant to understand how explicit safeguards inspection procedures would serve to expose conceivable nuclear materials diversion schemes, should such diversion occur.

Service quality in contracted facilities.

PubMed

Rabbani, Fauziah; Pradhan, Nousheen Akber; Zaidi, Shehla; Azam, Syed Iqbal; Yousuf, Farheen

2015-01-01

The purpose of this paper is to explore the readiness of contracted and non-contracted first-level healthcare facilities in Pakistan to deliver quality maternal and neonatal health (MNH) care. A balanced scorecard (BSC) was used as the assessment framework. Using a cross-sectional study design, two rural health centers (RHCs) contracted out to Aga Khan Health Service, Pakistan were compared with four government managed RHCs. A BSC was designed to assess RHC readiness to deliver good quality MNH care. In total 20 indicators were developed, representing five BSC domains: health facility functionality, service provision, staff capacity, staff and patient satisfaction. Validated data collection tools were used to collect information. Pearson χ2, Fisher's Exact and the Mann-Whitney tests were applied as appropriate to detect significant service quality differences among the two facilities. Contracted facilities were generally found to be better than non-contracted facilities in all five BSC domains. Patients' inclination for facility-based delivery at contracted facilities was, however, significantly higher than non-contracted facilities (80 percent contracted vs 43 percent non-contracted, p=0.006). The study shows that contracting out initiatives have the potential to improve MNH care. This is the first study to compare MNH service delivery quality across contracted and non-contracted facilities using BSC as the assessment framework.

Comparative Effects of Dexmedetomidine and Propofol on US-Guided Radiofrequency Ablation of Hepatic Neoplasm Under Monitored Anesthesia Care

PubMed Central

Joung, Kyoung-Woon; Choi, Seong-Soo; Jang, Dong-Min; Kong, Yu-Gyeong; Lee, Hwa-Mi; Shim, Ji-Hoon; Won, Hyung-Jin; Shin, Yong-Moon; Kim, Pyo-Nyun; Song, Myung-Hee

2015-01-01

Abstract Percutaneous radiofrequency ablation (RFA) is a useful and safe procedure for treating hepatic neoplasm. However, liver RFA causes severe pain, which thereby increases the demand for monitored anesthesia care (MAC). Here, we compared the efficacy and safety of propofol and dexmedetomidine, which are commonly administered during MAC when performing RFA to assess hepatic neoplasm. In this randomized controlled trial, 40 patients were randomly allocated to 2 groups for elective RFA. Patients received either dexmedetomidine (group D) or propofol (group P). Both groups received the continuous infusion of remifentanil for pain control. The primary outcomes were opioid consumption and differences in partial pressure of arterial carbon dioxide (PaCO2) between pre- and postprocedure RFA. In addition, hemodynamic parameters, patient satisfaction, and interventional radiologist satisfaction were determined. There were significant differences in opioid consumption (50.1 ± 16.8 ng/kg/min [group D] vs 71.2 ± 18.7 ng/kg/min [group P]; P = 0.001) and delta PaCO2 (10.4 ± 6.4 mm Hg vs 17.2 ± 9.2 mm Hg, respectively; P = 0.016). Moreover, respiratory rates were significantly different between groups during RFA (P < 0.001). However, blood pressure and heart rate did not significantly change during RFA. Neither patient nor interventional radiologist satisfaction was significantly different between groups. Dexmedetomidine provides better respiratory stability and reduces opioid consumption in comparison with propofol when administered under MAC when performing RFA for hepatic neoplasm. PMID:26266387

Substance Abuse Treatment in Adult and Juvenile Correctional Facilities: Findings from the Uniform Facility Data Set 1997 Survey of Correctional Facilities.

ERIC Educational Resources Information Center

Marsden, Mary Ellen, Ed.; Straw, Richard S., Ed.

This report presents methodology and findings from the Uniform Facility Data Set (UFDS) 1997 Survey of Correctional Facilities, which surveyed about 7,600 adult and juvenile correctional facilities to identify those that provide on-site substance abuse treatment to their inmates or residents. The survey assesses substance abuse treatment provided…

77 FR 123 - Final Reissuance of General NPDES Permits (GP) for Facilities Related to Oil and Gas Extraction

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-03

... Administrative Procedure Act (APA), or any other law, to publish general notice of proposed rulemaking.'' The RFA... NPDES general permits are permits, not rulemakings, under the APA and thus not subject to APA rulemaking...

78 FR 17661 - Proposed Reissuance of a General NPDES Permit for Oil and Gas Exploration Facilities in the...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... Administrative Procedure Act (APA), or any other law, to publish general notice of proposed rulemaking.'' The RFA... NPDES general permits are permits, not rulemakings, under the APA and thus not subject to APA rulemaking...

Pollution prevention opportunity assessment for Facilities Maintenance Team (FMT) paint shop.

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

Klossner, Kristin Ann

This Pollution Prevention Opportunity Assessment (PPOA) was conducted for Sandia National Laboratories/California Facilities Maintenance Team Paint Shop Operations in August and September 2002. The primary purpose of this PPOA is to provide recommendations to assist Paint Shop personnel in reducing the generation of waste and improving the efficiency of their processes. This report contains a summary of the information collected and analyses performed and recommends options for implementation. The Sandia National Laboratories Pollution Prevention staff will continue to work with the Paint Shop to implement the recommendations.

Factors Associated With Recurrence of Barrett's Esophagus After Radiofrequency Ablation.

PubMed

Tan, Mimi C; Kanthasamy, Kavin A; Yeh, Allison G; Kil, Daniel; Pompeii, Lisa; Yu, Xiaoying; El-Serag, Hashem B; Thrift, Aaron P

2018-06-11

Radiofrequency ablation (RFA) is effective treatment for Barrett's esophagus (BE). However, some patients have recurrence after complete eradication of intestinal metaplasia (CEIM). We investigated the incidence of and factors associated with BE recurrence, with or without neoplasia, after RFA and CEIM using data from the national Veterans Affairs (VA) healthcare system. We performed a retrospective cohort study of Veterans with BE treated by RFA from 2005 through 2016 with follow-up endoscopy. Subjects were followed until BE recurrence, neoplasia, death until October 2016. CEIM, BE recurrence, and factors associated with recurrence were identified by review of medical records. We calculated incidence rates of BE recurrence, with and without neoplasia, after CEIM and identified predictors using Cox proportional hazards models. We identified 430 Veterans with BE who were treated with RFA; of these 337 achieved CEIM (78.4%). Most were men (98.6%), White (83.7%), and 66.0% had baseline dysplasia. Of those with CEIM, 98 patients (29.1%) had recurrence of BE during a total 906.0 patient-years of follow-up (median 1.9 years) after CEIM (incidence, 10.8%/patient-year). Dysplasia developed in 20 patients (2.2%/patient-year) and cancer in 3 patients (0.3%/patient-year). Baseline dysplasia (hazard ratio [HR], 1.71; 95% CI, 1.03-2.84) and long-segment BE (HR, 1.61; 95% CI, 1.03-2.54) increased risk of BE recurrence whereas treatment at high-volume RFA facilities reduced risk of BE recurrence (for quartile 4 vs quartile 1: HR, 0.16; 95% CI, 0.05-0.60). In a nationwide VA system study of outcomes of RFA for BE, we associated baseline dysplasia, long-segment BE, and treatment at low-volume RFA centers with recurrence of BE after CEIM. The findings call for performing these procedures in high-volume centers. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Gaps in monitoring systems for Implanon NXT services in South Africa: An assessment of 12 facilities in two districts

PubMed

Pillay, D; Morroni, C; Pleaner, M; Adeogba, O; Chersich, M; Naidoo, N; Mullick, S; Rees, H

2017-10-01

Background. Implanon NXT, a long-acting subdermal contraceptive implant, was introduced in South Africa (SA) in early 2014 as part of an expanded contraceptive method mix. After initial high levels of uptake, reports emerged of frequent early removals and declines in use. Monitoring of progress and challenges in implant service delivery could identify aspects of the programme that require strengthening. Objectives. To assess data management and record keeping within implant services at primary care facilities. Methods. We developed a checklist to assess the tools used for monitoring implant services and data reporting to district offices. The checklist was piloted in seven facilities. An additional six high-volume and six low-volume implant insertion clinics in the City of Johannesburg (CoJ), Gauteng Province, and the Dr Kenneth Kaunda District, North West Province, were selected for assessment. Results. All 12 facilities completed a Daily Head Count Register, which tallied the number of clients attending the clinic, but not information about implant use. A more detailed Tick Register recorded services that clinic attendees received, with nine documenting number of implant insertions and six implant removals. A more specific tool, an Insertion Checklist, collected data on insertion procedures and client characteristics, but was only used in CoJ (five of six facilities). Other registers, which were developed de novo by staff at individual facilities, captured more detailed information about insertions and removals, including reasons. Five of six low-volume insertion facilities used these registers, but only three of six high-volume facilities. No facilities used the form specifically developed by the National Department of Health for implant pharmacovigilance. Nine of 12 clinics reported data on numbers of insertions to the district office, six reported removals and none provided data on reasons for removals. Conclusion. For data to inform effective decision

NUMERICAL FLOW AND TRANSPORT SIMULATIONS SUPPORTING THE SALTSTONE FACILITY PERFORMANCE ASSESSMENT

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

Flach, G.

2009-02-28

The Saltstone Disposal Facility Performance Assessment (PA) is being revised to incorporate requirements of Section 3116 of the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 (NDAA), and updated data and understanding of vault performance since the 1992 PA (Cook and Fowler 1992) and related Special Analyses. A hybrid approach was chosen for modeling contaminant transport from vaults and future disposal cells to exposure points. A higher resolution, largely deterministic, analysis is performed on a best-estimate Base Case scenario using the PORFLOW numerical analysis code. a few additional sensitivity cases are simulated to examine alternative scenarios andmore » parameter settings. Stochastic analysis is performed on a simpler representation of the SDF system using the GoldSim code to estimate uncertainty and sensitivity about the Base Case. This report describes development of PORFLOW models supporting the SDF PA, and presents sample results to illustrate model behaviors and define impacts relative to key facility performance objectives. The SDF PA document, when issued, should be consulted for a comprehensive presentation of results.« less

Impacts on non-human biota from a generic geological disposal facility for radioactive waste: some key assessment issues.

PubMed

Robinson, C A; Smith, K L; Norris, S

2010-06-01

This paper provides an overview of key issues associated with the application of currently available biota dose assessment methods to consideration of potential environmental impacts from geological disposal facilities. It explores philosophical, methodological and practical assessment issues and reviews the implications of test assessment results in the context of recent and on-going challenges and debates.

Endoscopic ultrasound-guided radiofrequency ablation for management of benign solid pancreatic tumors.

PubMed

Choi, Jun-Ho; Seo, Dong-Wan; Song, Tae Jun; Park, Do Hyun; Lee, Sang Soo; Lee, Sung Koo; Kim, Myung-Hwan

2018-05-04

 Radiofrequency ablation (RFA) has been increasingly employed in experimental and clinical settings for the management of pancreatic lesions. This study aimed to assess the safety and efficacy of endoscopic ultrasound (EUS)-guided RFA for benign solid pancreatic tumors.  In a single-center, prospective study, 10 patients with benign solid pancreatic tumors underwent EUS-RFA. After the RFA electrode had been inserted into the pancreatic mass, the radiofrequency generator was activated to deliver 50 W of ablation power.  Among the 10 patients, 16 sessions of EUS-RFA were successfully performed. Diagnoses included nonfunctioning neuroendocrine tumor (n = 7), solid pseudopapillary neoplasm (n = 2), and insulinoma (n = 1); the median largest diameter of the tumors was 20 mm (range 8 - 28 mm). During follow-up (median 13 months), radiologic complete response was achieved in seven patients. Two adverse events (12.4 %; 1 moderate and 1 mild) occurred.  EUS-RFA may be a safe and potentially effective treatment option in selected patients with benign solid pancreatic tumors. Multiple sessions may be required if there is a remnant tumor, and adverse events must be carefully monitored. © Georg Thieme Verlag KG Stuttgart · New York.

Debris and shrapnel assessments for National Ignition Facility targets and diagnostics

NASA Astrophysics Data System (ADS)

Masters, N. D.; Fisher, A.; Kalantar, D.; Stölken, J.; Smith, C.; Vignes, R.; Burns, S.; Doeppner, T.; Kritcher, A.; Park, H.-S.

2016-05-01

High-energy laser experiments at the National Ignition Facility (NIF) can create debris and shrapnel capable of damaging laser optics and diagnostic instruments. The size, composition and location of target components and sacrificial shielding (e.g., disposable debris shields, or diagnostic filters) and the protection they provide is constrained by many factors, including: chamber and diagnostic geometries, experimental goals and material considerations. An assessment of the generation, nature and velocity of shrapnel and debris and their potential threats is necessary prior to fielding targets or diagnostics. These assessments may influence target and shielding design, filter configurations and diagnostic selection. This paper will outline the approach used to manage the debris and shrapnel risk associated with NIF targets and diagnostics and present some aspects of two such cases: the Material Strength Rayleigh- Taylor campaign and the Mono Angle Crystal Spectrometer (MACS).

Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries.

PubMed

Kanyangarara, Mufaro; Chou, Victoria B; Creanga, Andreea A; Walker, Neff

2018-06-01

Improving access and quality of obstetric service has the potential to avert preventable maternal, neonatal and stillborn deaths, yet little is known about the quality of care received. This study sought to assess obstetric service availability, readiness and coverage within and between 17 low- and middle-income countries. We linked health facility data from the Service Provision Assessments and Service Availability and Readiness Assessments, with corresponding household survey data obtained from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Based on performance of obstetric signal functions, we defined four levels of facility emergency obstetric care (EmOC) functionality: comprehensive (CEmOC), basic (BEmOC), BEmOC-2, and low/substandard. Facility readiness was evaluated based on the direct observation of 23 essential items; facilities "ready to provide obstetric services" had ≥20 of 23 items available. Across countries, we used medians to characterize service availability and readiness, overall and by urban-rural location; analyses also adjusted for care-seeking patterns to estimate population-level coverage of obstetric services. Of the 111 500 health facilities surveyed, 7545 offered obstetric services and were included in the analysis. The median percentages of facilities offering EmOC and "ready to provide obstetric services" were 19% and 10%, respectively. There were considerable urban-rural differences, with absolute differences of 19% and 29% in the availability of facilities offering EmOC and "ready to provide obstetric services", respectively. Adjusting for care-seeking patterns, results from the linking approach indicated that among women delivering in a facility, a median of 40% delivered in facilities offering EmOC, and 28% delivered in facilities "ready to provide obstetric services". Relatively higher coverage of facility deliveries (≥65%) and coverage of deliveries in facilities "ready to provide obstetric

Environmental assessment for the construction, operation, and decommissioning of the Waste Segregation Facility at the Savannah River Site

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

NONE

1998-01-01

This Environmental Assessment (EA) has been prepared by the Department of Energy (DOE) to assess the potential environmental impacts associated with the construction, operation and decontamination and decommissioning (D&D) of the Waste Segregation Facility (WSF) for the sorting, shredding, and compaction of low-level radioactive waste (LLW) at the Savannah River Site (SRS) located near Aiken, South Carolina. The LLW to be processed consists of two waste streams: legacy waste which is currently stored in E-Area Vaults of SRS and new waste generated from continuing operations. The proposed action is to construct, operate, and D&D a facility to process low-activity job-controlmore » and equipment waste for volume reduction. The LLW would be processed to make more efficient use of low-level waste disposal capacity (E-Area Vaults) or to meet the waste acceptance criteria for treatment at the Consolidated Incineration Facility (CIF) at SRS.« less

National facilities study. Volume 4: Space operations facilities task group

NASA Technical Reports Server (NTRS)

1994-01-01

The principal objectives of the National Facilities Study (NFS) were to: (1) determine where U.S. facilities do not meet national aerospace needs; (2) define new facilities required to make U.S. capabilities 'world class' where such improvements are in the national interest; (3) define where consolidation and phase-out of existing facilities is appropriate; and (4) develop a long-term national plan for world-class facility acquisition and shared usage. The Space Operations Facilities Task Group defined discrete tasks to accomplish the above objectives within the scope of the study. An assessment of national space operations facilities was conducted to determine the nation's capability to meet the requirements of space operations during the next 30 years. The mission model used in the study to define facility requirements is described in Volume 3. Based on this model, the major focus of the Task Group was to identify any substantive overlap or underutilization of space operations facilities and to identify any facility shortfalls that would necessitate facility upgrades or new facilities. The focus of this initial study was directed toward facility recommendations related to consolidations, closures, enhancements, and upgrades considered necessary to efficiently and effectively support the baseline requirements model. Activities related to identifying facility needs or recommendations for enhancing U.S. international competitiveness and achieving world-class capability, where appropriate, were deferred to a subsequent study phase.

Is the closest facility the one actually used? An assessment of travel time estimation based on mammography facilities.

PubMed

Alford-Teaster, Jennifer; Lange, Jane M; Hubbard, Rebecca A; Lee, Christoph I; Haas, Jennifer S; Shi, Xun; Carlos, Heather A; Henderson, Louise; Hill, Deirdre; Tosteson, Anna N A; Onega, Tracy

2016-02-18

Characterizing geographic access depends on a broad range of methods available to researchers and the healthcare context to which the method is applied. Globally, travel time is one frequently used measure of geographic access with known limitations associated with data availability. Specifically, due to lack of available utilization data, many travel time studies assume that patients use the closest facility. To examine this assumption, an example using mammography screening data, which is considered a geographically abundant health care service in the United States, is explored. This work makes an important methodological contribution to measuring access--which is a critical component of health care planning and equity almost everywhere. We analyzed one mammogram from each of 646,553 women participating in the US based Breast Cancer Surveillance Consortium for years 2005-2012. We geocoded each record to street level address data in order to calculate travel time to the closest and to the actually used mammography facility. Travel time between the closest and the actual facility used was explored by woman-level and facility characteristics. Only 35% of women in the study population used their closest facility, but nearly three-quarters of women not using their closest facility used a facility within 5 min of the closest facility. Individuals that by-passed the closest facility tended to live in an urban core, within higher income neighborhoods, or in areas where the average travel times to work was longer. Those living in small towns or isolated rural areas had longer closer and actual median drive times. Since the majority of US women accessed a facility within a few minutes of their closest facility this suggests that distance to the closest facility may serve as an adequate proxy for utilization studies of geographically abundant services like mammography in areas where the transportation networks are well established.

Assessment System for Junior High Schools in Taiwan to Select Environmental Education Facilities and Sites

ERIC Educational Resources Information Center

Ho, Shyue-Yung; Chen, Wen-Te; Hsu, Wei-Ling

2017-01-01

Environmental education is essential for people to pursue sustainable development. In Taiwan, environmental education is taught to students until they graduate from junior high school. This study was conducted to establish an assessment system for junior high schools to select appropriate environmental education facilities and sites. A mix of…

X-ray transport and radiation response assessment (XTRRA) experiments at the National Ignition Facility.

PubMed

Fournier, K B; Brown, C G; Yeoman, M F; Fisher, J H; Seiler, S W; Hinshelwood, D; Compton, S; Holdener, F R; Kemp, G E; Newlander, C D; Gilliam, R P; Froula, N; Lilly, M; Davis, J F; Lerch, Maj A; Blue, B E

2016-11-01

Our team has developed an experimental platform to evaluate the x-ray-generated stress and impulse in materials. Experimental activities include x-ray source development, design of the sample mounting hardware and sensors interfaced to the National Ignition Facility's diagnostics insertion system, and system integration into the facility. This paper focuses on the X-ray Transport and Radiation Response Assessment (XTRRA) test cassettes built for these experiments. The test cassette is designed to position six samples at three predetermined distances from the source, each known to within ±1% accuracy. Built-in calorimeters give in situ measurements of the x-ray environment along the sample lines of sight. The measured accuracy of sample responses as well as planned modifications to the XTRRA cassette is discussed.

The effectiveness of environment assessment tools to guide refurbishment of Australian residential aged care facilities: A systematic review.

PubMed

Neylon, Samantha; Bulsara, Caroline; Hill, Anne-Marie

2017-06-01

To determine applicability of environment assessment tools in guiding minor refurbishments of Australian residential aged care facilities. Studies conducted in residential aged care settings using assessment tools which address the physical environment were eligible for inclusion in a systematic review. Given these studies are limited, tools which have not yet been utilised in research settings were also included. Tools were analysed using a critical appraisal screen. Forty-three publications met the inclusion criteria. Ten environment assessment tools were identified, of which four addressed all seven minor refurbishment domains of lighting, colour and contrast, sound, flooring, furniture, signage and way finding. Only one had undergone reliability and validity testing. There are four tools which may be suitable to use for minor refurbishment of Australian residential aged care facilities. Data on their reliability, validity and quality are limited. © 2017 AJA Inc.

Facility Detection and Popularity Assessment from Text Classification of Social Media and Crowdsourced Data

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

Sparks, Kevin A; Li, Roger G; Thakur, Gautam

Advances in technology have continually progressed our understanding of where people are, how they use the environment around them, and why they are at their current location. Having a better knowledge of when various locations become popular through space and time could have large impacts on research fields like urban dynamics and energy consumption. In this paper, we discuss the ability to identify and locate various facility types (e.g. restaurant, airport, stadiums) using social media, and assess methods in determining when these facilities become popular over time. We use natural language processing tools and machine learning classifiers to interpret geotaggedmore » Twitter text and determine if a user is seemingly at a location of interest when the tweet was sent. On average our classifiers are approximately 85% accurate varying across multiple facility types, with a peak precision of 98%. By using these methods to classify unstructured text, geotagged social media data can be an extremely useful tool to better understanding the composition of places and how and when people use them.« less

Automatic alignment of pre- and post-interventional liver CT images for assessment of radiofrequency ablation

NASA Astrophysics Data System (ADS)

Rieder, Christian; Wirtz, Stefan; Strehlow, Jan; Zidowitz, Stephan; Bruners, Philipp; Isfort, Peter; Mahnken, Andreas H.; Peitgen, Heinz-Otto

2012-02-01

Image-guided radiofrequency ablation (RFA) is becoming a standard procedure for minimally invasive tumor treatment in clinical practice. To verify the treatment success of the therapy, reliable post-interventional assessment of the ablation zone (coagulation) is essential. Typically, pre- and post-interventional CT images have to be aligned to compare the shape, size, and position of tumor and coagulation zone. In this work, we present an automatic workflow for masking liver tissue, enabling a rigid registration algorithm to perform at least as accurate as experienced medical experts. To minimize the effect of global liver deformations, the registration is computed in a local region of interest around the pre-interventional lesion and post-interventional coagulation necrosis. A registration mask excluding lesions and neighboring organs is calculated to prevent the registration algorithm from matching both lesion shapes instead of the surrounding liver anatomy. As an initial registration step, the centers of gravity from both lesions are aligned automatically. The subsequent rigid registration method is based on the Local Cross Correlation (LCC) similarity measure and Newton-type optimization. To assess the accuracy of our method, 41 RFA cases are registered and compared with the manually aligned cases from four medical experts. Furthermore, the registration results are compared with ground truth transformations based on averaged anatomical landmark pairs. In the evaluation, we show that our method allows to automatic alignment of the data sets with equal accuracy as medical experts, but requiring significancy less time consumption and variability.

An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania.

PubMed

Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini

2017-07-11

There is limited evidence on how health care inputs are distributed from the sub-national level down to health facilities and their potential influence on promoting health equity. To address this gap, this paper assesses equity in the distribution of health care inputs across public primary health facilities at the district level in Tanzania. This is a quantitative assessment of equity in the distribution of health care inputs (staff, drugs, medical supplies and equipment) from district to facility level. The study was carried out in three districts (Kinondoni, Singida Rural and Manyoni district) in Tanzania. These districts were selected because they were implementing primary care reforms. We administered 729 exit surveys with patients seeking out-patient care; and health facility surveys at 69 facilities in early 2014. A total of seventeen indices of input availability were constructed with the collected data. The distribution of inputs was considered in relation to (i) the wealth of patients accessing the facilities, which was taken as a proxy for the wealth of the population in the catchment area; and (ii) facility distance from the district headquarters. We assessed equity in the distribution of inputs through the use of equity ratios, concentration indices and curves. We found a significant pro-rich distribution of clinical staff and nurses per 1000 population. Facilities with the poorest patients (most remote facilities) have fewer staff per 1000 population than those with the least poor patients (least remote facilities): 0.6 staff per 1000 among the poorest, compared to 0.9 among the least poor; 0.7 staff per 1000 among the most remote facilities compared to 0.9 among the least remote. The negative concentration index for support staff suggests a pro-poor distribution of this cadre but the 45 degree dominated the concentration curve. The distribution of vaccines, antibiotics, anti-diarrhoeal, anti-malarials and medical supplies was approximately

Linking household and health facility surveys to assess obstetric service availability, readiness and coverage: evidence from 17 low- and middle-income countries

PubMed Central

Kanyangarara, Mufaro; Chou, Victoria B; Creanga, Andreea A; Walker, Neff

2018-01-01

Background Improving access and quality of obstetric service has the potential to avert preventable maternal, neonatal and stillborn deaths, yet little is known about the quality of care received. This study sought to assess obstetric service availability, readiness and coverage within and between 17 low- and middle-income countries. Methods We linked health facility data from the Service Provision Assessments and Service Availability and Readiness Assessments, with corresponding household survey data obtained from the Demographic and Health Surveys and Multiple Indicator Cluster Surveys. Based on performance of obstetric signal functions, we defined four levels of facility emergency obstetric care (EmOC) functionality: comprehensive (CEmOC), basic (BEmOC), BEmOC-2, and low/substandard. Facility readiness was evaluated based on the direct observation of 23 essential items; facilities “ready to provide obstetric services” had ≥20 of 23 items available. Across countries, we used medians to characterize service availability and readiness, overall and by urban-rural location; analyses also adjusted for care-seeking patterns to estimate population-level coverage of obstetric services. Results Of the 111 500 health facilities surveyed, 7545 offered obstetric services and were included in the analysis. The median percentages of facilities offering EmOC and “ready to provide obstetric services” were 19% and 10%, respectively. There were considerable urban-rural differences, with absolute differences of 19% and 29% in the availability of facilities offering EmOC and “ready to provide obstetric services”, respectively. Adjusting for care-seeking patterns, results from the linking approach indicated that among women delivering in a facility, a median of 40% delivered in facilities offering EmOC, and 28% delivered in facilities “ready to provide obstetric services”. Relatively higher coverage of facility deliveries (≥65%) and coverage of deliveries in

Systematic Planning for Educational Facilities.

ERIC Educational Resources Information Center

McGuffey, Carroll W.

This monograph provides a systematic approach to the problem of planning educational facilities. It first presents a conceptual framework for a general facilities planning and management system called Facilities Resource Allocation Management Evaluation System (FRAMES). The main components of FRAMES are identified as: (1) needs assessment, (2)…

MR-guided radiofrequency ablation of hepatic malignancies at 1.5 T: initial results.

PubMed

Mahnken, Andreas H; Buecker, Arno; Spuentrup, Elmar; Krombach, Gabriele A; Henzler, Dietrich; Günther, Rolf W; Tacke, Josef

2004-03-01

To assess the feasibility of magnetic resonance (MR)-guided radiofrequency ablation (RFA) of hepatic malignancies using a high-field MR scanner. A total of 10 patients with 14 primary (N = 1) or secondary (N = 13) hepatic malignancies underwent MR-guided RFA using a closed-bore 1.5 T MR scanner. Lesion diameters ranged from 2.0 cm to 4.7 cm. RFA was performed using a 200-W generator in combination with a 3.5-cm LeVeen electrode applying a standardized energy protocol. RFA was technically feasible in all patients. Necrosis diameter ranged from 2.5 cm to 6.8 cm. The mean follow-up period is 12.2 (1-18) months. In nine out of 10 patients, local tumor control was achieved. For this purpose, a second CT-guided RFA was required in two patients. In four patients, multifocal hepatic tumor progression occurred, with the treated lesion remaining tumor-free in three of these patients. Two patients showed extrahepatic tumor progression. Four patients remained tumor-free. No major complications occurred. MR-guided RFA of hepatic malignancies in a closed-bore high-field MR scanner is technically feasible and safe. It can be advantageous in locations considered unfavorable for CT-guided puncture or in patients in which iodinated contrast material is contraindicated. Copyright 2004 Wiley-Liss, Inc.

Breast-conservative surgery followed by radiofrequency ablation of margins decreases the need for a second surgical procedure for close or positive margins.

PubMed

Rubio, Isabel T; Landolfi, Stefania; Molla, Meritxell; Cortes, Javier; Xercavins, Jordi

2014-10-01

Excision of breast cancer followed by radiofrequency ablation (eRFA) is a technique designed to increase negative margins in breast-conservative surgical procedures. The objective of this study is to analyze the impact of eRFA in avoiding a second surgical procedure for close or positive margins after a breast-conservative surgical procedure. From February 2008 to May 2010, 20 patients were included. After lumpectomy, the eRFA was performed in the lumpectomy cavity, and biopsies from each margin from the radial ablated cavity walls were obtained. Biopsy samples were assessed for tumor viability. eRFA was successful in 19 of 20 patients. In all patients, the devitalized tissue extended beyond a 5- to 10-mm radial depth of the biopsy sample. Overall, 6 patients (31%) had margins < 2 mm, 4 of them with < 1 mm margin. All 6 of these patients had no tumor viability according to analysis of biopsy samples stained with 2,3,5-triphenyltetrazolium chloride. At a median follow-up of 46 months, no local recurrence had been found. This study supports the feasibility of eRFA treatment. In our study, the eRFA method has spared 31% of patients from undergoing a re-excision surgical procedure, and it may, in the long-term, reduce local recurrences. Copyright © 2014 Elsevier Inc. All rights reserved.

10-year follow-up after radiofrequency ablation of idiopathic ventricular arrhythmias from right ventricular outflow tract.

PubMed

Rørvik, Synne Dragesund; Chen, Jian; Hoff, Per Ivar; Solheim, Eivind; Schuster, Peter

The aim of this study was to examine the effect of radiofrequency ablation (RFA) of ventricular arrhythmias from right ventricular outflow tract (RVOT) during long-term follow-up. A follow-up analysis was conducted using an in-house questionnaire, as well as a qualitative assessment of the patients' medical records. The study population of 34 patients had a previous diagnosis of idiopathic VT or frequent PVCs from the RVOT, and received RFA treatment between 2002 and 2005. The main symptoms prior to RFA were palpitations (82.4%) and dizziness (76.5%). A reduction in symptoms following RFA was reported by 91.2% of patients (p < 0.001). Furthermore, there was a reduced use of antiarrhythmic medication after RFA (p < 0.001). General health perception classified on a scale of 1 (poor) to 4 (excellent), improved from median class 1 to 3 (p < 0.001) during long-term follow-up. The fitness to work increased from median class 3 to class 5 (1 = incapacitated, 5 = full time employment, p = 0.038), while the rate of patients in full time employment increased from 26.5% to 55.9% after RFA (p = 0.02). A reduction of symptoms and use of antiarrhythmic medication, as well as an improvement in the general health perception and fitness to work after RFA of idiopathic ventricular arrhythmias can be demonstrated at ten-year follow-up. Copyright © 2016 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.

Influence of residual bone thickness on primary stability of hybrid self-tapping and cylindric non-self-tapping implants in vitro.

PubMed

Divac, Marija; Stawarczyk, Bogna; Sahrmann, Philipp; Attin, Thomas; Schmidlin, Patrick R

2013-01-01

To assess the primary stability of a hybrid self-tapping implant and a cylindric non-self-tapping implant in an in vitro test model using polyurethane foam. Eighty standardized blocks of cellular rigid polyurethane foam, 2 cm long and 1 cm wide, with different thicknesses of 2, 4, 6, and 9 mm (n = 10 per group) were cut. Two implant systems--a hybrid self-tapping (Tapered Effect [TE], Straumann) and a cylindric non-self-tapping (Standard Plus [SP] Wide Neck, Straumann) were placed in the block specimens. Subsequently, resonance frequency analysis (RFA) was performed. The RFA measurements were made in triplicate on four aspects of each implant (mesial, distal, buccal, and oral), and the mean RFA value was calculated. Subsequently, the tensile load of the implants was determined by pull-out tests. The data were analyzed using one-way and two-way analysis of variance followed by a post hoc Scheffe test and a t test (α = .05). Additionally, the simple linear correlation between the RFA and tensile load values was evaluated. No statistically significant differences were found between TE and SP in terms of RFA at different bone thicknesses. Starting from a bone thickness of 4 mm, TE implants showed significantly higher tensile load compared to SP implants (P = .016 to .040). A correlation was found between the RFA measurements and tensile load. Mechanically stable placement is possible with TE and SP implants in a trabecular bone model. RFA and tensile load increased with greater bone thickness.

Assessing the potential of rural and urban private facilities in implementing child health interventions in Mukono district, central Uganda-a cross sectional study.

PubMed

Rutebemberwa, Elizeus; Buregyeya, Esther; Lal, Sham; Clarke, Sîan E; Hansen, Kristian S; Magnussen, Pascal; LaRussa, Philip; Mbonye, Anthony K

2016-07-15

Private facilities are the first place of care seeking for many sick children. Involving these facilities in child health interventions may provide opportunities to improve child welfare. The objective of this study was to assess the potential of rural and urban private facilities in diagnostic capabilities, operations and human resource in the management of malaria, pneumonia and diarrhoea. A survey was conducted in pharmacies, private clinics and drug shops in Mukono district in October 2014. An assessment was done on availability of diagnostic equipment for malaria, record keeping, essential drugs for the treatment of malaria, pneumonia and diarrhoea; the sex, level of education, professional and in-service training of the persons found attending to patients in these facilities. A comparison was made between urban and rural facilities. Univariate and bivariate analysis was done. A total of 241 private facilities were assessed with only 47 (19.5 %) being in rural areas. Compared to urban areas, rural private facilities were more likely to be drug shops (OR 2.80; 95 % CI 1.23-7.11), less likely to be registered (OR 0.31; 95 % CI 0.16-0.60), not have trained clinicians, less likely to have people with tertiary education (OR 0.34; 95 % CI 0.17-0.66) and less likely to have zinc tablets (OR 0.38; 95 % CI 0.19-0.78). In both urban and rural areas, there was low usage of stock cards and patient registers. About half of the facilities in both rural and urban areas attended to at least one sick child in the week prior to the interview. There were big gaps between rural and urban private facilities with rural ones having less trained personnel and less zinc tablets' availability. In both rural and urban areas, record keeping was low. Child health interventions need to build capacity of private facilities with special focus on rural areas where child mortality is higher and capacity of facilities lower.

Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo

PubMed Central

2009-01-01

Background Prolonged exposure to war has severely impacted the provision of health services in the Democratic Republic of the Congo (DRC). Health infrastructure has been destroyed, health workers have fled and government support to health care services has been made difficult by ongoing conflict. Poor reproductive health (RH) indicators illustrate the effect that the prolonged crisis in DRC has had on the on the reproductive health (RH) of Congolese women. In 2007, with support from the RAISE Initiative, the International Rescue Committee (IRC) and CARE conducted baseline assessments of public hospitals to evaluate their capacities to meet the RH needs of the local populations and to determine availability, utilization and quality of RH services including emergency obstetric care (EmOC) and family planning (FP). Methods Data were collected from facility assessments at nine general referral hospitals in five provinces in the DRC during March, April and November 2007. Interviews, observation and clinical record review were used to assess the general infrastructure, EmOC and FP services provided, and the infection prevention environment in each of the facilities. Results None of the nine hospitals met the criteria for classification as an EmOC facility (either basic or comprehensive). Most facilities lacked any FP services. Shortage of trained staff, essential supplies and medicines and poor infection prevention practices were consistently documented. All facilities had poor systems for routine monitoring of RH services, especially with regard to EmOC. Conclusions Women's lives can be saved and their well-being improved with functioning RH services. As the DRC stabilizes, IRC and CARE in partnership with the local Ministry of Health and other service provision partners are improving RH services by: 1) providing necessary equipment and renovations to health facilities; 2) improving supply management systems; 3) providing comprehensive competency-based training for

Assessment of the correlation between insertion torque and resonance frequency analysis of implants placed in bone tissue of different densities.

PubMed

Filho, Luiz Carlos Magno; Cirano, Fabiano Ribeiro; Hayashi, Fernando; Feng, Hsu Shao; Conte, Alexandre; Dib, Luciano Lauria; Casati, Marcio Zaffalon

2014-06-01

The primary stability of dental implants is fundamental for osseointegration. Therefore, this study aimed to assess the correlation between insertion torque (IT) and resonance frequency analysis (RFA) of implants placed in mandibles and maxillas of different bone densities. Eighty dental implants were placed in maxillas and mandibles, and IT and the implant stability quotient (ISQ) were measured at the time of implant insertion. Bone density was assessed subjectively by the Lekholm and Zarb index. The type I and II densities were grouped together (group A)as were the type III and IV densities (group B). The IT in group A was higher (Student t test, P = .0013) than in group B (46.27 ± 18.51 Ncm, 33.62 ± 14.74 Ncm, respectively). The implants placed in group A showed higher ISQ (Student t test, P = .0004) than those placed in group B (70.09 ± 7.50, 63.66 ± 8.00, respectively). A significant correlation between IT and the ISQ value was observed for group A (Pearson correlation test; r = 0.35; P = .0213) and for group B (r = 0.37; P = .0224). Within the limitations of this study, it was possible to conclude that there is a correlation between IT and RFA of implants placed in mandibles and maxillas of different bone densities.

Safety of Prior Endoscopic Mucosal Resection in Patients Receiving Radiofrequency Ablation of Barrett’s Esophagus

PubMed Central

Okoro, Ngozi I.; Tomizawa, Yutaka; Dunagan, Kelly T.; Lutzke, Lori S.; Wang, Kenneth K.; Prasad, Ganapathy A.

2011-01-01

BACKGROUND & AIMS Radiofrequency ablation (RFA) is safe and effective treatment for flat dysplasia associated with Barrett’s esophagus (BE). However, there are limited data on the safety of RFA in patients who had prior endoscopic mucosal resection (EMR), which might increase the risk of complications. We compared complications and histologic outcomes between patients who had EMR before RFA and those who received only RFA. METHODS We performed a retrospective analysis of data collected from patients treated for BE, associated with dysplasia or intramucosal cancer, at the Mayo Clinic in Rochester, Minnesota, from 1998–2009. Patients were divided into groups that had RFA after EMR (group 1, n = 44) or only RFA (group 2, n = 46). We compared the incidence of complications (strictures, bleeding, and esophageal perforation) and histologic features (complete resolution of dysplasia and complete resolution of intestinal metaplasia [CR-IM]) between groups. Logistic regression analysis was performed to assess predictors of stricture formation. RESULTS Stricture rates were 14% in group 1 and 9% in group 2 (odds ratio, 1.53; 95% confidence interval [CI], 0.26 –9.74). The rates of CR-IM were 43% in group 1 and 74% in group 2 (odds ratio, 0.33; 95% CI, 0.14 – 0.78). The rates of complete resolution of dysplasia were 76% in group 1 and 71% in group 2 (odds ratio, 1.28; 95% CI, 0.39 – 4.17). The adjusted odds ratio for CR-IM in group 1 (adjusting for age, segment length, and grade of dysplasia) was 0.50 (95% CI, 0.15–1.66). CONCLUSIONS Stricture rates among patients who receive only RFA are comparable to those of patients who had prior EMR. EMR appears safe to perform prior to RFA. PMID:22056303

Preliminary assessment report for Virginia Army National Guard Army Aviation Support Facility, Richmond International Airport, Installation 51230, Sandston, Virginia

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

Dennis, C.B.

This report presents the results of the preliminary assessment (PA) conducted by Argonne National Laboratory at the Virginia Army National Guard (VaARNG) property in Sandston, Virginia. The Army Aviation Support Facility (AASF) is contiguous with the Richmond International Airport. Preliminary assessments of federal facilities are being conducted to compile the information necessary for completing preremedial activities and to provide a basis for establishing corrective actions in response to releases of hazardous substances. The PA is designed to characterize the site accurately and determine the need for further action by examining site activities, quantities of hazardous substances present, and potential pathwaysmore » by which contamination could affect public health and the environment. The AASF, originally constructed as an active Air Force interceptor base, provides maintenance support for VaARNG aircraft. Hazardous materials used and stored at the facility include JP-4 jet fuel, diesel fuel, gasoline, liquid propane gas, heating oil, and motor oil.« less

Contrast-enhanced cardiac C-arm CT evaluation of radiofrequency ablation lesions in the left ventricle

PubMed Central

Girard, Erin E; Al-Ahmad, Amin A; Rosenberg, Jarrett; Luong, Richard; Moore, Teri; Lauritsch, Günter; Boese, Jan; Fahrig, Rebecca

2011-01-01

Objectives The purpose of this study was to evaluate use of cardiac C-arm computed tomography (CT) in the assessment of the dimensions and temporal characteristics of radiofrequency ablation (RFA) lesions. This imaging modality uses a standard C-arm fluoroscopy system rotating around the patient, providing CT-like images during the RFA procedure. Background Both magnetic resonance imaging (MRI) and CT can be used to assess myocardial necrotic tissue. Several studies have reported visualizing cardiac RF ablation lesions with MRI, however obtaining MR images during interventional procedures is not common practice. Direct visualization of RFA lesions using C-arm CT during the procedure may improve outcomes and circumvent complications associated with cardiac ablation procedures. Methods RFA lesions were created on the endocardial surface of the left ventricle of 9 swine using a 7-F RF ablation catheter. An ECG-gated C-arm CT imaging protocol was used to acquire projection images during iodine contrast injection and following the injection every 5 min for up to 30 min, with no additional contrast. Reconstructed images were analyzed offline. The mean and standard deviation of the signal intensity of the lesion and normal myocardium were measured in all images in each time series. Lesion dimensions and area were measured and compared in pathologic specimens and C-arm CT images. Results All ablation lesions (n=29) were visualized and lesion dimensions, as measured on C-arm CT, correlated well with postmortem tissue measurements (1D dimensions : concordance correlation = 0.87; area : concordance correlation = 0.90). Lesions were visualized as a perfusion defect on first-pass C-arm CT images with a signal intensity 95 HU lower than normal myocardium (95% confidence interval: -111 to -79 HU). Images acquired at 1 and 5 minutes exhibited an enhancing ring surrounding the perfusion defect in 24 (83%) lesions. Conclusions RFA lesion size, including transmurality, can be

Environmental Assessment for the NASA First Response Facility

NASA Technical Reports Server (NTRS)

Kennedy, Carolyn

2003-01-01

NASA intends to construct a First Response Facility for integrated emergency response and health management. This facility will consolidate the Stennis Space Center fire department, medical clinic, security operations, emergency operations and the energy management and control center. The alternative considered is the "No Action Alternative". The proposed action will correct existing operational weaknesses and enhance capabilities to respond to medical emergencies and mitigate any other possible threats. Environmental impacts include are emissions, wetlands disturbance, solid waste generation, and storm water control.

Implementation of Telemedicine Consultation to Assess Unplanned Transfers in Rural Long-Term Care Facilities, 2012-2015: A Pilot Study.

PubMed

Hofmeyer, Joshua; Leider, Jonathon P; Satorius, Jennifer; Tanenbaum, Erin; Basel, David; Knudson, Alana

2016-11-01

Public and private entities in the United States spend billions of dollars each year on potentially avoidable hospitalizations. This is a common occurrence in long-term care (LTC) facilities, especially in rural jurisdictions. This article details the creation of a telemedicine approach to assess residents from rural LTC facilities for potential transfer to hospitals. An electronic LTC (eLTC) pilot was conducted in 20 pilot LTC facilities from 2012-2015. Each site underwent technologic assessment and upgrading to ensure that 2-way video communication was possible. A new central "hub" was staffed with advanced practice providers and registered nurses. Long-term care pilot sites were trained and rolled out over 3 years. This article reports development and implementation of the pilot, as well as descriptive statistics associated with provider assessments and averted transfers. Over 3 years, 736 eLTC consultations occurred in pilot sites. One-quarter of consultations occurred between 10 pm and 9 am. Overall, approximately 31% of cases were transferred. This decreased from 54% of cases in 2013 to 17% in 2015. Rural pilot facilities had an average of 23 eLTC consults per site per year. Averted transfers represent a dramatic benefit to the residents, as potentially avoidable hospitalizations cause undue stress and allow for nosocomial infections, among other risks. In addition, averting these unnecessary transfers likely saved the taxpayers of the United States over $5 million in admission-related charges to Centers for Medicare and Medicaid Services (511 avoided transfers × $11,000 per average hospitalization from a LTC facility). Overall, the eLTC pilot showed promise as a proof-of-concept. The pilot's implementation resulted in increasing utilization and promising reductions in unnecessary transfers to emergency departments and hospitalizations. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

Assessment of workplace air concentrations of formaldehyde during and before working hours in medical facilities.

PubMed

Higashikubo, Ichiro; Miyauchi, Hiroyuki; Yoshida, Satoru; Tanaka, Shinsuke; Matsuoka, Mitsunori; Arito, Heihachiro; Araki, Akihiro; Shimizu, Hidesuke; Sakurai, Haruhiko

2017-04-07

Workplace air concentrations of formaldehyde (FA) in medical facilities where FA and FA-treated organs were stored and handled were measured before and during working hours and assessed by the official method specified by Work Environment Measurement Law. Sixty-percent of the total facilities examined were judged as inappropriately controlled work environment. The concentrations of FA before working hours by spot sampling were found to exceed 0.1 ppm in some facilities, and tended to increase with increasing volume of containers storing FA and FA-treated materials. Regression analysis revealed that logarithmic concentrations of FA during working hours by the Law-specified analytical method were highly correlated with those before working hours by spot sampling, suggesting the importance for appropriate storing methods of FA and FA-treated materials. The concentrations of FA during working hours are considered to be lowered by effective ventilation of FA-contaminated workplace air and appropriate storage of FA and FA-treated materials in plastic containers in the medical facilities. In particular, such improvement by a local exhaust ventilation system and tightly-sealed containment of FA-treated material were urgently needed for the dissecting room where FA-treated cadavers were prepared and handled for a gross anatomy course in a medical school.

Marker Configuration Model-Based Roentgen Fluoroscopic Analysis.

PubMed

Garling, Eric H; Kaptein, Bart L; Geleijns, Koos; Nelissen, Rob G H H; Valstar, Edward R

2005-04-01

It remains unknown if and how the polyethylene bearing in mobile bearing knees moves during dynamic activities with respect to the tibial base plate. Marker Configuration Model-Based Roentgen Fluoroscopic Analysis (MCM-based RFA) uses a marker configuration model of inserted tantalum markers in order to accurately estimate the pose of an implant or bone using single plane Roentgen images or fluoroscopic images. The goal of this study is to assess the accuracy of (MCM-Based RFA) in a standard fluoroscopic set-up using phantom experiments and to determine the error propagation with computer simulations. The experimental set-up of the phantom study was calibrated using a calibration box equipped with 600 tantalum markers, which corrected for image distortion and determined the focus position. In the computer simulation study the influence of image distortion, MC-model accuracy, focus position, the relative distance between MC-models and MC-model configuration on the accuracy of MCM-Based RFA were assessed. The phantom study established that the in-plane accuracy of MCM-Based RFA is 0.1 mm and the out-of-plane accuracy is 0.9 mm. The rotational accuracy is 0.1 degrees. A ninth-order polynomial model was used to correct for image distortion. Marker-Based RFA was estimated to have, in a worst case scenario, an in vivo translational accuracy of 0.14 mm (x-axis), 0.17 mm (y-axis), 1.9 mm (z-axis), respectively, and a rotational accuracy of 0.3 degrees. When using fluoroscopy to study kinematics, image distortion and the accuracy of models are important factors, which influence the accuracy of the measurements. MCM-Based RFA has the potential to be an accurate, clinically useful tool for studying kinematics after total joint replacement using standard equipment.

A trial of radiofrequency ablation for anal intraepithelial neoplasia.

PubMed

Goldstone, Robert N; Hasan, Shirin R; Drury, Steven; Darragh, Teresa M; van Zante, Annemieke; Goldstone, Stephen E

2017-03-01

Radiofrequency ablation (RFA) effectively treats esophageal high-grade dysplasia, but its efficacy in treating anal canal high-grade squamous intraepithelial lesions (HSILs) is unsubstantiated. This prospective study assessed the safety and efficacy of applying hemi-circumferential RFA to anal canal HSIL. Twenty-one HIV-negative participants with HSIL occupying ≤ half the anal canal circumference were treated with hemi-circumferential anal canal RFA. Participants were assessed every 3 months for 12 months with high-resolution anoscopy; recurrence in the treatment zone was re-treated with focal RFA. Twenty-one participants with a mean of 1.7 lesions (range 1-4) enrolled and completed the trial. Six (29 %) participants had recurrent HSIL within the treated hemi-circumference within 1 year. Four participants (19 %) had persistence of an index lesion at 3 months. One (2.9 %) index HSIL persisted again at 12 months. No participants had more than two RFA treatments. KM curve-predicted HSIL-free survival within the treatment zone at 1 year was 76 % (95 % CI 52-89 %). Comparing the first 7 and last 14 participants, the predicted 1-year HSIL-free survivals are 43 % (95 % CI 10-73 %) and 93 % (95 % CI 59-99 %), respectively (p = 0.008), suggesting a learning curve with the treating physician. Multivariable analysis showed decreased recurrence in the last 14 participants (HR 0.02; 95 % CI 0.001-0.63) while increasing BMI increased recurrence (HR 1.43, 95 % CI 1.01-2.01). No participants had device or procedure-related serious adverse events, anal stricture, or heavy bleeding. Hemi-circumferential RFA yielded a high rate of anal HSIL eradication in HIV-negative patients at 1 year with minimal adverse events. Lesion persistence was probably related to incomplete initial ablation.

High Performance Computing Facility Operational Assessment 2015: Oak Ridge Leadership Computing Facility

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

Barker, Ashley D.; Bernholdt, David E.; Bland, Arthur S.

Oak Ridge National Laboratory’s (ORNL’s) Leadership Computing Facility (OLCF) continues to surpass its operational target goals: supporting users; delivering fast, reliable systems; creating innovative solutions for high-performance computing (HPC) needs; and managing risks, safety, and security aspects associated with operating one of the most powerful computers in the world. The results can be seen in the cutting-edge science delivered by users and the praise from the research community. Calendar year (CY) 2015 was filled with outstanding operational results and accomplishments: a very high rating from users on overall satisfaction that ties the highest-ever mark set in CY 2014; the greatestmore » number of core-hours delivered to research projects; the largest percentage of capability usage since the OLCF began tracking the metric in 2009; and success in delivering on the allocation of 60, 30, and 10% of core hours offered for the INCITE (Innovative and Novel Computational Impact on Theory and Experiment), ALCC (Advanced Scientific Computing Research Leadership Computing Challenge), and Director’s Discretionary programs, respectively. These accomplishments, coupled with the extremely high utilization rate, represent the fulfillment of the promise of Titan: maximum use by maximum-size simulations. The impact of all of these successes and more is reflected in the accomplishments of OLCF users, with publications this year in notable journals Nature, Nature Materials, Nature Chemistry, Nature Physics, Nature Climate Change, ACS Nano, Journal of the American Chemical Society, and Physical Review Letters, as well as many others. The achievements included in the 2015 OLCF Operational Assessment Report reflect first-ever or largest simulations in their communities; for example Titan enabled engineers in Los Angeles and the surrounding region to design and begin building improved critical infrastructure by enabling the highest-resolution Cybershake map for

Environmental Assessment (EA): Proposed Software Facilities, Hill Air Force Base, Utah

DTIC Science & Technology

2011-04-19

retention facilities ; • connections to adjacent buried utilities consisting of water, electricity, natural gas, telephone/ data , sanitary sewer, and storm...engineering, development, and testing workloads for F-22 and F-35 aircraft. Military construction (MILCON) project data explain existing facilities ...Existing Facilities MILCON project data state there are no facilities on Hill AFB with adequate security to house the specialized laboratory space or

Assessment and documentation of non-healing, chronic wounds in inpatient health care facilities in the Czech Republic: an evaluation study.

PubMed

Pokorná, Andrea; Leaper, David

2015-04-01

The foundation of health care management of patients with non-healing, chronic wounds needs accurate evaluation followed by the selection of an appropriate therapeutic strategy. Assessment of non-healing, chronic wounds in clinical practice in the Czech Republic is not standardised. The aim of this study was to analyse the methods being used to assess non-healing, chronic wounds in inpatient facilities in the Czech Republic. The research was carried out at 77 inpatient medical facilities (8 university/faculty hospitals, 63 hospitals and 6 long- term hospitals) across all regions of the Czech Republic. A mixed model was used for the research (participatory observation including creation of field notes and content analysis of documents for documentation and analysis of qualitative and quantitative data). The results of this research have corroborated the suspicion of inconsistencies in procedures used by general nurses for assessment of non-healing, chronic wounds. However, the situation was found to be more positive with regard to evaluation of basic/fundamental parameters of a wound (e.g. size, depth and location of a wound) compared with the evaluation of more specific parameters (e.g. exudate or signs of infection). This included not only the number of observed variables, but also the action taken. Both were significantly improved when a consultant for wound healing was present (P = 0·047). The same applied to facilities possessing a certificate of quality issued by the Czech Wound Management Association (P = 0·010). In conclusion, an effective strategy for wound management depends on the method and scope of the assessment of non-healing, chronic wounds in place in clinical practice in observed facilities; improvement may be expected following the general introduction of a 'non-healing, chronic wound assessment' algorithm. © 2014 The Authors. International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Climate change in safety assessment of a surface disposal facility

NASA Astrophysics Data System (ADS)

Leterme, B.

2012-04-01

The Belgian Agency for Radioactive Waste and Enriched Fissile Materials (ONDRAF/NIRAS) aims to develop a surface disposal facility for LILW-SL in Dessel (North-East of Belgium). Given the time scale of interest for the safety assessment (several millennia), a number of parameters in the modelling chain near field - geosphere - biosphere may be influenced by climate change. The present study discusses how potential climate change impact was accounted for the following quantities: (i) near field infiltration through the repository earth cover, (ii) partial pressure of CO2 in the water infiltrating the cover and draining the concrete, and (iii) groundwater recharge in the vicinity of the site. For these three parameters, the impact of climate change is assessed using climatic analogue stations, i.e. stations presently under climatic conditions corresponding to a given climate state. Results indicate that : (i) Using Gijon (Spain) as representative analogue station for the next millennia, infiltration at the bottom of the soil layer towards the modules of the facility is expected to increase (from 346 to 413 mm/y) under a subtropical climate. Although no colder climate is foreseen in the next 10 000 years, the approach was also tested with analogue stations for a colder climate state. Using Sisimiut (Greenland) as representative analogue station, infiltration is expected to decrease (109 mm/y). (ii) Due to changes of the partial pressure of CO2 in the soil water, cement degradation is estimated to occur more rapidly under a warmer climate. (iii) A decrease of long-term annual average groundwater recharge by 12% was simulated using Gijon representative analogue (from 314 to 276 mm), although total rainfall was higher (947 mm) in the warmer climate compared to the current temperate climate (899 mm). For a colder climate state, groundwater recharge simulated for the representative analogue Sisimiut showed a decrease by 69% compared to current climate conditions. The

Pain control in patients with hepatocellular carcinoma treated by percutaneous radiofrequency ablation: comparison of the efficacy of one-shot and continuous intravenous fentanyl delivery.

PubMed

Yokoyama, Koichi; Ikeda, Osamu; Kawanaka, Koichi; Nakasone, Yutaka; Inoue, Seijiro; Tamura, Yoshitaka; Yamashita, Yasuyuki

2014-12-01

Hepatic percutaneous radiofrequency ablation (RFA) is usually performed with the patient under deep intravenous (i.v.) sedation or general anesthesia. Nonetheless, many patients report pain during and/or after the procedure. To perform a prospective study of pain control obtained by the i.v. one-shot delivery and the continuous i.v. infusion of fentanyl in patients with hepatocellular carcinoma (HCC) treated by RFA. Between April 2007 and March 2010, 83 patients with 106 HCCs underwent percutaneous RFA. All HCCs were addressed by computed tomography (CT)-guided percutaneous RFA performed within 5 h of embolization of the tumor vessels with iodized oil and gelatin sponges. Standard anesthesia consisted of 10 mL of 1% lidocaine injected locally. For conscious sedation, group one patients (n = 41) were injected i.v. with 100 µg of fentanyl before and 100 µg of fentanyl 30 min after percutaneous RFA. In group two (n = 42) we delivered fentanyl by continuous i.v. infusion at 100 µg/h during RFA. Upon request, patients in both groups also received 5 mg of diazepam i.v. for pain during the RFA procedure. The severity of pain experienced by all patients was evaluated on a visual analogue scale (VAS) and complications elicited by the anesthesia regimens were recorded. We also assessed the effectiveness of the treatment on sequential follow-up CT and/or magnetic resonance imaging (MRI) at 3-month intervals. Percutaneous RFA was technically successful in all 83 patients. Two patients in group one (4.8%) and one patient in group two (2.4%) manifested residual enhancement 3 months post RFA. There was no significant difference in the local recurrence rate between the two groups. At 4.0 ± 1.8 for group one and 3.4 ± 1.9 for group two, the VAS score was not significantly different. Major fentanyl or diazepam toxicity was recorded in 11 patients (24.4%) in group one and two patients (4.8%) in group two; the difference was statistically significant (P < 0.01). The continuous

Surviving the storms: Emergency preparedness in Texas nursing facilities and assisted living facilities.

PubMed

Castro, Carmen; Persson, Diane; Bergstrom, Nancy; Cron, Stanley

2008-08-01

This study assesses the preparedness of long-term care facilities in Texas responding to Hurricanes Katrina and Rita. A 41-item questionnaire was mailed to facilities; the response rate was 42%. Among responding facilities, 4513 residents were evacuated, and 6% of respondents reported resident death. Financial losses were reported by 8% of nursing facilities and 45% of assisted living facilities due to transportation and staff overtime. Respondents indicated the need for improved disaster preparednesstraining, better coordination, and transportation. Changes in policy and practice will lead to better trained staff who will provide the care residents need for improved health outcomes during future public health disasters.

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries

PubMed Central

de Graft-Johnson, Joseph; Vesel, Linda; Rosen, Heather E; Rawlins, Barbara; Abwao, Stella; Mazia, Goldy; Bozsa, Robert; Mwebesa, Winifrede; Khadka, Neena; Kamunya, Rosemary; Getachew, Ashebir; Tibaijuka, Gaudiosa; Rakotovao, Jean Pierre; Tekleberhan, Alemnesh

2017-01-01

Objective To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. Design Cross-sectional observational health facility assessment. Setting Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. Participants Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. Main outcome measures Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. Results Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. Conclusions The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have

EPA Facility Registry Service (FRS): Facility Interests Dataset

EPA Pesticide Factsheets

This web feature service consists of location and facility identification information from EPA's Facility Registry Service (FRS) for all sites that are available in the FRS individual feature layers. The layers comprise the FRS major program databases, including:Assessment Cleanup and Redevelopment Exchange System (ACRES) : brownfields sites ; Air Facility System (AFS) : stationary sources of air pollution ; Air Quality System (AQS) : ambient air pollution data from monitoring stations; Bureau of Indian Affairs (BIA) : schools data on Indian land; Base Realignment and Closure (BRAC) facilities; Clean Air Markets Division Business System (CAMDBS) : market-based air pollution control programs; Comprehensive Environmental Response, Compensation, and Liability Information System (CERCLIS) : hazardous waste sites; Integrated Compliance Information System (ICIS) : integrated enforcement and compliance information; National Compliance Database (NCDB) : Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) and the Toxic Substances Control Act (TSCA); National Pollutant Discharge Elimination System (NPDES) module of ICIS : NPDES surface water permits; Radiation Information Database (RADINFO) : radiation and radioactivity facilities; RACT/BACT/LAER Clearinghouse (RBLC) : best available air pollution technology requirements; Resource Conservation and Recovery Act Information System (RCRAInfo) : tracks generators, transporters, treaters, storers, and disposers of haz

Endovascular Radiofrequency Ablation for Varicose Veins

PubMed Central

2011-01-01

treatment plan. The RFA procedure involves the introduction of a guide wire into the target vein under ultrasound guidance followed by the insertion of an introducer sheath through which the RFA catheter is advanced. Once satisfactory positioning has been confirmed with ultrasound, a tumescent anaesthetic solution is injected into the soft tissue surrounding the target vein along its entire length. This serves to anaesthetize the vein, insulate the heat from damaging adjacent structures, including nerves and skin and compresses the vein increasing optimal contact of the vessel wall with the electrodes or expanded prongs of the RF device. The RF generator is then activated and the catheter is slowly pulled along the length of the vein. At the end of the procedure, hemostasis is then achieved by applying pressure to the vein entry point. Adequate and proper compression stockings and bandages are applied after the procedure to reduce the risk of venous thromboembolism and to reduce postoperative bruising and tenderness. Patients are encouraged to walk immediately after the procedure. Follow-up protocols vary, with most patients returning 1 to 3 weeks later for an initial follow-up visit. At this point, the initial clinical result is assessed and occlusion of the treated vessels is confirmed with ultrasound. Patients often have a second follow-up visit 1 to 3 months following RFA at which time clinical evaluation and ultrasound are repeated. If required, additional procedures such as phlebectomy or sclerotherapy may be performed during the RFA procedure or at any follow-up visits. Regulatory Status The Closure System® radiofrequency generator for endovascular thermal ablation of varicose veins was approved by Health Canada as a class 3 device in March 2005, registered under medical device license 67865. The RFA intravascular catheter was approved by Health Canada in November 2007 for the ClosureFast catheter, registered under medical device license 16574. The Closure System

Waste Form Release Calculations for the 2005 Integrated Disposal Facility Performance Assessment. Erratum

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

Smith, Gary L.

2016-09-06

This report refers to or contains K g values for glasses LAWA44, LAWB45 and LAWC22 affected by calculations errors as identified by Papathanassiu et al. (2011). The corrected K g values are reported in an erratum included in the revised version of the original report. The revised report can be referenced as follows: Pierce E. M. et al. (2004) Waste Form Release Data Package for the 2005 Integrated Disposal Facility Performance Assessment. PNNL-14805 Rev. 0 Erratum. Pacific Northwest National Laboratory, Richland, WA, USA.

Toward guidance of epicardial cardiac radiofrequency ablation therapy using optical coherence tomography

NASA Astrophysics Data System (ADS)

Fleming, Christine P.; Quan, Kara J.; Rollins, Andrew M.

2010-07-01

Radiofrequency ablation (RFA) is the standard of care to cure many cardiac arrhythmias. Epicardial ablation for the treatment of ventricular tachycardia has limited success rates due in part to the presence of epicardial fat, which prevents proper rf energy delivery, inadequate contact of ablation catheter with tissue, and increased likelihood of complications with energy delivery in close proximity to coronary vessels. A method to directly visualize the epicardial surface during RFA could potentially provide feedback to reduce complications and titrate rf energy dose by detecting critical structures, assessing probe contact, and confirming energy delivery by visualizing lesion formation. Currently, there is no technology available for direct visualization of the heart surface during epicardial RFA therapy. We demonstrate that optical coherence tomography (OCT) imaging has the potential to fill this unmet need. Spectral domain OCT at 1310 nm is employed to image the epicardial surface of freshly excised swine hearts using a microscope integrated bench-top scanner and a forward imaging catheter probe. OCT image features are observed that clearly distinguish untreated myocardium, ablation lesions, epicardial fat, and coronary vessels, and assess tissue contact with catheter-based imaging. These results support the potential for real-time guidance of epicardial RFA therapy using OCT imaging.

EPA Facility Registry Service (FRS): Facility Interests Dataset Download

EPA Pesticide Factsheets

This downloadable data package consists of location and facility identification information from EPA's Facility Registry Service (FRS) for all sites that are available in the FRS individual feature layers. The layers comprise the FRS major program databases, including:Assessment Cleanup and Redevelopment Exchange System (ACRES) : brownfields sites ; Air Facility System (AFS) : stationary sources of air pollution ; Air Quality System (AQS) : ambient air pollution data from monitoring stations; Bureau of Indian Affairs (BIA) : schools data on Indian land; Base Realignment and Closure (BRAC) facilities; Clean Air Markets Division Business System (CAMDBS) : market-based air pollution control programs; Comprehensive Environmental Response, Compensation, and Liability Information System (CERCLIS) : hazardous waste sites; Integrated Compliance Information System (ICIS) : integrated enforcement and compliance information; National Compliance Database (NCDB) : Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) and the Toxic Substances Control Act (TSCA); National Pollutant Discharge Elimination System (NPDES) module of ICIS : NPDES surface water permits; Radiation Information Database (RADINFO) : radiation and radioactivity facilities; RACT/BACT/LAER Clearinghouse (RBLC) : best available air pollution technology requirements; Resource Conservation and Recovery Act Information System (RCRAInfo) : tracks generators, transporters, treaters, storers, and disposers

An assessment of risk posed by a Campylobacter-positive puppy living in an Australian residential aged-care facility.

PubMed

Moffatt, Cameron; Appuhamy, Ranil; Andrew, Will; Wynn, Sandy; Roberts, Jan; Kennedy, Karina

2014-01-01

In April and June 2012, two outbreaks of Campylobacter gastroenteritis were investigated in an Australian aged-care facility (ACF); a Campylobacter-positive puppy was identified as a potential source of infection. An expert panel was convened to assess transmission risk from the puppy to elderly residents and to guide further public health action. Criteria considered as part of the panel's assessment included the puppy's infectivity, the bacterium's transmissibility, puppy-resident contact, infection control and cleaning practices and animal management at the facility. A literature review was used to assist the panel, with a final risk being determined using a likelihood and consequence matrix. The panel determined that the setting and low infective dose made transmission likely despite varying degrees of contact between the puppy and cases. While infection control practices were generally appropriate, the facility's animal policy did not adequately address potential zoonotic risk. In summary, puppies should not be considered as companion animals in ACFs due to high rates of Campylobacter carriage and the underlying susceptibility of the elderly. Infection control and animal policies in ACFs should reflect an awareness of zoonotic disease potential.

Facilities Condition and Hazards Assessment for Materials and Fuel Complex Facilities MFC-799, 799A, and 770C

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

Gary Mecham; Don Konoyer

2009-11-01

The Materials & Fuel Complex (MFC) facilities 799 Sodium Processing Facility (a single building consisting of two areas: the Sodium Process Area (SPA) and the Carbonate Process Area (CPA), 799A Caustic Storage Area, and 770C Nuclear Calibration Laboratory have been declared excess to future Department of Energy mission requirements. Transfer of these facilities from Nuclear Energy to Environmental Management, and an associated schedule for doing so, have been agreed upon by the two offices. The prerequisites for this transfer to occur are the removal of nonexcess materials and chemical inventory, deinventory of the calibration source in MFC-770C, and the reroutingmore » and/or isolation of utility and service systems. This report provides a description of the current physical condition and any hazards (material, chemical, nuclear or occupational) that may be associated with past operations of these facilities. This information will document conditions at time of transfer of the facilities from Nuclear Energy to Environmental Management and serve as the basis for disposition planning. The process used in obtaining this information included document searches, interviews and facility walk-downs. A copy of the facility walk-down checklist is included in this report as Appendix A. MFC-799/799A/770C are all structurally sound and associated hazardous or potentially hazardous conditions are well defined and well understood. All installed equipment items (tanks, filters, etc.) used to process hazardous materials remain in place and appear to have maintained their integrity. There is no evidence of leakage and all openings are properly sealed or closed off and connections are sound. The pits appear clean with no evidence of cracking or deterioration that could lead to migration of contamination. Based upon the available information/documentation reviewed and the overall conditions observed during the facilities walk-down, it is concluded that these facilities may be

Radiofrequency ablation for locally advanced pancreatic cancer: SMAD4 analysis segregates a responsive subgroup of patients.

PubMed

Paiella, Salvatore; Malleo, Giuseppe; Cataldo, Ivana; Gasparini, Clizia; De Pastena, Matteo; De Marchi, Giulia; Marchegiani, Giovanni; Rusev, Borislav; Scarpa, Aldo; Girelli, Roberto; Giardino, Alessandro; Frigerio, Isabella; D'Onofrio, Mirko; Secchettin, Erica; Bassi, Claudio; Salvia, Roberto

2018-03-01

SMAD4 mutational status correlates with pancreatic ductal adenocarcinoma (PDAC) failure pattern. We investigated in a subset of locally advanced patients submitted to radiofrequency ablation (RFA) whether the assessment of SMAD4 status is a useful way to select the patients. Clinical, radiological, and follow-up details of patients submitted to RFA for locally advanced pancreatic cancer (LAPC), in whom cytohistological material was available at our institution, were retrospectively retrieved. SMAD4 expression was evaluated by immunohistochemistry (IHC) and considered "negative" or "positive." The survival analysis was conducted using Kaplan-Meier and Cox proportional hazards models. The study population consisted of 30 patients. Thirteen patients (43.3%) received RFA upfront, whereas 17 (56.7%) after induction treatments. SMAD4 was mutant in 18 out of 30 patients (60%). The overall estimated post-RFA disease-specific survival (DSS) was 15 months (95% CI 11.64-18.35). The estimated post-RFA DSS of patients with wild-type and mutant SMAD4 was 22 and 12 months, respectively (log-rank p < 0.05). At the multivariate analysis, SMAD4 was the only independent predictor of survival (p = 0.05). The pattern of failure was not associated with SMAD4 status (p = 0.4). Within patients undergoing RFA for LAPC, SMAD4 analysis could segregate a subgroup of subjects with improved survival, who likely benefited from tumor ablation.

A prospective development study of software-guided radio-frequency ablation of primary and secondary liver tumors: Clinical intervention modelling, planning and proof for ablation cancer treatment (ClinicIMPPACT).

PubMed

Reinhardt, Martin; Brandmaier, Philipp; Seider, Daniel; Kolesnik, Marina; Jenniskens, Sjoerd; Sequeiros, Roberto Blanco; Eibisberger, Martin; Voglreiter, Philip; Flanagan, Ronan; Mariappan, Panchatcharam; Busse, Harald; Moche, Michael

2017-12-01

Radio-frequency ablation (RFA) is a promising minimal-invasive treatment option for early liver cancer, however monitoring or predicting the size of the resulting tissue necrosis during the RFA-procedure is a challenging task, potentially resulting in a significant rate of under- or over treatments. Currently there is no reliable lesion size prediction method commercially available. ClinicIMPPACT is designed as multicenter-, prospective-, non-randomized clinical trial to evaluate the accuracy and efficiency of innovative planning and simulation software. 60 patients with early liver cancer will be included at four European clinical institutions and treated with the same RFA system. The preinterventional imaging datasets will be used for computational planning of the RFA treatment. All ablations will be simulated simultaneously to the actual RFA procedure, using the software environment developed in this project. The primary outcome measure is the comparison of the simulated ablation zones with the true lesions shown in follow-up imaging after one month, to assess accuracy of the lesion prediction. This unique multicenter clinical trial aims at the clinical integration of a dedicated software solution to accurately predict lesion size and shape after radiofrequency ablation of liver tumors. Accelerated and optimized workflow integration, and real-time intraoperative image processing, as well as inclusion of patient specific information, e.g. organ perfusion and registration of the real RFA needle position might make the introduced software a powerful tool for interventional radiologists to optimize patient outcomes.

Validation of Fall Risk Assessment Specific to the Inpatient Rehabilitation Facility Setting.

PubMed

Thomas, Dan; Pavic, Andrea; Bisaccia, Erin; Grotts, Jonathan

2016-09-01

To evaluate and compare the Morse Fall Scale (MFS) and the Casa Colina Fall Risk Assessment Scale (CCFRA) for identification of patients at risk for falling in an acute inpatient rehabilitation facility. The primary objective of this study was to perform a retrospective validation study of the CCFRAS, specifically for use in the inpatient rehabilitation facility (IRF) setting. Retrospective validation study. The study was approved under expedited review by the local Institutional Review Board. Data were collected on all patients admitted to Cottage Rehabiliation Hospital (CRH), a 38-bed acute inpatient rehabilitation hospital, from March 2012 to August 2013. Patients were excluded from the study if they had a length of stay less than 3 days or age less than 18. The area under the receiver operating characteristic curve (AUC) and the diagnostic odds ratio were used to examine the differences between the MFS and CCFRAS. AUC between fall scales was compared using the DeLong Test. There were 931 patients included in the study with 62 (6.7%) patient falls. The average age of the population was 68.8 with 503 males (51.2%). The AUC was 0.595 and 0.713 for the MFS and CCFRAS, respectively (0.006). The diagnostic odds ratio of the MFS was 2.0 and 3.6 for the CCFRAS using the recommended cutoffs of 45 for the MFS and 80 for the CCFRAS. The CCFRAS appears to be a better tool in detecting fallers vs. nonfallers specific to the IRF setting. The assessment and identification of patients at high risk for falling is important to implement specific precautions and care for these patients to reduce their risk of falling. The CCFRAS is more clinically relevant in identifying patients at high risk for falling in the IRF setting compared to other fall risk assessments. Implementation of this scale may lead to a reduction in fall rate and injuries from falls as it more appropriately identifies patients at high risk for falling. © 2015 Association of Rehabilitation Nurses.

Assessment of Malaria Reporting and Epidemic Preparedness Systems in Health Facilities in Eldoret West District, Uasin Gishu County, Kenya

PubMed Central

Kirinyet, Ruth C.; Juma, Ahmad

2016-01-01

The most important factor in reducing the impact of an epidemic is a timely response with implementation of effective control measures at the point of detection. This study sought to assess the malaria reporting and epidemic preparedness systems of health facilities in Eldoret West District, Kenya. A cross-sectional study design was adapted. A census technique was used to select all the forty five health facilities in the district comprising of government, mission and non-governmental facilities. An interviewer administered questionnaire was used for data collection and analysis done using Stata. Categorical variables were summarized as frequencies and corresponding percentages. The overall reporting rate was 91.7% for all the health facilities. Only 15 health facilities (33%) plotted malaria trend lines for number of cases of malaria. Malaria epidemics were reported within 24 hours in 22 health facilities but they lacked the appropriate supplies to respond to confirmed cases or epidemics. The overall malaria reporting completeness rate was above 90% implying that the malaria surveillance system was generally good. Concerted efforts by concerned stakeholders should ensure improvement of malaria epidemic preparedness system in all health facilities and provision of information to health personnel on malaria outbreak response strategies. PMID:28299154

Economic Assessment of FMDv Releases from the National Bio and Agro Defense Facility

PubMed Central

Pendell, Dustin L.; Marsh, Thomas L.; Coble, Keith H.; Lusk, Jayson L.; Szmania, Sara C.

2015-01-01

This study evaluates the economic consequences of hypothetical foot-and-mouth disease releases from the future National Bio and Agro Defense Facility in Manhattan, Kansas. Using an economic framework that estimates the impacts to agricultural firms and consumers, quantifies costs to non-agricultural activities in the epidemiologically impacted region, and assesses costs of response to the government, we find the distribution of economic impacts to be very significant. Furthermore, agricultural firms and consumers bear most of the impacts followed by the government and the regional non-agricultural firms. PMID:26114546

Shared use of school facilities with community organizations and afterschool physical activity program participation: a cost-benefit assessment.

PubMed

Kanters, Michael A; Bocarro, Jason N; Filardo, Mary; Edwards, Michael B; McKenzie, Thomas L; Floyd, Myron F

2014-05-01

Partnerships between school districts and community-based organizations to share school facilities during afterschool hours can be an effective strategy for increasing physical activity. However, the perceived cost of shared use has been noted as an important reason for restricting community access to schools. This study examined shared use of middle school facilities, the amount and type of afterschool physical activity programs provided at middle schools together with the costs of operating the facilities. Afterschool programs were assessed for frequency, duration, and type of structured physical activity programs provided and the number of boys and girls in each program. School operating costs were used to calculate a cost per student and cost per building square foot measure. Data were collected at all 30 middle schools in a large school district over 12 months in 2010-2011. Policies that permitted more use of school facilities for community-sponsored programs increased participation in afterschool programs without a significant increase in operating expenses. These results suggest partnerships between schools and other community agencies to share facilities and create new opportunities for afterschool physical activity programs are a promising health promotion strategy. © 2014, American School Health Association.

Malaria diagnostic capacity in health facilities in Ethiopia

PubMed Central

2014-01-01

Background Accurate early diagnosis and prompt treatment is one of the key strategies to control and prevent malaria in Ethiopia where both Plasmodium falciparum and Plasmodium vivax are sympatric and require different treatment regimens. Microscopy is the standard for malaria diagnosis at the health centres and hospitals whereas rapid diagnostic tests are used at community-level health posts. The current study was designed to assess malaria microscopy capacity of health facilities in Oromia Regional State and Dire Dawa Administrative City, Ethiopia. Methods A descriptive cross-sectional study was conducted from February to April 2011 in 122 health facilities, where health professionals were interviewed using a pre-tested, standardized assessment tool and facilities’ laboratory practices were assessed by direct observation. Results Of the 122 assessed facilities, 104 (85%) were health centres and 18 (15%) were hospitals. Out of 94 health facilities reportedly performing blood films, only 34 (36%) used both thin and thick smears for malaria diagnosis. The quality of stained slides was graded in 66 health facilities as excellent, good and poor quality in 11(17%), 31 (47%) and 24 (36%) respectively. Quality assurance guidelines and malaria microscopy standard operating procedures were found in only 13 (11%) facilities and 12 (10%) had involved in external quality assessment activities, and 32 (26%) had supportive supervision within six months of the survey. Only seven (6%) facilities reported at least one staff’s participation in malaria microscopy refresher training during the previous 12 months. Although most facilities, 96 (79%), had binocular microscopes, only eight (7%) had the necessary reagents and supplies to perform malaria microscopy. Treatment guidelines for malaria were available in only 38 (31%) of the surveyed facilities. Febrile patients with negative malaria laboratory test results were managed with artemether-lumefantrine or chloroquine in 51% (53

Head Start Facilities Manual.

ERIC Educational Resources Information Center

Research Assessment Management, Inc., Silver Spring, MD.

A quality Head Start facility should provide a physical environment responsive both to the needs of the children and families served and to the needs of staff, volunteers, and community agencies that share space with Head Start. This manual is a tool for Head Start grantees and delegate agencies for assessing existing facilities, making…

Facility Energy Decision System (FEDS) Assessment Report for US Army Garrison, Japan - Honshu Installations

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

Kora, Angela R.; Brown, Daryl R.; Dixon, Douglas R.

2010-03-09

This report documents an assessment was performed by a team of engineers from Pacific Northwest National Laboratory (PNNL) under contract to the Installation Management Command (IMCOM) Pacific Region Office (PARO). The effort used the Facility Energy Decision System (FEDS) model to determine how energy is consumed at five U.S. Army Garrison-Japan (USAG-J) installations in the Honshu area, identify the most cost-effective energy retrofit measures, and calculate the potential energy and cost savings.

Performance-assessment progress for the Rozan low-level waste disposal facility

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

Smietanski, L.; Mitrega, J.; Frankowski, Z.

1995-12-31

The paper presents a condensed progress report on the performance assessment of Poland`s low-level waste disposal facility which is operating since 1961. The Rozan repository is of near-surface type with facilities which are the concrete fortifications built about 1910. Site characterization activities supplied information on regional geology, geohydrology, climatic and hydrologic conditions and terrain surface evolution due to geodynamic processes. Field surveys enabled to decode lithological, hydrogeological and geochemical site specific conditions. From the laboratory tests the data on groundwater chemistry and soil geochemical and hydraulic characteristics were obtained. The site geohydrologic main vulnerable element is the upmost directly endangeredmore » unconfined aquifer which is perched in relation to the region-wide hydraulic system. Heterogeneity of this system reflects in a wide range of hydraulic conductivity and thickness variations. It strongly affects velocity and flow directions. The chemistry of groundwater is unstable due to large sensitivity to external impacts. Modeling of the migration of the critical long-lived radionuclides Tc-99, U-238 and Pu-239 showed that the nearly 20 m thick unsaturated zone plays crucial role as an effective protective barrier. These radionuclides constitute minor part of the total inventory. Modeling of the development of the H-3 plume pointed out the role the macrodispersion plays in the unsaturated zone beneath the repository.« less

A preliminary assessment of avian mortality at utility-scale solar energy facilities in the United States

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

Walston, Leroy J.; Rollins, Katherine E.; LaGory, Kirk E.

Despite the benefits of reduced toxic and carbon emissions and a perpetual energy resource, there is potential for negative environmental impacts resulting from utility-scale solar energy (USSE) development. Although USSE development may represent an avian mortality source, there is little knowledge regarding the magnitude of these impacts in the context of other avian mortality sources. In this study we present a first assessment of avian mortality at USSE facilities through a synthesis of available avian monitoring and mortality information at existing USSE facilities. Using this information, we contextualize USSE avian mortality relative to other forms of avian mortality at 2more » spatial scales: a regional scale (confined to southern California) and a national scale. Systematic avian mortality information was available for three USSE facilities in the southern California region. We estimated annual USSE-related avian mortality to be between 16,200 and 59,400 birds in the southern California region, which was extrapolated to between 37,800 and 138,600 birds for all USSE facilities across the United States that are either installed or under construction. We also discuss issues related to avian–solar interactions that should be addressed in future research and monitoring programs.« less

Heat sink phenomenon of bipolar and monopolar radiofrequency ablation observed using polypropylene tubes for vessel simulation.

PubMed

Al-Alem, Ihssan; Pillai, Krishna; Akhter, Javed; Chua, Terence C; Morris, David L

2014-06-01

Radiofrequency ablation (RFA) is widely used for treating liver tumors; recurrence is common owing to proximity to blood vessels possibly due to the heat sink effect. We seek to investigate this phenomenon using unipolar and bipolar RFA on an egg white tumor tissue model and an animal liver model. Temperature profiles during ablation (with and without vessel simulation) were studied, using both bipolar and unipolar RFA probes by 4 strategically placed temperature leads to monitor temperature profile during ablation. The volume of ablated tissue was also measured. The volume ablated during vessel simulation confirmed the impact of the heat sink phenomenon. The heat sink effect of unipolar RFA was greater compared with bipolar RFA (ratio of volume affected 2:1) in both tissue and liver models. The volume ablated using unipolar RFA was less than the bipolar RFA (ratio of volume ablated = 1:4). Unipolar RFA achieved higher ablation temperatures (122°C vs 98°C). Unipolar RFA resulted in tissue damage beyond the vessel, which was not observed using bipolar RFA. Bipolar RFA ablates a larger tumor volume compared with unipolar RFA, with a single ablation. The impact of heat sink phenomenon in tumor ablation is less so with bipolar than unipolar RFA with sparing of adjacent vessel damage. © The Author(s) 2013.

Assessment of primary health care facilities' service readiness in Nigeria.

PubMed

Oyekale, Abayomi Samuel

2017-03-01

Effective delivery of healthcare services requires availability of adequate infrastructure, diagnostic medical equipment, drugs and well-trained medical personnel. In Nigeria, poor funding and mismanagement often characterize healthcare service delivery thereby affecting coverage and quality of healthcare services. Therefore, the state of service delivery in Nigeria's health sector has come under some persistent criticisms. This paper analyzed service readiness of Primary Health Care (PHC) facilities in Nigeria with focus on availability of some essential drugs and medical equipment. Service Delivery Indicator (SDI) data for PHC in Nigeria were used. The data were collected from 2480 healthcare facilities from 12 states in the Nigeria's 6 geopolitical zones between 2013 and 2014. Data were analyzed with descriptive statistics, Principal Component Analysis (PCA) and Ordinary Least Square regression. Medical disposables such as hand gloves and male condoms were reported to be available in 77.18 and 44.03% of all the healthcare facilities respectively, while immunization services were provided by 86.57%. Functional stethoscopes were reported by 77.22% of the healthcare facilities, while only 68.10% had sphygmomanometers. In the combined healthcare facilities, availability of some basic drugs such as Azithromycin, Nifedipine, Dexamethasone and Misoprostol was low with 10.48, 25.20, 21.94 and 17.06%, respectively, while paracetamol and folic acid both had high availability with 74.31%. Regression results showed that indices of drug and medical equipment availability increased significantly (p < 0.05) among states in southern Nigeria and with presence of some power sources (electricity, generators, batteries and solar), but decreased among dispensaries/health posts. Travel time to headquarters and rural facilities significantly reduced indices of equipment availability (p < 0.05). It was concluded that for Nigeria to ensure better equity in access to healthcare

Correlation Between Resonance Frequency Analysis and Bone Quality Assessments at Dental Implant Recipient Sites.

PubMed

Fu, Min-Wen; Fu, Earl; Lin, Fu-Gong; Chang, Wei-Jeng; Hsieh, Yao-Dung; Shen, E-Chin

To evaluate whether primary implant stability could be used to predict bone quality, the association between the implant stability quotient (ISQ) value and the bone type at the implant site was evaluated. Ninety-five implant sites in 50 patients were included. Bone type (categorized by Lekholm and Zarb) at the implant site was initially assessed using presurgical dental radiography. During the preparation of the implant site, a bone core specimen was carefully obtained. The bone type was assessed by tactile sensation during the drilling operation, according to the Misch criteria. The primary stability of the inserted implant was evaluated by resonance frequency analysis (RFA). The ISQ value was recorded. The bone core specimen was then examined by stereomicroscopy or microcomputed tomography (micro-CT), and the bone type was determined by the surface characteristics of the specimen, based on Lekholm and Zarb classification. Agreement between the bone quality assessed by the four methods (ie, presurgical radiography, tactile sensation, stereomicroscopy, and micro-CT) was tested by Cohen's kappa statistics, whereas the association between the ISQ value and the bone type was evaluated by the generalized linear regression model. The mean ISQ score was 72.6, and the score was significantly influenced by the maxillary or mandibular arch (P = .001). The bone type at the implant sites varied according to the assessment method. However, a significant influence of the arch was repeatedly noted when using radiography or tactile sensation. Among the four bone-quality assessment methods, a weak agreement existed only between stereomicroscopy and micro-CT, especially in the maxilla (κ = 0.469). A negative association between the ISQ value and the bone type assessed by stereomicroscopy or by micro-CT was significant in the maxilla, but not in the mandible, after adjustments for sex, age, and right/left side (P = .013 and P = .027 for stereomicroscopy and micro-CT, respectively

Impacts assessment for the National Ignition Facility

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

Bay Area Economics

1996-12-01

This report documents the economic and other impacts that will be created by the National Ignition Facility (NIF) construction and ongoing operation, as well as the impacts that may be created by new technologies that may be developed as a result of NIF development and operation.

Surgical vs percutaneous radiofrequency ablation for hepatocellular carcinoma in dangerous locations

PubMed Central

Huang, Ji-Wei; Hernandez-Alejandro, Roberto; Croome, Kristopher P; Yan, Lu-Nan; Wu, Hong; Chen, Zhe-Yu; Prasoon, Pankaj; Zeng, Yong

2011-01-01

AIM: To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) in dangerous locations. METHODS: One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this study. The patients were divided into percutaneous RFA group and surgical RFA group. After the patients were regularly followed up for a long time, their curative rate, hospital stay time, postoperative complications and 5-year local tumor progression were compared and analyzed. RESULTS: No significant difference was observed in curative rate between the two groups (91.3% vs 96.8%, P = 0.841). The hospital stay time was longer and more analgesics were required while the incidence of bile duct injury and RFA-related hemorrhage was lower in surgical RFA group than in percutaneous RFA group (P < 0.05). The local progression rate of HCC in dangerous locations was significantly lower in surgical RFA group than in percutaneous RFA group (P = 0.05). The relative risk of local tumor progression was 14.315 in percutaneous RFA group. CONCLUSION: The incidence of severe postoperative complications and local tumor progression is lower after surgical RFA than after percutaneous RFA. PMID:21218093

National facilities study. Volume 5: Space research and development facilities task group

NASA Technical Reports Server (NTRS)

1994-01-01

With the beginnings of the U.S. space program, there was a pressing need to develop facilities that could support the technology research and development, testing, and operations of evolving space systems. Redundancy in facilities that was once and advantage in providing flexibility and schedule accommodation is instead fast becoming a burden on scarce resources. As a result, there is a clear perception in many sectors that the U.S. has many space R&D facilities that are under-utilized and which are no longer cost-effective to maintain. At the same time, it is clear that the U.S. continues to possess many space R&D facilities which are the best -- or among the best -- in the world. In order to remain world class in key areas, careful assessment of current capabilities and planning for new facilities is needed. The National Facility Study (NFS) was initiated in 1992 to develop a comprehensive and integrated long-term plan for future aerospace facilities that meets current and projected government and commercial needs. In order to assess the nation's capability to support space research and development (R&D), a Space R&D Task Group was formed. The Task Group was co-chaired by NASA and DOD. The Task Group formed four major, technologically- and functionally- oriented working groups: Human and Machine Operations; Information and Communications; Propulsion and Power; and Materials, Structures, and Flight Dynamics. In addition to these groups, three supporting working groups were formed: Systems Engineering and Requirements; Strategy and Policy; and Costing Analysis. The Space R&D Task Group examined several hundred facilities against the template of a baseline mission and requirements model (developed in common with the Space Operations Task Group) and a set of excursions from the baseline. The model and excursions are described in Volume 3 of the NFS final report. In addition, as a part of the effort, the group examined key strategic issues associated with space R

Secondary Waste Cementitious Waste Form Data Package for the Integrated Disposal Facility Performance Assessment

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

Cantrell, Kirk J.; Westsik, Joseph H.; Serne, R Jeffrey

A review of the most up-to-date and relevant data currently available was conducted to develop a set of recommended values for use in the Integrated Disposal Facility (IDF) performance assessment (PA) to model contaminant release from a cementitious waste form for aqueous wastes treated at the Hanford Effluent Treatment Facility (ETF). This data package relies primarily upon recent data collected on Cast Stone formulations fabricated with simulants of low-activity waste (LAW) and liquid secondary wastes expected to be produced at Hanford. These data were supplemented, when necessary, with data developed for saltstone (a similar grout waste form used at themore » Savannah River Site). Work is currently underway to collect data on cementitious waste forms that are similar to Cast Stone and saltstone but are tailored to the characteristics of ETF-treated liquid secondary wastes. Recommended values for key parameters to conduct PA modeling of contaminant release from ETF-treated liquid waste are provided.« less

EPA Facility Registry Service (FRS): Facility Interests Dataset - Intranet

EPA Pesticide Factsheets

This web feature service consists of location and facility identification information from EPA's Facility Registry Service (FRS) for all sites that are available in the FRS individual feature layers. The layers comprise the FRS major program databases, including:Assessment Cleanup and Redevelopment Exchange System (ACRES) : brownfields sites ; Air Facility System (AFS) : stationary sources of air pollution ; Air Quality System (AQS) : ambient air pollution data from monitoring stations; Bureau of Indian Affairs (BIA) : schools data on Indian land; Base Realignment and Closure (BRAC) facilities; Clean Air Markets Division Business System (CAMDBS) : market-based air pollution control programs; Comprehensive Environmental Response, Compensation, and Liability Information System (CERCLIS) : hazardous waste sites; Integrated Compliance Information System (ICIS) : integrated enforcement and compliance information; National Compliance Database (NCDB) : Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) and the Toxic Substances Control Act (TSCA); National Pollutant Discharge Elimination System (NPDES) module of ICIS : NPDES surface water permits; Radiation Information Database (RADINFO) : radiation and radioactivity facilities; RACT/BACT/LAER Clearinghouse (RBLC) : best available air pollution technology requirements; Resource Conservation and Recovery Act Information System (RCRAInfo) : tracks generators, transporters, treaters, storers, and disposers of haz

Mapping the Characteristics of Critical Care Facilities: Assessment, Distribution, and Level of Critical Care Facilities from Central India.

PubMed

Saigal, Saurabh; Sharma, Jai Prakash; Pakhare, Abhijit; Bhaskar, Santosh; Dhanuka, Sanjay; Kumar, Sanjay; Sabde, Yogesh; Bhattacharya, Pradip; Joshi, Rajnish

2017-10-01

In low- and middle-income countries such as India, where health systems are weak, the number of available Critical Care Unit (Intensive Care Unit [ICU]) beds is expected to be low. There is no study from the Indian subcontinent that has reported the characteristics and distribution of existing ICUs. We performed this study to understand the characteristics and distribution of ICUs in Madhya Pradesh (MP) state of Central India. We also aimed to develop a consensus scoring system and internally validate it to define levels of care and to improve health system planning and to strengthen referral networks in the state. We obtained a list of potential ICU facilities from various sources and then performed a cross-sectional survey by visiting each facility and determining characteristics for each facility. We collected variables with respect to infrastructure, human resources, equipment, support services, procedures performed, training courses conducted, and in-place policies or standard operating procedure documents. We identified a total of 123 ICUs in MP. Of 123 ICUs, 35 were level 1 facilities, 74 were level 2 facilities, and only 14 were level 3 facilities. Overall, there were 0.17 facilities per 100,000 population (95* confidence interval [CI] 0.14-0.20 per 100,000 populations). There were a total of 1816 ICU beds in the state, with an average of 2.5 beds per 100,000 population (95* CI 2.4-2.6 per 100,000 population). Of the total number of ICU beds, 250 are in level 1, 1141 are in level 2, and 425 are in level 3 facilities. This amounts to 0.34, 1.57, and 0.59 ICU beds per 100,000 population for levels 1, 2, and 3, respectively. This study could just be an eye opener for our healthcare authorities at both state and national levels to estimate the proportion of ICU beds per lac population. Similar mapping of intensive care services from other States will generate national data that is hitherto unknown.

EPA Facility Registry Service (FRS): Facility Interests Dataset - Intranet Download

EPA Pesticide Factsheets

This downloadable data package consists of location and facility identification information from EPA's Facility Registry Service (FRS) for all sites that are available in the FRS individual feature layers. The layers comprise the FRS major program databases, including:Assessment Cleanup and Redevelopment Exchange System (ACRES) : brownfields sites ; Air Facility System (AFS) : stationary sources of air pollution ; Air Quality System (AQS) : ambient air pollution data from monitoring stations; Bureau of Indian Affairs (BIA) : schools data on Indian land; Base Realignment and Closure (BRAC) facilities; Clean Air Markets Division Business System (CAMDBS) : market-based air pollution control programs; Comprehensive Environmental Response, Compensation, and Liability Information System (CERCLIS) : hazardous waste sites; Integrated Compliance Information System (ICIS) : integrated enforcement and compliance information; National Compliance Database (NCDB) : Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA) and the Toxic Substances Control Act (TSCA); National Pollutant Discharge Elimination System (NPDES) module of ICIS : NPDES surface water permits; Radiation Information Database (RADINFO) : radiation and radioactivity facilities; RACT/BACT/LAER Clearinghouse (RBLC) : best available air pollution technology requirements; Resource Conservation and Recovery Act Information System (RCRAInfo) : tracks generators, transporters, treaters, storers, and disposers

Risk assessment and optimization (ALARA) analysis for the environmental remediation of Brookhaven National Laboratory`s hazardous waste management facility

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

Dionne, B.J.; Morris, S.C. III; Baum, J.W.

1998-01-01

The Department of Energy`s (DOE) Office of Environment, Safety, and Health (EH) sought examples of risk-based approaches to environmental restoration to include in their guidance for DOE nuclear facilities. Extensive measurements of radiological contamination in soil and ground water have been made at Brookhaven National Laboratory`s Hazardous Waste Management Facility (HWMF) as part of a Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) remediation process. This provided an ideal opportunity for a case study. This report provides a risk assessment and an {open_quotes}As Low as Reasonably Achievable{close_quotes} (ALARA) analysis for use at other DOE nuclear facilities as an example ofmore » a risk-based decision technique. This document contains the Appendices for the report.« less

Cross-sectional observational assessment of quality of newborn care immediately after birth in health facilities across six sub-Saharan African countries.

PubMed

de Graft-Johnson, Joseph; Vesel, Linda; Rosen, Heather E; Rawlins, Barbara; Abwao, Stella; Mazia, Goldy; Bozsa, Robert; Mwebesa, Winifrede; Khadka, Neena; Kamunya, Rosemary; Getachew, Ashebir; Tibaijuka, Gaudiosa; Rakotovao, Jean Pierre; Tekleberhan, Alemnesh

2017-03-27

To present information on the quality of newborn care services and health facility readiness to provide newborn care in 6 African countries, and to advocate for the improvement of providers' essential newborn care knowledge and skills. Cross-sectional observational health facility assessment. Ethiopia, Kenya, Madagascar, Mozambique, Rwanda and Tanzania. Health workers in 643 facilities. 1016 health workers were interviewed, and 2377 babies were observed in the facilities surveyed. Indicators of quality of newborn care included (1) provision of immediate essential newborn care: thermal care, hygienic cord care, and early and exclusive initiation of breast feeding; (2) actual and simulated resuscitation of asphyxiated newborn infants; and (3) knowledge of health workers on essential newborn care, including resuscitation. Sterile or clean cord cutting instruments, suction devices, and tables or firm surfaces for resuscitation were commonly available. 80% of newborns were immediately dried after birth and received clean cord care in most of the studied facilities. In all countries assessed, major deficiencies exist for essential newborn care supplies and equipment, as well as for health worker knowledge and performance of key routine newborn care practices, particularly for immediate skin-to-skin contact and breastfeeding initiation. Of newborns who did not cry at birth, 89% either recovered on their own or through active steps taken by the provider through resuscitation with initial stimulation and/or ventilation. 11% of newborns died. Assessment of simulated resuscitation using a NeoNatalie anatomic model showed that less than a third of providers were able to demonstrate ventilation skills correctly. The findings shared in this paper call attention to the critical need to improve health facility readiness to provide quality newborn care services and to ensure that service providers have the necessary equipment, supplies, knowledge and skills that are critical to

Implementation of sustainable evidence-based practice for the assessment and management of pain in residential aged care facilities.

PubMed

Savvas, Steven; Toye, Christine; Beattie, Elizabeth; Gibson, Stephen J

2014-12-01

Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Probabilistic dose assessment of normal operations and accident conditions for an assured isolation facility in Texas

NASA Astrophysics Data System (ADS)

Arno, Matthew Gordon

Texas is investigating building a long-term waste storage facility, also known as an Assured Isolation Facility. This is an above-ground low-level radioactive waste storage facility that is actively maintained and from which waste may be retrieved. A preliminary, scoping-level analysis has been extended to consider more complex scenarios of radiation streaming and skyshine by using the computer code Monte Carlo N-Particle (MCNP) to model the facility in greater detail. Accidental release scenarios have been studied in more depth to better assess the potential dose to off-site individuals. Using bounding source term assumptions, the projected radiation doses and dose rates are estimated to exceed applicable limits by an order of magnitude. By altering the facility design to fill in the hollow cores of the prefabricated concrete slabs used in the roof over the "high-gamma rooms," where the waste with the highest concentration of gamma emitting radioactive material is stored, dose rates outside the facility decrease by an order of magnitude. With the modified design, the annual dose at the site fenceline is estimated at 86 mrem, below the 100 mrem annual limit for exposure of the public. Within the site perimeter, the dose rates are lowered sufficiently such that it is not necessary to categorize many workers and contractor personnel as radiation workers, saving on costs as well as being advisable under ALARA principles. A detailed analysis of bounding accidents incorporating information on the local meteorological conditions indicate that the maximum committed effective dose equivalent from the passage of a plume of material released in an accident at any of the cities near the facility is 59 :rem in the city of Eunice, NM based on the combined day and night meteorological conditions. Using the daytime meteorological conditions, the maximum dose at any city is 7 :rem, also in the city of Eunice. The maximum dose at the site boundary was determined to be 230 mrem

Risk factors for fetal death after radiofrequency ablation for complicated monochorionic twin pregnancies.

PubMed

Sun, Luming; Zou, Gang; Yang, Yingjun; Zhou, Fenhe; Tao, Duan

2018-04-19

Radiofrequency ablation (RFA) is a management alternative for complicated monochorionic twin pregnancies. The purpose of this study is to evaluate risk factors for fetal death after RFA. An observational study was performed to document the perinatal outcomes of all cases undergoing fetal reduction using RFA from 2010 to 2016 at the Shanghai First Maternity and Infant Hospital. A multiple regression model was built to identify predictors of the death of the remaining fetus after RFA. A total of 183 patients treated with RFA for fetal reduction were analyzed, including 53 selective intrauterine growth restriction, 35 twin-twin transfusion syndrome, 36 dichorionic triamniotic triplets, 24 monochorionic twins discordant for fetal anomaly, and 35 twin reversed arterial perfusion. The prevalence of fetal death after RFA was 23% (43:183). The occurrence of fetal death after RFA was independently associated with more than 2 cycles of RFA coagulation (OR 3.46; 95% CI, 1.34-8.94; P = .01). More than 2 cycles of RFA coagulation is the only independent risk factors of fetal death after RFA. © 2018 John Wiley & Sons, Ltd.

Resonance frequency analysis, insertion torque, and bone to implant contact of 4 implant surfaces: comparison and correlation study in sheep.

PubMed

Dagher, Maroun; Mokbel, Nadim; Jabbour, Gabriel; Naaman, Nada

2014-12-01

Primary stability is evaluated using resonance frequency analysis (RFA) and insertion torque (IT). Although there is a strong correlation between RFA and IT, studies failed to find a correlation between RFA and bone to implant contact (BIC) or IT and BIC. To compare RFA, IT, and BIC of SLA, SLActive, Euroteknika, and TiUnite implant surfaces and evaluate the correlation between them. Thirty-two implants were placed in 8 sheep. RFA and IT were recorded. Animals were killed at 1 and 2 months. A significant difference was found in RFA between the 4 surfaces. No significant difference was found for IT. Mean BIC was different between all 4 surfaces. A significant positive correlation was found between RFA and IT with SLA. No significant correlation was found between RFA and BIC and between IT and BIC at 1 and 2 months. Implants with 4 different surfaces have similar IT values but different RFA and BIC. Additionally irrespective of the implant surface, there is no correlation between IT and BIC and between RFA and BIC.

Nuclear criticality safety assessment of the low level radioactive waste disposal facility trenches

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

Kahook, S.D.

1994-04-01

Results of the analyses performed to evaluate the possibility of nuclear criticality in the Low Level Radioactive Waste Disposal Facility (LLRWDF) trenches are documented in this report. The studies presented in this document are limited to assessment of the possibility of criticality due to existing conditions in the LLRWDF. This document does not propose nor set limits for enriched uranium (EU) burial in the LLRWDF and is not a nuclear criticality safety evaluation nor analysis. The calculations presented in the report are Level 2 calculations as defined by the E7 Procedure 2.31, Engineering Calculations.

Water, sanitation and hygiene in Jordan's healthcare facilities.

PubMed

Khader, Yousef Saleh

2017-08-14

Purpose The purpose of this paper is to determine water availability, sanitation and hygiene (WSH) services, and healthcare waste management in Jordan healthcare facilities. Design/methodology/approach In total, 19 hospitals (15 public and four private) were selected. The WSH services were assessed in hospitals using the WSH in health facilities assessment tool developed for this purpose. Findings All hospitals (100 percent) had a safe water source and most (84.2 percent) had functional water sources to provide enough water for users' needs. All hospitals had appropriate and sufficient gender separated toilets in the wards and 84.2 percent had the same in outpatient settings. Overall, 84.2 percent had sufficient and functioning handwashing basins with soap and water, and 79.0 percent had sufficient showers. Healthcare waste management was appropriately practiced in all hospitals. Practical implications Jordan hospital managers achieved major achievements providing access to drinking water and improved sanitation. However, there are still areas that need improvements, such as providing toilets for patients with special needs, establishing handwashing basins with water and soap near toilets, toilet maintenance and providing sufficient trolleys for collecting hazardous waste. Efforts are needed to integrate WSH service policies with existing national policies on environmental health in health facilities, establish national standards and targets for the various healthcare facilities to increase access and improve services. Originality/value There are limited WSH data on healthcare facilities and targets for basic coverage in healthcare facilities are also lacking. A new assessment tool was developed to generate core WSH indicators and to assess WSH services in Jordan's healthcare facilities. This tool can be used by a non-WSH specialist to quickly assess healthcare facility-related WSH services and sanitary hazards in other countries. This tool identified some areas

Transarterial chemoembolization for early stage hepatocellular carcinoma decrease local tumor control and overall survival compared to radiofrequency ablation

PubMed Central

Hocquelet, Arnaud; Seror, Olivier; Blanc, Jean-Frédéric; Frulio, Nora; Salut, Cécile; Nault, Jean-Charles; Hervé Trillaud

2017-01-01

Background & Aims To compare treatment failure and survival associated with ultrasound-guided radiofrequency ablation (RFA) and trans-arterial chemoembolization (TACE) for early-stage HCC in Child-Pugh A cirrhosis patients. Methods 122 cirrhotic patients (RFA: 61; TACE: 61) were well matched according to cirrhosis severity; tumor size and serum alpha-fetoprotein. TACE was performed in case of inconspicuous nodule on US or nodule with “at risk location”. Treatment failure was defined as local tumor progression (LTP) and primary treatment failure (failing to obtain complete response after two treatment session). Treatment failure and overall survival (OS) were compared after coarsened exact matching. Cox proportional model to assess independent predictive factors was performed. Results No significant difference was seen for baseline characteristics between the two groups. Mean tumor size was 3cm in both group with 41% HCC>3cm. Treatment failure rates after TACE was 42.6% (14 primary treatment failures and 12 LTP) and 9.8% after RFA (no primary treatment failure and 6 LTP) P < 0.001. TACE was the only predictive factor of treatment failure (Hazard ratio: 5.573). The 4-years OS after RFA and TACE were 54.1% and 31.5% (P = 0.042), respectively. Conclusion For Child-Pugh A patients with early-stage HCC, alternative treatment as supra-selective TACE to RFA regarded as too challenging using common US guidance decrease significantly the local tumor control and overall survival. Efforts to improve feasibility of RFA especially for inconspicuous target have to be made. PMID:27793027

Waste Form Release Data Package for the 2005 Integrated Disposal Facility Performance Assessment. Erratum

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

Smith, Gary L.

2016-09-06

This report refers to or contains K g values for glasses LAWA44, LAWB45 and LAWC22 affected by calculations errors as identified by Papathanassiu et al. (2011). The corrected K g values are reported in an erratum included in the revised version of the original report. The revised report can be referenced as follows: Pierce E. M. et al. (2004) Waste Form Release Data Package for the 2005 Integrated Disposal Facility Performance Assessment. PNNL-14805 Rev. 0 Erratum. Pacific Northwest National Laboratory, Richland, WA, USA.

Facility effluent monitoring plan for the plutonium uranium extraction facility

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

Wiegand, D.L.

A facility effluent monitoring plan is required by the US Department of Energy in DOE Order 5400.1 for any operations that involve hazardous materials and radioactive substances that could impact employee or public safety or the environment. This document is prepared using the specific guidelines identified in A Guide for Preparing Hanford Site Facility Effluent Monitoring Plans, WHC-EP-0438-01. This facility effluent monitoring plan assesses effluent monitoring systems and evaluates whether they are adequate to ensure the public health and safety as specified in applicable federal, state, and local requirements. This facility effluent monitoring plan shall ensure long-range integrity of themore » effluent monitoring systems by requiring an update whenever a new process or operation introduces new hazardous materials or significant radioactive materials. This document must be reviewed annually even if there are no operational changes, and it must be updated at a minimum of every three years.« less

[Assessment of cyto- and genotoxicity of natural waters in the vicinity of radioactive waste storage facility using Allium-test].

PubMed

Udalova, A A; Geras'kin, S A; Dikarev, V G; Dikareva, N S

2014-01-01

Efficacy of bioassays of "aberrant cells frequency" and "proliferative activity" in root meristem of Allium cepa L. is studied in the present work for a cyto- and genotoxicity assessment of natural waters contaminated with 90Sr and heavy metals in the vicinity of the radioactive waste storage facility in Obninsk, Kaluga region. The Allium-test is shown to be applicable for the diagnostics of environmental media at their combined pollution with chemical and radioactive substances. The analysis of aberration spectrum shows an important role of chemical toxicants in the mutagenic potential of waters collected in the vicinity of the radioactive waste storage facility. Biological effects are not always possible to explain from the knowledge on water contamination levels, which shows limitations of physical-chemical monitoring in providing the adequate risk assessment for human and biota from multicomponent environmental impacts.

High Performance Computing Facility Operational Assessment, FY 2011 Oak Ridge Leadership Computing Facility

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

Baker, Ann E; Bland, Arthur S Buddy; Hack, James J

Oak Ridge National Laboratory's Leadership Computing Facility (OLCF) continues to deliver the most powerful resources in the U.S. for open science. At 2.33 petaflops peak performance, the Cray XT Jaguar delivered more than 1.5 billion core hours in calendar year (CY) 2010 to researchers around the world for computational simulations relevant to national and energy security; advancing the frontiers of knowledge in physical sciences and areas of biological, medical, environmental, and computer sciences; and providing world-class research facilities for the nation's science enterprise. Scientific achievements by OLCF users range from collaboration with university experimentalists to produce a working supercapacitor thatmore » uses atom-thick sheets of carbon materials to finely determining the resolution requirements for simulations of coal gasifiers and their components, thus laying the foundation for development of commercial-scale gasifiers. OLCF users are pushing the boundaries with software applications sustaining more than one petaflop of performance in the quest to illuminate the fundamental nature of electronic devices. Other teams of researchers are working to resolve predictive capabilities of climate models, to refine and validate genome sequencing, and to explore the most fundamental materials in nature - quarks and gluons - and their unique properties. Details of these scientific endeavors - not possible without access to leadership-class computing resources - are detailed in Section 4 of this report and in the INCITE in Review. Effective operations of the OLCF play a key role in the scientific missions and accomplishments of its users. This Operational Assessment Report (OAR) will delineate the policies, procedures, and innovations implemented by the OLCF to continue delivering a petaflop-scale resource for cutting-edge research. The 2010 operational assessment of the OLCF yielded recommendations that have been addressed (Reference Section 1) and where

Illustrative assessment of human health issues arising from the potential release of chemotoxic substances from a generic geological disposal facility for radioactive waste.

PubMed

Wilson, James C; Thorne, Michael C; Towler, George; Norris, Simon

2011-12-01

Many countries have a programme for developing an underground geological disposal facility for radioactive waste. A case study is provided herein on the illustrative assessment of human health issues arising from the potential release of chemotoxic and radioactive substances from a generic geological disposal facility (GDF) for radioactive waste. The illustrative assessment uses a source-pathway-receptor methodology and considers a number of human exposure pathways. Estimated exposures are compared with authoritative toxicological assessment criteria. The possibility of additive and synergistic effects resulting from exposures to mixtures of chemical contaminants or a combination of radiotoxic and chemotoxic substances is considered. The case study provides an illustration of how to assess human health issues arising from chemotoxic species released from a GDF for radioactive waste and highlights potential difficulties associated with a lack of data being available with which to assess synergistic effects. It also highlights how such difficulties can be addressed.

[Assessment of social networks between developmental physicians and welfare facilities/specialists for children with intellectual disabilities in Japan].

PubMed

Inagaki, Masumi; Horiguchi, Toshihiro; Kaga, Makiko

2004-05-01

The social networks between Japanese child neurologists and welfare facilities/specialists for children with mental retardation (MR) were assessed. A total of 113 physicians answered our mail-in questionnaire. Most of the doctors had various connections with nursery homes for children with MR or severe motor and intellectual disabilities (SMID) and with public health centers, and often collaborated with teachers of schools and kindergartens. On the other hand, most physicians had little relation with residential and vocational facilities for adults with MR, and with specialists in residential or community care. There was a statistical correlation between the number of facilities or collaborated specialists and the number of persons seen by each physician; however, the physicians' experience and affiliations had no relation. In view of 'social participation', physicians who usually see children with developmental disorders can play an important role in decision making of their life-style with their families.

Accreditation of ambulatory facilities.

PubMed

Urman, Richard D; Philip, Beverly K

2014-06-01

With the continued growth of ambulatory surgical centers (ASC), the regulation of facilities has evolved to include new standards and requirements on both state and federal levels. Accreditation allows for the assessment of clinical practice, improves accountability, and better ensures quality of care. In some states, ASC may choose to voluntarily apply for accreditation from a recognized organization, but in others it is mandated. Accreditation provides external validation of safe practices, benchmarking performance against other accredited facilities, and demonstrates to patients and payers the facility's commitment to continuous quality improvement. Copyright © 2014 Elsevier Inc. All rights reserved.

Pilot Implementation and Preliminary Evaluation of START:AV Assessments in Secure Juvenile Correctional Facilities

PubMed Central

Sellers, Brian G; Viljoen, Jodi L.; Cruise, Keith R.; Nicholls, Tonia L.; Dvoskin, Joel A.

2012-01-01

The Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) is a new structured professional judgment guide for assessing short-term risks in adolescents. The scheme may be distinguished from other youth risk assessment and treatment planning instruments by its inclusion of 23 dynamic factors that are each rated for both vulnerability and strength. In addition, START:AV is also unique in that it focuses on multiple adverse outcomes—namely, violence, self-harm, suicide, unauthorized leave, substance abuse, self-neglect, victimization, and general offending—over the short-term (i.e., weeks to months) rather than long-term (i.e., years). This paper describes a pilot implementation and preliminary evaluation of START:AV in three secure juvenile correctional facilities in the southern United States. Specifically, we examined the descriptive characteristics and psychometric properties of START:AV assessments completed by 21 case managers on 291 adolescent offenders (250 boys and 41 girls) at the time of admission. Results provide preliminary support for the feasibility of completing START:AV assessments as part of routine practice. Findings also highlight differences in the characteristics of START:AV assessments for boys and girls and differential associations between the eight START:AV risk domains. Though results are promising, further research is needed to establish the reliability and validity of START:AV assessments completed in the field. PMID:23316116

Groundwater Impact Assessment of Tailings Storage Facility, Western Turkey

NASA Astrophysics Data System (ADS)

Peksezer-Sayit, A.; Yazicigil, H.

2015-12-01

A tailings storage facility (TSF) is a fundamental part of the mining process and should be carefully designed and managed to prevent any adverse environmental effects. TSF is site-specific and its design criteria are determined by regulations. The new mine waste regulation for the deposition of hazardous waste in a tailings storage facility in Turkey enforces, from bottom to top, 0.5 m thick compacted clay layer with K less than or equal to 1X10-9 m/s , 2 mm thick HDPE geomembrane, and a protective natural material or geotextile. Although these criteria seem to be enough to prevent leakage from the base, in practice, manufacturing and application errors may cause leakage and subsequent contamination of groundwater. The purpose of this study is to assess potential impacts of leakage from the base of TSF on groundwater quality both in operational and post-closure period of a mine site in western Turkey. For this purpose, analytical and 2-D and 3-D numerical models are used together. The potential leakage rate of sulphate-bearing solution from the base of TSF is determined from analytical model. 2-D finite element models (SEEP/W and CTRAN/W) are used to simulate unsaturated flow conditions and advective-dispersive contaminant transport below the TSF under steady-state and transient conditions for the operating period. The long-term impacts of leakage from the base of TSF on groundwater resources are evaluated by 3-D numerical groundwater flow (MODFLOW) and contaminant transport models (MT3DMS). The model results suggest that sulphate-bearing solution leaking from the base of TSF can reach water table in about 290 years. Hence, during the operational period (i.e. 21 years), no interaction is expected between the solution and groundwater. Moreover, long-term simulation results show that about 500 years later, the sulphate concentration in groundwater will be below the maximum allowable limits (i.e. 250 mg/L).

Experimental Fuels Facility Re-categorization Based on Facility Segmentation

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

Reiss, Troy P.; Andrus, Jason

The Experimental Fuels Facility (EFF) (MFC-794) at the Materials and Fuels Complex (MFC) located on the Idaho National Laboratory (INL) Site was originally constructed to provide controlled-access, indoor storage for radiological contaminated equipment. Use of the facility was expanded to provide a controlled environment for repairing contaminated equipment and characterizing, repackaging, and treating waste. The EFF facility is also used for research and development services, including fuel fabrication. EFF was originally categorized as a LTHC-3 radiological facility based on facility operations and facility radiological inventories. Newly planned program activities identified the need to receive quantities of fissionable materials in excessmore » of the single parameter subcritical limit in ANSI/ANS-8.1, “Nuclear Criticality Safety in Operations with Fissionable Materials Outside Reactors” (identified as “criticality list” quantities in DOE-STD-1027-92, “Hazard Categorization and Accident Analysis Techniques for Compliance with DOE Order 5480.23, Nuclear Safety Analysis Reports,” Attachment 1, Table A.1). Since the proposed inventory of fissionable materials inside EFF may be greater than the single parameter sub-critical limit of 700 g of U-235 equivalent, the initial re-categorization is Hazard Category (HC) 2 based upon a potential criticality hazard. This paper details the facility hazard categorization performed for the EFF. The categorization was necessary to determine (a) the need for further safety analysis in accordance with LWP-10802, “INL Facility Categorization,” and (b) compliance with 10 Code of Federal Regulations (CFR) 830, Subpart B, “Safety Basis Requirements.” Based on the segmentation argument presented in this paper, the final hazard categorization for the facility is LTHC-3. Department of Energy Idaho (DOE-ID) approval of the final hazard categorization determined by this hazard assessment document (HAD) was required

Final Environmental Assessment: For Immediate Storm Surge Protection for Santa Rosa Island Facilities, Eglin Air Force Base, FL

DTIC Science & Technology

2006-06-01

ALTERNATIVES .............................................................. 2-1 2.1 Proposed Action ( Preferred Alternative...effects for all alternatives. This section also identifies the preferred alternative and discusses regulatory requirements and/or best management... Preferred Alternative) 06/23/06 Environmental Assessment Page 2-1 for Immediate Storm Surge Protection for Santa Rosa Island Facilities

Coagulation necrosis induced by radiofrequency ablation in the liver: histopathologic and radiologic review of usual to extremely rare changes.

PubMed

Kim, Young-sun; Rhim, Hyunchul; Lim, Hyo Keun; Choi, Dongil; Lee, Min Woo; Park, Min Jung

2011-01-01

As the clinical role of radiofrequency ablation (RFA) of the liver grows, the importance of radiologic imaging after liver RFA to depict the diversity of post-RFA manifestations is also increasing. Because RFA induces coagulation necrosis of the hepatic parenchyma, cross-sectional imaging studies, in principle, demonstrate an area with a defect in contrast enhancement. However, for various reasons, such as the occurrence of a complication, the RFA zone may demonstrate different patterns or be accompanied by other abnormalities. In this investigation, a large number of imaging studies performed after more than 4000 procedures of liver RFA during the past 10-year period were reviewed, and various radiologic manifestations of the RFA zone were compiled. Herein, the basic principles of RFA, as well as the histopathologic features of coagulation necrosis of the liver, are catalogued to provide a more complete understanding of such changes. Through this review, the reader will become more familiar with the usual and unusual radiologic findings of coagulation necrosis induced by RFA in the liver. This increased familiarity will not only facilitate the daily practice of radiology but also deepen understanding of the therapeutic modality of RFA. © RSNA, 2011.

Comparison of switching bipolar ablation with multiple cooled wet electrodes and switching monopolar ablation with separable clustered electrode in treatment of small hepatocellular carcinoma: A randomized controlled trial

PubMed Central

Chang, Won; Lee, Dong Ho; Yoon, Jeong Hee; Kim, Yoon Jun; Yoon, Jung Hwan; Han, Joon Koo

2018-01-01

Objective A randomized controlled trial was conducted to prospectively compare the therapeutic effectiveness of switching bipolar (SB) radiofrequency ablation (RFA) using cooled-wet electrodes and switching monopolar (SM) RFA using separable clustered (SC) electrodes in patients with hepatocellular carcinomas (HCCs). Materials and methods This prospective study was approved by our Institutional Review Board. Between April 2014 and January 2015, sixty-nine patients with 74 HCCs were randomly treated with RFA using either internally cooled-wet (ICW) electrodes in SB mode (SB-RFA, n = 36) or SC electrodes in SM mode (SM-RFA, n = 38). Technical parameters including the number of ablations, ablation time, volume, energy delivery, and complications were evaluated. Thereafter, 1-year and 2-year local tumor progression (LTP) free survival rates were compared between the two groups using the Kaplan-Meier method. Results In the SB-RFA group, less number of ablations were required (1.72±0.70 vs. 2.31±1.37, P = 0.039), the ablation time was shorter (10.9±3.9 vs.14.3±5.0 min, p = 0.004), and energy delivery was smaller (13.1±6.3 vs.23.4±12.8 kcal, p<0.001) compared to SM-RFA. Ablation volume was not significantly different between SB-RFA and SM-RFA groups (61.8±24.3 vs.54.9±23.7 cm3, p = 0.229). Technical failure occurred in one patient in the SM-RFA group, and major complications occurred in one patient in each group. The 1-year and 2-year LTP free survival rates were 93.9% and 84.3% in the SB-RFA group and 94.4% and 88.4% in the SM-RFA group (p = 0.687). Conclusion Both SB-RFA using ICW electrodes and SM-RFA using SC electrodes provided comparable LTP free survival rates although SB-RFA required less ablations and shorter ablation time. PMID:29420589

Environmental Assessment: Proposed Training Facilities, Hill Air Force Base, Utah

DTIC Science & Technology

2013-08-08

FA8201-09-D-0002 Facilities, Hill Air Force Base, Utah 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Klein, Randal 5d...PERFORMING ORGANIZATION REPORT NUMBER Streamline Consulting, LLC 1713 N. Sweetwater Lane Farmington, Utah 84025...proposes to construct new training facilities at Hill Air Force Base, Utah . The findings of this EA indicate that the proposed action would not have

Quality of child healthcare at primary healthcare facilities: a national assessment of the Integrated Management of Childhood Illnesses in Afghanistan.

PubMed

Mansoor, Ghulam Farooq; Chikvaidze, Paata; Varkey, Sherin; Higgins-Steele, Ariel; Safi, Najibullah; Mubasher, Adela; Yusufi, Khaksar; Alawi, Sayed Alisha

2017-02-01

To assess quality of the national Integrated Management of Childhood Illness (IMCI) program services provided for sick children at primary health facilities in Afghanistan. Mixed methods including cross-sectional study. Thirteen (of thirty-four) provinces in Afghanistan. Observation of case management and re-examination of 177 sick children, exit interviews with caretakers and review of equipment/supplies at 44 health facilities. Introduction and scale up of Integrated Management of Childhood Illnesses at primary health care facilities. Care of sick children according to IMCI guidelines, health worker skills and essential health system elements. Thirty-two (71%) of the health workers were trained in IMCI and five (11%) received supervision in clinical case management during the past 6 months. On average, 5.4 out of 10 main assessment tasks were performed during cases observed, the index being higher in children seen by trained providers than untrained (6.3 vs 3.5, 95% CI 5.8-6.8 vs 2.9-4.1). In all, 74% of the 104 children who needed oral antibiotics received prescriptions, while 30% received complete and correct advice and 30% were overprescribed, and more so by untrained providers. Home care counseling was associated with provider training status (41.3% by trained and 24.5% by untrained). Essential oral and pre-referral injectable medicine and equipment/supplies were available in 66%, 23%, and 45% of health facilities, respectively. IMCI training improved assessment, rational use of antibiotics and counseling; further investment in IMCI in Afghanistan, continuing provider capacity building and supportive supervision for improved quality of care and counseling for sick children is needed, especially given high burden treatable childhood illness. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

A screening level risk assessment of the indirect impacts from the Columbus Waste to Energy facility in Columbus, Ohio

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

Lorber, M.; Cleverly, D.; Schaum, J.

1996-12-31

Testing for emissions of dioxins from the stack of the Columbus, Ohio Waste to Energy (WTE) municipal solid waste combustion facility in 1992 implied that dioxin emissions could approach 1,000 grams of dioxin toxic equivalents (TEQs) per year. The incinerator has been in operation since the early 1980s. Several varying activities to further evaluate or curtail emissions were conducted by local, state and federal agencies in 1994. Also in that year, US EPA`s Region 5 issued an emergency order under Section 7003 of RCRA requiring the facility to install maximum Achievable Control Technology (MACT). As part of their justification formore » this emergency order, Region 5 used a screening level risk assessment of potential indirect impacts. This paper describes this assessment. The exposure setting is a hypothetical dairy farm where individuals on the farm obtain their beef, milk, and vegetables from home sources. A 70-year exposure scenario is considered, which includes 45 years of facility operation at the pre- and post-MACT emission rates, followed by 25 years of impact due to residual soil concentrations. Soil dermal contact, inhalation, and breast milk exposures were also considered for this assessment. The source term, or dioxin loadings to this setting, were derived from air dispersion modeling of emissions from the Columbus WTE. A key finding of the assessment was that exposures to dioxin in beef and milk dominated the estimated risks, with excess cancer risk form these two pathways estimated at 2.8 {times} 10{sup {minus}4}. A second key finding was that over 90% of a lifetime of impact from these two pathways, and the inhalation and vegetable ingestion pathways, has already occurred due to pre-MACT emissions.« less

Assessment of Space Nuclear Thermal Propulsion Facility and Capability Needs

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

James Werner

The development of a Nuclear Thermal Propulsion (NTP) system rests heavily upon being able to fabricate and demonstrate the performance of a high temperature nuclear fuel as well as demonstrating an integrated system prior to launch. A number of studies have been performed in the past which identified the facilities needed and the capabilities available to meet the needs and requirements identified at that time. Since that time, many facilities and capabilities within the Department of Energy have been removed or decommissioned. This paper provides a brief overview of the anticipated facility needs and identifies some promising concepts to bemore » considered which could support the development of a nuclear thermal propulsion system. Detailed trade studies will need to be performed to support the decision making process.« less

12 CFR 1010.114 - Recreational facilities.

Code of Federal Regulations, 2012 CFR

2012-01-01

... annual cost or assessments. State the lot buyer's annual cost or assessments for using the facility. These costs should include any applicable property owners' association assessment, and the developer's maintenance assessment. If the cost information is lengthy, you may use an asterisk or other appropriate...

12 CFR 1010.114 - Recreational facilities.

Code of Federal Regulations, 2014 CFR

2014-01-01

... annual cost or assessments. State the lot buyer's annual cost or assessments for using the facility. These costs should include any applicable property owners' association assessment, and the developer's maintenance assessment. If the cost information is lengthy, you may use an asterisk or other appropriate...

12 CFR 1010.114 - Recreational facilities.

Code of Federal Regulations, 2013 CFR

2013-01-01

... annual cost or assessments. State the lot buyer's annual cost or assessments for using the facility. These costs should include any applicable property owners' association assessment, and the developer's maintenance assessment. If the cost information is lengthy, you may use an asterisk or other appropriate...

Surgical Human Resources According to Types of Health Care Facility: An Assessment in Low- and Middle-Income Countries.

PubMed

Sheik Ali, Shirwa; Jaffry, Zahra; Cherian, Meena N; Kunjumen, Teena; Nkwowane, Annette M; Leather, Andrew J M; Von Muhlenbrock, Hernan Montenegro; Kelley, Edward; Campbell, James

2017-11-01

A robust health care system providing safe surgical care to a population can only be achieved in conjunction with access to competent surgical personnel. It has been reported that 5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. This study aims to fill the existing gap in evidence by quantifying shortfalls in trained personnel delivering safe surgical and anaesthetic care in low- and middle-income countries (LMICs) according to the type of health care facility. We conducted secondary analysis of 1323 health facilities, in 35 low- and middle-income countries using facility-based cross-sectional data from the World Health Organization Situational Analysis Tool to Assess Emergency and Essential Surgical Care. The majority of surgical and anaesthetic care in LMICs was provided by general doctors (range 13.8-41.1%; mean 27.1%). Non-physicians made up a significant proportion of the surgical workforce in LMICs. 26.76% of the surgical and anaesthetic workforce was provided by clinical medical officers and nurses. Private/NGO/mission hospitals, large, well-resourced institutions had the highest proportion of surgeons compared to any other type of health care facility at 27.92%. This compares to figures of 18.2 and 19.96% of surgeons at health centres and subdistrict/community hospitals, respectively, representing the lowest level of health facility. We highlight the significant proportion of non-physicians delivering surgical and anaesthetic care in LMICs and illustrate wide variations according to the type of health care facility.

Ames Hybrid Combustion Facility

NASA Technical Reports Server (NTRS)

Zilliac, Greg; Karabeyoglu, Mustafa A.; Cantwell, Brian; Hunt, Rusty; DeZilwa, Shane; Shoffstall, Mike; Soderman, Paul T.; Bencze, Daniel P. (Technical Monitor)

2003-01-01

The report summarizes the design, fabrication, safety features, environmental impact, and operation of the Ames Hybrid-Fuel Combustion Facility (HCF). The facility is used in conducting research into the scalability and combustion processes of advanced paraffin-based hybrid fuels for the purpose of assessing their applicability to practical rocket systems. The facility was designed to deliver gaseous oxygen at rates between 0.5 and 16.0 kg/sec to a combustion chamber operating at pressures ranging from 300 to 900. The required run times were of the order of 10 to 20 sec. The facility proved to be robust and reliable and has been used to generate a database of regression-rate measurements of paraffin at oxygen mass flux levels comparable to those of moderate-sized hybrid rocket motors.

Assessment of air velocity sensors for use in animal produciton facilities

USDA-ARS?s Scientific Manuscript database

Ventilation is an integral part of thermal environment control in animal production facilities. Accurately measuring the air velocity distribution within these facilities is cumbersome using the traverse method and a distributed velocity measurement system would reduce the time necessary to perform ...

NASA’s Wallops Flight Facility Completes Initial Assessment after Orbital Launch Mishap

NASA Image and Video Library

2017-12-08

An aerial view of the Wallops Island launch facilities taken by the Wallops Incident Response Team Oct. 29 following the failed launch attempt of Orbital Science Corp.'s Antares rocket Oct. 28. Credit: NASA/Terry Zaperach --- The Wallops Incident Response Team completed today an initial assessment of Wallops Island, Virginia, following the catastrophic failure of Orbital Science Corp.’s Antares rocket shortly after liftoff at 6:22 p.m. EDT Tuesday, Oct. 28, from Pad 0A of the Mid-Atlantic Regional Spaceport at NASA’s Wallops Flight Facility in Virginia. “I want to praise the launch team, range safety, all of our emergency responders and those who provided mutual aid and support on a highly-professional response that ensured the safety of our most important resource -- our people,” said Bill Wrobel, Wallops director. “In the coming days and weeks ahead, we'll continue to assess the damage on the island and begin the process of moving forward to restore our space launch capabilities. There's no doubt in my mind that we will rebound stronger than ever.” The initial assessment is a cursory look; it will take many more weeks to further understand and analyze the full extent of the effects of the event. A number of support buildings in the immediate area have broken windows and imploded doors. A sounding rocket launcher adjacent to the pad, and buildings nearest the pad, suffered the most severe damage. At Pad 0A the initial assessment showed damage to the transporter erector launcher and lightning suppression rods, as well as debris around the pad. The Wallops team also met with a group of state and local officials, including the Virginia Department of Environmental Quality, the Virginia Department of Emergency Management, the Virginia Marine Police, and the U.S. Coast Guard. The Wallops environmental team also is conducting assessments at the site. Preliminary observations are that the environmental effects of the launch failure were largely contained

Risk assessment of CST-7 proposed waste treatment and storage facilities Volume I: Limited-scope probabilistic risk assessment (PRA) of proposed CST-7 waste treatment & storage facilities. Volume II: Preliminary hazards analysis of proposed CST-7 waste storage & treatment facilities

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

Sasser, K.

1994-06-01

In FY 1993, the Los Alamos National Laboratory Waste Management Group [CST-7 (formerly EM-7)] requested the Probabilistic Risk and Hazards Analysis Group [TSA-11 (formerly N-6)] to conduct a study of the hazards associated with several CST-7 facilities. Among these facilities are the Hazardous Waste Treatment Facility (HWTF), the HWTF Drum Storage Building (DSB), and the Mixed Waste Receiving and Storage Facility (MWRSF), which are proposed for construction beginning in 1996. These facilities are needed to upgrade the Laboratory`s storage capability for hazardous and mixed wastes and to provide treatment capabilities for wastes in cases where offsite treatment is not availablemore » or desirable. These facilities will assist Los Alamos in complying with federal and state requlations.« less

Professional Development through Organizational Assessment: Using APPA's Facilities Management Evaluation Program

ERIC Educational Resources Information Center

Medlin, E. Lander; Judd, R. Holly

2013-01-01

APPA's Facilities Management Evaluation Program (FMEP) provides an integrated system to optimize organizational performance. The criteria for evaluation not only provide a tool for organizational continuous improvement, they serve as a compelling leadership development tool essential for today's facilities management professional. The senior…

AN ASSESSMENT OF CULTURAL VALUES AND RESIDENT-CENTERED CULTURE CHANGE IN US NURSING FACILITIES

PubMed Central

Banaszak-Holl, Jane; Castle, Nicholas G.; Lin, Michael; Spreitzer, Gretchen

2012-01-01

Background Culture Change initiatives propose to improve care by addressing the lack of managerial supports and prevalent stressful work environments in the industry; however, little is known about how Culture Change facilities differ from facilities in the industry that have not chosen to affiliate with the resident-centered care movements. Purpose To evaluate representation of organizational culture values within a random sample of U.S. nursing home facilities using the Competing Values Framework (CVF) and to determine whether organizational values are related to membership in resident-centered Culture Change initiatives. Design and Methods We collected reports of cultural values using a well-established CVF instrument in a random survey of facility administrators and directors of nursing within all states. We received responses from 57% of the facilities that were mailed the survey. Directors of nursing and administrators did not vary significantly in their reports of culture and facility measures combine their responses. Findings Nursing facilities favored market-focused cultural values on average and developmental values, key to innovation, were the least common across all nursing homes. Approximately 17% of facilities reported all cultural values were strong within their facilities. Only high developmental cultural values were linked to participation in culture change initiatives. Culture Change facilities were not different from non-Culture Change facilities in the promotion of employee focus as organizational culture, as is emphasized in group culture values. Likewise, Culture Change facilities were also not any more likely to have hierarchical or market foci than non-Culture Change facilities. Practice Implications Our results counter the argument that Culture Change facilities have a stronger internal employee focus than facilities more generally but does show that Culture Change facilities report stronger developmental cultures than non-Culture Change

Health technology assessments conducted in health care facilities: A strategic practice? Findings from a content analysis of HTA reports

PubMed Central

Lalancette, Pascal; Racine, Alexandre

2017-01-01

In this paper, we test the hypothesis that health technology assessment units located in hospitals tend to be more optimistic toward technologies that are currently in use in their organization than technologies that are not. The data include 108 health technologies assessed in 87 full-scale health technology assessment reports produced by the four main local health technology assessment units in Quebec (Canada) on behalf of decision makers from the same facility. We found that 58 (53.7 percent) of the 108 technologies were currently in use within the hospital during their assessment. Based on the assessors' interpretation of the scientific evidence regarding the efficacy of the technologies, 67.3 percent of the technologies that were in use in the hospital during the evaluation were effective (56 percent for those that were not currently being used), but the difference is not statistically significant (chi-square 1.38; p = 0.24). Controlling for the efficacy judgment, the type of technologies (i.e. preventive, diagnostic, therapeutic or organizational), the number of technologies assessed in the report and the assessment unit, we found that the technologies that were currently in use in the facility during the evaluation were 62 percent more likely to be recommended favorably by the assessment unit than the technologies that were not currently being used (RR = 1.62; 95 percent CI = 1.06–1.88). This suggests that the local health technology units that were examined in the study tended to be more optimistic toward technologies that were currently in use in their hospital at the time of the evaluation. PMID:28945772

Assessing patient safety in Canadian ambulatory surgery facilities: A national survey

PubMed Central

Ahmad, Jamil; Ho, Olivia A; Carman, Wayne W; Thoma, Achilles; Lalonde, Donald H; Lista, Frank

2014-01-01

BACKGROUND: There has been increased interest regarding patient safety and standards of care in Canadian ambulatory surgery facilities where surgical procedures are performed. The Canadian Association for Accreditation of Ambulatory Surgical Facilities (CAAASF) is a national organization formed to establish and maintain standards to ensure that surgical procedures conducted outside of public hospitals are performed safely. OBJECTIVE: To determine how many procedures are performed annually at CAAASF member sites, and to examine complication rates and several key patient safety practices. METHODS: All 69 facilities accredited by the CAAASF were surveyed. The survey focused on procedural data, complication rates and patient safety interventions. RESULTS: In 2010, 40,240 estimated procedures were performed. A total of 263 (0.007%) complications were reported. Sixteen (0.0004%) patients required reoperations in hospital and 19 (0.0004%) patients required transfer to hospital on the day of surgery. There were only two mortalities within 30 days of surgery reported in the past five years. With regard to patient safety practices, 93% used antimicrobial prophylaxis, 100% used strategies to maintain normothermia and 82% used measures for venous thromboembolism prevention. CONCLUSION: The present study is the first to report on the Canadian experience in ambulatory surgery facilities and provides insight into current practices at these facilities. Appropriate accreditation of ambulatory surgery facilities, well-established patient safety-related standards of care, careful patient selection and procedures performed by qualified health care professionals with appropriate certification practicing within the scope of their practice form the basis for safe and effective ambulatory surgery. PMID:25152645

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein

PubMed Central

Hirokawa, Masayuki; Yamamoto, Takashi

2016-01-01

Objective: Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are safe and effective treatments for varicose veins caused by saphenous reflux. Deep venous thrombosis (DVT) and endovenous heat-induced thrombosis (EHIT) are known complications of these procedures. The purpose of this article is to investigate the incidence of postoperative DVT and EHIT in patients undergoing EVLA and RFA. Methods: The patients were assessed by clinical examination and venous duplex ultrasonography before operation and at 24–72 hours, 1 month, and 1 year follow-up after operation. Endovenous ablation (EVA) had been treated for 1026 limbs (835 patients) using an RFA; 1174 limbs (954 patients) using a 1470-nm wavelength diode laser with radial two-ring fiber (1470R); and 6118 limbs (5513 patients) using a 980-nm wavelength diode laser with bare-tip fiber (980B). Results: DVT was detected in 3 legs (0.3%) of RFA, 5 legs (0.4%) of 1470R, and 27 legs (0.4%) of 980B. One patient in three symptomatic DVT treated with 980B developed asymptomatic pulmonary embolus. In all, 31 of the 35 DVTs were confined to the calf veins. The incidence of EHIT classes 2 and 3 was 2.7% following RFA procedure, 6.7% after 1470R, and 7.5% after 980B. Conclusion: The incidence of EHIT following EVA was low, especially the RFA procedure. EHIT resolves within 2–4 weeks in most patients. DVT rates after EVA were compared with those published for saphenous vein stripping. (This is a translation of J Jpn Coll Angiol 2015; 55: 153–161.) PMID:28018495

Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis

PubMed Central

Fisette, Jean-François; Bédard, Suzanne K.; Despatis, Marc-Antoine

2018-01-01

Background Since the 1990s, new techniques for the treatment of varicose veins have emerged, including radiofrequency ablation (RFA) and laser treatment. We performed a study to compare the safety, efficacy and outcomes of RFA compared to those of open surgery and laser ablation for the treatment of varicose veins. We also carried out a cost analysis of RFA compared to open surgery to assess whether RFA could help free up operating room time by being performed in an outpatient context. Methods We conducted a systematic literature review (publication date May 2010–September 2013 for articles in English, January 1991–September 2013 for those in French). We used several checklists to measure the quality of the studies. We also collected data on costing. Results The literature search identified 924 publications, of which 38 were retained for analysis: 15 literature reviews, 1 good-practice guideline and 22 new primary studies. The overall level of evidence was low to moderate owing to the limited sample sizes, lack of information on patient characteristics and lack of standardization of the outcome measures. However, the results obtained are consistent from study to study. In the short and medium term, RFA is considered as effective as open surgery or laser treatment (moderate level of evidence) and presents fewer major and minor complications than open surgery (low level of evidence). Radiofrequency ablation can be performed on an outpatient basis. We calculated that RFA would be about $110–$220 more expensive per patient than open surgery. Conclusion Radiofrequency ablation is a valuable alternative to open surgery and would free up operating room time in a context of low accessibility. PMID:29582749

Transarterial Chemoembolization Combined with Either Radiofrequency or Microwave Ablation in Management of Hepatocellular Carcinoma

PubMed Central

Abdelaziz, Ashraf Omar; Abdelmaksoud, Ahmed Hosni; Nabeel, Mohamed Mahmoud; Shousha, Hend Ibrahim; Cordie, Ahmed Abdelmonem; Mahmoud, Sherif Hamdy; Medhat, Eman; Omran, Dalia; Elbaz, Tamer Mahmoud

2017-01-01

Introduction: Local ablative therapy and trans arterial chemoembolization (TACE) are applied to ablate non resectable hepatocellular carcinoma (HCC). Combination of both techniques has proven to be more effective. We aimed to study combined ablation techniques and assess survival benefit comparing TACE with radiofrequency (RFA) versus TACE with microwave (MWA) techniques. Methods: We retrospectively studied 22 patients who were ablated using TACE-RFA and 45 with TACE-MWA. All were classified as Child A-B and lesions did not exceed 5 cm in diameter. TACE was followed within two weeks by either RFA or MWA. We recorded total and partial ablation rates and complication rates. Survival analysis was then performed. Results: TACE-MWA showed a higher tendency to provide complete response rates than TACE-RFA (P 0.06). This was particularly evident with lesions sized 3-5 cm (P 0.01). Rates of complications showed no significant difference between the groups. Overall median survival was 27 months. The overall actuarial probability of survival was 80.1% at 1 year, 55% at 2 years, and 36.3% at 3 years. The recurrence free survival at 1 year, 2years and 3 years for the TACE-RFA group was 70%, 42% and 14% respectively and for TACE-MWA group 81.2%, 65.1% and 65.1% without any significant difference (P 0.1). In relation to the size of focal lesions, no statistically significant difference in the survival rates was detected between the groups. Conclusion: TACE-MWA led to better response rates than TACE-RFA with tumors 3-5 cm, with no difference in survival rates. PMID:28240516

Transarterial Chemoembolization Combined with Either Radiofrequency or Microwave Ablation in Management of Hepatocellular Carcinoma

PubMed

Abdelaziz, Ashraf Omar; Abdelmaksoud, Ahmed Hosni; Nabeel, Mohamed Mahmoud; Shousha, Hend Ibrahim; Cordie, Ahmed Abdelmonem; Mahmoud, Sherif Hamdy; Medhat, Eman; Omran, Dalia; Elbaz, Tamer Mahmoud

2017-01-01

Introduction: Local ablative therapy and trans arterial chemoembolization (TACE) are applied to ablate non resectable hepatocellular carcinoma (HCC). Combination of both techniques has proven to be more effective. We aimed to study combined ablation techniques and assess survival benefit comparing TACE with radiofrequency (RFA) versus TACE with microwave (MWA) techniques. Methods: We retrospectively studied 22 patients who were ablated using TACE-RFA and 45 with TACE-MWA. All were classified as Child A-B and lesions did not exceed 5 cm in diameter. TACE was followed within two weeks by either RFA or MWA. We recorded total and partial ablation rates and complication rates. Survival analysis was then performed. Results: TACE-MWA showed a higher tendency to provide complete response rates than TACE-RFA (P 0.06). This was particularly evident with lesions sized 3-5 cm (P 0.01). Rates of complications showed no significant difference between the groups. Overall median survival was 27 months. The overall actuarial probability of survival was 80.1% at 1 year, 55% at 2 years, and 36.3% at 3 years. The recurrence free survival at 1 year, 2years and 3 years for the TACE-RFA group was 70%, 42% and 14% respectively and for TACE-MWA group 81.2%, 65.1% and 65.1% without any significant difference (P 0.1). In relation to the size of focal lesions, no statistically significant difference in the survival rates was detected between the groups. Conclusion: TACE-MWA led to better response rates than TACE-RFA with tumors 3-5 cm, with no difference in survival rates. Creative Commons Attribution License

Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis.

PubMed

Poder, Thomas G; Fisette, Jean-François; Bédard, Suzanne K; Despatis, Marc-Antoine

2018-04-01

Since the 1990s, new techniques for the treatment of varicose veins have emerged, including radiofrequency ablation (RFA) and laser treatment. We performed a study to compare the safety, efficacy and outcomes of RFA compared to those of open surgery and laser ablation for the treatment of varicose veins. We also carried out a cost analysis of RFA compared to open surgery to assess whether RFA could help free up operating room time by being performed in an outpatient context. We conducted a systematic literature review (publication date May 2010-September 2013 for articles in English, January 1991-September 2013 for those in French). We used several checklists to measure the quality of the studies. We also collected data on costing. The literature search identified 924 publications, of which 38 were retained for analysis: 15 literature reviews, 1 good-practice guideline and 22 new primary studies. The overall level of evidence was low to moderate owing to the limited sample sizes, lack of information on patient characteristics and lack of standardization of the outcome measures. However, the results obtained are consistent from study to study. In the short and medium term, RFA is considered as effective as open surgery or laser treatment (moderate level of evidence) and presents fewer major and minor complications than open surgery (low level of evidence). Radiofrequency ablation can be performed on an outpatient basis. We calculated that RFA would be about $110-$220 more expensive per patient than open surgery. Radiofrequency ablation is a valuable alternative to open surgery and would free up operating room time in a context of low accessibility.

Percutaneous radiofrequency ablation of hepatic tumours: factors affecting technical failure of artificial ascites formation using an angiosheath.

PubMed

Kang, T W; Lee, M W; Hye, M J; Song, K D; Lim, S; Rhim, H; Lim, H K; Cha, D I

2014-12-01

To evaluate the technical feasibility of artificial ascites formation using an angiosheath before percutaneous radiofrequency ablation (RFA) for hepatic tumours and to determine predictive factors affecting the technical failure of artificial ascites formation. This retrospective study was approved by the institutional review board. One hundred and thirteen patients underwent percutaneous RFA of hepatic tumours after trying to make artificial ascites using an angiosheath to avoid collateral thermal damage. The technical success rate of making artificial ascites using an angiosheath and conversion rate to other techniques after initial failure of making artificial ascites were evaluated. The technical success rate for RFA was assessed. In addition, potential factors associated with technical failure including previous history of transcatheter arterial chemoembolization (TACE) or RFA, type of abdominal surgery, and adjacent perihepatic structures were reviewed. Predictive factors for the technical failure of artificial ascites formation were analysed using multivariate analysis. The technical success rates of artificial ascites formation by angiosheath and that of RFA were 84.1% (95/113) and 97.3% (110/113), respectively. The conversion rate to other techniques after the failure of artificial ascites formation using an angiosheath was 15.9% (18/113). Previous hepatic resection was the sole independent predictive factor affecting the technical failure of artificial ascites formation (p<0.001, odds ratio = 29.03, 95% confidence interval: 4.56-184.69). Making artificial ascites for RFA of hepatic tumours using an angiosheath was technically feasible in most cases. However, history of hepatic resection was a significant predictive factor affecting the technical failure of artificial ascites formation. Copyright © 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Complications after 1000 lung radiofrequency ablation sessions in 420 patients: a single center's experiences.

PubMed

Kashima, Masataka; Yamakado, Koichiro; Takaki, Haruyuki; Kodama, Hiroshi; Yamada, Tomomi; Uraki, Junji; Nakatsuka, Atsuhiro

2011-10-01

This study retrospectively evaluates complications after lung radiofrequency ablation (RFA). Complications were assessed for each RFA session in 420 consecutive patients with 1403 lung tumors who underwent 1000 RFA sessions with a cool-tip RFA system. A major complication was defined as a grade 3 or 4 adverse event. Risk factors affecting frequent major complications that occurred with an incidence of 1% or more were detected using multivariate analysis. Four deaths (0.4% [4/1000]) related to RFA procedures occurred. Three patients died of interstitial pneumonia. The other patient died of hemothorax. The major complication rate was 9.8% (98/1000). Frequent major complications were aseptic pleuritis (2.3% [23/1000]), pneumonia (1.8% [18/1000]), lung abscess (1.6% [16/1000]), bleeding requiring blood transfusion (1.6% [16/1000]), pneumothorax requiring pleural sclerosis (1.6% [16/1000]), followed by bronchopleural fistula (0.4% [4/1000]), brachial nerve injury (0.3% [3/1000]), tumor seeding (0.1% [1/1000]), and diaphragm injury (0.1% [1/1000]). Puncture number (p < 0.02) and previous systemic chemotherapy (p < 0.05) were significant risk factors for aseptic pleuritis. Previous external beam radiotherapy (p < 0.001) and age (p < 0.02) were significant risk factors for pneumonia, as were emphysema (p < 0.02) for lung abscess, and serum platelet count (p < 0.002) and tumor size (p < 0.02) for bleeding. Emphysema (p < 0.02) was a significant risk factor for pneumothorax requiring pleural sclerosis. Lung RFA is a relatively safe procedure, but it can be fatal. Risk factors found in this study will help to stratify high-risk patients.

Rational design of a low molecular weight, stable, potent, and long-lasting GPR103 aza-β3-pseudopeptide agonist.

PubMed

Neveu, Cindy; Lefranc, Benjamin; Tasseau, Olivier; Do-Rego, Jean-Claude; Bourmaud, Adèle; Chan, Philippe; Bauchat, Patrick; Le Marec, Olivier; Chuquet, Julien; Guilhaudis, Laure; Boutin, Jean A; Ségalas-Milazzo, Isabelle; Costentin, Jean; Vaudry, Hubert; Baudy-Floc'h, Michèle; Vaudry, David; Leprince, Jérôme

2012-09-13

26RFa, a novel RFamide neuropeptide, is the endogenous ligand of the former orphan receptor GPR103. Intracerebroventricular injection of 26RFa and its C-terminal heptapeptide, 26RFa((20-26)), stimulates food intake in rodents. To develop potent, stable ligands of GPR103 with low molecular weight, we have designed a series of aza-β(3)-containing 26RFa((20-26)) analogues for their propensity to establish intramolecular hydrogen bonds, and we have evaluated their ability to increase [Ca(2+)](i) in GPR103-transfected cells. We have identified a compound, [Cmpi(21),aza-β(3)-Hht(23)]26RFa((21-26)), which was 8-fold more potent than 26RFa((20-26)) in mobilizing [Ca(2+)](i). This pseudopeptide was more stable in serum than 26RFa((20-26)) and exerted a longer lasting orexigenic effect in mice. This study constitutes an important step toward the development of 26RFa analogues that could prove useful for the treatment of feeding disorders.

Radiofrequency ablation combined with transcatheter arterial embolisation in rabbit liver: investigation of the ablation zone according to the time interval between the two therapies.

PubMed

Lee, I J; Kim, Y I; Kim, K W; Kim, D H; Ryoo, I; Lee, M W; Chung, J W

2012-11-01

This study was designed to evaluate the extent of the radiofrequency ablation zone in relation to the time interval between transcatheter arterial embolisation (TAE) and radiofrequency ablation (RFA) and, ultimately, to determine the optimal strategy of combining these two therapies for hepatocellular carcinoma. 15 rabbits were evenly divided into three groups: Group A was treated with RFA alone; Group B was treated with TAE immediately followed by RFA; and Group C was treated with TAE followed by RFA 5 days later. All animals underwent perfusion CT (PCT) scans immediately after RFA. Serum liver transaminases were measured to evaluate acute liver damage. Animals were euthanised for pathological analysis of ablated tissues 10 days after RFA. Non-parametric analyses were conducted to compare PCT indices, the RFA zone and liver transaminase levels among the three experimental groups. Group B showed a significantly larger ablation zone than the other two groups. Arterial liver perfusion and hepatic perfusion index represented well the perfusion decrease after TAE on PCT. Although Group B showed the most elevated liver transaminase levels at 1 day post RFA, the enzymes decreased to levels that were not different from the other groups at 10 days post-RFA. When combined TAE and RFA therapy is considered, TAE should be followed by RFA as quickly as possible, as it can be performed safely without serious hepatic deterioration, despite the short interval between the two procedures.

Creating Standards-Based Technology Education Facilities

ERIC Educational Resources Information Center

Daugherty, Michael K.; Klenke, Andrew M.; Neden, Michael

2008-01-01

One of the most intimidating tasks faced by new or practicing technology education teachers is the challenge of creating new facilities or renovating current facilities for a new purpose. While the fourth program standard in "Advancing Excellence in Technological Literacy: Student Assessment, Professional Development, and Program Standards (AETL)"…

Effects on the torsional vibration behavior in the investigation of dental implant osseointegration using resonance frequency analysis: a numerical approach.

PubMed

Zhai, Min; Li, Bing; Li, Dehua

2017-09-01

Resonance frequency analysis (RFA) methods are widely used to assess implant stability, particularly the Osstell ® device. The potential effects associated with this method have been discussed in the literature. Torsional RFA (T-RFA), mentioned in our previous study, could represent a new measurement method. The purpose of this study was to simulate T-shaped and Osstell ® transducer-implant-bone system models; compare their vibration modes and corresponding resonance frequencies; and investigate the effects of their parameters, such as the effective implant length (EIL), bone quality, and osseointegration level, on the torsional resonance frequency (TRF) and bending resonance frequency (BRF) using three-dimensional finite element analysis. Following the finite element model validation, the TRFs and BRFs for three different EILs and four types of bone quality were obtained, and the change rates during 25 degrees of osseointegration were observed. The analysis showed that an increase in the EIL and a decrease in bone quality have less effect on the declination rate of TRFs than on that of BRFs. TRFs are highly sensitive to the stiffness of the implant-bone interface during the healing period. It was concluded that T-RFA has better sensitivity and specificity.

Characterization and reclamation assessment for the Central Shops Diesel Storage Facility, Savannah River Site, Aiken, South Carolina

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

Fliermans, C.B.; Hazen, T.C.; Bledsoe, H.

1993-10-01

The contamination of subsurface terrestrial environments by organic contaminants is a global phenomenon. The remediation of such environments requires innovative assessment techniques and strategies for successful clean-ups. Central Shops Diesel Storage Facility at Savannah River Site was characterized to determine the extent of subsurface diesel fuel contamination using innovative approaches and effective bioremediation techniques for clean-up of the contaminant plume have been established.

Facility Pollution Prevention Guide

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

Not Available

The U.S. Environmental Protection Agency (U.S. EPA) has developed the Facility Pollution Prevention Guide for those who are interested in and responsible for pollution prevention in industrial or service facilities. It summarizes the benefits of a company-wide pollution prevention program and suggests ways to incorporate pollution prevention in company policies and practices. The Guide describes how to establish a company-wide pollution prevention program. It outlines procedures for conducting a preliminary assessment to identify opportunities for waste reduction or elimination. Then, it describes how to use the results of the preassessment to prioritize areas for detailed assessment, how to use themore » detailed assessment to develop pollution prevention options, and how to implement those options that withstand feasibility analysis. Methods of evaluating, adjusting, and maintaining the program are described. Later chapters deal with cost analysis for pollution prevention projects and with the roles of product design and energy conservation in pollution prevention. Appendices consist of materials that will support the pollution prevention effort: assessment worksheets, sources of additional information, examples of evaluative methods, and a glossary.« less

Evaluation of Quantitative Exposure Assessment Method for Nanomaterials in Mixed Dust Environments: Application in Tire Manufacturing Facilities.

PubMed

Kreider, Marisa L; Cyrs, William D; Tosiano, Melissa A; Panko, Julie M

2015-11-01

Current recommendations for nanomaterial-specific exposure assessment require adaptation in order to be applied to complicated manufacturing settings, where a variety of particle types may contribute to the potential exposure. The purpose of this work was to evaluate a method that would allow for exposure assessment of nanostructured materials by chemical composition and size in a mixed dust setting, using carbon black (CB) and amorphous silica (AS) from tire manufacturing as an example. This method combined air sampling with a low pressure cascade impactor with analysis of elemental composition by size to quantitatively assess potential exposures in the workplace. This method was first pilot-tested in one tire manufacturing facility; air samples were collected with a Dekati Low Pressure Impactor (DLPI) during mixing where either CB or AS were used as the primary filler. Air samples were analyzed via scanning transmission electron microscopy (STEM) coupled with energy dispersive spectroscopy (EDS) to identify what fraction of particles were CB, AS, or 'other'. From this pilot study, it was determined that ~95% of all nanoscale particles were identified as CB or AS. Subsequent samples were collected with the Dekati Electrical Low Pressure Impactor (ELPI) at two tire manufacturing facilities and analyzed using the same methodology to quantify exposure to these materials. This analysis confirmed that CB and AS were the predominant nanoscale particle types in the mixing area at both facilities. Air concentrations of CB and AS ranged from ~8900 to 77600 and 400 to 22200 particles cm(-3), respectively. This method offers the potential to provide quantitative estimates of worker exposure to nanoparticles of specific materials in a mixed dust environment. With pending development of occupational exposure limits for nanomaterials, this methodology will allow occupational health and safety practitioners to estimate worker exposures to specific materials, even in scenarios

Computational Analyses in Support of Sub-scale Diffuser Testing for the A-3 Facility. Part 2; Unsteady Analyses and Risk Assessment

NASA Technical Reports Server (NTRS)

Ahuja, Vineet; Hosangadi, Ashvin; Allgood, Daniel

2008-01-01

Simulation technology can play an important role in rocket engine test facility design and development by assessing risks, providing analysis of dynamic pressure and thermal loads, identifying failure modes and predicting anomalous behavior of critical systems. This is especially true for facilities such as the proposed A-3 facility at NASA SSC because of a challenging operating envelope linked to variable throttle conditions at relatively low chamber pressures. Design Support of the feasibility of operating conditions and procedures is critical in such cases due to the possibility of startup/shutdown transients, moving shock structures, unsteady shock-boundary layer interactions and engine and diffuser unstart modes that can result in catastrophic failure. Analyses of such systems is difficult due to resolution requirements needed to accurately capture moving shock structures, shock-boundary layer interactions, two-phase flow regimes and engine unstart modes. In a companion paper, we will demonstrate with the use of CFD, steady analyses advanced capability to evaluate supersonic diffuser and steam ejector performance in the sub-scale A-3 facility. In this paper we will address transient issues with the operation of the facility especially at startup and shutdown, and assess risks related to afterburning due to the interaction of a fuel rich plume with oxygen that is a by-product of the steam ejectors. The primary areas that will be addressed in this paper are: (1) analyses of unstart modes due to flow transients especially during startup/ignition, (2) engine safety during the shutdown process (3) interaction of steam ejectors with the primary plume i.e. flow transients as well as probability of afterburning. In this abstract we discuss unsteady analyses of the engine shutdown process. However, the final paper will include analyses of a staged startup, drawdown of the engine test cell pressure, and risk assessment of potential afterburning in the facility. Unsteady

Technology Readiness Assessment of Department of Energy Waste Processing Facilities

DTIC Science & Technology

2007-09-11

Must Be Reliable, Robust, Flexible, and Durable 6 EM Is Piloting the TRA/AD2 Process Hanford Waste Treatment Plant ( WTP ) – The Initial Pilot Project...Evaluation WTP can only treat ~ ½ of the LAW in the time it will take to treat all the HLW. • There is a need for tank space that will get more urgent with...Facility before the WTP Pretreatment and High-Level Waste (HLW) Vitrification Facilities are available (Requires tank farm pretreatment capability) TRAs

Comparison of medicine availability measurements at health facilities: evidence from Service Provision Assessment surveys in five sub-Saharan African countries.

PubMed

Choi, Yoonjoung; Ametepi, Paul

2013-07-09

With growing emphasis on health systems strengthening in global health, various health facility assessment methods have been used increasingly to measure medicine and commodity availability. However, few studies have systematically compared estimates of availability based on different definitions. The objective of this study was to compare estimates of medicine availability based on different definitions. A secondary data analysis was conducted using data from the Service Provision Assessment (SPA)--a nationally representative sample survey of health facilities--conducted in five countries: Kenya SPA 2010, Namibia SPA 2009, Rwanda SPA 2007, Tanzania SPA 2006, and Uganda SPA 2007. For 32 medicines, percent of facilities having the medicine were estimated using five definitions: four for current availability and one for six-month period availability. 'Observed availability of at least one valid unit' was used as a reference definition, and ratios between the reference and each of the other four estimates were calculated. Summary statistics of the ratios among the 32 medicines were calculated by country. The ratios were compared further between public and non-public facilities within each country. Across five countries, compared to current observed availability of at least one valid unit, 'reported availability without observation' was on average 6% higher (ranging from 3% in Rwanda to 8% in Namibia), 'observed availability where all units were valid' was 11% lower (ranging from 2% in Tanzania to 19% in Uganda), and 'six-month period availability' was 14% lower (ranging from 5% in Namibia to 25% in Uganda). Medicine availability estimates vary substantially across definitions, and need to be interpreted with careful consideration of the methods used.

Real-time optical monitoring of permanent lesion progression in radiofrequency ablated cardiac tissue (Conference Presentation)

NASA Astrophysics Data System (ADS)

Singh-Moon, Rajinder P.; Hendon, Christine P.

2016-02-01

Despite considerable advances in guidance of radiofrequency ablation (RFA) therapies for atrial fibrillation, success rates have been hampered by an inability to intraoperatively characterize the extent of permanent injury. Insufficient lesions can elusively create transient conduction blockages that eventually reconduct. Prior studies suggest significantly greater met-myoglobin (Mmb) concentrations in the lesion core than those in the healthy myocardium and may serve as a marker for irreversible tissue damage. In this work, we present real-time monitoring of permanent injury through spectroscopic assessment of Mmb concentrations at the catheter tip. Atrial wedges (n=6) were excised from four fresh swine hearts and submerged under pulsatile flow of warm (37oC) phosphate buffered saline. A commercial RFA catheter inserted into a fiber optic sheath allowed for simultaneous measurement of tissue diffuse reflectance (DR) spectra (500-650nm) during application of RF energy. Optical measurements were continuously acquired before, during, and post-ablation, in addition to healthy neighboring tissue. Met-myoglobin, oxy-myoglobin, and deoxy-myoglobin concentrations were extracted from each spectrum using an inverse Monte Carlo method. Tissue injury was validated with Masson's trichrome and hematoxylin and eosin staining. Time courses revealed a rapid increase in tissue Mmb concentrations at the onset of RFA treatment and a gradual plateauing thereafter. Extracted Mmb concentrations were significantly greater post-ablation (p<0.0001) as compared to healthy tissue and correlated well with histological assessment of severe thermal tissue destruction. On going studies are aimed at integrating these findings with prior work on near infrared spectroscopic lesion depth assessment. These results support the use of spectroscopy-facilitated guidance of RFA therapies for real-time permanent injury estimation.

Renal sympathetic denervation using an externally irrigated radiofrequency ablation catheter for treatment of resistant hypertension - Acute safety and short term efficacy.

PubMed

Yalagudri, Sachin; Raju, Narayana; Das, Bharati; Daware, Ashwin; Maiya, Shreesha; Jothiraj, Kannan; Ravikishore, A G

2015-01-01

This study was conducted to assess the acute safety and short term efficacy of renal sympathetic denervation (RSDN) using solid tip radiofrequency ablation (RFA) catheter and saline irrigation through the renal guiding catheter to achieve effective denervation. RSDN using a specialized solid-tip RFA catheter has recently been demonstrated to safely reduce systemic blood pressure in patients with refractory hypertension, the limitation being inadequate power delivery in renal arteries. So, we used solid-tip RFA catheter along with saline irrigation for RSDN. Nine patients with resistant hypertension underwent CT and conventional renal angiography, followed by bilateral or unilateral RSDN using 5F RFA catheter with saline irrigation through renal guiding catheter. Repeat renal angiography was performed at the end of the procedure. In all patients, pre- and post-procedure serum creatinine was measured. Over 1-month period: 1) the systolic/diastolic blood pressure decreased by -57 ± 20/-25 ± 7.5 mm Hg; 2) all patients experienced a decrease in systolic blood pressure of at least -36 mm Hg (range 36-98 mm Hg); 3) there was no evidence of renal artery injury immediate post-procedure. There was no significant change in serum creatinine level. This data shows the acute procedural safety and short term efficacy of RSDN using modified externally irrigated solid tip RFA catheter. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Health Care Facilities Resilient to Climate Change Impacts

PubMed Central

Paterson, Jaclyn; Berry, Peter; Ebi, Kristie; Varangu, Linda

2014-01-01

Climate change will increase the frequency and magnitude of extreme weather events and create risks that will impact health care facilities. Health care facilities will need to assess climate change risks and adopt adaptive management strategies to be resilient, but guidance tools are lacking. In this study, a toolkit was developed for health care facility officials to assess the resiliency of their facility to climate change impacts. A mixed methods approach was used to develop climate change resiliency indicators to inform the development of the toolkit. The toolkit consists of a checklist for officials who work in areas of emergency management, facilities management and health care services and supply chain management, a facilitator’s guide for administering the checklist, and a resource guidebook to inform adaptation. Six health care facilities representing three provinces in Canada piloted the checklist. Senior level officials with expertise in the aforementioned areas were invited to review the checklist, provide feedback during qualitative interviews and review the final toolkit at a stakeholder workshop. The toolkit helps health care facility officials identify gaps in climate change preparedness, direct allocation of adaptation resources and inform strategic planning to increase resiliency to climate change. PMID:25522050

Environmental assessment for the proposed construction and operation of a Genome Sequencing Facility in Building 64 at Lawrence Berkeley Laboratory, Berkeley, California

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

NONE

1995-04-01

This document is an Environmental Assessment (EA) for a proposed project to modify 14,900 square feet of an existing building (Building 64) at Lawrence Berkeley Laboratory (LBL) to operate as a Genome Sequencing Facility. This EA addresses the potential environmental impacts from the proposed modifications to Building 64 and operation of the Genome Sequencing Facility. The proposed action is to modify Building 64 to provide space and equipment allowing LBL to demonstrate that the Directed DNA Sequencing Strategy can be scaled up from the current level of 750,000 base pairs per year to a facility that produces over 6,000,000 basemore » pairs per year, while still retaining its efficiency.« less

Examining school-based hygiene facilities: a quantitative assessment in a Ghanaian municipality.

PubMed

Appiah-Brempong, Emmanuel; Harris, Muriel J; Newton, Samuel; Gulis, Gabriel

2018-05-02

The crucial role of adequate water, sanitation and hygiene (WASH) facilities in influencing children's handwashing behaviour is widely reported. Report from UNICEF indicates a dearth of adequate data on WASH facilities in schools, especially in the developing world. This study sought to contribute to building the evidence-base on school hygiene facilities in Ghana. The study further explored for possible associations and differences between key variables within the context of school water, sanitation and hygiene. Data was collected from 37 junior high schools using an observational checklist. Methods of data analysis included a Scalogram model, Fisher's exact test, and a Student's t-test. Results of the study showed a facility deficiency in many schools: 33% of schools had students washing their hands in a shared receptacle (bowl), 24% had students using a single cotton towel to dry hands after handwashing, and only 16% of schools had a functional water facility. Furthermore, results of a proportion test indicated that 83% of schools which had functional water facilities also had functional handwashing stations. On the other hand, only 3% of schools which had functional water facilities also had a functional handwashing stations. A test of difference in the proportions of the two sets of schools showed a statistically significant difference (p < 0.001). In addition, 40% of schools which had financial provisions for water supply also had functional handwashing stations. On the other hand, only 7% of schools which had financial provisions for water supply also had functional handwashing stations. There was a statistically significant difference in the proportions of the two sets of schools (p = 0.02). We conclude that it is essential to have a financial provision for water supply in schools as this can potentially influence the existence of a handwashing station in a school. An intervention by government, educational authorities and civil society

Systemic siRNA Nanoparticle-Based Drugs Combined with Radiofrequency Ablation for Cancer Therapy

PubMed Central

Ahmed, Muneeb; Kumar, Gaurav; Navarro, Gemma; Wang, Yuanguo; Gourevitch, Svetlana; Moussa, Marwan H.; Rozenblum, Nir; Levchenko, Tatyana; Galun, Eithan; Torchilin, Vladimir P.; Goldberg, S. Nahum

2015-01-01

Purpose Radiofrequency thermal ablation (RFA) of hepatic and renal tumors can be accompanied by non-desired tumorigenesis in residual, untreated tumor. Here, we studied the use of micelle-encapsulated siRNA to suppress IL-6-mediated local and systemic secondary effects of RFA. Methods We compared standardized hepatic or renal RFA (laparotomy, 1 cm active tip at 70±2°C for 5 min) and sham procedures without and with administration of 150nm micelle-like nanoparticle (MNP) anti-IL6 siRNA (DOPE-PEI conjugates, single IP dose 15 min post-RFA, C57Bl mouse:3.5 ug/100ml, Fisher 344 rat: 20ug/200ul), RFA/scrambled siRNA, and RFA/empty MNPs. Outcome measures included: local periablational cellular infiltration (α-SMA+ stellate cells), regional hepatocyte proliferation, serum/tissue IL-6 and VEGF levels at 6-72hr, and distant tumor growth, tumor proliferation (Ki-67) and microvascular density (MVD, CD34) in subcutaneous R3230 and MATBIII breast adenocarcinoma models at 7 days. Results For liver RFA, adjuvant MNP anti-IL6 siRNA reduced RFA-induced increases in tissue IL-6 levels, α-SMA+ stellate cell infiltration, and regional hepatocyte proliferation to baseline (p<0.04, all comparisons). Moreover, adjuvant MNP anti-IL6- siRNA suppressed increased distant tumor growth and Ki-67 observed in R3230 and MATBIII tumors post hepatic RFA (p<0.01). Anti-IL6 siRNA also reduced RFA-induced elevation in VEGF and tumor MVD (p<0.01). Likewise, renal RFA-induced increases in serum IL-6 levels and distant R3230 tumor growth was suppressed with anti-IL6 siRNA (p<0.01). Conclusions Adjuvant nanoparticle-encapsulated siRNA against IL-6 can be used to modulate local and regional effects of hepatic RFA to block potential unwanted pro-oncogenic effects of hepatic or renal RFA on distant tumor. PMID:26154425

Percutaneous Dual-Switching Monopolar Radiofrequency Ablation Using a Separable Clustered Electrode: A Preliminary Study

PubMed Central

Choi, Tae Won; Lee, Dong Ho; Lee, Jeong-Hoon; Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung-Hwan; Han, Joon Koo

2017-01-01

Objective To prospectively evaluate the safety and therapeutic effectiveness of dual-switching monopolar (DSM) radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), and to retrospectively compare the results with those of single-switching monopolar (SSM) RFA in a historical control group. Materials and Methods This study was approved by the Institutional Review Board, with informed consent obtained from all patients. Fifty-two HCC patients who underwent DSM-RFA using a separable clustered electrode and dual-generators were prospectively enrolled. Technical parameters, complications, technical success, technical effectiveness, and local tumor progression (LTP) rates were evaluated by means of post-procedural and follow-up imaging. Thereafter, the outcome of DSM-RFA was compared with those of 249 retrospectively included HCC patients treated with SSM-RFA. Results There were two major complications (3.8%, 2/52) including pleural and pericardial effusion in the DSM-RFA group. The DSM-RFA yielded a 100% technical success rate, a 98.1% technical effectiveness rate, and a 4.3% 2-year LTP rate. In a retrospective comparison between the two groups, DSM-RFA created significantly larger ablation volume (4.20 ± 2.07 cm3/min vs. 3.03 ± 1.99 cm3/min, p < 0.01), and delivered higher energy (1.43 ± 0.37 kcal/min vs. 1.25 ± 0.50 kcal/min, p < 0.01) per given time, than SSM-RFA. There was no significant difference in major procedure-related complications (3.8% vs. 4.4%) and technical effectiveness rate (98.1% vs. 96.4%) between the two groups (p = 1.00). In addition, the 2-year LTP rate of DSM-RFA and SSM-RFA were 4.3% and 10.1%, respectively (p = 0.15). Conclusion DSM-RFA using a separable clustered electrode is safe and provides high local tumor control and good preliminary clinical outcome for small HCCs, which are at least comparable to those of SSM-RFA. PMID:28860897

From Cure to Care: Assessing the Ethical and Professional Learning Needs of Medical Learners in a Care-Based Facility

ERIC Educational Resources Information Center

Hall, Pippa; O'Reilly, Jane; Dojeiji, Sue; Blair, Richard; Harley, Anne

2009-01-01

The purpose of this study was to assess the ethical and professional learning needs of medical trainees on clinical placements at a care-based facility, as they shifted from acute care to care-based philosophy. Using qualitative data analysis and grounded theory techniques, 12 medical learners and five clinical supervisors were interviewed. Five…

[Hepato-pericardial fistula caused by radiofrequency ablation of colorectal liver metastases].

PubMed

Mogensen, Mads Filtenborg; Edling, Poul; Raade, Thomas Bo; Pedersen, Torben Ingemann; Pilegaard, Hans Kristian

2015-03-30

Radiofrequency ablation (RFA) of colorectal liver metastases is a well tolerated minimally invasive procedure. Various complications can occur but most of these are self-limiting if diagnosed and treated in time. This case report describes a serious and rare complication following RFA treatment: hepato-pericardial fistula caused by several RFA procedures aiming to cure colorectal liver metastases. Complications to RFA treatment vary and can be difficult to diagnose. We recommend that RFA procedures and management of complications take place in highly specialised multidisciplinary departments.

Assessing Organizational Readiness for a Participatory Occupational Health/Health Promotion Intervention in Skilled Nursing Facilities

PubMed Central

Zhang, Yuan; Flum, Marian; West, Cheryl; Punnett, Laura

2018-01-01

The long-term care sector is characterized by high morbidity and employee turnover, along with associated costs. Effective health protection and health promotion are important to improve physical and psychosocial well-being of caregivers. Assessment of organizational readiness for change is an essential precursor to the successful implementation of workplace programs addressing work climate, structure of tasks and relationships, and other issues that may be perceived as challenging by some within the institution. This study qualitatively assessed readiness of five skilled nursing facilities for a participatory occupational health/health promotion intervention. Selection criteria were developed to screen for program feasibility and ability to conduct prospective evaluations, and information was collected from managers and employees (interviews and focus groups). Three centers were selected for the program, and the first year of formative evaluation and intervention experience was then reviewed to evaluate and modify our selection criteria after the fact. Lessons learned include adding assessment of communication and the structure of problem solving to our selection criteria, improving methods to assess management support in a concrete (potentially nonverbal) form, and obtaining a stated financial commitment and resources to enable the team to function. Assessment of organizational readiness for change is challenging, although necessary to implement effective and sustainable health promotion programs in specific organizations. PMID:25715335

Cost-effectiveness of hepatic resection versus percutaneous radiofrequency ablation for early hepatocellular carcinoma.

PubMed

Cucchetti, Alessandro; Piscaglia, Fabio; Cescon, Matteo; Colecchia, Antonio; Ercolani, Giorgio; Bolondi, Luigi; Pinna, Antonio D

2013-08-01

Both hepatic resection and radiofrequency ablation (RFA) are considered curative treatments for hepatocellular carcinoma (HCC), but their economic impact still remains not determined. Aim of the present study was to analyze the cost-effectiveness (CE) of these two strategies in early stage HCC (Milan criteria). As first step, a meta-analysis of the pertinent literature of the last decade was performed. Seventeen studies fulfilled the inclusion criteria: 3996 patients underwent resection and 4424 underwent RFA for early HCC. Data obtained from the meta-analysis were used to construct a Markov model. Costs were assessed from the health care provider perspective. A Monte Carlo probabilistic sensitivity analysis was used to estimate outcomes with distribution samples of 1000 patients for each treatment arm. In a 10-year perspective, for very early HCC (single nodule <2 cm) in Child-Pugh class A patients, RFA provided similar life-expectancy and quality-adjusted life-expectancy at a lower cost than resection and was the most cost-effective therapeutic strategy. For single HCCs of 3-5 cm, resection provided better life-expectancy and was more cost-effective than RFA, at a willingness-to-pay above €4200 per quality-adjusted life-year. In the presence of two or three nodules ≤3 cm, life-expectancy and quality-adjusted life-expectancy were very similar between the two treatments, but cost-effectiveness was again in favour of RFA. For very early HCC and in the presence of two or three nodules ≤3 cm, RFA is more cost-effective than resection; for single larger early stage HCCs, surgical resection remains the best strategy to adopt as a result of better survival rates at an acceptable increase in cost. Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Tackling the issue of environmental survival of live Salmonella Typhimurium vaccines: deletion of the lon gene.

PubMed

Leyman, Bregje; Boyen, Filip; Van Parys, Alexander; Verbrugghe, Elin; Haesebrouck, Freddy; Pasmans, Frank

2012-12-01

Vaccination is an important measure to control Salmonella contamination in the meat production chain. A previous study showed that both the ΔrfaJ and ΔrfaL strains are suitable markers and allow serological differentiation of infected and vaccinated animals. The aim of this study was to verify whether deletion of the lon gene in a Salmonella Typhimurium ΔrfaJ marker strain resulted in decreased environmental survival. Our results indicate that deletion of the lon gene in the ΔrfaJ strain did not affect invasiveness in IPEC-J2 cells and resulted in an increased susceptibility to UV, disinfectants (such as hydrogen peroxide and tosylchloramide sodium) and citric acid. Immunization of pigs with inactivated ΔrfaJ or ΔlonΔrfaJ vaccines allowed differentiation of infected and vaccinated pigs. Furthermore, deletion of the lon gene did not reduce the protection conferred by live wild type or ΔrfaJ vaccines against subsequent challenge with a virulent Salmonella Typhimurium strain in BALB/c mice. Based on our results in mice, we conclude that deletion of lon in ΔrfaJ contributes to environmental safety of the ΔrfaJ DIVA strain. Copyright © 2012 Elsevier Ltd. All rights reserved.

Lessons Learned from Radioactive Waste Storage and Disposal Facilities

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

Esh, David W.; Bradford, Anna H.

2008-01-15

The safety of radioactive waste disposal facilities and the decommissioning of complex sites may be predicated on the performance of engineered and natural barriers. For assessing the safety of a waste disposal facility or a decommissioned site, a performance assessment or similar analysis is often completed. The analysis is typically based on a site conceptual model that is developed from site characterization information, observations, and, in many cases, expert judgment. Because waste disposal facilities are sited, constructed, monitored, and maintained, a fair amount of data has been generated at a variety of sites in a variety of natural systems. Thismore » paper provides select examples of lessons learned from the observations developed from the monitoring of various radioactive waste facilities (storage and disposal), and discusses the implications for modeling of future waste disposal facilities that are yet to be constructed or for the development of dose assessments for the release of decommissioning sites. Monitoring has been and continues to be performed at a variety of different facilities for the disposal of radioactive waste. These include facilities for the disposal of commercial low-level waste (LLW), reprocessing wastes, and uranium mill tailings. Many of the lessons learned and problems encountered provide a unique opportunity to improve future designs of waste disposal facilities, to improve dose modeling for decommissioning sites, and to be proactive in identifying future problems. Typically, an initial conceptual model was developed and the siting and design of the disposal facility was based on the conceptual model. After facility construction and operation, monitoring data was collected and evaluated. In many cases the monitoring data did not comport with the original site conceptual model, leading to additional investigation and changes to the site conceptual model and modifications to the design of the facility. The following cases are

Sea/Lake Water Air Conditioning at Naval Facilities.

DTIC Science & Technology

1980-05-01

ECONOMICS AT TWO FACILITIES ......... ................... 2 Facilities ........... .......................... 2 Computer Models...of an operational test at Naval Security Group Activity (NSGA) Winter Harbor, Me., and the economics of Navywide application. In FY76 an assessment of... economics of Navywide application of sea/lake water AC indicated that cost and energy savings at the sites of some Naval facilities are possible, depending

A model for evaluating the environmental benefits of elementary school facilities.

PubMed

Ji, Changyoon; Hong, Taehoon; Jeong, Kwangbok; Leigh, Seung-Bok

2014-01-01

In this study, a model that is capable of evaluating the environmental benefits of a new elementary school facility was developed. The model is composed of three steps: (i) retrieval of elementary school facilities having similar characteristics as the new elementary school facility using case-based reasoning; (ii) creation of energy consumption and material data for the benchmark elementary school facility using the retrieved similar elementary school facilities; and (iii) evaluation of the environmental benefits of the new elementary school facility by assessing and comparing the environmental impact of the new and created benchmark elementary school facility using life cycle assessment. The developed model can present the environmental benefits of a new elementary school facility in terms of monetary values using Environmental Priority Strategy 2000, a damage-oriented life cycle impact assessment method. The developed model can be used for the following: (i) as criteria for a green-building rating system; (ii) as criteria for setting the support plan and size, such as the government's incentives for promoting green-building projects; and (iii) as criteria for determining the feasibility of green building projects in key business sectors. Copyright © 2013 Elsevier Ltd. All rights reserved.

An assessment of cultural values and resident-centered culture change in U.S. nursing facilities.

PubMed

Banaszak-Holl, Jane; Castle, Nicholas G; Lin, Michael; Spreitzer, Gretchen

2013-01-01

Culture change initiatives propose to improve care by addressing the lack of managerial supports and prevalent stressful work environments in the industry; however, little is known about how culture change facilities differ from facilities in the industry that have not chosen to affiliate with the resident-centered care movements. The aim of this study was to evaluate representation of organizational culture values within a random sample of U.S. nursing home facilities using the competing values framework and to determine whether organizational values are related to membership in resident-centered culture change initiatives. We collected reports of cultural values using a well-established competing values framework instrument in a random survey of facility administrators and directors of nursing within all states. We received responses from 57% of the facilities that were mailed the survey. Directors of nursing and administrators did not differ significantly in their reports of culture and facility measures combined their responses. Nursing facilities favored market-focused cultural values on average, and developmental values, key to innovation, were the least common across all nursing homes. Approximately 17% of the facilities reported that all cultural values were strong within their facilities. Only high developmental cultural values were linked to participation in culture change initiatives. Culture change facilities were not different from non-culture change facilities in the promotion of employee focus as organizational culture, as emphasized in group culture values. Likewise, culture change facilities were also not more likely to have hierarchical or market foci than non-culture change facilities. Our results counter the argument that culture change facilities have a stronger internal employee focus than facilities more generally but do show that culture change facilities report stronger developmental cultures than non-culture change facilities, which

Early Stage Hepatocellular Carcinomas Not Feasible for Ultrasound-Guided Radiofrequency Ablation: Comparison of Transarterial Chemoembolization Alone and Combined Therapy with Transarterial Chemoembolization and Radiofrequency Ablation

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

Hyun, Dongho; Cho, Sung Ki, E-mail: chosk@skku.edu; Shin, Sung Wook

2016-03-15

PurposeTo report the results of combined therapy with transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) for early stage hepatocellular carcinoma (HCC) considered infeasible for ultrasound (US)-guided RFA in comparison with those of TACE monotherapy.MethodsFrom January 2007 through December 2010, 91 patients with early or very early stage HCC infeasible for US-guided RFA received either TACE alone (TACE group; n = 54) or TACE immediately followed by RFA (TACE–RFA group; n = 37) as a first-line treatment. 1-month tumor response, time to progression (TTP), and overall survival (OS) rates were calculated. Univariate and multivariate analyses were performed to identify prognostic factors.ResultsTACE–RFA group showed a bettermore » 1-month tumor response than TACE group (P < .001). The mean TTP was 29.7 ± 3.4 months (95 % confidence intervals [CIs] 23.0–36.5) in TACE group and 34.9 ± 2.8 months (95 % CIs 29.4–40.4) in TACE–RFA group. TACE–RFA group had a significantly longer TTP (P = .014). Cumulative 1-, 2-, and 3-year OS rates in the TACE and TACE–RFA groups were 91, 79, and 71 % and 100, 97, and 93 %, respectively (P = .008). Initial treatment of TACE was found to be the only significant risk factor for tumor progression and OS in multivariate analysis.ConclusionTACE–RFA combination therapy appears superior to TACE monotherapy in terms of 1-month tumor response, TTP, and OS when performed for early stage HCC infeasible for US-guided RFA.« less

Assessing cow-calf welfare. Part 1: Benchmarking beef cow health and behavior, handling; and management, facilities, and producer perspectives.

PubMed

Simon, G E; Hoar, B R; Tucker, C B

2016-08-01

Assessment programs are one way beef producers communicate information about animal welfare to retailers and the public. Programs that monitor cattle through the production cycle (e.g., the Global Animal Partnership) or at individual stages (e.g., slaughter; the North American Meat Institute) exist, but to date, there is no assessment program addressing welfare specifically in the cow-calf sector. The objectives of this study were to measure cow-calf health and handling welfare outcomes and gather management, facility, and producer perspective information to 1) describe current practices and 2) inform assessment design. A welfare assessment, designed using features of similar beef and dairy programs, was conducted on 30 California ranches that varied in size (mean 1,051 cows [SD 1,849], range 28 to 10,000 cows) and location within the state. Cattle health and behavior and stockperson handling were measured during a routine procedure (e.g., pregnancy checks) on breeding females ( = 3,065). Management and producer perspectives were evaluated through an interview, and facility features were recorded at the chute and water access points. Cattle health problems were rare and seen only on specific ranches (e.g., prevalence of lame cattle: mean 1.3% [SD 1.5], range 0 to 7.1%). Cattle behavior and stockperson handling varied between ranches (e.g., cattle balking: mean 22.0% [SD 21.9], range 1.6 to 78.3%; electric prod use: mean 23.5 [SD 21.5], range 0 to 73.0%). Although some management and facility characteristics were shared by most (e.g., all ranches castrated bull calves; 86% used alleyways with an anti-back gate), other aspects varied (e.g., weaning age: mean 8.2 mo [SD 1.4], range 6 to 11 mo; 43% used shade cover over chute). Most producers shared similar perspectives toward their herd health management plan, but their responses varied when asked to evaluate an animal's pain experience. In terms of assessment design, there were challenges with feasibility (e

Tribal Child Care Facilities: A Guide to Construction and Renovation.

ERIC Educational Resources Information Center

National Child Care Information Center, Vienna, VA.

This document provides technical assistance in addressing major areas of the child care facility construction and renovation process, including conducting a child care community needs assessment, identifying a site, financing costs, developing a business plan, conducting an environmental assessment, building and designing a facility, and hiring…

Sustainable Facility Development: Perceived Benefits and Challenges

ERIC Educational Resources Information Center

Stinnett, Brad; Gibson, Fred

2016-01-01

Purpose: The purpose of this paper is to assess the perceived benefits and challenges of implementing sustainable initiatives in collegiate recreational sports facilities. Additionally, this paper intends to contribute to the evolving field of facility sustainability in higher education. Design/methodology/approach The design included qualitative…

Sexually transmitted disease syndromic case management through public sector facilities: development and assessment study in Punjab Pakistan.

PubMed

Khan, Muhammad Amir; Javed, Wajiha; Ahmed, Maqsood; Walley, John; Munir, Muhammad Arif

2014-01-01

Sexually transmitted infections (STIs) are a priority health problem. We proposed a prospective study in two districts of Punjab, using an intervention package, which included guidelines and protocols on syndrome-based management of STIs, adapted in light of technical guidelines from the National AIDS Control Program and the World Health Organization. The aim of this study was to assess the operational effectiveness of STI case management guidelines and to assess factors that determine the adherence to guidelines for management of STIs at public health facilities in Pakistan. A prospective study lasting 18 months (January 2008 to June 2009), which reviewed early implementation experiences of updated case management guidelines for delivery of syndrome-based STI/reproductive tract infection care, through public-sector health care facilities. The project was implemented in two districts of Punjab, Sargodha and Jhang. A Cox regression model with stratification was done. The prevalence of STI was 26 per 100,000 patients. In women, the reported symptoms were 80% vaginal discharge and 12% abdominal pain. Forty-four percent of men had a genital ulcer and 29% of men had genital discharge. Age of participants ranged from 13 to 60 years. The study comprised 28.6% men and 71.4% women. The majority of the population attending these clinics was from rural areas (70%). The variables independently associated with adherence to guidelines were availability of male paramedic, age of patient, and type of diagnosis made. There was an important interaction (effect modification) present between the area of health facility and patient sex. Screening, diagnosis, and treatment costs for many STIs are expensive and thus an easier, low-cost, syndrome-based public health strategy is the adoption of the proposed STI syndrome case management guidelines. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

Emerging indications of endoscopic radiofrequency ablation

PubMed Central

Becq, Aymeric; Camus, Marine; Rahmi, Gabriel; de Parades, Vincent; Marteau, Philippe

2015-01-01

Introduction Radiofrequency ablation (RFA) is a well-validated treatment of dysplastic Barrett's esophagus. Other indications of endoscopic RFA are under evaluation. Results Four prospective studies (total 69 patients) have shown that RFA achieved complete remission of early esophageal squamous intra-epithelial neoplasia at a rate of 80%, but with a substantial risk of stricture. In the setting of gastric antral vascular ectasia, two prospective monocenter studies, and a retrospective multicenter study, (total 51 patients), suggest that RFA is efficacious in terms of reducing transfusion dependency. In the setting of chronic hemorrhagic radiation proctopathy, a prospective monocenter study and a retrospective multicenter study (total 56 patients) suggest that RFA is an efficient treatment. A retrospective comparative study (64 patients) suggests that RFA improves stents patency in malignant biliary strictures. Conclusions Endoscopic RFA is an upcoming treatment modality in early esophageal squamous intra-epithelial neoplasia, as well as in gastric, rectal, and biliary diseases. PMID:26279839

Assessment of the MHD capability in the ATHENA code using data from the ALEX facility

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

Roth, P.A.

1989-03-01

The ATHENA (Advanced Thermal Hydraulic Energy Network Analyzer) code is a system transient analysis code with multi-loop, multi-fluid capabilities, which is available to the fusion community at the National Magnetic Fusion Energy Computing Center (NMFECC). The work reported here assesses the ATHENA magnetohydrodynamic (MHD) pressure drop model for liquid metals flowing through a strong magnetic field. An ATHENA model was developed for two simple geometry, adiabatic test sections used in the Argonne Liquid Metal Experiment (ALEX) at Argonne National Laboratory (ANL). The pressure drops calculated by ATHENA agreed well with the experimental results from the ALEX facility.

INTEGRATION OF FACILITY MODELING CAPABILITIES FOR NUCLEAR NONPROLIFERATION ANALYSIS

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

Gorensek, M.; Hamm, L.; Garcia, H.

2011-07-18

Developing automated methods for data collection and analysis that can facilitate nuclear nonproliferation assessment is an important research area with significant consequences for the effective global deployment of nuclear energy. Facility modeling that can integrate and interpret observations collected from monitored facilities in order to ascertain their functional details will be a critical element of these methods. Although improvements are continually sought, existing facility modeling tools can characterize all aspects of reactor operations and the majority of nuclear fuel cycle processing steps, and include algorithms for data processing and interpretation. Assessing nonproliferation status is challenging because observations can come frommore » many sources, including local and remote sensors that monitor facility operations, as well as open sources that provide specific business information about the monitored facilities, and can be of many different types. Although many current facility models are capable of analyzing large amounts of information, they have not been integrated in an analyst-friendly manner. This paper addresses some of these facility modeling capabilities and illustrates how they could be integrated and utilized for nonproliferation analysis. The inverse problem of inferring facility conditions based on collected observations is described, along with a proposed architecture and computer framework for utilizing facility modeling tools. After considering a representative sampling of key facility modeling capabilities, the proposed integration framework is illustrated with several examples.« less

Financing School Facilities.

ERIC Educational Resources Information Center

Honeyman, David S., Ed.

Millions of students are attending classes in substandard schools, a condition that is becoming a major concern for many public school parents, teachers, students, and administrators. This report is the result of research investigating school facility issues, assessing the scope of the problem, and making recommendations to the membership of the…

A combined approach of simulation and analytic hierarchy process in assessing production facility layouts

NASA Astrophysics Data System (ADS)

Ramli, Razamin; Cheng, Kok-Min

2014-07-01

One of the important areas of concern in order to obtain a competitive level of productivity in a manufacturing system is the layout design and material transportation system (conveyor system). However, changes in customers' requirements have triggered the need to design other alternatives of the manufacturing layout for existing production floor. Hence, this paper discusses effective alternatives of the process layout specifically, the conveyor system layout. Subsequently, two alternative designs for the conveyor system were proposed with the aims to increase the production output and minimize space allocation. The first proposed layout design includes the installation of conveyor oven in the particular manufacturing room based on priority, and the second one is the one without the conveyor oven in the layout. Simulation technique was employed to design the new facility layout. Eventually, simulation experiments were conducted to understand the performance of each conveyor layout design based on operational characteristics, which include predicting the output of layouts. Utilizing the Analytic Hierarchy Process (AHP), the newly and improved layout designs were assessed before the final selection was done. As a comparison, the existing conveyor system layout was included in the assessment process. Relevant criteria involved in this layout design problem were identified as (i) usage of space of each design, (ii) operator's utilization rates, (iii) return of investment (ROI) of the layout, and (iv) output of the layout. In the final stage of AHP analysis, the overall priority of each alternative layout was obtained and thus, a selection for final use by the management was made based on the highest priority value. This efficient planning and designing of facility layout in a particular manufacturing setting is able to minimize material handling cost, minimize overall production time, minimize investment in equipment, and optimize utilization of space.

Immunohistochemical and radiological characterization of wound healing in porcine liver after radiofrequency ablation.

PubMed

Stadlbauer, Vanessa; Lang-Olip, Ingrid; Leber, Bettina; Mayrhauser, Ursula; Koestenbauer, Sonja; Tawdrous, Monika; Moche, Michael; Sereinigg, Michael; Seider, Daniel; Iberer, Florian; Wiederstein-Grasser, Iris; Portugaller, Rupert Horst; Stiegler, Philipp

2016-01-01

Radiofrequency ablation (RFA) is a minimal invasive therapeutic option for patients with hepatocellular carcinoma or liver metastases. We investigated RFA-induced cellular changes in the liver of pigs. Healthy pigs (n=18) were sacrificed between day 0 and 3 months after RFA. The wound healing process was evaluated by computed tomography (CT), chromotrope anilinblue (CAB) staining of large-scale and standard tissue sections. Immunohistochemistry (IHC) for heat shock protein 70, Caspase-3, Ki67, Reelin, Vinculin, Vimentin and α-SMA was perfomed. One day after RFA, CAB staining showed cell damage and massive hyperaemia. All IHC markers were predominantly expressed at the outer borders of the lesion, except Reelin, which was mainly detected in untreated liver regions. By staining for Hsp70, the heat stress during RFA was monitored, which was most distinct 1-2 days after RFA. CT revealed decreased lesion size after one week. Development of a Vimentin and α-SMA positive fibrotic capsule was observed. In the early phase signs of cell damage, apoptosis and proliferation are dominant. Reduced expression of Reelin suggests a minor role of hepatic stellate cells in the RFA zone. After one week myofibroblasts become prominent and contribute to the development of the fibrotic capsule. This elucidates the pathophysiology of RFA and could contribute to the future optimization of RFA procedures.

Safety Assessment for the Kozloduy National Disposal Facility in Bulgaria - 13507

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

Biurrun, E.; Haverkamp, B.; Lazaro, A.

2013-07-01

Due to the early decommissioning of four Water-Water Energy Reactors (WWER) 440-V230 reactors at the Nuclear Power Plant (NPP) near the city of Kozloduy in Bulgaria, large amounts of low and intermediate radioactive waste will arise much earlier than initially scheduled. In or-der to manage the radioactive waste from the early decommissioning, Bulgaria has intensified its efforts to provide a near surface disposal facility at Radiana with the required capacity. To this end, a project was launched and assigned in international competition to a German-Spanish consortium to provide the complete technical planning including the preparation of the Intermediate Safety Assessmentmore » Report. Preliminary results of operational and long-term safety show compliance with the Bulgarian regulatory requirements. The long-term calculations carried out for the Radiana site are also a good example of how analysis of safety assessment results can be used for iterative improvements of the assessment by pointing out uncertainties and areas of future investigations to reduce such uncertainties in regard to the potential radiological impact. The computer model used to estimate the long-term evolution of the future repository at Radiana predicted a maximum total annual dose for members of the critical group, which is carried to approximately 80 % by C-14 for a specific ingestion pathway. Based on this result and the outcome of the sensitivity analysis, existing uncertainties were evaluated and areas for reasonable future investigations to reduce these uncertainties were identified. (authors)« less

WASH and gender in health care facilities: The uncharted territory.

PubMed

Kohler, Petra; Renggli, Samuel; Lüthi, Christoph

2017-11-08

Health care facilities in low- and middle-income countries are high-risk settings, and face special challenges to achieving sustainable water, sanitation, and hygiene (WASH) services. Our applied interdisciplinary research conducted in India and Uganda analyzed six dimensions of WASH services in selected health care facilities, including menstrual hygiene management. To be effective, WASH monitoring strategies in health care facilities must include gender sensitive measures. We present a novel strategy, showing that applied gender sensitive multitool assessments are highly productive in assessments of WASH services and facilities from user and provider perspectives. We discuss its potential for applications at scale and as an area of future research.

Radiofrequency ablation for postsurgical thyroid removal of differentiated thyroid carcinoma

PubMed Central

Xu, Dong; Wang, Lipin; Long, Bin; Ye, Xuemei; Ge, Minghua; Wang, Kejing; Guo, Liang; Li, Linfa

2016-01-01

Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy. Surgical removal with radioactive iodine therapy is recommended for recurrent thyroid carcinoma, and the postsurgical thyroid removal is critical. This study evaluated the clinical values of radiofrequency ablation (RFA) in the postsurgical thyroid removal for DTC. 35 DTC patients who had been treated by subtotal thyroidectomy received RFA for postsurgical thyroid removal. Before and two weeks after RFA, the thyroid was examined by ultrasonography and 99mTcO4 - thyroid imaging, and the serum levels of free triiodothyronine (FT3), free thyroxin (FT4), thyroid stimulating hormone (TSH) and thyroglobulin (Tg) were detected. The efficacy and complications of RFA were evaluated. Results showed that, the postsurgical thyroid removal by RFA was successfully performed in 35 patients, with no significant complication. After RFA, the average largest diameter and volume were significantly decreased in 35 patients (P > 0.05), and no obvious contrast media was observed in ablation area in the majority of patients. After RFA, the serum FT3, FT4 and Tg levels were markedly decreased (P < 0.05), and TSH level was significantly increased (P < 0.05). After RFA, radioiodine concentration in the ablation area was significantly reduced in the majority of patients. The reduction rate of thyroid update was 0.69±0.20%. DTC staging and interval between surgery and RFA had negative correlation (Pearson coefficient = -0.543; P = 0.001), with no obvious correlation among others influential factors. RFA is an effective and safe method for postsurgical thyroid removal of DTC. PMID:27186311

Systematic Review of Radiofrequency Ablation and Pulsed Radiofrequency for Management of Cervicogenic Headaches.

PubMed

Grandhi, Ravi K; Kaye, Alan David; Abd-Elsayed, Alaa

2018-02-23

Cervicogenic headache (CHA) is a secondary headache which has a source in the upper cervical spine. Many traditional analgesic choices lack good efficacy in managing the associated pain. As a result, in management of CHA, radiofrequency ablation (RFA) or pulse radiofrequency (PRF) has been tried with success. Our study investigated the use of RFA and PRF for the management of CHA. In the present investigation, a review of the literature was conducted using PubMed (1966 to February 2017). The quality assessment was determined using The Cochrane Risk of Bias. After initial search and consultation with experts, 34 articles were identified for initial review and 10 articles met inclusion for review. Criteria for inclusion were primarily based on identification of articles discussing cervicogenic headaches which were previously treatment resistant and occurred without any other pathology of the craniofacial region or inciting event such as trauma. This systematic review demonstrated that RFA and PRFA provide very limited benefit in the management of CHA. At present, there is no high-quality RCT and/or strong non-RCTs to support the use of these techniques, despite numerous case reports which have demonstrated benefit. This review is one of the first to provide a comprehensive overview of the use of RFA and PRF in the management of CHA.

Challenges Ahead for Nuclear Facility Site-Specific Seismic Hazard Assessment in France: The Alternative Energies and the Atomic Energy Commission (CEA) Vision

NASA Astrophysics Data System (ADS)

Berge-Thierry, C.; Hollender, F.; Guyonnet-Benaize, C.; Baumont, D.; Ameri, G.; Bollinger, L.

2017-09-01

Seismic analysis in the context of nuclear safety in France is currently guided by a pure deterministic approach based on Basic Safety Rule ( Règle Fondamentale de Sûreté) RFS 2001-01 for seismic hazard assessment, and on the ASN/2/01 Guide that provides design rules for nuclear civil engineering structures. After the 2011 Tohohu earthquake, nuclear operators worldwide were asked to estimate the ability of their facilities to sustain extreme seismic loads. The French licensees then defined the `hard core seismic levels', which are higher than those considered for design or re-assessment of the safety of a facility. These were initially established on a deterministic basis, and they have been finally justified through state-of-the-art probabilistic seismic hazard assessments. The appreciation and propagation of uncertainties when assessing seismic hazard in France have changed considerably over the past 15 years. This evolution provided the motivation for the present article, the objectives of which are threefold: (1) to provide a description of the current practices in France to assess seismic hazard in terms of nuclear safety; (2) to discuss and highlight the sources of uncertainties and their treatment; and (3) to use a specific case study to illustrate how extended source modeling can help to constrain the key assumptions or parameters that impact upon seismic hazard assessment. This article discusses in particular seismic source characterization, strong ground motion prediction, and maximal magnitude constraints, according to the practice of the French Atomic Energy Commission. Due to increases in strong motion databases in terms of the number and quality of the records in their metadata and the uncertainty characterization, several recently published empirical ground motion prediction models are eligible for seismic hazard assessment in France. We show that propagation of epistemic and aleatory uncertainties is feasible in a deterministic approach, as in a

Early Diagnosis of Scrub Typhus with a Rapid Flow Assay Using Recombinant Major Outer Membrane Protein Antigen (r56) of Orientia tsutsugamushi

PubMed Central

Ching, W.-M.; Rowland, D.; Zhang, Z.; Bourgeois, A. L.; Kelly, D.; Dasch, G. A.; Devine, P. L.

2001-01-01

The variable 56-kDa major outer membrane protein of Orientia tsutsugamushi is the immunodominant antigen in human scrub typhus infections. We developed a rapid immunochromatographic flow assay (RFA) for the detection of immunoglobulin M (IgM) and IgG antibodies to O. tsutsugamushi. The RFA employs a truncated recombinant 56-kDa protein from the Karp strain as the antigen. The performance of the RFA was evaluated with a panel of 321 sera (serial bleedings of 85 individuals suspected of scrub typhus) which were collected in the Pescadore Islands, Taiwan, from 1976 to 1977. Among these 85 individuals, IgM tests were negative for 7 cases by both RFA and indirect fluorescence assay (IFA) using Karp whole-cell antigen. In 29 cases specific responses were detected by the RFA earlier than by IFA, 44 cases had the same detection time, and 5 cases were detected earlier by IFA than by RFA. For IgG responses, 4 individuals were negative with both methods, 37 cases exhibited earlier detection by RFA than IFA, 42 cases were detected at the same time, and 2 cases were detected earlier by IFA than by RFA. The sensitivities of RFA detection of antibody in sera from confirmed cases were 74 and 86% for IgM and IgG, respectively. When IgM and IgG results were combined, the sensitivity was 89%. A panel of 78 individual sera collected from patients with no evidence of scrub typhus was used to evaluate the specificity of the RFA. The specificities of the RFA were 99% for IgM and 97% for IgG. The sensitivities of IFA were 53 and 73% for IgM and IgG, respectively, and were 78% when the results of IgM and IgG were combined. The RFA test was significantly better than the IFA test for the early detection of antibody to scrub typhus in primary infections, while both tests were equally sensitive with reinfected individuals. PMID:11238230

CesrTA Retarding Field Analyzer Modeling Results

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

Calvey, J.R.; Celata, C.M.; Crittenden, J.A.

2010-05-23

Retarding field analyzers (RFAs) provide an effective measure of the local electron cloud density and energy distribution. Proper interpretation of RFA data can yield information about the behavior of the cloud, as well as the surface properties of the instrumented vacuum chamber. However, due to the complex interaction of the cloud with the RFA itself, understanding these measurements can be nontrivial. This paper examines different methods for interpreting RFA data via cloud simulation programs. Techniques include postprocessing the output of a simulation code to predict the RFA response; and incorporating an RFA model into the cloud modeling program itself.

The Modification of Fluorescein Angiography and Its Applications in Age-Related Macular Degeneration and Polypoidal Choroidal Vasculopathy.

PubMed

Peng, Qing; Chen, Yutong; Hua, Rui

2018-06-07

To establish a novel retinal angiography method, red-free angiography (RFA), to investigate retinal changes in age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). Following the venous phase of fundus fluorescein angiography (FFA), the detection mode was switched to red-free reflectance to acquire RFA images using the same parameters. RFA showed subretinal fluid, polyps, and outer retinal tubulation, with a higher definition than the FFA and red-free reflectance results. The absorption coefficients in RFA provided more detailed images for AMD and PCV diagnosis. RFA is therefore a promising approach to supplement FFA. © 2018 S. Karger AG, Basel.

Assessing Organizational Readiness for a Participatory Occupational Health/Health Promotion Intervention in Skilled Nursing Facilities.

PubMed

Zhang, Yuan; Flum, Marian; West, Cheryl; Punnett, Laura

2015-09-01

The long-term care sector is characterized by high morbidity and employee turnover, along with associated costs. Effective health protection and health promotion are important to improve physical and psychosocial well-being of caregivers. Assessment of organizational readiness for change is an essential precursor to the successful implementation of workplace programs addressing work climate, structure of tasks and relationships, and other issues that may be perceived as challenging by some within the institution. This study qualitatively assessed readiness of five skilled nursing facilities for a participatory occupational health/health promotion intervention. Selection criteria were developed to screen for program feasibility and ability to conduct prospective evaluations, and information was collected from managers and employees (interviews and focus groups). Three centers were selected for the program, and the first year of formative evaluation and intervention experience was then reviewed to evaluate and modify our selection criteria after the fact. Lessons learned include adding assessment of communication and the structure of problem solving to our selection criteria, improving methods to assess management support in a concrete (potentially nonverbal) form, and obtaining a stated financial commitment and resources to enable the team to function. Assessment of organizational readiness for change is challenging, although necessary to implement effective and sustainable health promotion programs in specific organizations. © 2015 Society for Public Health Education.

Can India's primary care facilities deliver? A cross-sectional assessment of the Indian public health system's capacity for basic delivery and newborn services.

PubMed

Sharma, Jigyasa; Leslie, Hannah H; Regan, Mathilda; Nambiar, Devaki; Kruk, Margaret E

2018-06-04

To assess input and process capacity for basic delivery and newborn (intrapartum care hereafter) care in the Indian public health system and to describe differences in facility capacity between rural and urban areas and across states. Cross-sectional study. Data from the nationally representative 2012-2014 District Level Household and Facility Survey, which includes a census of community health centres (CHC) and sample of primary health centres (PHC) across 30 states and union territories in India. 8536 PHCs and 4810 CHCs. We developed a summative index of 33 structural and process capacity items matching the Indian Public Health Standards for PHCs as a metric of minimum facility capacity for intrapartum care. We assessed differences in performance on this index across facility type and location. About 30% of PHCs and 5% of CHCs reported not offering any intrapartum care. Among those offering services, volumes were low: median monthly delivery volume was 8 (IQR=13) in PHCs and 41 (IQR=73) in CHCs. Both PHCs and CHCs failed to meet the national standards for basic intrapartum care capacity. Mean facility capacity was low in PHCs in both urban (0.64) and rural (0.63) areas, while in CHCs, capacity was slightly higher in urban areas (0.77vs0.74). Gaps were most striking in availability of skilled human resources and emergency obstetric services. Poor capacity facilities were more concentrated in the more impoverished states, with 37% of districts from these states receiving scores in the lowest third of the facility capacity index (<0.70), compared with 21% of districts otherwise. Basic intrapartum care capacity in Indian public primary care facilities is weak in both rural and urban areas, especially lacking in the poorest states with worst health outcomes. Improving maternal and newborn health outcomes will require focused attention to quality measurement, accountability mechanisms and quality improvement. Policies to address deficits in skilled providers and

Summary Report of Ecological Risk Assessment for the Operation of the Explosives Waste Treatment Facility at Site 300 of the Lawrence Livermore National Laboratory.

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

Gallegos, Gretchen M.; Terusaki, Stan H.

2013-12-01

An ecological risk assessment is required as part of the Resource Recovery and Conservation Act (RCRA) permit renewal process for Miscellaneous Units subject to 22 CCR 66270.23. This risk assessment is prepared in support of the RCRA permit renewal for the Explosives Waste Treatment Facility (EWTF) at Site 300 of the Lawrence Livermore National Laboratory (LLNL). LLNL collected soil samples and used the resulting data to produce a scoping-level ecological risk assessment pursuant to the Department of Toxic Substances Control, Guidance for Ecological Risk Assessment at Hazardous Waste Sites and Permitted Facilities, Part A: Overview, July 4, 1996. The scoping-levelmore » ecological risk assessment provides a framework to determine the potential interaction between ecological receptors and chemicals of concern from hazardous waste treatment operations in the area of EWTF. A scoping-level ecological risk assessment includes the step of conducting soil sampling in the area of the treatment units. The Sampling Plan in Support of the Human Health and Ecological Risk Assessment for the Operation of the Explosives Waste Treatment Facility at Site 300 of the Lawrence Livermore National Laboratory, (Terusaki, 2007), outlines the EWTF project-specific soil sampling requirements. Soil samples were obtained and analyzed for constituents from four chemical groups: furans, explosives, semi-volatiles and metals. Analytical results showed that furans, explosives and semi-volatiles were not detected; therefore, no further analysis was conducted. The soil samples did show the presence of metals. Soil samples analyzed for metals were compared to site-wide background levels, which had been developed for site -wide cleanup activities pursuant to the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA). Total metal concentrations from 28 discrete soil samples obtained in the EWTF area were all below CERCLA-developed background levels. Therefore, following DTSC

Survey of EPA facilities for solar thermal energy applications

NASA Technical Reports Server (NTRS)

Nelson, E. V.; Overly, P. T.; Bell, D. M.

1980-01-01

A study was done to assess the feasibility of applying solar thermal energy systems to EPA facilities. A survey was conducted to determine those EPA facilities where solar energy could best be used. These systems were optimized for each specific application and the system/facility combinations were ranked on the basis of greatest cost effectiveness.

Systems test facilities existing capabilities compilation

NASA Technical Reports Server (NTRS)

Weaver, R.

1981-01-01

Systems test facilities (STFS) to test total photovoltaic systems and their interfaces are described. The systems development (SD) plan is compilation of existing and planned STFs, as well as subsystem and key component testing facilities. It is recommended that the existing capabilities compilation is annually updated to provide and assessment of the STF activity and to disseminate STF capabilities, status and availability to the photovoltaics program.

The Impact of Laparoscopic Approaches on Short-term Outcomes in Patients Undergoing Liver Surgery for Metastatic Tumors.

PubMed

Karagkounis, Georgios; Seicean, Andreea; Berber, Eren

2015-06-01

To compare the perioperative outcomes associated with open and laparoscopic (LAP) surgical approaches for liver metastases. The American College of Surgeons National Surgical Quality Improvement Program database was used to identify all adult patients who underwent surgical therapy for metastatic liver tumors between 2006 and 2012 (N=7684). Patients who underwent >1 procedure were excluded. Logistic regression after matching on propensity scores was used to assess the association between surgical approaches and perioperative outcomes. A total of 4555 patients underwent open resection, 387 LAP resection, 297 open radiofrequency ablation (RFA), and 265 LAP RFA. In propensity-matched samples (over 95% of patients successfully matched), there was no significant difference between LAP resection and LAP RFA in perioperative complications and length of stay and both compared favorably with their open counterparts. Minimally invasive approaches for secondary hepatic malignancies were associated with improved postoperative morbidity and length of stay and should be preferred in appropriate patients.

Novel Percutaneous Radiofrequency Ablation of Portal Vein Tumor Thrombus: Safety and Feasibility

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

Mizandari, Malkhaz; Ao, Guokun; Zhang Yaojun

2013-02-15

We report our experience of the safety of partial recanalization of the portal vein using a novel endovascular radiofrequency (RF) catheter for portal vein tumor thrombosis. Six patients with liver cancer and tumor thrombus in the portal vein underwent percutaneous intravascular radiofrequency ablation (RFA) using an endovascular bipolar RF device. A 0.035-inch guidewire was introduced into a tributary of the portal vein and through which a 5G guide catheter was introduced into the main portal vein. After manipulation of the guide catheter over the thrombus under digital subtraction angiography, the endovascular RF device was inserted and activated around the thrombus.more » There were no observed technique specific complications, such as hemorrhage, vessel perforation, or infection. Post-RFA portography showed partial recanalization of portal vein. RFA of portal vein tumor thrombus in patients with hepatocellular carcinoma is technically feasible and warrants further investigation to assess efficacy compared with current recanalization techniques.« less

Advanced Hypervelocity Aerophysics Facility Workshop

NASA Technical Reports Server (NTRS)

Witcofski, Robert D. (Compiler); Scallion, William I. (Compiler)

1989-01-01

The primary objective of the workshop was to obtain a critical assessment of a concept for a large, advanced hypervelocity ballistic range test facility powered by an electromagnetic launcher, which was proposed by the Langley Research Center. It was concluded that the subject large-scale facility was feasible and would provide the required ground-based capability for performing tests at entry flight conditions (velocity and density) on large, complex, instrumented models. It was also concluded that advances in remote measurement techniques and particularly onboard model instrumentation, light-weight model construction techniques, and model electromagnetic launcher (EML) systems must be made before any commitment for the construction of such a facility can be made.

Ecological risk assessment of landfill air emissions from a hazardous waste management facility in Ontario

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

Durda, J.L.; Suit-Kowalski, L.; Preziosi, D.

1997-12-31

An ecological risk assessment was conducted to evaluate the potential for adverse environmental impacts associated with chemicals released to air as a result of a proposed expansion of a hazardous waste landfill in Ontario. The purpose of the risk assessment was to characterize ecological risks associated with the proposed expansion relative to those associated with the existing landfill and those that would exist if the current landfill was completely closed and background conditions prevailed. The ecological risk assessment was one part of a comprehensive environmental impact assessment of the proposed landfill continuation that was being performed under the requirements ofmore » Ontario`s Environmental Assessment Act. Air monitoring data from the facility were used to identify a list of 141 chemicals potentially released during landfill continuation, as well as to characterize current emissions and background chemical levels. An ecological risk-based chemical screening process that considered background concentration, source strength, environmental partitioning, bioaccumulation potential, and toxicity was used to select a group of 23 chemicals for detailed evaluation in the ecological risk assessment. Dispersion, deposition, partitioning and bioaccumulation modeling were used to predict potential exposures in ecological receptors. Receptors were selected for evaluation based on regional habitat characteristics, exposure potential, toxicant sensitivity, ecological significance, population status, and societal value. Livestock and agricultural crop and pasture species were key receptors for the assessment, given the highly agricultural nature of the study area. In addition, native wildlife species, including the endangered Henslow`s sparrow and the regionally vulnerable pugnose minnow, also were considered.« less

Factors associated with initial incomplete ablation for benign thyroid nodules after radiofrequency ablation: First results of CEUS evaluation.

PubMed

Zhao, Chong-Ke; Xu, Hui-Xiong; Lu, Feng; Sun, Li-Ping; He, Ya-Ping; Guo, Le-Hang; Li, Xiao-Long; Bo, Xiao-Wan; Yue, Wen-Wen

2017-01-01

To assess the factors associated with initial incomplete ablation (ICA) after radiofrequency ablation for benign thyroid nodules (BTNs). 69 BTNs (mean volume 6.35±5.66 ml, range 1.00-25.04 ml) confirmed by fine-needle aspiration cytology (FNAC) in fifty-four patients were treated with ultrasound-guided percutaneous radiofrequency ablation (RFA) and the local treatment efficacy was immediately assessed by intra-procedural contrast-enhanced ultrasound (CEUS). The RFA was performed with a bipolar electrode (CelonProSurge 150-T20, output power: 20 W). CEUS was performed with a second generation contrast agent under low acoustic power (i.e. coded phase inversion, CPI). Characteristics of clinical factors, findings on conventional gray-scale ultrasound, color-Doppler ultrasound, and CEUS were evaluated preoperatively. Factors associated with initial ICA and initial ICA patterns on CEUS were assessed. Volume reduction ratios (VRRs) of ICA nodules were compared with those with complete ablation (CA). The RFA procedures were accomplished with a mean ablation time and mean total energy deposition of 11.13±3.39 min (range, 5.38-22.13 min) and 12612±4466 J (range, 6310-26130 J) respectively. CEUS detected initial ICA in 21 of 69 (30.8%) BTNs and 16 (76.2%) of the 21 BTNs with initial ICA achieved CA after additional RFA, leading to a final CA rate of 92.8% (64/69). The factors associated with initial ICA were predominantly solid nodule, nodule close to danger triangle area, nodule close to carotid artery, and peripheral blood flow on color-Doppler ultrasound (all P < 0.05). The mean VRRs of all BTNs were 23.4%, 54.4% and 81.9% at the 1-, 3- and 6-month follow-up, respectively. All BTNs achieved therapeutic success in this series in that all had VRRs of >50% at the 6-month follow-up, among which 7 nodules (10.1%) had VRRs of >90%. There were significant differences in VRRs between ICA nodules and CA nodules at the 3- and 6-month follow-up (all P < 0

33 CFR 106.305 - Facility Security Assessment (FSA) requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... available to maintain essential services; (vi) The essential maintenance equipment and storage areas; (vii... procedures relating to essential services; (v) Measures to protect radio and telecommunication equipment... property, or economic disruption, of an attack on or at the OCS facility; and (7) Locations where access...

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

PubMed Central

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Assessment of Environmental Contamination with Pathogenic Bacteria at a Hospital Laundry Facility.

PubMed

Michael, Karen E; No, David; Daniell, William E; Seixas, Noah S; Roberts, Marilyn C

2017-11-10

Little is known about exposure to pathogenic bacteria among industrial laundry workers who work with soiled clinical linen. To study worker exposures, an assessment of surface contamination was performed at an industrial laundry facility serving hospitals in Seattle, WA, USA. Surface swab samples (n = 240) from the environment were collected during four site visits at 3-month intervals. These samples were cultured for Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). Voluntary participation of 23 employees consisted of nasal swabs for detection of MRSA, observations during work, and questionnaires. Contamination with all three pathogens was observed in both dirty (laundry handling prior to washing) and clean areas (subsequent to washing). The dirty area had higher odds of overall contamination (≥1 pathogen) than the clean area (odds ratio, OR = 18.0, 95% confidence interval 8.9-36.5, P < 0.001). The odds of contamination were high for each individual pathogen: C. difficile, OR = 15.5; MRSA, OR = 14.8; and VRE, OR = 12.6 (each, P < 0.001). The highest odds of finding surface contamination occurred in the primary and secondary sort areas where soiled linens were manually sorted by employees (OR = 63.0, P < 0.001). The study substantiates that the laundry facility environment can become contaminated by soiled linens. Workers who handle soiled linen may have a higher risk of exposure to C. difficile, MRSA, and VRE than those who handle clean linens. Improved protocols for prevention and reduction of environmental contamination were implemented because of this study. © The Author 2017. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.

MicroRNA-34a expression is predictive of recurrence after radiofrequency ablation in early hepatocellular carcinoma.

PubMed

Cui, Xianping; Wu, Yaguang; Wang, Zhiyi; Liu, Xin; Wang, Shikang; Qin, Chengkun

2015-05-01

The prognosis of hepatocellular carcinoma (HCC) treated by radiofrequency ablation (RFA) is mainly associated with tumor recurrence. So far, no tissue biomarker of recurrence has been confirmed in biopsy specimens. Previous studies have reported that aberrant expression of microRNA-34a (miR-34a) is involved in oncogenesis and progression of HCC. The aim of this study was to investigate the prognostic value of tissue miR-34a expression in patients with HCC treated with RFA. Patients with early-stage single-nodule HCC treated with RFA were included, and tissue expression of miR-34a were assessed by quantitative reverse-transcription polymerase chain reaction. Main clinical endpoints were overall and early recurrence. The Kaplan-Meier method was used to plot recurrence curves and univariable and multivariable Cox regression analyses were performed to assess independent predictive factors for recurrence. Of 120 patients, recurrence occurred in 67 patients (55.8 %) with a median follow-up of 31 months. Forty-one patients (34.2 %) recurred within 2 years after RFA. The median miR-34a level was 0.87 (range 0.06-21.54). Low miR-34a level was associated with larger tumor size (P = 0.033) and higher serum alpha-fetoprotein (AFP) level (P = 0.004). When analyzed with a Cox regression model, the two independent predictive factors for overall recurrence were high serum AFP level (hazard ratio [HR] = 1.21; 95 % confidence interval [CI] = 1.04-1.36; P = 0.039) and low miR-34a level (HR = 1.44; 95 % CI = 1.13-1.72; P = 0.011). The expression of miR-34a was also an independent predictive factor for early recurrence (HR = 1.49; 95 % CI = 1.15-1.79; P = 0.008). Taken together, this study suggests that the expression of miR-34a in HCC biopsy specimens has an independent predictive value of early recurrence after RFA.

Importance of anticoagulation and postablation silent cerebral lesions: Subanalyses of REVOLUTION and reMARQable studies.

PubMed

Grimaldi, Massimo; Swarup, Vijay; DeVille, Brian; Sussman, Jonathan; Jaïs, Pierre; Gaita, Fiorenzo; Duytschaever, Mattias; Ng, G Andre; Daoud, Emile; Lakkireddy, Dhanunjaya Dj; Horton, Rodney; Wickliffe, Andrew; Ellis, Christopher; Geller, Laszlo

2017-12-01

Silent cerebral lesions (SCLs) are a potential complication of left atrial radiofrequency ablation (RFA) procedures for paroxysmal atrial fibrillation (PAF). We aimed to compare the incidence of SCLs in patients treated with irrigated RFA multielectrode catheters (nMARQ ® Catheter group) and irrigated focal RFA catheters (NAVISTAR ® THERMOCOOL ® Catheter; TC group) after PAF ablation from subpopulation neurological assessment (SNA) cohorts of the REVOLUTION and reMARQable studies. Data from SNA cohorts in the prospective, nonrandomized REVOLUTION study (March 2011-September 2013) and the prospective, randomized, controlled reMARQable study (October 2013-November 2015) were included. The incidence of SCLs was assessed pre- and postablation using magnetic resonance imaging. Neurological deficits were assessed using the National Institutes of Health Stroke Scale, modified Rankin Scale, and Montreal Cognitive Assessment. A total of 37 patients from REVOLUTION and 76 patients from reMARQable were included in the SNA cohort of each study. In the REVOLUTION SNA cohort, the incidence of SCLs was 21.1% (4/19) in the nMARQ ® Catheter group and 5.9% (1/17) in the TC group. Findings from REVOLUTION helped inform the reMARQable study protocol's stringent anticoagulation regimen. SCL incidence was subsequently reduced in both groups (nMARQ ® Catheter, 7.9%; TC, 3.3%). No permanent neurological deficits were observed. Adherence to a stringent anticoagulation regimen prior to and during ablation procedures appears to be an important factor in minimizing the risk of SCL. © 2017 Wiley Periodicals, Inc.

3D patient-specific models for left atrium characterization to support ablation in atrial fibrillation patients.

PubMed

Valinoti, Maddalena; Fabbri, Claudio; Turco, Dario; Mantovan, Roberto; Pasini, Antonio; Corsi, Cristiana

2018-01-01

Radiofrequency ablation (RFA) is an important and promising therapy for atrial fibrillation (AF) patients. Optimization of patient selection and the availability of an accurate anatomical guide could improve RFA success rate. In this study we propose a unified, fully automated approach to build a 3D patient-specific left atrium (LA) model including pulmonary veins (PVs) in order to provide an accurate anatomical guide during RFA and without PVs in order to characterize LA volumetry and support patient selection for AF ablation. Magnetic resonance data from twenty-six patients referred for AF RFA were processed applying an edge-based level set approach guided by a phase-based edge detector to obtain the 3D LA model with PVs. An automated technique based on the shape diameter function was designed and applied to remove PVs and compute LA volume. 3D LA models were qualitatively compared with 3D LA surfaces acquired during the ablation procedure. An expert radiologist manually traced the LA on MR images twice. LA surfaces from the automatic approach and manual tracing were compared by mean surface-to-surface distance. In addition, LA volumes were compared with volumes from manual segmentation by linear and Bland-Altman analyses. Qualitative comparison of 3D LA models showed several inaccuracies, in particular PVs reconstruction was not accurate and left atrial appendage was missing in the model obtained during RFA procedure. LA surfaces were very similar (mean surface-to-surface distance: 2.3±0.7mm). LA volumes were in excellent agreement (y=1.03x-1.4, r=0.99, bias=-1.37ml (-1.43%) SD=2.16ml (2.3%), mean percentage difference=1.3%±2.1%). Results showed the proposed 3D patient-specific LA model with PVs is able to better describe LA anatomy compared to models derived from the navigation system, thus potentially improving electrograms and voltage information location and reducing fluoroscopic time during RFA. Quantitative assessment of LA volume derived from our 3D LA

Radio frequency ablation of small renal tumors:: intermediate results.

PubMed

Hwang, J J; Walther, M M; Pautler, S E; Coleman, J A; Hvizda, J; Peterson, James; Linehan, W M; Wood, B J

2004-05-01

With evolving radio frequency technology, the clinical application of radio frequency ablation (RFA) has been actively investigated in the treatment for small renal tumors. We present our intermediate patient outcomes after RFA. Since January 2001, 17 patients with a total of 24 hereditary renal tumors ranging from 1.2 to 2.85 cm were treated with RFA using the 200 W Cool-tip RF System (Radionics, Burlington, Massachusetts) under laparoscopic (9) or percutaneous (8) guidance and had a minimum 1-year followup. A percutaneous approach was considered unsuitable if kidney tumors were contiguous to bowel, ureter or large vessels. Treatment eligibility criteria included an average tumor diameter of less than 3.0 cm, tumor growth during 1 year and solid appearance with contrast enhancement (HU change greater than 20) on computerized tomography (CT). Postoperative followup consisted of CT with and without intravenous contrast, and renal function assessment at regular intervals. Median patient age was 38 years (range 20 to 51). At a median followup of 385 days (range 342 to 691), median tumor or thermal lesion diameter decreased from 2.26 to 1.62 cm (p = 0.0013), and only 1 lesion (4%), which was located centrally near the hilum, exhibited contrast enhancement (HU change greater than 10) on CT at 12 months. Of the 15 renal tumors ablated laparoscopically, 13 were in direct contact with the bowel and 2 were abutting the ureter, necessitating mobilization before RFA. Laparoscopic ultrasound was used to guide radio frequency electrode placement and monitor the ablation process in these cases. Operative time and intraoperative blood loss (mean +/- standard mean of error) were 243 +/- 29 minutes and 67 +/- 9 cc, respectively. In 1 patient whose ureter was adherent to the tumor a ureteropelvic junction obstruction developed after laparoscopic RFA, requiring open repair. At the minimum 1-year followup 23 of 24 ablated tumors lacked contrast uptake on CT, meeting our radiographic

Determining the critical effective temperature and heat dispersal pattern in monopolar radiofrequency ablation using temperature-time integration

PubMed Central

TSENG, HOW; LIN, SEY-EN; CHANG, YEN-LIANG; CHEN, MING-HSU; HUNG, SHIH-HAN

2016-01-01

The radiofrequency ablation (RFA) lesion size is posited to be disproportionate to the total delivered energy, and temperature-time integration (TTI) may have a more critical effect on lesion size. The present study aimed to evaluate this hypothesis by determining the temperature threshold and temperature distribution over tissues during the RFA lesioning process. Using an ex vivo chicken tissue model and an in vivo rabbit model with RFA applied for 2 min under various target temperature settings, the resultant lesions were evaluated histologically using Masson's trichrome stain. The temperature distribution over the tissue during the RFA lesioning process was also determined using a VT02 Visual IR Thermometer. It was revealed that the thermal injury threshold for RFA in the chicken tissues was ~65°C, but that it ranged from 55–65°C in mammals. Using infra-red thermal imaging, the temperature gradient (from the center to the periphery) during the RFA lesioning process demonstrated a uniform heat diffusion pattern. This data supports the proposed hypothesis that TTI is a critical parameter in determining RFA lesion size and can be applied clinically using the following equation: [Target temperature − 55 (°C)] × time (sec) is proportional to RFA lesion size. PMID:26997990

Radiofrequency ablation-assisted liver resection: review of the literature and our experience

PubMed Central

Yao, Peng

2006-01-01

Background: Surgical resection is the best established treatment known to provide long-term survival and possibility of cure for liver malignancy. Intraoperative blood loss has been the major concern during major liver resections, and mortality and morbidity of surgery are clearly associated with the amount of blood loss. Different techniques have been developed to minimize intraoperative blood loss during liver resection. The radiofrequency ablation (RFA) technique has been used widely in the treatment of unresectable liver tumors. This review concentrates on the use of RFA to provide an avascular liver resection plane. Methods and results: The following review is based on two types of RFA device during liver resection: single needle probe RFA and the In-Line RFA device. Conclusion: Liver resection assisted by RFA is safe and is associated with very limited blood loss. PMID:18333135

Thyroid Radiofrequency Ablation: Updates on Innovative Devices and Techniques

PubMed Central

Park, Hye Sun; Park, Auh Whan; Chung, Sae Rom; Choi, Young Jun; Lee, Jeong Hyun

2017-01-01

Radiofrequency ablation (RFA) is a well-known, effective, and safe method for treating benign thyroid nodules and recurrent thyroid cancers. Thyroid-dedicated devices and basic techniques for thyroid RFA were introduced by the Korean Society of Thyroid Radiology (KSThR) in 2012. Thyroid RFA has now been adopted worldwide, with subsequent advances in devices and techniques. To optimize the treatment efficacy and patient safety, understanding the basic and advanced RFA techniques and selecting the optimal treatment strategy are critical. The goal of this review is to therefore provide updates and analysis of current devices and advanced techniques for RFA treatment of benign thyroid nodules and recurrent thyroid cancers. PMID:28670156

Radon Assessment of Occupational Facilities, Homestead ARB, FL

DTIC Science & Technology

2013-11-21

electrets is directly measured and used to calculate radon levels. The radon detectors were placed in the test locations for greater than 90 days in...of USAFSAM’s radon analysis. A proficiency test was last performed and passed on 18 July 2012. (2) Blanks: Six field blanks were used during the...voltage. 5. CONCLUSIONS AND RECOMMENDATIONS: a. All 46 facilities tested had radon concentrations below the action limit of 4 pCi/L; no radon

Assessment of laboratory logistics management information system practice for HIV/AIDS and tuberculosis laboratory commodities in selected public health facilities in Addis Ababa, Ethiopia.

PubMed

Desale, Adino; Taye, Bineyam; Belay, Getachew; Nigatu, Alemayehu

2013-01-01

Logistics management information system for health commodities remained poorly implemented in most of developing countries. To assess the status of laboratory logistics management information system for HIV/AIDS and tuberculosis laboratory commodities in public health facilities in Addis Ababa. A cross-sectional descriptive study was conducted from September 2010-January 2011 at selected public health facilities. A stratified random sampling method was used to include a total of 43 facilities which, were investigated through quantitative methods using structured questionnaires interviews. Focus group discussion with the designated supply chain managers and key informant interviews were conducted for the qualitative method. There exists a well-designed logistics system for laboratory commodities with trained pharmacy personnel, distributed standard LMIS formats and established inventory control procedures. However, majority of laboratory professionals were not trained in LMIS. Majority of the facilities (60.5%) were stocked out for at least one ART monitoring and TB laboratory reagents and the highest stock out rate was for chemistry reagents. Expired ART monitoring laboratory commodities were found in 25 (73.5%) of facilities. Fifty percent (50%) of the assessed hospitals and 54% of health centers were currently using stock/bin cards for all HIV/AIDS and TB laboratory commodities in main pharmacy store, among these only 25% and 20.8% of them were updated with accurate information matching with the physical count done at the time of visit for hospitals and health centers respectively. Even though there exists a well designed laboratory LMIS, keeping quality stock/bin cards and LMIS reports were very low. Key ART monitoring laboratory commodities were stock out at many facilities at the day of visit and during the past six months. Based on findings, training of laboratory personnel's managing laboratory commodities and keeping accurate inventory control procedures

Assessment of laboratory logistics management information system practice for HIV/AIDS and tuberculosis laboratory commodities in selected public health facilities in Addis Ababa, Ethiopia

PubMed Central

Desale, Adino; Taye, Bineyam; Belay, Getachew; Nigatu, Alemayehu

2013-01-01

Introduction Logistics management information system for health commodities remained poorly implemented in most of developing countries. To assess the status of laboratory logistics management information system for HIV/AIDS and tuberculosis laboratory commodities in public health facilities in Addis Ababa. Methods A cross-sectional descriptive study was conducted from September 2010-January 2011 at selected public health facilities. A stratified random sampling method was used to include a total of 43 facilities which, were investigated through quantitative methods using structured questionnaires interviews. Focus group discussion with the designated supply chain managers and key informant interviews were conducted for the qualitative method. Results There exists a well-designed logistics system for laboratory commodities with trained pharmacy personnel, distributed standard LMIS formats and established inventory control procedures. However, majority of laboratory professionals were not trained in LMIS. Majority of the facilities (60.5%) were stocked out for at least one ART monitoring and TB laboratory reagents and the highest stock out rate was for chemistry reagents. Expired ART monitoring laboratory commodities were found in 25 (73.5%) of facilities. Fifty percent (50%) of the assessed hospitals and 54% of health centers were currently using stock/bin cards for all HIV/AIDS and TB laboratory commodities in main pharmacy store, among these only 25% and 20.8% of them were updated with accurate information matching with the physical count done at the time of visit for hospitals and health centers respectively. Conclusion Even though there exists a well designed laboratory LMIS, keeping quality stock/bin cards and LMIS reports were very low. Key ART monitoring laboratory commodities were stock out at many facilities at the day of visit and during the past six months. Based on findings, training of laboratory personnel's managing laboratory commodities and keeping

Sandia National Laboratories: Locations: Kauai Test Facility

Science.gov Websites

Defense Systems & Assessments About Defense Systems & Assessments Program Areas Accomplishments Foundations Bioscience Computing & Information Science Electromagnetics Engineering Science Geoscience Suppliers iSupplier Account Accounts Payable Contract Information Construction & Facilities Contract

Can India’s primary care facilities deliver? A cross-sectional assessment of the Indian public health system’s capacity for basic delivery and newborn services

PubMed Central

Leslie, Hannah H; Regan, Mathilda; Nambiar, Devaki; Kruk, Margaret E

2018-01-01

Objectives To assess input and process capacity for basic delivery and newborn (intrapartum care hereafter) care in the Indian public health system and to describe differences in facility capacity between rural and urban areas and across states. Design Cross-sectional study. Setting Data from the nationally representative 2012–2014 District Level Household and Facility Survey, which includes a census of community health centres (CHC) and sample of primary health centres (PHC) across 30 states and union territories in India. Participants 8536 PHCs and 4810 CHCs. Outcome measures We developed a summative index of 33 structural and process capacity items matching the Indian Public Health Standards for PHCs as a metric of minimum facility capacity for intrapartum care. We assessed differences in performance on this index across facility type and location. Results About 30% of PHCs and 5% of CHCs reported not offering any intrapartum care. Among those offering services, volumes were low: median monthly delivery volume was 8 (IQR=13) in PHCs and 41 (IQR=73) in CHCs. Both PHCs and CHCs failed to meet the national standards for basic intrapartum care capacity. Mean facility capacity was low in PHCs in both urban (0.64) and rural (0.63) areas, while in CHCs, capacity was slightly higher in urban areas (0.77vs0.74). Gaps were most striking in availability of skilled human resources and emergency obstetric services. Poor capacity facilities were more concentrated in the more impoverished states, with 37% of districts from these states receiving scores in the lowest third of the facility capacity index (<0.70), compared with 21% of districts otherwise. Conclusions Basic intrapartum care capacity in Indian public primary care facilities is weak in both rural and urban areas, especially lacking in the poorest states with worst health outcomes. Improving maternal and newborn health outcomes will require focused attention to quality measurement, accountability mechanisms and

Barriers to providing palliative care in long-term care facilities

PubMed Central

Brazil, Kevin; Bédard, Michel; Krueger, Paul; Taniguchi, Alan; Kelley, Mary Lou; McAiney, Carrie; Justice, Christopher

2006-01-01

OBJECTIVE To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. DESIGN Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. SETTING All licensed LTC facilities in Ontario with designated medical directors. PARTICIPANTS Medical directors in the facilities. MAIN OUTCOME MEASURES Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. RESULTS Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff’s capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice

Barriers to providing palliative care in long-term care facilities.

PubMed

Brazil, Kevin; Bédard, Michel; Krueger, Paul; Taniguchi, Alan; Kelley, Mary Lou; McAiney, Carrie; Justice, Christopher

2006-04-01

To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. All licensed LTC facilities in Ontario with designated medical directors. Medical directors in the facilities. Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67

Human Health and Ecological Risk Assessment for the Operation of the Explosives Waste Treatment Facility at Site 300 of the Lawrence Livermore National Laboratory

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

Gallegos, G; Daniels, J; Wegrecki, A

2007-10-01

This document contains the human health and ecological risk assessment for the Resource Recovery and Conservation Act (RCRA) permit renewal for the Explosives Waste Treatment Facility (EWTF). Volume 1 is the text of the risk assessment, and Volume 2 (provided on a compact disc) is the supporting modeling data. The EWTF is operated by the Lawrence Livermore National Laboratory (LLNL) at Site 300, which is located in the foothills between the cities of Livermore and Tracy, approximately 17 miles east of Livermore and 8 miles southwest of Tracy. Figure 1 is a map of the San Francisco Bay Area, showingmore » the location of Site 300 and other points of reference. One of the principal activities of Site 300 is to test what are known as 'high explosives' for nuclear weapons. These are the highly energetic materials that provide the force to drive fissionable material to criticality. LLNL scientists develop and test the explosives and the integrated non-nuclear components in support of the United States nuclear stockpile stewardship program as well as in support of conventional weapons and the aircraft, mining, oil exploration, and construction industries. Many Site 300 facilities are used in support of high explosives research. Some facilities are used in the chemical formulation of explosives; others are locations where explosive charges are mechanically pressed; others are locations where the materials are inspected radiographically for such defects as cracks and voids. Finally, some facilities are locations where the machined charges are assembled before they are sent to the onsite test firing facilities, and additional facilities are locations where materials are stored. Wastes generated from high-explosives research are treated by open burning (OB) and open detonation (OD). OB and OD treatments are necessary because they are the safest methods for treating explosives wastes generated at these facilities, and they eliminate the requirement for further handling and

Nutritional Assessment of the Ft. Riley Non-Commissioned Officer Academy Dining Facility

DTIC Science & Technology

1987-05-01

Initiatives, Revised Armed Forces Recipe Service, Cholesterol Consumption, Sodium, Fat Reduction, Visual Portion Estimation. Garrison Dining Facility...moderate cholesterol intakes vii i Ue should be evaluated. Revised Armed Forces Recipe Service recipes with reduced salt content should be tested and...preparation methods used and recipes followed in the NCO Academy Dining Facility. Standard recipes from the Armed Forces Recipe Service Tri-Service

Charter School Facilities: A Resource Guide on Development and Financing.

ERIC Educational Resources Information Center

Jakubowski, Lara

This manual provides information to help charter schools navigate the facility development process, including worksheets that can be customized to suit a particular school's needs. Sections cover how facility planning fits into business planning for charter schools, review a process for assessing a school's facility needs, and summarize how to…

Coupled Facility/Payload Vibration Modeling Improvements

NASA Technical Reports Server (NTRS)

Carnahan, Timothy M.; Kaiser, Michael

2015-01-01

A major phase of aerospace hardware verification is vibration testing. The standard approach for such testing is to use a shaker to induce loads into the payload. In preparation for vibration testing at NASA/GSFC there is an analysis to assess the responses of the payload. A new method of modeling the test is presented that takes into account dynamic interactions between the facility and the payload. This dynamic interaction has affected testing in the past, but been ignored or adjusted for during testing. By modeling the combination of the facility and test article (payload) it is possible to improve the prediction of hardware responses. Many aerospace test facilities work in similar way to those at NASA Goddard Space Flight Center. Lessons learned here should be applicable to other test facilities with similar setups.

Thermal Ablation in the Management of Adrenal Metastasis Originating from Non-small Cell Lung Cancer: A 5-year Single-center Experience

PubMed Central

Botsa, Evanthia I; Thanou, Ioanna L; Papatheodoropoulou, Aspasia T; Thanos, Loukas I

2017-01-01

Background: Treatment of adrenal metastasis from lung carcinoma may prolong survival in the selected patients. However, not all patients can undergo surgery; thus, minimally invasive ablation procedures such as radiofrequency ablation (RFA) and microwave ablation (MWA) have gained acceptance as alternative treatment methods. This study summarized a 5-year single-center experience regarding the evaluation of safety and efficacy of computed tomography (CT)-guided thermal ablation in the management of adrenal metastasis originating from non-small cell lung cancer (NSCLC). Methods: The data of NSCLC patients ablated for adrenal metastasis at the Department of Diagnostic Imaging and Interventional Radiology, General Hospital Sotiria, were retrospectively analyzed. Patients were divided into two groups: RFA group and MWA group according to the therapeutic approaches. Preprocedural blood tests included measurement of international normalized ratio, partial thromboplastin time, and platelet enumeration. A dual-phase contrast-enhanced spiral CT was performed immediately after the procedure to assess the immediate response after ablation and to screen for related complications. Follow-up was performed with CT or magnetic resonance imaging at 1, 3, 6 months and 1 year after ablation and every 6 months thereafter. Results: A total of 99 ablation sessions in 71 patients with adrenal metastasis originating from NSCLC were included in the final analysis. Self-limited, postablation syndrome occurred in 16/99 (16.1%) of ablation sessions. All procedures were technically successful. Immediate postablation imaging showed no contrast enhancement of the ablated tumor in all patients. Follow-up imaging at 3 months revealed local tumor progression in 8 (22.8%) patients of the RFA group and 7 (19.4%) patients of MWA group, all of them underwent a second session successfully. The 1-year assessment revealed local recurrence of the ablated tumor in six patients (17.1%) of RFA group and seven

A geographical assessment of vegetation carbon stocks and greenhouse gas emissions on potential microalgae-based biofuel facilities in the United States.

PubMed

Quiroz Arita, Carlos; Yilmaz, Özge; Barlak, Semin; Catton, Kimberly B; Quinn, Jason C; Bradley, Thomas H

2016-12-01

The microalgae biofuels life cycle assessments (LCA) present in the literature have excluded the effects of direct land use change (DLUC) from facility construction under the assumption that DLUC effects are negligible. This study seeks to model the greenhouse gas (GHG) emissions of microalgae biofuels including DLUC by quantifying the CO 2 equivalence of carbon released to the atmosphere through the construction of microalgae facilities. The locations and types of biomass and Soil Organic Carbon that are disturbed through microalgae cultivation facility construction are quantified using geographical models of microalgae productivity potential including consideration of land availability. The results of this study demonstrate that previous LCA of microalgae to biofuel processes have overestimated GHG benefits of microalgae-based biofuels production by failing to include the effect of DLUC. Previous estimations of microalgae biofuel production potential have correspondingly overestimated the volume of biofuels that can be produced in compliance with U.S. environmental goals. Copyright © 2016 Elsevier Ltd. All rights reserved.

Retarding field energy analyzer for the Saskatchewan Torus-Modified plasma boundary

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

Dreval, M.; Rohraff, D.; Xiao, C.

2009-10-15

The retarding field energy analyzer (RFA) is a simple and reliable diagnostic technique to measure the ion temperature in the scrape-off layer and edge of magnetic fusion devices. Design and operation features of a single-sided (facing the ion flow) RFA for ion temperature measurements in the Saskatchewan Torus-Modified (STOR-M) tokamak are described. Its compact size (21x15x20 mm{sup 3}) allows RFA measurements without perturbing plasma significantly. Both ion and electron temperature have been measured by RFA in the STOR-M tokamak. A method is proposed to correct the effects of ion flow on the ion temperature using the simultaneously measured Mach number.more » The measured electron temperature is consistent with the previously reported Langmuir probe data. Abnormal behavior of the RFA has been observed in both ion and electron modes when RFA is inserted deep into the plasma.« less

Adjuvant percutaneous radiofrequency ablation of feeding artery of hepatocellular carcinoma before treatment

PubMed Central

Hou, Yi-Bin; Chen, Min-Hua; Yan, Kun; Wu, Jin-Yu; Yang, Wei

2009-01-01

AIM: To evaluate the feasibility and efficacy of percutaneous radiofrequency ablation (RFA) of the feeding artery of hepatocellular carcinoma (HCC) in reducing the blood-flow-induced heat-sink effect of RFA. METHODS: A total of 154 HCC patients with 177 pathologically confirmed hypervascular lesions participated in the study and were randomly assigned into two groups. Seventy-one patients with 75 HCCs (average tumor size, 4.3 ± 1.1 cm) were included in group A, in which the feeding artery of HCC was identified by color Doppler flow imaging, and were ablated with multiple small overlapping RFA foci [percutaneous ablation of feeding artery (PAA)] before routine RFA treatment of the tumor. Eighty-three patients with 102 HCC (average tumor size, 4.1 ± 1.0 cm) were included in group B, in which the tumors were treated routinely with RFA. Contrast-enhanced computed tomography was used as post-RFA imaging, when patients were followed-up for 1, 3 and 6 mo. RESULTS: In group A, feeding arteries were blocked in 66 (88%) HCC lesions, and the size of arteries decreased in nine (12%). The average number of punctures per HCC was 2.76 ± 1.12 in group A, and 3.36 ± 1.60 in group B (P = 0.01). The tumor necrosis rate at 1 mo post-RFA was 90.67% (68/75 lesions) in group A and 90.20% (92/102 lesions) in group B. HCC recurrence rate at 6 mo post-RFA was 17.33% (13/75) in group A and 31.37% (32/102) in group B (P = 0.04). CONCLUSION: PAA blocked effectively the feeding artery of HCC. Combination of PAA and RFA significantly decreased post-RFA recurrence and provided an alternative treatment for hypervascular HCC. PMID:19496195

Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh

PubMed Central

2017-01-01

Background Signal functions for emergency obstetric and newborn care (EmONC) are the major interventions for averting maternal and neonatal mortalities. Readiness of the facilities is essential to provide all the basic and comprehensive signal functions for EmONC to ensure emergency services from the designated facilities. The study assessed population coverage and availability of EmONC services in public and private facilities in Bangladesh. Methods An assessment was conducted in all the public and private facilities providing obstetric care in to in-patients 24 districts. Data were collected on the performance of signal functions for EmONC from the study facilities in the last three months prior to the date of assessment. Trained data-collectors interviewed the facility managers and key service providers, along with review of records, using contextualized tools. Population coverage of signal functions was assessed by estimating the number of facilities providing the signal functions for EmONC compared to the United Nations requirements. Availability was assessed in terms of the proportion of facilities providing the services by type of facilities and by district. Results Caesarean section (CS) delivery and blood transfusion (BT) services (the two major components of comprehensive EmONC) were respectively available in 6.4 (0.9 public and 5.5 private) and 5.6 (1.3 public and 4.3 private) facilities per 500,000 population. The signal functions for basic EmONC, except two (parental anticonvulsants and assisted vaginal delivery), were available in a minimum of 5 facilities (public and private sectors combined) per 500,000 population. A major inter-district variation in the availability of signal functions was observed in each public- and private-sector facility. Among the various types of facilities, only the public medical college hospitals had all the signal functions. The situation was poor in other public facilities at the district and sub-district levels as well

Emergency obstetric and newborn care signal functions in public and private facilities in Bangladesh.

PubMed

Roy, Lumbini; Biswas, Taposh Kumar; Chowdhury, Mahbub Elahi

2017-01-01

Signal functions for emergency obstetric and newborn care (EmONC) are the major interventions for averting maternal and neonatal mortalities. Readiness of the facilities is essential to provide all the basic and comprehensive signal functions for EmONC to ensure emergency services from the designated facilities. The study assessed population coverage and availability of EmONC services in public and private facilities in Bangladesh. An assessment was conducted in all the public and private facilities providing obstetric care in to in-patients 24 districts. Data were collected on the performance of signal functions for EmONC from the study facilities in the last three months prior to the date of assessment. Trained data-collectors interviewed the facility managers and key service providers, along with review of records, using contextualized tools. Population coverage of signal functions was assessed by estimating the number of facilities providing the signal functions for EmONC compared to the United Nations requirements. Availability was assessed in terms of the proportion of facilities providing the services by type of facilities and by district. Caesarean section (CS) delivery and blood transfusion (BT) services (the two major components of comprehensive EmONC) were respectively available in 6.4 (0.9 public and 5.5 private) and 5.6 (1.3 public and 4.3 private) facilities per 500,000 population. The signal functions for basic EmONC, except two (parental anticonvulsants and assisted vaginal delivery), were available in a minimum of 5 facilities (public and private sectors combined) per 500,000 population. A major inter-district variation in the availability of signal functions was observed in each public- and private-sector facility. Among the various types of facilities, only the public medical college hospitals had all the signal functions. The situation was poor in other public facilities at the district and sub-district levels as well as in private facilities

Radiofrequency ablation during continuous saline infusion can extend ablation margins

PubMed Central

Ishikawa, Toru; Kubota, Tomoyuki; Horigome, Ryoko; Kimura, Naruhiro; Honda, Hiroki; Iwanaga, Akito; Seki, Keiichi; Honma, Terasu; Yoshida, Toshiaki

2013-01-01

AIM: To determine whether fluid injection during radiofrequency ablation (RFA) can increase the coagulation area. METHODS: Bovine liver (1-2 kg) was placed on an aluminum tray with a return electrode affixed to the base, and the liver was punctured by an expandable electrode. During RFA, 5% glucose; 50% glucose; or saline fluid was infused continuously at a rate of 1.0 mL/min through the infusion line connected to the infusion port. The area and volume of the thermocoagulated region of bovine liver were determined after RFA. The Joule heat generated was determined from the temporal change in output during the RFA experiment. RESULTS: No liquid infusion was 17.3 ± 1.6 mL, similar to the volume of a 3-cm diameter sphere (14.1 mL). Mean thermocoagulated volume was significantly larger with continuous infusion of saline (29.3 ± 3.3 mL) than with 5% glucose (21.4 ± 2.2 mL), 50% glucose (16.5 ± 0.9 mL) or no liquid infusion (17.3 ± 1.6 mL). The ablated volume for RFA with saline was approximately 1.7-times greater than for RFA with no liquid infusion, representing a significant difference between these two conditions. Total Joule heat generated during RFA was highest with saline, and lowest with 50% glucose. CONCLUSION: RFA with continuous saline infusion achieves a large ablation zone, and may help inhibit local recurrence by obtaining sufficient ablation margins. RFA during continuous saline infusion can extend ablation margins, and may be prevent local recurrence. PMID:23483097

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.

Percutaneous radiofrequency ablation of lung tumors in a large animal model.

PubMed

Ahrar, Kamran; Price, Roger E; Wallace, Michael J; Madoff, David C; Gupta, Sanjay; Morello, Frank A; Wright, Kenneth C

2003-08-01

Percutaneous radiofrequency ablation (RFA) is accepted therapy for liver tumors in the appropriate clinical setting, but its use in lung neoplasms remains investigational. We undertook this study to evaluate the feasibility and immediate effectiveness of RFA for treatment of both solitary pulmonary nodules and clusters of lung tumors in a large animal model. Percutaneous RFA of 14 lung tumors in five dogs was performed under CT guidance. Animals were euthanatized 8-48 hours after the procedure. The lungs and adjacent structures were harvested for gross and histopathologic evaluation. Five solitary pulmonary nodules (range, 17-26 mm) and three clusters of three nodules each (range, 7-17 mm per nodule) were treated with RFA. All ablations were technically successful. Perilesional ground-glass opacity and small asymptomatic pneumothoraces (n = 4) were visualized during the RFA sessions. One dog developed a large pneumothorax treated with tube thoracostomy but was euthanatized 8 hours post-RFA for persistent pneumothorax and continued breathing difficulty. Follow-up CT 48 hours post-RFA revealed opacification of the whole lung segment. Gross and histopathologic evaluation showed complete thermal coagulation necrosis of all treated lesions without evidence of any viable tumor. The region of thermal coagulation necrosis typically extended to the lung surface. Small regions of pulmonary hemorrhage and congestion often surrounded the areas of coagulation necrosis. RFA can be used to treat both solitary pulmonary nodules and clusters of tumor nodules in the canine lung tumor model. This model may be useful for development of specific RFA protocols for human lung tumors.

Feasibility of liquid nitrogen cryotherapy after failed radiofrequency ablation for Barrett's esophagus.

PubMed

Trindade, Arvind J; Inamdar, Sumant; Kothari, Shivangi; Berkowitz, Joshua; McKinley, Matthew; Kaul, Vivek

2017-09-01

Radiofrequency ablation (RFA) for dysplastic Barrett's esophagus (BE) is highly effective. RFA failures are infrequent but can be a challenging cohort to manage. There are limited data on the feasibility of liquid nitrogen cryospray ablation for complete eradication of dysplasia (CE-D) and/or intestinal metaplasia (CE-IM) after RFA has failed to achieve CE-IM in patients with dysplastic BE. This is a retrospective review from two medical centers of prospectively maintained databases looking at patients that underwent liquid nitrogen cryospray ablation for refractory intestinal metaplasia post failed RFA. Eighteen patients were identified that met inclusion criteria. Eleven patients had persistent dysplasia and IM following RFA and seven had persistent non-dysplastic IM. More than 80% of patients were male with long-segment BE (median length 8 cm). Seventy two percent of patients with dysplasia achieved CE-D after cryotherapy. Fifty percent (9/18) of all RFA failures achieved CE-IM with cryotherapy. In comparison, RFA has a CE-IM of 78% in a less challenging treatment naïve cohort from a large-scale meta-analysis of 3802 patients. No adverse events occurred in our cohort. Cryospray ablation is feasible and safe for achieving CE-D and CE-IM after RFA failure. The CE-D rates are high with cryotherapy in this population. CE-IM with cryotherapy is acceptable in this difficult-to-treat cohort when compared to CE-IM rates with RFA in dysplastic BE treatment naïve patients (50% vs 78%). © 2017 Japan Gastroenterological Endoscopy Society.