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Sample records for intra-operative planning day

  1. Rectal dosimetry following prostate brachytherapy with stranded seeds--comparison of transrectal ultrasound intra-operative planning (day 0) and computed tomography-postplanning (day 1 vs. day 30) with special focus on sources placed close to the rectal wall.

    PubMed

    Pinkawa, Michael; Asadpour, Branka; Piroth, Marc D; Gagel, Bernd; Klotz, Jens; Fischedick, Karin; Borchers, Holger; Jakse, Gerhard; Eble, Michael J

    2009-05-01

    The aim of the study was to compare intra-operative and postplanning at different intervals with special focus on sources placed close to the rectal wall. In 61 consecutive patients, CT scans were performed on day 1 and day 30 after an I-125 implant with stranded seeds. The number of sources < or =7 mm to the rectal wall was determined, and displacements were analyzed. The angulation of strands relative to rectal wall was compared between intra-operative transrectal ultrasound (TRUS) and both postplanning CT scans. Sources close to the rectum on day 1 (n=204) have been the most apical in a strand in 98.5% (n=201). By comparing day 1 and day 30 data, significant inferior source displacements (mean 3.6 mm; p=0.02) relative to pelvic bones and a decreasing distance to the rectal wall (mean 1.2 mm; p<0.01)--consequentially increasing rectal dose--were determined only for sources initially > or =3 mm to the rectum. In contrast to an almost parallel arrangement of the needle track and the rectal wall in TRUS, strands and rectal wall converged towards the apex in the postplanning CT scans (mean >30 degrees). Posterior preplanning margins around the prostate should be particularly limited at the level of the prostate apex.

  2. Registration-free laparoscope augmentation for intra-operative liver resection planning

    NASA Astrophysics Data System (ADS)

    Feuerstein, Marco; Mussack, Thomas; Heining, Sandro M.; Navab, Nassir

    2007-03-01

    In recent years, an increasing number of liver tumor indications were treated by minimally invasive laparoscopic resection. Besides the restricted view, a major issue in laparoscopic liver resection is the enhanced visualization of (hidden) vessels, which supply the tumorous liver segment and thus need to be divided prior to the resection. To navigate the surgeon to these vessels, pre-operative abdominal imaging data can hardly be used due to intraoperative organ deformations mainly caused by appliance of carbon dioxide pneumoperitoneum and respiratory motion. While regular respiratory motion can be gated and synchronized intra-operatively, motion caused by pneumoperitoneum is individual for every patient and difficult to estimate. Therefore, we propose to use an optically tracked mobile C-arm providing cone-beam CT imaging capability intraoperatively. The C-arm is able to visualize soft tissue by means of its new flat panel detector and is calibrated offline to relate its current position and orientation to the coordinate system of a reconstructed volume. Also the laparoscope is optically tracked and calibrated offline, so both laparoscope and C-arm are registered in the same tracking coordinate system. Intra-operatively, after patient positioning, port placement, and carbon dioxide insufflation, the liver vessels are contrasted and scanned during patient exhalation. Immediately, a three-dimensional volume is reconstructed. Without any further need for patient registration, the volume can be directly augmented on the live laparoscope video, visualizing the contrasted vessels. This augmentation provides the surgeon with advanced visual aid for the localization of veins, arteries, and bile ducts to be divided or sealed.

  3. Day-care for breast cancer: ambulatory surgery and intra-operative radiation. Techniques and preliminary results of the Centre Val-d'Aurelle--Montpellier.

    PubMed

    Mourregot, A; Lemanski, C; Gutowski, M; Colombo, P-E; Charissoux, M; Dubois, J-B; Azria, D; Saint-Aubert, B; Domergue, J; Mathieu-Daude, H; Rouanet, P

    2014-04-01

    One-day breast carcinoma treatment is defined as association of ambulatory surgery and intra-operative irradiation. Selection and rigorous process of patients is the key to success. The surgical technique is not changed by the radiotherapy. Patient's satisfaction index is very high. Financial loss should not be a hurdle to its implementation.

  4. SU-E-T-285: Revisiting the Nomogram for Intra-Operative Planning Based Pd-103 Brachytherapy

    SciTech Connect

    Narayanan, S; Cho, P

    2014-06-01

    Purpose: The seed implant technique at our institution involves using a published nomogram for seed ordering based on CT based volume studies of the prostate. Ultrasound volume studies are subsequently used in the operating room for planning a modified peripheral loading with urethra sparing seed implant. The purpose of this study is to determine the appropriate modality for prostate volume measurement and creating an updated nomogram for intra-operative planning specific to our technique for pd-103 brachytherapy for efficient seed ordering. Methods: Prostate volumes based on pre-implant CT (Pre-CT), intra-operative ultrasound (TRUS), and post-implant CT (post-CT) studies as well as the total airkerma strength (AKS) of the implants were analyzed for 135 seed implant cases (69 monotherapy, 66 boost). Regression analysis was performed to derive the relationship between the total AKS and pre-CT and TRUS volumes. The correlation between TRUS and pre-CT volumes and TRUS and post-CT volumes were also studied. Results: Ultrasound based prostate volume exhibited a stronger correlation with total AKS than the pre-implant CT volume (R{sup 2} = 0.97 vs 0.88 for monotherapy and 0.96 vs 0.89 for boost). In general the pre-CT overestimated the prostate volume leading to ordering of a larger number of seeds and thus leading to higher number of unused/wasted seeds. Newly derived TRUS based nomogram was better suited for our technique than the published data. The post-implant CT volume closely followed the ultrasound volume (R{sup 2} = 0.88) as compared to pre-implant CT volumes (R{sup 2} = 0.57). Conclusion: In an era of costconscious health care where waste reduction is of utmost importance, an updated technique-specific nomogram is useful for ordering optimal number of seeds resulting in significant cost savings. In addition, our study shows that ultrasound based prostate volume is a better predictor for seed ordering for intra-operative planning than pre-implant CT.

  5. Pre-operative planning and intra-operative guidance in modern neurosurgery: a review of 300 cases.

    PubMed Central

    Wadley, J.; Dorward, N.; Kitchen, N.; Thomas, D.

    1999-01-01

    Operative neurosurgery has recently entered an exciting era of image guided surgery or neuronavigation and application of this novel technology is beginning to have a significant impact in many ways in a variety of intracranial procedures. In order to fully assess the advantages of image guided techniques over conventional planning and surgery in selected cases, detailed prospective evaluation has been carried out during the advanced development of an optically tracked neuronavigation system. Over a 2-year period, 300 operative neurosurgical procedures have been performed with the assistance of interactive image guidance, as well as the development of new software applications and hardware tools. A broad range of intracranial neurosurgical procedures were seen to benefit from image guidance, including 163 craniotomies, 53 interactive stereotactic biopsies, 7 tracked neuroendoscopies and 37 complex skull base procedures. The most common pathological diagnoses were cerebral glioma in 98 cases, meningioma in 64 and metastasis in 23. Detailed analysis of a battery of postoperative questions revealed benefits in operative planning, appreciation of anatomy, lesion location, safety of surgery and greatly enhanced surgical confidence. The authors believe that image guided surgical technology, with new developments such as those described, has a significant role to play in contemporary neurosurgery and its widespread adoption in practice will be realised in the near future. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 PMID:10615186

  6. Reliability of the Planned Pedicle Screw Trajectory versus the Actual Pedicle Screw Trajectory using Intra-operative 3D CT and Image Guidance

    PubMed Central

    Ledonio, Charles G.; Hunt, Matthew A.; Siddiq, Farhan; Polly, David W.

    2016-01-01

    Background Technological advances, including navigation, have been made to improve safety and accuracy of pedicle screw fixation. We evaluated the accuracy of the virtual screw placement (Stealth projection) compared to actual screw placement (intra-operative O-Arm) and examined for differences based on the distance from the reference frame. Methods A retrospective evaluation of prospectively collected data was conducted from January 2013 to September 2013. We evaluated thoracic and lumbosacral pedicle screws placed using intraoperative O-arm and Stealth navigation by obtaining virtual screw projections and intraoperative O-arm images after screw placement. The screw trajectory angle to the midsagittal line and superior endplate was compared in the axial and sagittal views, respectively. Percent error and paired t-test statistics were then performed. Results Thirty-one patients with 240 pedicle screws were analyzed. The mean angular difference between the virtual and actual image in all screws was 2.17° ± 2.20° on axial images and 2.16° ± 2.24° on sagittal images. There was excellent agreement between actual and virtual pedicle screw trajectories in the axial and sagittal plane with ICC = 0.99 (95%CI: 0.992-0.995) (p<0.001) and ICC= 0.81 (95%CI: 0.759-0.855) (p<0.001) respectively. When comparing thoracic and lumbar screws, there was a significant difference in the sagittal angulation between the two distributions. No statistical differences were found distance from the reference frame. Conclusion The virtual projection view is clinically accurate compared to the actual placement on intra-operative CT in both the axial and sagittal views. There is slight imprecision (~2°) in the axial and sagittal planes and a minor difference in the sagittal thoracic and lumbar angulation, although these did not affect clinical outcomes. In general, we find that pedicle screw placement using intraoperative cone beam CT and navigation to be accurate and reliable, and as such

  7. Fitness Day. Lesson Plan.

    ERIC Educational Resources Information Center

    McNamara, Jeanne

    This lesson plan introduces students to the concept of supply and demand by appealing to bodily/kinesthetic intelligences. Students participate in a fitness class and then analyze the economic motives behind making an individual feel better after a fitness activity; i.e., analyzing how much an individual would pay for a drink and snack after a…

  8. Positioning control of the upper incisors in orthognathic surgery. Pre-operative planning with the Model Positioning Device and intra-operative application of the Sandwich Splint.

    PubMed

    Schwestka, R; Engelke, D; Zimmer, B; Kubein-Meesenburg, D

    1991-10-01

    In orthognathic surgery a three-dimensional positioning of the maxilla is possible by means of the Le Fort I osteotomy and subsequent maxillary movement. In treatment planning and at the time of surgery it is very important to achieve an exact positioning of the upper incisors in relation to the upper lip and the rest of the skull. The Model Positioning Device described here allows three-dimensional positioning of the upper incisors in one- or two-jaw surgery. The reference plane is the upper surface of the upper part of a semi-individually adjustable articulator. The application of the Sandwich Splint enables the three-dimensional positioning of the maxilla in relation to the rest of the skull. The Sandwich Splint ensures that the vertical position of the mandible in relation to the rest of the skull above the osteotomy plane is exactly reproducible in the pre- and post-operative situation in both model surgery and at time of surgery. To this mandibular position the maxilla is positioned in three dimensions, as preplanned. The vertical dimension, which is identically reproducible before and after surgery is measured with a caliper. After surgery the mandible can be rotated into the planned new intercuspidation.

  9. Intra-operative robotics: NeuroArm.

    PubMed

    Lang, Michael J; Greer, Alexander D; Sutherland, Garnette R

    2011-01-01

    This manuscript describes the development and ongoing integration of neuroArm, an image-guided MR-compatible robot. A neurosurgical robotics platform was developed, including MR-compatible manipulators, or arms, with seven degrees of freedom, a main system controller, and a human-machine interface. This system was evaluated during pre-clinical trials and subsequent clinical application, combined with intra-operative MRI, at both 1.5 and 3.0 T. An MR-compatible surgical robot was successfully developed and merged with ioMRI at both 1.5 or 3.0 T. Image-guidance accuracy and microsurgical capability were established in pre-clinical trials. Early clinical experience demonstrated feasibility and showed the importance of a master-slave configuration. Surgeon-directed manipulator control improved performance and safety. NeuroArm successfully united the precision and accuracy of robotics with the executive decision-making capability of the surgeon.

  10. Intra-operative implantation errors during Austin Moore Hemiarthroplasty.

    PubMed

    Naqvi, Zohaib Gulzar; Markhand, Javed Ali; Ahmed, Syed Kamran; Chinoy, Amin; Khan, Mansoor Ali

    2016-10-01

    Austin Moore hemiarthroplasty is an established treatment in elderly patients with neck of femur fractures. Being commonly performed, it is also associated with several technical errors of implantation which results in complications and failure requiring revision surgery. This retrospective pre- and post-operative radiographic study to determine the frequency of technical errors was conducted at the Indus Hospital, Karachi, and comprised data of 50 patients who underwent Austin Moore hemiarthroplasty between January and November 2016. Of the total, 29(58%%) patients had no error of implantation. Overhanging of prosthesis was observed in 21(42%) patients, followed by inadequate length of the neck remnant in 18(36%). Moreover, 8(16%) patients sustained intra-operative periprosthetic fractures managed with cerclage wire. Also, 33(66%) patients had a Dorr type-Afemur morphologic pattern. Hemiarthroplasty was found to be a technically demanding procedure associated with avoidable intra-operative implantation errors by proper preoperative planning, careful patient selection, proper training of surgeons, hence avoiding failure.

  11. Youth Field Day Planning Guide.

    ERIC Educational Resources Information Center

    Wisconsin State Dept. of Natural Resources, Madison.

    Youth field days expose children to outdoor activities, land use ethics, and habitat conservation and encourage adults to be mentors in these areas. A typical youth field day could have programs in archery, fishing, boating, shooting, or safety. The event requires a diverse steering committee that usually includes sporting clubs and state…

  12. Intra-Operative Indocyanine Green Angiography of the Parathyroid Gland.

    PubMed

    Vidal Fortuny, Jordi; Karenovics, Wolfram; Triponez, Frederic; Sadowski, Samira M

    2016-10-01

    Major complications of thyroid and parathyroid surgery are recurrent laryngeal nerve injuries and definitive hypoparathyroidism. The use of intra-operative Indocyanine Green Angiography for confirmation of vascular status of the parathyroid gland is reported here.

  13. Three-dimensional imaging in the context of minimally invasive and transcatheter cardiovascular interventions using multi-detector computed tomography: from pre-operative planning to intra-operative guidance.

    PubMed

    Schoenhagen, Paul; Numburi, Uma; Halliburton, Sandra S; Aulbach, Peter; von Roden, Martin; Desai, Milind Y; Rodriguez, Leonardo L; Kapadia, Samir R; Tuzcu, E Murat; Lytle, Bruce W

    2010-11-01

    The rapid expansion of less invasive surgical and transcatheter cardiovascular procedures for a wide range of cardiovascular conditions, including coronary, valvular, structural cardiac, and aortic disease has been paralleled by novel three-dimensional (3-D) approaches to imaging. Three-dimensional imaging allows acquisition of volumetric data sets and subsequent off-line reconstructions along unlimited 2-D planes and 3-D volumes. Pre-procedural 3-D imaging provides detailed understanding of the operative field for surgical/interventional planning. Integration of imaging modalities during the procedure allows real-time guidance. Because computed tomography routinely acquires 3-D data sets, it has been one of the early imaging modalities applied in the context of surgical and interventional planning. This review describes the continuum of applications from pre-operative planning to procedural integration, based on the emerging experience with computed tomography and rotational angiography, respectively. At the same time, the potential adverse effects of imaging with X-ray-based tomographic or angiographic modalities are discussed. It is emphasized that the role of imaging guidance in this context remains unclear and will need to be evaluated in clinical trials. This is in particular true, because data showing improved outcome or even non-inferiority for most of the emerging transcatheter procedures are still lacking.

  14. Intra-operative neurophysiology during microvascular decompression for hemifacial spasm.

    PubMed

    Fernández-Conejero, I; Ulkatan, S; Sen, C; Deletis, V

    2012-01-01

    There is evidence that primary hemifacial spasm (HFS) in the majority of patients is related to a vascular compression of the facial nerve at its root exit zone (REZ). As a consequence, the hyperexcitability of facial nerve generates spasms of the facial muscles. Microvascular decompression (MVD) of the facial nerve near its REZ has been established as an effective treatment of HFS. Intra-operative disappearance of abnormal muscle responses (lateral spread) elicited by stimulating one of the facial nerve branches has been used as a method to predict MVD effectiveness. Other neurophysiologic techniques, such as facial F-wave, blink reflex and facial corticobulbar motor evoked potentials (FCoMEP), are feasible to intra-operatively study changes in excitability of the facial nerve and its nucleus during MVDs. Intra-operative neuromonitoring with the mentioned techniques allows a better understanding of HFS pathophysiology and helps to optimise the MVD.

  15. Intra-operative optical diagnostics with vibrational spectroscopy.

    PubMed

    Stelling, Allison; Salzer, Reiner; Kirsch, Matthias; Sobottka, Stephan B; Geiger, Kathrin; Koch, Edmund; Schackert, Gabriele; Steiner, Gerald

    2011-07-01

    Established methods for characterization of tissue and diagnostics, for example histochemistry, magnetic resonance imaging (MRI), X-ray tomography, or positron emission tomography (PET), are mostly not suitable for intra-operative use. However, there is a clear need for an intra-operative diagnostics especially to identify the borderline between normal and tumor tissue. Currently, vibrational spectroscopy techniques (both Raman and infrared) complement the standard methods for tissue diagnostics. Vibrational spectroscopy has the potential for intra-operative use, because it can provide a biochemically based profile of tissue in real time and without requiring additional contrast agents, which may perturb the tissue under investigation. In addition, no electric potential needs to be applied, and the measurements are not affected by electromagnetic fields. Currently, promising approaches include Raman fiber techniques and nonlinear Raman spectroscopy. Infrared spectroscopy is also being used to examine freshly resected tissue ex vivo in the operating theater. The immense volume of information contained in Raman and infrared spectra requires multivariate analysis to extract relevant information to distinguish different types of tissue. The promise and limitations of vibrational spectroscopy methods as intra-operative tools are surveyed in this review.

  16. Photoacoustic intra-operative nodal staging using clinically approved superparamagnetic iron oxide nanoparticles

    NASA Astrophysics Data System (ADS)

    Grootendorst, Diederik J.; Fratila, Raluca M.; Visscher, Martijn; Ten Haken, Bennie; van Wezel, Richard; Steenbergen, Wiendelt; Manohar, Srirang; Ruers, Theo J. M.

    2013-02-01

    Detection of tumor metastases in the lymphatic system is essential for accurate staging of various malignancies, however fast, accurate and cost-effective intra-operative evaluation of the nodal status remains difficult to perform with common available medical imaging techniques. In recent years, numerous studies have confirmed the additional value of superparamagnetic iron oxide dispersions (SPIOs) for nodal staging purposes, prompting the clearance of different SPIO dispersions for clinical practice. We evaluate whether a combination of photoacoustic (PA) imaging and a clinically approved SPIO dispersion, could be applied for intra-operative nodal staging. Metastatic adenocarcinoma was inoculated in Copenhagen rats for 5 or 8 days. After SPIO injection, the lymph nodes were photoacoustically imaged both in vivo and ex vivo whereafter imaging results were correlated with MR and histology. Results were compared to a control group without tumor inoculation. In the tumor groups clear irregularities, as small as 1 mm, were observed in the PA contrast pattern of the nodes together with an decrease of PA response. These irregularities could be correlated to the absence of contrast in the MR images and could be linked to metastatic deposits seen in the histological slides. The PA and MR images of the control animals did not show these features. We conclude that the combination of photoacoustic imaging with a clinically approved iron oxide nanoparticle dispersion is able to detect lymph node metastases in an animal model. This approach opens up new possibilities for fast intra-operative nodal staging in a clinical setting.

  17. Trajectory optimization for intra-operative nuclear tomographic imaging.

    PubMed

    Vogel, Jakob; Lasser, Tobias; Gardiazabal, José; Navab, Nassir

    2013-10-01

    Diagnostic nuclear imaging modalities like SPECT typically employ gantries to ensure a densely sampled geometry of detectors in order to keep the inverse problem of tomographic reconstruction as well-posed as possible. In an intra-operative setting with mobile freehand detectors the situation changes significantly, and having an optimal detector trajectory during acquisition becomes critical. In this paper we propose an incremental optimization method based on the numerical condition of the system matrix of the underlying iterative reconstruction method to calculate optimal detector positions during acquisition in real-time. The performance of this approach is evaluated using simulations. A first experiment on a phantom using a robot-controlled intra-operative SPECT-like setup demonstrates the feasibility of the approach.

  18. Intra-operative correction of brain-shift.

    PubMed

    Reinertsen, Ingerid; Lindseth, Frank; Askeland, Christian; Iversen, Daniel Høyer; Unsgård, Geirmund

    2014-07-01

    Brain-shift is a major source of error in neuronavigation systems based on pre-operative images. In this paper, we present intra-operative correction of brain-shift using 3D ultrasound. The method is based on image registration of vessels extracted from pre-operative MRA and intra-operative power Doppler-based ultrasound and is fully integrated in the neuronavigation software. We have performed correction of brain-shift in the operating room during surgery and provided the surgeon with updated information. Here, we present data from seven clinical cases with qualitative and quantitative error measures. The registration algorithm is fast enough to provide the surgeon with updated information within minutes and accounts for large portions of the experienced shift. Correction of brain-shift can make pre-operative data like fMRI and DTI reliable for a longer period of time and increase the usefulness of the MR data as a supplement to intra-operative 3D ultrasound in terms of overview and interpretation.

  19. Pediatric awake craniotomy and intra-operative stimulation mapping.

    PubMed

    Balogun, James A; Khan, Osaama H; Taylor, Michael; Dirks, Peter; Der, Tara; Carter Snead Iii, O; Weiss, Shelly; Ochi, Ayako; Drake, James; Rutka, James T

    2014-11-01

    The indications for operating on lesions in or near areas of cortical eloquence balance the benefit of resection with the risk of permanent neurological deficit. In adults, awake craniotomy has become a versatile tool in tumor, epilepsy and functional neurosurgery, permitting intra-operative stimulation mapping particularly for language, sensory and motor cortical pathways. This allows for maximal tumor resection with considerable reduction in the risk of post-operative speech and motor deficits. We report our experience of awake craniotomy and cortical stimulation for epilepsy and supratentorial tumors located in and around eloquent areas in a pediatric population (n=10, five females). The presenting symptom was mainly seizures and all children had normal neurological examinations. Neuroimaging showed lesions in the left opercular (n=4) and precentral or peri-sylvian regions (n=6). Three right-sided and seven left-sided awake craniotomies were performed. Two patients had a history of prior craniotomy. All patients had intra-operative mapping for either speech or motor or both using cortical stimulation. The surgical goal for tumor patients was gross total resection, while for all epilepsy procedures, focal cortical resections were completed without any difficulty. None of the patients had permanent post-operative neurologic deficits. The patient with an epileptic focus over the speech area in the left frontal lobe had a mild word finding difficulty post-operatively but this improved progressively. Follow-up ranged from 6 to 27 months. Pediatric awake craniotomy with intra-operative mapping is a precise, safe and reliable method allowing for resection of lesions in eloquent areas. Further validations on larger number of patients will be needed to verify the utility of this technique in the pediatric population.

  20. Mini gamma cameras for intra-operative nuclear tomographic reconstruction.

    PubMed

    Matthies, Philipp; Gardiazabal, José; Okur, Aslı; Vogel, Jakob; Lasser, Tobias; Navab, Nassir

    2014-12-01

    Nuclear imaging modalities like PET or SPECT are in extensive use in medical diagnostics. In a move towards personalized therapy, we present a flexible nuclear tomographic imaging system to enable intra-operative SPECT-like 3D imaging. The system consists of a miniaturized gamma camera mounted on a robot arm for flexible positioning, while spatio-temporal localization is provided by an optical tracking system. To facilitate statistical tomographic reconstruction of the radiotracer distribution using a maximum likelihood approach, a precise model of the mini gamma camera is generated by measurements. The entire system is evaluated in a series of experiments using a hot spot phantom, with a focus on criteria relevant for the intra-operative workflow, namely the number of required imaging positions as well as the required imaging time. The results show that high quality reconstructed images of simple hot spot configurations with positional errors of less than one millimeter are possible within acquisition times as short as 15s.

  1. Intra-operative high frequency ultrasound improves surgery of intramedullary cavernous malformations.

    PubMed

    Bozinov, Oliver; Burkhardt, Jan-Karl; Woernle, Christoph M; Hagel, Vincent; Ulrich, Nils H; Krayenbühl, Niklaus; Bertalanffy, Helmut

    2012-04-01

    Intra-operative ultrasound (ioUS) is a very useful tool in surgery of spinal lesions. Here we focus on modern ioUS to analyze its use for localisation, visualisation and resection control in intramedullary cavernous malformations (IMCM). A series of 35 consecutive intradural lesions were operated in our hospital in a time period of 24 months using modern ioUS with a high frequency 7-15 MHz transducer and a true real time 3D transducer (both Phillips iU 22 ultrasound system). Six of those cases were treated with the admitting diagnosis of a deep IMCM (two cervical, four thoracic lesions). IoUS images were performed before and after the IMCM resection. Pre-operative and early postoperative MRI images were performed in all patients. In all six IMCM cases a complete removal of the lesion was achieved microsurgically resulting in an improved neurological status of all patients. High frequency ioUS emerged to be a very useful tool during surgery for localization and visualization. Excellent resection control by ultrasound was possible in three cases. Minor resolution of true real time 3D ioUS decreases the actual advantage of simultaneous reconstruction in two planes. High frequency ioUS is the best choice for intra-operative imaging in deep IMCM to localize and to visualize the lesion and to plan the perfect surgical approach. Additionally, high frequency ioUS is suitable for intra-operative resection control of the lesion in selected IMCM cases.

  2. Realistic Planning for the Day Care Consumer.

    ERIC Educational Resources Information Center

    Emlen, Arthur C.

    This paper questions public attitudes of disparagement toward child care that is privately arranged in neighborhood homes, and cites research to show that the widespread non-use of organized facilities is based on realistic alternative patterns of day care behavior. Some determinants of day care use are discussed, and an understanding of…

  3. Prediction of gross post-transplant outcomes based on the intra-operative decline in C-reactive protein in living donor liver transplantation.

    PubMed

    Chung, H S; Kim, E S; Park, J H; Park, C S

    2015-03-01

    C-reactive protein (CRP), a marker of infection and inflammation, is produced mainly in the liver. Its slow onset and various influencing factors have limited studies on the intra-operative changes in CRP in living donor liver transplantation (LDLT). In this study, we asked whether the intra-operative changes in CRP predicts post-transplant outcome. The peri-transplant data of 263 LDLT patients were reviewed. "Intra-operative CRP decline" was calculated by subtracting the pretransplant CRP from the 1-day post-transplant CRP. A negative value defined an intra-operative decline. Peri-transplant variables were compared between patients with and without gross post-transplant outcomes (GPOs), including death, allograft dysfunction, infection, and kidney injury. Multivariate logistic regression was used to develop a model to predict GPO, and area receiver operating characteristic curve (AUC) analysis was used to evaluate the prognostic accuracies for GPO. GPOs were determined in 95 LDLT patients (36.1%). GPO-positive patients had a lesser change in CRP levels (0.51 versus 1.16 mg/dL) and a higher incidence of a decline in CRP (34.7% versus 13.7%) during LDLT (P < .05) than did GPO-negative patients. The AUC of the intra-operative CRP change (0.585; P = .018) did not significantly differ from that of the pretransplant CRP. After multivariate adjustment, a patient with an intra-operative decline in CRP had a 3.21-fold higher risk for GPO occurrence (P = .001). GPO occurrence was related to the intra-operative decline of CRP in LDLT patients. However, multivariate compensation might be required for the clinical utilization of intra-operative decline in CRP as a prognostic indicator. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Comparison between real-time intra-operative ultrasound-based dosimetry and CT-based dosimetry for prostate brachytherapy using cesium-131.

    PubMed

    Jacobs, B L; Gibbons, E P; Smith, R P; Beriwal, S; Komanduri, K; Benoit, R M

    2008-12-01

    The purpose of this study was to evaluate the correlation between real-time intra-operative ultrasound-based dosimetry (USD) and day 0 post-implant CT dosimetry (CTD) (131)Cs permanent prostate brachytherapy. Fifty-two consecutive patients who underwent prostate brachytherapy with (131)Cs were evaluated. Real time operating room planning was performed using VariSeed 7.1 software. Post-needle placement prostate volume was used for real-time planning. Targets for dosimetry were D(90) >110%, V(100) >90%, V(150) <50%, and V(200) <20%. The CT scan for post-operative dosimetry was obtained on day 0. The mean values for USD, CTD, and the linear correlation, respectively, were, for D(90): 114.0%, 105.61%, and 0.15; for V(100): 95.1%, 91.6%, and 0.22; for V(150): 51.5%, 46.4%, and 0.40; and for V(200): 15.8%, 17.9%, and 0.42. The differences between the mean values for USD and CTD for D(90) (p<0.01), V(100) (p<0.01), and V(150) (p<0.05) were statistically significant. For D(90), 30.8% of patients had a >15% difference between USD and CTD and 51.9% of patients had a >10% difference between these values. In contrast, the USD and CTD for V(100) were within 5% in 55.8% of patients and within 10% in 86.5% of patients. This study demonstrates a correlation between the mean intra-operative USD and post-implant day 0 CTD values only for V(200). Significant variation in D(90), V(150), and V(200) values existed for individual patients between USD and CTD. These results suggest that real-time intra-operative USD does not serve as a surrogate for post-operative CTD, and that post-operative CTD is still necessary.

  5. Plans for a Business Education Day.

    ERIC Educational Resources Information Center

    National Consumer Finance Association, Washington, DC. Educational Services Div.

    The document is a manual for local consumer finance offices, to guide them in their participation as an industry in a Chamber of Commerce Business-Education Day, a program offered as a means for teachers and business executives to become better acquainted, exchange views, clear up misconceptions, and gain better insight into each other's problems.…

  6. Intra-Operative Lymphatic Mapping and Sentinel Node Biopsy in Laryngeal Carcinoma: Preliminary Results

    PubMed Central

    Khadivi, Ehsan; Daghighi, Maryam; Khazaeni, Kamran; Dabbagh Kakhki, Vahid Reza; Zarifmahmoudi, Leili; Sadeghi, Ramin

    2015-01-01

    Introduction: Sentinel node mapping has been used for laryngeal carcinoma in several studies, with excellent results thus far. In the current study, we report our preliminary results on sentinel node mapping in laryngeal carcinoma using intra-operative peri-tumoral injection of a radiotracer. Materials and Methods: Patients with biopsy-proven squamous cell carcinoma of the larynx were included in the study. Two mCi/0.4 cc Tc-99m-phytate in four aliquots was injected on the day of surgery, after induction of anesthesia, in the sub-mucosal peri-tumoral location using a suspension laryngoscopy. After waiting for 10 minutes, a portable gamma probe was used to search for sentinel nodes. All patients underwent laryngectomy and modified radical bilateral neck dissection. All sentinel nodes and removed non-sentinel nodes were examined by hematoxylin and eosin (H&E) staining. Results: Ten patients with laryngeal carcinoma were included. At least one sentinel node could be detected in five patients (bilateral nodes in four patients). One patient had pathologically involved sentinel and non-sentinel nodes (no false-negative cases). Conclusion: Sentinel node mapping in laryngeal carcinoma is technically feasible using an intra-operative radiotracer injection. In order to evaluate the relationship of T-stage and the laterality of the tumor with accuracy, larger studies are needed. PMID:26788477

  7. Intra-operative 3D guidance and edema detection in prostate brachytherapy using a non-isocentric C-arm

    PubMed Central

    Jain, A.; Deguet, A.; Iordachita, I.; Chintalapani, G.; Vikal, S.; Blevins, J.; Le, Y.; Armour, E.; Burdette, C.; Song, D.; Fichtinger, G.

    2015-01-01

    Purpose Brachytherapy (radioactive seed insertion) has emerged as one of the most effective treatment options for patients with prostate cancer, with the added benefit of a convenient outpatient procedure. The main limitation in contemporary brachytherapy is faulty seed placement, predominantly due to the presence of intra-operative edema (tissue expansion). Though currently not available, the capability to intra-operatively monitor the seed distribution, can make a significant improvement in cancer control. We present such a system here. Methods Intra-operative measurement of edema in prostate brachytherapy requires localization of inserted radioactive seeds relative to the prostate. Seeds were reconstructed using a typical non-isocentric C-arm, and exported to a commercial brachytherapy treatment planning system. Technical obstacles for 3D reconstruction on a non-isocentric C-arm include pose-dependent C-arm calibration; distortion correction; pose estimation of C-arm images; seed reconstruction; and C-arm to TRUS registration. Results In precision-machined hard phantoms with 40–100 seeds and soft tissue phantoms with 45–87 seeds, we correctly reconstructed the seed implant shape with an average 3D precision of 0.35 mm and 0.24 mm, respectively. In a DoD Phase-1 clinical trial on six patients with 48–82 planned seeds, we achieved intra-operative monitoring of seed distribution and dosimetry, correcting for dose inhomogeneities by inserting an average of over four additional seeds in the six enrolled patients (minimum 1; maximum 9). Additionally, in each patient, the system automatically detected intra-operative seed migration induced due to edema (mean 3.84 mm, STD 2.13 mm, Max 16.19 mm). Conclusions The proposed system is the first of a kind that makes intra-operative detection of edema (and subsequent re-optimization) possible on any typical non-isocentric C-arm, at negligible additional cost to the existing clinical installation. It achieves a

  8. Intra-operative probe for brain cancer: feasibility study

    NASA Astrophysics Data System (ADS)

    Vu Thi, M. H.; Charon, Y.; Duval, M. A.; Lefebvre, F.; Menard, L.; Pitre, S.; Pinot, L.; Siebert, R.

    2007-07-01

    The present work aims a new medical probe for surgeons devoted to brain cancers, in particular glioblastoma multiforme. Within the last years, our group has started the development of a new intra-operative beta imaging probe. More recently, we took an alternative approach for the same application: a fluorescence probe. In both cases the purpose is to differentiate normal from tumor brain tissue. In a first step, we developed set-ups capable to measure autofluorescence. They are based on a dedicated epi-fluorescence design and on specific fiber optic probes. Relative signal amplitude, spectral shape and fluorescence lifetime measurements are foreseen to distinguish normal and cancer tissue by analyzing fluorophores like NADH, lipopigments and porphyrines. The autofluorescence spectra are recorded in the 460-640 nm range with a low resolution spectrometer. For lifetime measurements a fast detector (APD) is used together with a TCSPC-carte. Intrinsic wavelength- and time-resolutions are a few nm and 200 ps, respectively. Different samples have been analyzed to validate our new detection system and to allow a first configuration of our medical fluorescence probe. First results from the tissue measurements are shown.

  9. Intra-operative augmented reality in distal locking.

    PubMed

    Londei, Roberto; Esposito, Marco; Diotte, Benoit; Weidert, Simon; Euler, Ekkehard; Thaller, Peter; Navab, Nassir; Fallavollita, Pascal

    2015-09-01

    To design an augmented reality solution that assists surgeons during the distal locking of intramedullary nailing procedures. Traditionally, the procedure is performed under X-ray guidance and requires a significant amount of time and radiation exposure. To absolve these complications, we propose video guidance that allows surgeons to achieve both the down-the-beam position of the intramedullary nail and its subsequent locking. For the down-the-beam position, the IM nail pose in X-ray is calculated using a 2D/3D registration scheme and later related to the patient leg pose which is calculated using video-tracked AR markers. For the distal locking, surgeons use an augmented radiolucent drill in which its tip position is detected and tracked in real-time under video guidance. To evaluate the feasibility of our solution, we performed a preclinical study on dry bone phantom with the participation of four clinicians. Participants achieved 100 % success rate in the down-the beam positioning and 93 % success rate in distal locking using only two X-ray images in 100 s. We confirmed that intra-operative navigation using augmented reality provides an alternative way to perform distal locking in a safe and timely manner.

  10. Intra-Operative Vertebroplasty Combined with Posterior Cord Decompression

    PubMed Central

    Allegretti, Luca; Mavilio, Nicola; Fiaschi, Pietro; Bragazzi, Roberto; Pacetti, Mattia; Castelletti, Lara; Saitta, Laura; Castellan, Lucio

    2014-01-01

    Summary Percutaneous vertebroplasty (VP) is a minimally invasive technique for the treatment of vertebral pathology providing early vertebral stabilization and pain relief. In cases of vertebral pathology complicated by spinal cord compression with associated neurological deficits, VP alone cannot be performed free of risks. We describe a combined approach in which decompressive laminectomy and intra-operative vertebroplasty (IVP) are performed during a single session. Among the 252 VP performed in our centre in the past three years, 12 patients (12 vertebral levels) with different pathologies (six symptomatic haemangiomas, two metastatic fractures, four osteoporotic fractures) were treated with an open procedure combined with surgery. All cases were treated with decompressive laminectomy and IVP (mono/bipeduncular or median-posterior trans-somatic access). Five patients with symptomatic haemangiomas were treated with endovascular embolization prior to the combined approach. A visual analogue scale (VAS) was applied to assess pain intensity before and after surgery. The neurological deficits were evaluated with an ASIA impairment scale. In all cases benefit from pain and neurological deficits was observed. The mean VAS score decreased from 7.8 to 2.5 after surgery. The ASIA score improved in all cases (five cases from D to E and five cases from C to D). No clinical complications were observed. In one case a CT scan performed after the procedure showed a foraminal accumulation of PMMA, but the patient referred no symptoms. IVP can be successfully applied in different pathologies affecting the vertebrae. In our limited series this approach proved safe and efficient to provide decompression of spinal cord and dural sac and vertebral body stabilization in a single session. PMID:25363261

  11. A Planning and Budget Management System for Day Care.

    ERIC Educational Resources Information Center

    Byers, Bruce B.

    Federal guidelines and pressures for accountability make it essential that more and better planning management information be made available concerning the delivery of day care services. With the existence of a fully developed and operational system, planning and management of resource allocations can be made that can lead to an improved quality…

  12. Percutaneous Tenolig(®) repair under intra-operative ultrasonography guidance in acute Achilles tendon rupture.

    PubMed

    Lacoste, S; Féron, J M; Cherrier, B

    2014-12-01

    Acute Achilles tendon rupture can be treated conservatively or surgically. Open surgery restores tendon continuity but carries a risk of skin complications. Tenolig(®) is a device designed for the percutaneous biological treatment of acute Achilles tendon rupture. Earlier studies found high rates of recurrent tears and nerve injury after Tenolig(®) repair. We hypothesised that intra-operative ultrasonography during Tenolig(®) repair would decrease the post-operative complication rate and improve functional outcomes. We studied 75 consecutive patients with a mean age of 39.9 years. The injury was sports-related in 82.8% of cases. Mean distance from the calcaneal tendon attachment to the tear was 5cm and mean time from injury to repair was 4.2 days. All patients underwent Tenolig(®) repair under ultrasound guidance followed by early rehabilitation therapy with partial weight bearing started after 3 weeks. Mean follow-up was 20.7 months and no patient was lost to follow-up. A single patient (1.3%) experienced rerupture and none had permanent sural nerve damage. Mean time to sports resumption was 8.6 months, with two-thirds of patients returning to their previous level of sporting activities. The mean AOFAS functional score was 95 and the mean ATRS score was 91.3. Our experience suggests that intra-operative ultrasonography, a non-invasive, widely available, and accurate tool, provided improved control of Tenolig(®) suture position. Ultrasonography provided valuable guidance during this demanding procedure and allowed the very early initiation of rehabilitation therapy. Another crucial factor is patient education about the physical therapy programme. Attention to this point allowed us to obtain robust and reliable functional outcomes in a population predominantly composed of athletes. Level IV. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  13. Impact of right-handedness on anaesthetic sensitivity, intra-operative awareness and postoperative mortality.

    PubMed

    Rao, S; Huverserian, A R; Ben Abdallah, A; Lees, K; Willingham, M D; Burnside, B A; Villafranca, A J; Glick, D B; Jacobsohn, E; Avidan, M S

    2014-08-01

    Anatomical, neurological and behavioural research has suggested differences between the brains of right- and non-right-handed individuals, including differences in brain structure, electroencephalogram patterns, explicit memory and sleep architecture. Some studies have also found decreased longevity in left-handed individuals. We therefore aimed to determine whether handedness independently affects the relationship between volatile anaesthetic concentration and the bispectral index, the incidence of definite or possible intra-operative awareness with explicit recall, or postoperative mortality. We studied 5585 patients in this secondary analysis of data collected in a multicentre clinical trial. There were 4992 (89.4%) right-handed and 593 (10.6%) non-right-handed patients. Handedness was not associated with (a) an alteration in anaesthetic sensitivity in terms of the relationship between the bispectral index and volatile anaesthetic concentration (estimated effect on the regression relationship -0.52 parallel shift; 95% CI -1.27 to 0.23, p = 0.17); (b) the incidence of intra-operative awareness with 26/4992 (0.52%) right-handed vs 1/593 (0.17%) non-right-handed (difference = 0.35%; 95% CI -0.45 to 0.63%; p = 0.35); or (c) postoperative mortality rates (90-day relative risk for non-right-handedness 1.19, 95% CI 0.76-1.86; p = 0.45). Thus, no change in anaesthetic management is indicated for non-right-handed patients. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

  14. Intra-Operational Area Coordination: The Zone EOC Concept

    DTIC Science & Technology

    2015-09-01

    the four OES and Law Enforcement Mutual Aid System coordination zones taken from the Operation Cohesive Capability 2014–2015 exercise plan ...center EOD explosive ordnance disposal EOP emergency operations plan ESC Emergency Services Council ESRI Environmental Systems Research...staffing and training-exercise plans , and provision of appropriate facilities for the zone EOCs. The key elements of the concept of operations for the

  15. How to Plan a Theme Based Field Day

    ERIC Educational Resources Information Center

    Shea, Scott A.; Fagala, Lisa M.

    2006-01-01

    Having a theme-based field day is a great way to get away from doing the traditional track-and-field type events, such as the softball throw, 50 yard dash, and sack race, year after year. In a theme-based field day format all stations or events are planned around a particular theme. This allows the teacher to be creative while also adding…

  16. Celebrate Your Freedom. Law Day 1998 Planning Guide.

    ERIC Educational Resources Information Center

    White, Charles, Ed.

    This planning guide can serve as the basis for innovative Law Day observances all over the United States. The guide offers suggestions for programs for schools and people in the community, as well as creative ways to reach the media. It also presents resources and ideas for conveying how the United States Constitution restrains unlawful arrests,…

  17. The impact of intra-operative sufentanil dosing on post-operative pain, hyperalgesia and morphine consumption after cardiac surgery.

    PubMed

    Fechner, J; Ihmsen, H; Schüttler, J; Jeleazcov, C

    2013-04-01

    There is an ongoing debate whether opioids when used for intra-operative analgesia may enhance post-operative pain. We studied the effect of two different intra-operative dosings of sufentanil on post-operative morphine consumption, pain and hyperalgesia after cardiac anaesthesia. Forty-two male patients (age: 48-74 years) undergoing first-time coronary artery bypass graft surgery were randomized to one of two groups receiving total intravenous anaesthesia with propofol and a target controlled infusion of sufentanil with a target of 0.4 ng/mL (group SL, n = 20) or 0.8 ng/mL (group SH, n = 22) plasma concentration. Post-operative morphine requirement in the first 48 h was assessed using patient-controlled analgesia (PCA). Pain rating during deep inspiration, and the extent of primary and secondary hyperalgesia near the sternotomy wound were assessed. The post-operative morphine requirements in the first 48 h were 0.68 ± 0.21 mg/kg in group SL and 0.96 ± 0.44 mg/kg in group SH (p < 0.05). In group SL, pain during deep inspiration was significantly lower on the first post-operative day (p < 0.05). Primary hyperalgesia had its maximum on the second and third post-operative day, without a difference between the two groups. The extent of secondary mechanical pinprick hyperalgesia was not different between the groups. Intra-operative dosing of sufentanil significantly influenced post-operative morphine consumption, pain and hyperalgesia. For cardiac anaesthesia in combination with propofol, a sufentanil target concentration of 0.4 ng/mL may be preferable. © 2012 European Federation of International Association for the Study of Pain Chapters.

  18. Management of intra-operative acute pulmonary embolism during general anesthesia: a case report.

    PubMed

    Mao, Yuanyuan; Wen, Shuai; Chen, Gezi; Zhang, Wei; Ai, Yanqiu; Yuan, Jingjing

    2017-05-26

    Acute pulmonary embolism (APE) can be life-threatening. Early detection is even more difficult for patients under general anesthesia as common symptoms are not available and the pathophysiological course of intra-operative APE is influenced by procedures of surgery and anesthesia, which makes patients under general anesthesia a distinctive group. We report a case of APE during orthopedic surgery under general anesthesia. A 64-year-old female with atrial fibrillation and surgical history of varicosity underwent total right hip replacement surgery under general anesthesia. No arterial or deep vein thrombosis (DVT) was found prior to the surgery, but APE still occurred intraoperatively. The sudden decrease in PETCO2 and increase in PaCO2 combined other clues raised the suspect of APE, which is further evidenced by transesophageal echocardiogram (TEE). Multidisciplinary consultation was started immediately. After discussion with the consultation team and communication with patient's family members, anticoagulation therapy was started and IVC filter was placed to prevent PE recurrence. The patient went through the operation and discharged uneventfully 30 days later. Pulmonary embolism is a rare and potentially high-risk perioperative situation, with a difficult diagnosis when occurs under anesthesia. The separation phenomenon of decrease in PETCO2 and increase in PaCO2 might be a useful and suggestive sign, enabling prompt management and therefore improving the prognosis.

  19. The intra-operative radius joystick test to diagnose complete disruption of the interosseous membrane.

    PubMed

    Soubeyrand, M; Ciais, G; Wassermann, V; Kalouche, I; Biau, D; Dumontier, C; Gagey, O

    2011-10-01

    Disruption of the interosseous membrane is easily missed in patients with Essex-Lopresti syndrome. None of the imaging techniques available for diagnosing disruption of the interosseous membrane are completely dependable. We undertook an investigation to identify whether a simple intra-operative test could be used to diagnose disruption of the interosseous membrane during surgery for fracture of the radial head and to see if the test was reproducible. We studied 20 cadaveric forearms after excision of the radial head, ten with and ten without disruption of the interosseous membrane. On each forearm, we performed the radius joystick test: moderate lateral traction was applied to the radial neck with the forearm in maximal pronation, to look for lateral displacement of the proximal radius indicating that the interosseous membrane had been disrupted. Each of six surgeons (three junior and three senior) performed the test on two consecutive days. Intra-observer agreement was 77% (95% confidence interval (CI) 67 to 85) and interobserver agreement was 97% (95% CI 92 to 100). Sensitivity was 100% (95% CI 97 to 100), specificity 88% (95% CI 81 to 93), positive predictive value 90% (95% CI 83 to 94), and negative predictive value 100%). This cadaveric study suggests that the radius joystick test may be useful for detecting disruption of the interosseous membrane in patients undergoing open surgery for fracture of the radial head and is reproducible. A confirmatory study in vivo is now required.

  20. Intra-operative femoral neck fracture during attempted dislocation of a reduced hemi-arthroplasty.

    PubMed

    Ling, Samuel Ka Kin; Ma, Chun Man; Lui, Tun Hing

    2015-05-01

    Fragility hip fractures are increasingly common and hemiarthroplasty is one of the standard treatments. Although a common surgery, it should be performed with great caution because of the poor premorbid and bone quality in this demographic. Intra-operative fractures can occur while attempting press fit of the femoral implant. However; vigilance often steps down once the implant is secured and the hip reduced. This case report reminds surgeons that a large amount of torque can be transmitted during intra-operative positioning, such as during an attempt of hip dislocation. This torque, in addition to the risk factor of osteoporotic bone, can result in iatrogenic fractures. Published literature regarding management of an intra-operative fracture while the prosthetic hip is still reduced is lacking. The authors propose that temporary prophylactic cerclage wiring is a prudent and safe procedure prior to hip dislocation.

  1. Estimation of intra-operative brain shift using a tracked laser range scanner.

    PubMed

    Ding, Siyi; Miga, Michael I; Thompson, Reid C; Dumpuri, Prashanth; Cao, Aize; Dawant, Benoit M

    2007-01-01

    Intra-operative brain shift limits the usefulness of image-guided neurosurgery systems (IGNS), which are based on pre-operative images. Methods that are being developed to address this problem need intra-operative measurements as input. In this work, we present an intra-operative surface shift measurement technique that relies on a tracked 3D laser range scanner. This scanner acquires both 3D range data and 2D images, which are co-registered. We compare two methods to derive displacements at every point in the field of view. The first one relies on the registration of the 2D images; the second relies on the direct 3D registration of the 3D range data. Our results, based on five data sets, show that the 2D method is preferable.

  2. Intra-operative visualization of brain tumors with 5-aminolevulinic acid-induced fluorescence.

    PubMed

    Widhalm, Georg

    2014-01-01

    Precise histopathological diagnosis of brain tumors is essential for the correct patient management. Furthermore, complete resection of brain tumors is associated with an improved patient prognosis. However, histopathological undergrading and incomplete tumor removal are not uncommon, especially due to insufficient intra-operative visualization of brain tumor tissue. The fluorescent dye 5-aminolevulinic acid (5-ALA) is currently applied for fluorescence-guided resections of high-grade gliomas. The value of 5-ALA-induced protoporphyrin (PpIX) fluorescence for intra-operative visualization of other tumors than high-grade gliomas remains unclear. Within the frame of this thesis, we found a significantly higher rate of complete resections of our high-grade gliomas as compared to control cases by using the newly established 5-ALA fluorescence technology at our department. Additionally, we showed that MRI spectroscopy-based chemical shift imaging (CSI) is capable to identify intratumoral high-grade glioma areas (= anaplastic foci) during navigation guided resections to avoid histopathological undergrading. However, the accuracy of navigation systems with integrated pre-operative imaging data such as CSI declines during resections due to intra-operative brainshift. In two further studies, we found that 5-ALA induced PpIX fluorescence is capable as a novel intra-operative marker to detect anaplastic foci within initially suspected low-grade gliomas independent of brainshift. Finally, we showed that the application of 5-ALA is also of relevance in needle biopsies for intra-operative identification of representative brain tumor tissue. These data indicate that 5-ALA is not only of major importance for resection of high-grade gliomas, but also for intra-operative visualization of anaplastic foci as well as representative brain tumor tissue in needle biopsies unaffected by brainshift. Consequently, this new technique might become a novel standard in brain tumor surgery that

  3. Radiation protection for an intra-operative X-ray device

    PubMed Central

    Eaton, D J; Gonzalez, R; Duck, S; Keshtgar, M

    2011-01-01

    Objectives Therapeutic partial breast irradiation can be delivered intra-operatively using the Intrabeam 50 kVp compact X-ray device. Spherical applicators are added to the source to give an isotropic radiation dose. The low energy of this unit leads to rapid attenuation with distance, but dose rates are much greater than for diagnostic procedures. Methods To investigate the shielding requirements for this unit, attenuation measurements were carried out with manufacturer-provided tungsten–rubber sheets, lead, plasterboard and bricks. A prospective environmental dose rate survey was also conducted in the designated theatre. Results As a result of isotropic geometry, the scattered dose around shielding can be 1% of primary and thus often dominates measured dose rates compared with transmission. The absorbed dose rate of the unshielded source at 1 m was 11.6 mGy h−1 but this was reduced by 95% with the shielding sheets. Measured values for the common shielding materials were similar to reference data for the attenuation of a 50 kVp diagnostic X-ray beam. Two lead screens were constructed to shield operators remaining in the theatre and an air vent into a service corridor. A lead apron would also provide suitable attenuation, although a screen allows greater flexibility for treatment operators. With these measures, staff doses were reduced to negligible quantities. Survey measurements taken during patient treatments confirmed no additional measures were required, but the theatre should be a controlled area and access restricted. Conclusion Results from this study and reference data can be used for planning other facilities. PMID:21304003

  4. [Low field intra-operative magnetic resonance imaging for brain tumour surgery: preliminary experience].

    PubMed

    Roldán, Pedro; García, Sergio; González, Josep; Reyes, Luis Alberto; Torales, Jorge; Valero, Ricard; Oleaga, Laura; Enseñat, Joaquim

    Intra-operative magnetic resonance imaging (iMRI) is a recently introduced tool in the most advanced neurosurgical operating rooms worldwide. We present our preliminary experience in brain tumour surgery with low field PoleStar N30® intraoperative MRI since its introduction in 2013 in the Barcelona Clinic Hospital. A prospective non-randomised study was conducted on cases operated on using iMRI and intention of complete removal up to October 2015. A record was made of the data as regards surgical times, resection rates, histological diagnosis, hospital stay, and survival rates during follow-up. The study included 50 patients, with a mean age of 55 years (±13.7), a preoperative mean Karnofsky of 92 (being 81 post-operatively), and a mean follow-up of 10.5 months (±6.5). There were 26% re-operations due to recurrence. High-grade gliomas were reported in 56%, low-grade gliomas in 24%, and 20% "Other" tumours. Overall hospital stay was 10 days (±4.5). Depending on the histologiacl diagnosis, the "Others" group had a longer hospital stay. Overall, there were 52% complete removal, 18% of maximum removals, and 30% of partial removals. The overall survival rates during follow-up was 84%. iMRI is a safe and effective tool for brain tumour surgery. Its use allows an increase in resection rates, and minimises post-operative complications. Its implementation involves an increase in surgical time, which improves with the characteristic learning curve. More studies are needed to establish its role in the long-term survival of patients. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Use of virtual slide system for quick frozen intra-operative telepathology diagnosis in Kyoto, Japan

    PubMed Central

    Tsuchihashi, Yasunari; Takamatsu, Terumasa; Hashimoto, Yukimasa; Takashima, Tooru; Nakano, Kooji; Fujita, Setsuya

    2008-01-01

    We started to use virtual slide (VS) and virtual microscopy (VM) systems for quick frozen intra-operative telepathology diagnosis in Kyoto, Japan. In the system we used a digital slide scanner, VASSALO by CLARO Inc., and a broadband optic fibre provided by NTT West Japan Inc. with the best effort capacity of 100 Mbps. The client is the pathology laboratory of Yamashiro Public hospital, one of the local centre hospitals located in the south of Kyoto Prefecture, where a fulltime pathologist is not present. The client is connected by VPN to the telepathology centre of our institute located in central Kyoto. As a result of the recent 15 test cases of VS telepathology diagnosis, including cases judging negative or positive surgical margins, we could estimate the usefulness of VS in intra-operative remote diagnosis. The time required for the frozen section VS file making was found to be around 10 min when we use ×10 objective and if the maximal dimension of the frozen sample is less than 20 mm. Good correct focus of VS images was attained in all cases and all the fields of each tissue specimen. Up to now the capacity of best effort B-band appears to be sufficient to attain diagnosis on time in intra-operation. Telepathology diagnosis was achieved within 5 minutes in most cases using VS viewer provided by CLARO Inc. The VS telepathology system was found to be superior to the conventional still image telepathology system using a robotic microscope since in the former we can observe much greater image information than in the latter in a certain limited time of intra-operation and in the much more efficient ways. In the near future VS telepathology will replace conventional still image telepathology with a robotic microscope even in quick frozen intra-operative diagnosis. PMID:18673520

  6. Use of virtual slide system for quick frozen intra-operative telepathology diagnosis in Kyoto, Japan.

    PubMed

    Tsuchihashi, Yasunari; Takamatsu, Terumasa; Hashimoto, Yukimasa; Takashima, Tooru; Nakano, Kooji; Fujita, Setsuya

    2008-07-15

    We started to use virtual slide (VS) and virtual microscopy (VM) systems for quick frozen intra-operative telepathology diagnosis in Kyoto, Japan. In the system we used a digital slide scanner, VASSALO by CLARO Inc., and a broadband optic fibre provided by NTT West Japan Inc. with the best effort capacity of 100 Mbps. The client is the pathology laboratory of Yamashiro Public Hospital, one of the local centre hospitals located in the south of Kyoto Prefecture, where a full-time pathologist is not present. The client is connected by VPN to the telepathology centre of our institute located in central Kyoto. As a result of the recent 15 test cases of VS telepathology diagnosis, including cases judging negative or positive surgical margins, we could estimate the usefulness of VS in intra-operative remote diagnosis. The time required for the frozen section VS file making was found to be around 10 min when we use x10 objective and if the maximal dimension of the frozen sample is less than 20 mm. Good correct focus of VS images was attained in all cases and all the fields of each tissue specimen. Up to now the capacity of best effort B-band appears to be sufficient to attain diagnosis on time in intra-operation. Telepathology diagnosis was achieved within 5 minutes in most cases using VS viewer provided by CLARO Inc. The VS telepathology system was found to be superior to the conventional still image telepathology system using a robotic microscope since in the former we can observe much greater image information than in the latter in a certain limited time of intra-operation and in the much more efficient ways. In the near future VS telepathology will replace conventional still image telepathology with a robotic microscope even in quick frozen intra-operative diagnosis.

  7. Safety, effectiveness and economic evaluation of intra-operative radiation therapy: a systematic review.

    PubMed

    Najafipour, Farshad; Hamouzadeh, Pejman; Arabloo, Jalal; Mobinizadeh, Mohammadreza; Norouzi, Amir

    2015-01-01

    Intra-operative radiation therapy (IORT) is the transfer of a single large radiation dose to the tumor bed during surgery with the final goal of improving regional tumor control. This study aimed to investigate the safety, effectiveness and economic evaluation of intra-operative radiation therapy. The scientific literature was searched in the main biomedical databases (Centre for Reviews and Dissemination, Cochrane Library and PubMed) up to March 2014. Two independent reviewers selected the papers based on pre-established inclusion criteria, with any disagreements being resolved by consensus. Data were then extracted and summarized in a structured form. RESULTS from studies were analyzed and discussed within a descriptive synthesis. Sixteen studies met the inclusion criteria. It seems that outcomes from using intraoperative radiation therapy can be considered in various kinds of cancers like breast, pancreatic and colorectal cancers. The application of this method may provide significant survival increase only for colorectal cancer, but this increase was not significant for other types of cancer. This technology had low complications; and it is relatively safe. Using intra-operative radiation therapy could potentially be accounted as a cost-effective strategy for controlling and managing breast cancer. According to the existing evidences, that are the highest medical evidences for using intra-operative radiation therapy, one can generally conclude that intra-operative radiation therapy is considered as a relatively safe and cost-effective method for managing early-stage breast cancer and it can significantly increase the survival of patients with colorectal cancer. Also, the results of this study have policy implications with respect to the reimbursement of this technology.

  8. Intra-operative measurement of applied forces during anterior scoliosis correction.

    PubMed

    Fairhurst, H; Little, J P; Adam, C J

    2016-12-01

    Spinal instrumentation and fusion for the treatment of scoliosis is primarily a mechanical intervention to correct the deformity and halt further progression. While implant-related complications remain a concern, little is known about the magnitudes of the forces applied to the spine during surgery, which may affect post-surgical outcomes. In this study, the compressive forces applied to each spinal segment during anterior instrumentation were measured in a series of patients with Adolescent Idiopathic Scoliosis. A force transducer was designed and retrofit to a routinely used surgical tool, and compressive forces applied to each segment during surgery were measured for 15 scoliosis patients. Cobb angle correction achieved by each force was measured on intra-operative fluoroscope images. Relative changes in orientation of the screw within the vertebra were also measured to detect intra-operative screw plough. Intra-operative forces were measured for a total of 95 spinal segments. The mean applied compressive force was 540N (SD 230N, range 88N-1019N). There was a clear trend for higher forces to be applied at segments toward the apex of the scoliosis. Fluoroscopic evidence of screw plough was detected at 10 segments (10.5%). The magnitude of forces applied during anterior scoliosis correction vary over a broad range. These forces do reach magnitudes capable of causing intra-operative vertebral body screw plough. Surgeons should be aware there is a risk for tissue overload during correction, however the clinical implications of intra-operative screw plough remain unclear. The dataset presented here is valuable for providing realistic input parameters for in silico surgical simulations. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Outcome of renal transplantation with and without intra-operative diuretics.

    PubMed

    Hanif, F; Macrae, A N; Littlejohn, M G; Clancy, M J; Murio, E

    2011-01-01

    This paper presents an e-survey of current clinical practice of use of intra-operative diuretics during renal transplantation in the United Kingdom and a study to compare outcome of renal transplants carried out with or without intra-operative diuretics in our centre. An e-mail questionnaire to renal transplant surgeons exploring their practice of renal transplantation with or without intra-operative diuretics, the type of a diuretic/s if used and the relevant doses. An observational study comparing the outcome of renal transplant recipients, group no-diuretics (GND, n = 80) carried out from 2004 to 2008 versus group diuretics (GD n = 69) renal transplant recipients who received intra-operative diuretics over a one year period is presented. Outcome measures were incidence of delayed graft function and a comparison of graft survival in both groups. Forty surgeons answered from 18 transplant centres with a response rate of 67%. 13 surgeons do not use diuretics. Mannitol is used by 10/40, Furosemide 6/40 and 11 surgeons use a combination of both. In comparative study there was no significant overall difference in one year graft survival of GD versus GND (N = 65/69, 94% and 75/80, 94% respectively, p = 0.08) and the incidence of delayed graft function was also comparable (16/69, 23% and 21/80, 26% respectively, p = 0.07). The donor characteristics in both groups were comparable. The study showed variation in clinical practice on the use of intra-operative diuretics in renal transplantation and it did not demonstrate that the use of diuretics can improve renal graft survival. Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  10. A safe and efficient method for intra-operative digital photography using a waterproof case.

    PubMed

    Tsai, Johnlong; Liao, Han-Tsung; Wang, Wen-Ke; Lam, Wee Leon; Kuo, Liang-Mou; Chen, Ruei-Feng; Chen, Chien-Tzung

    2011-10-01

    Intra-operative photography provides valuable information for photo-documentation. In order to improve quality of photographs and avoid additional contamination, we applied a sterilised waterproof case to adapt a digital camera that allowed the operating surgeon himself to obtain his own ideal images. A prospective study was designed to investigate the efficacy and safety of this technique. A total of 46 patients were enrolled in this study. The Fujifilm FinePix F30 digital camera encased in Fuji WP-FXF30 waterproof case was used in this study. Microbiological swabs were taken from the case's surface immediately after sealing the digital camera and at the end of surgery. In addition, intra-operative wound swabs were taken for correlation. The patients were followed up to record the possibility of any additional wound infections. None of the swab results on the waterproof case were positive before use. Overall, 11 patients had positive results of bacteria growth from intra-operative wound cultures. Eight of them also revealed positive microorganisms cultured from the case surface after use, in which the bacteria strains were correlated with the intra-operative wound cultures. However, no additional bacteria growth was noted from the culture of case surface. A digital camera encased in a sterilised waterproof case met the strict requirements for sterility in our series and demonstrated no added increase in infection rate. Safe use of this technique for obtaining intra-operative photographs with high image quality can be achieved. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Safety, effectiveness and economic evaluation of intra-operative radiation therapy: a systematic review

    PubMed Central

    Najafipour, Farshad; Hamouzadeh, Pejman; Arabloo, Jalal; Mobinizadeh, Mohammadreza; Norouzi, Amir

    2015-01-01

    Background: Intra-operative radiation therapy (IORT) is the transfer of a single large radiation dose to the tumor bed during surgery with the final goal of improving regional tumor control. This study aimed to investigate the safety, effectiveness and economic evaluation of intra-operative radiation therapy. Methods: The scientific literature was searched in the main biomedical databases (Centre for Reviews and Dissemination, Cochrane Library and PubMed) up to March 2014. Two independent reviewers selected the papers based on pre-established inclusion criteria, with any disagreements being resolved by consensus. Data were then extracted and summarized in a structured form. Results from studies were analyzed and discussed within a descriptive synthesis. Results: Sixteen studies met the inclusion criteria. It seems that outcomes from using intraoperative radiation therapy can be considered in various kinds of cancers like breast, pancreatic and colorectal cancers. The application of this method may provide significant survival increase only for colorectal cancer, but this increase was not significant for other types of cancer. This technology had low complications; and it is relatively safe. Using intra-operative radiation therapy could potentially be accounted as a cost-effective strategy for controlling and managing breast cancer. Conclusion: According to the existing evidences, that are the highest medical evidences for using intra-operative radiation therapy, one can generally conclude that intra-operative radiation therapy is considered as a relatively safe and cost-effective method for managing early-stage breast cancer and it can significantly increase the survival of patients with colorectal cancer. Also, the results of this study have policy implications with respect to the reimbursement of this technology. PMID:26793649

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

    PubMed Central

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

    2012-01-01

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

  13. Rotational X-ray angiography: a method for intra-operative volume imaging of the left-atrium and pulmonary veins for atrial fibrillation ablation guidance

    NASA Astrophysics Data System (ADS)

    Manzke, R.; Zagorchev, L.; d'Avila, A.; Thiagalingam, A.; Reddy, V. Y.; Chan, R. C.

    2007-03-01

    Catheter-based ablation in the left atrium and pulmonary veins (LAPV) for treatment of atrial fibrillation in cardiac electrophysiology (EP) are complex and require knowledge of heart chamber anatomy. Electroanatomical mapping (EAM) is typically used to define cardiac structures by combining electromagnetic spatial catheter localization with surface models which interpolate the anatomy between EAM point locations in 3D. Recently, the incorporation of pre-operative volumetric CT or MR data sets has allowed for more detailed maps of LAPV anatomy to be used intra-operatively. Preoperative data sets are however a rough guide since they can be acquired several days to weeks prior to EP intervention. Due to positional and physiological changes, the intra-operative cardiac anatomy can be different from that depicted in the pre-operative data. We present an application of contrast-enhanced rotational X-ray imaging for CT-like reconstruction of 3D LAPV anatomy during the intervention itself. Depending on the heart size a single or two selective contrastenhanced rotational acquisitions are performed and CT-like volumes are reconstructed with 3D filtered back projection. In case of dual injection, the two volumes depicting the left and right portions of the LAPV are registered and fused. The data sets are visualized and segmented intra-procedurally to provide anatomical data and surface models for intervention guidance. Our results from animal and human experiments indicate that the anatomical information from intra-operative CT-like reconstructions compares favorably with preacquired imaging data and can be of sufficient quality for intra-operative guidance.

  14. Computed tomography, endoscopic, laparoscopic, and intra-operative sonography for assessing resectability of pancreatic cancer.

    PubMed

    Long, Eliza E; Van Dam, Jacques; Weinstein, Stefanie; Jeffrey, Brooke; Desser, Terry; Norton, Jeffrey A

    2005-08-01

    Pancreas cancer is the fourth leading cancer killer in adults. Cure of pancreas cancer is dependent on the complete surgical removal of localized tumor. A complete surgical resection is dependent on accurate preoperative and intra-operative imaging of tumor and its relationship to vital structures. Imaging of pancreatic tumors preoperatively and intra-operatively is achieved by pancreatic protocol computed tomography (CT), endoscopic ultrasound (EUS), laparoscopic ultrasound (LUS), and intra-operative ultrasound (IOUS). Multi-detector CT with three-dimensional (3-D) reconstruction of images is the most useful preoperative modality to assess resectability. It has a sensitivity and specificity of 90 and 99%, respectively. It is not observer dependent. The images predict operative findings. EUS and LUS have sensitivities of 77 and 78%, respectively. They both have a very high specificity. Further, EUS has the ability to biopsy tumor and obtain a definitive tissue diagnosis. IOUS is a very sensitive (93%) method to assess tumor resectability during surgery. It adds little time and no morbidity to the operation. It greatly facilitates the intra-operative decision-making. In reality, each of these methods adds some information to help in determining the extent of tumor and the surgeon's ability to remove it. We rely on pancreatic protocol CT with 3-D reconstruction and either EUS or IOUS depending on the tumor location and operability of the tumor and patient. With these modern imaging modalities, it is now possible to avoid major operations that only determine an inoperable tumor. With proper preoperative selection, surgery is able to remove tumor in the majority of patients.

  15. Risk factors for intra-operative complications during phacoemulsification performed by residents.

    PubMed

    Lomi, Neiwete; Sharma, Reetika; Khokhar, Sudarshan; Dada, Tanuj; Vanathi, Murugesan; Agarwal, Tushar

    2016-06-01

    The purpose of this study was to determine the risk factors for occurrence of intra-operative complications during phacoemulsification performed by residents. One hundred fifty patients with cataract who underwent phacoemulsification by residents, with an experience of five or more phacoemulsification surgery, at a tertiary care centre were included in this study. The pre-operative data of these patients were collected from the hospital records. Surgeons were interviewed immediately after the surgery regarding the surgeon experience, phacoemulsification technique, machine factors, and intra-operative complications. Statistical analysis was done to determine pre-operative and intra-operative risk factors. The overall surgical complication rate in resident-performed phacoemulsification was 37 % of which major and minor complications were 21 and 16 %, respectively. Success in terms of placement of intraocular lens in capsular bag was 84 %. The most common major and minor complications found were posterior capsular tear and irregular capsulorhexis, respectively. Systemic and ocular features of patients as well as type of machine (longitudinal versus torsional longitudinal) had no significant association in terms of complication rate. Increase in success rate was seen with increase in semester and number of surgeries performed. Patient factors including general physical condition, systemic diseases, and anatomical factors do not influence success in resident-performed phacoemulsification. With increase in semester of residents, there is a significant decrease in intra-operative complications. Minor complications in the beginning of case lead to increase in major complications later on during the case and decrease in success rate by junior-semester residents.

  16. Bimanual, intra-operative, fluoroscopy-guided removal of nasopharyngeal migratory fish bone from carotid space.

    PubMed

    Al-Abduwani, J A; Bhargava, D; Sawhney, S; Al-Abri, R

    2010-07-01

    We report a rare and unusual case of a patient with an ingested fishbone which migrated from the oropharynx to the anterior compartment of the retropharyngeal space and then to the deep neck space in the nasopharynx (i.e. the carotid space). This report aims to describe a successful, minimally invasive method of foreign body removal which avoided both major skull base surgery and any potential life-threatening complications. A secondary aim is to highlight the role of intra-operative fluoroscopy, an under-used tool. We present a 67-year-old man with a history of fish bone impaction but no fish bone visible on plain X-ray or flexible endoscopy. The diagnosis of fish bone lodged in the retropharyngeal space was confirmed by computed tomography. Surgical exploration of the anterior retropharyngeal space failed to locate the fish bone, as it had migrated to a new, unknown location. Intra-operative fluoroscopy was vital for the removal of the fish bone, as it was impossible to see with the naked eye and had migrated from its previously imaged position. The fish bone was finally retrieved bimanually using external pressure on the submandibular region, which displaced the fish bone, and fluoroscopic guidance, which assisted its removal from the nasopharyngeal lumen. To the best of our knowledge, this is the first reported case of bimanual, intra-operative, fluoroscopy-guided, intra-luminal removal of a migratory fish bone from the deep neck space in this region of the nasopharynx.

  17. The consequence of day-to-day stochastic dose deviation from the planned dose in fractionated radiation therapy.

    PubMed

    Paul, Subhadip; Roy, Prasun Kumar

    2016-02-01

    Radiation therapy is one of the important treatment procedures of cancer. The day-to-day delivered dose to the tissue in radiation therapy often deviates from the planned fixed dose per fraction. This day-to-day variation of radiation dose is stochastic. Here, we have developed the mathematical formulation to represent the day-to-day stochastic dose variation effect in radiation therapy. Our analysis shows that that the fixed dose delivery approximation under-estimates the biological effective dose, even if the average delivered dose per fraction is equal to the planned dose per fraction. The magnitude of the under-estimation effect relies upon the day-to-day stochastic dose variation level, the dose fraction size and the values of the radiobiological parameters of the tissue. We have further explored the application of our mathematical formulation for adaptive dose calculation. Our analysis implies that, compared to the premise of the Linear Quadratic Linear (LQL) framework, the Linear Quadratic framework based analytical formulation under-estimates the required dose per fraction necessary to produce the same biological effective dose as originally planned. Our study provides analytical formulation to calculate iso-effect in adaptive radiation therapy considering day-to-day stochastic dose deviation from planned dose and also indicates the potential utility of LQL framework in this context.

  18. [Intra-operative myelography in treatment of fractures of thoracolumbar spine].

    PubMed

    Tomčovčík, L; Cuha, R; Raši, R

    2010-08-01

    The aim of this retrospective study was to evaluate the results of intra-operative myelography as the method used to assess the reduction of bone fragments from the posterior margin of the vertebral body. Forty patients with 42 comminuted fractures of the thoracolumbar spine were included in the study. The pre-operative spinal stenosis caused by bone fragments from the posterior margin of the vertebral body, as detected by CT scanning, ranged from 25 % to 85 %. Neurological deficit was due to injury in 19 patients and in one it developed post-operatively after the patient stood and walked. After ligamentotaxis and internal fixation, intra-operative myelography was used to show decompression of the spinal canal. A spinal block or severe constriction of contrast flow was an indication for hemilaminectomy (laminectomy) and direct decompression of the spinal canal. In the patients with neurological deficit and severe spinal stenosis persisting after ligamentotaxis and detectable by skiascopy, hemilaminectomy (laminectomy) and direct spinal decompression followed by intra-operative myelography were carried out. Intra-operative myelography was used 46 -times (20-times in 20 patients free from neurological deficit and 26-times in 20 patients with neurological deficit). In 38 cases (82.6 %) dural sac compression was not present (patients with neurological deficit, 13-times after ligamentotaxis, eight-times after ligamentotaxis and hemilaminectomy with direct decompression, twi- ce at repeat surgeryúúú patients without neurological deficit, 15-times). On two occasions (4.4 %) the contrast agent injected into the dural sac did not make the interior body part visible, on three occasions (6.5 %) contrast medium was injected extradurally, and dural sac compression following ligamentotaxis requiring hemilaminectomy (laminectomy) and direct decompression occurred in three cases (6.5 %). In the patients without neurological deficit, dural sac compression was not recorded. No

  19. Liposomally formulated phospholipid-conjugated indocyanine green for intra-operative brain tumor detection and resection.

    PubMed

    Suganami, Akiko; Iwadate, Yasuo; Shibata, Sayaka; Yamashita, Masamichi; Tanaka, Tsutomu; Shinozaki, Natsuki; Aoki, Ichio; Saeki, Naokatsu; Shirasawa, Hiroshi; Okamoto, Yoshiharu; Tamura, Yutaka

    2015-12-30

    Some tumor-specific near-infrared (NIR) fluorescent dyes such as indocyanine green (ICG), IDRye800CW, and 5-aminolevulinic acid have been used clinically for detecting tumor margins or micro-cancer lesions. In this study, we evaluated the physicochemical properties of liposomally formulated phospholipid-conjugated ICG, denoted by LP-iDOPE, as a clinically translatable NIR imaging nanoparticle for brain tumors. We also confirmed its brain-tumor-specific biodistribution and its characteristics as the intra-operative NIR imaging nanoparticles for brain tumor surgery. These properties of LP-iDOPE may enable neurosurgeons to achieve more accurate identification and more complete resection of brain tumor.

  20. Intra-operative post-induction hyperthermia, possibly malignant hyperthermia: Anesthetic implications, challenges and management.

    PubMed

    Gulabani, Michell; Gurha, Pavan; Ahmad, Sabih; Dass, Prashant

    2014-10-01

    Malignant Hyperthermia is a pharmacogenetic disorder. Classical manifestations comprise of tachycardia, increase in expired carbon dioxide levels, muscle rigidity, hyperthermia (>38.8°C) and unexpected acidosis. Here we report a case of 16-year-old female patient, ASA-I with chronic rhino-sinusitis and slight strabismus of the left eye posted for functional endoscopic sinus surgery, developing a rise in ETCO2 and temperature immediately following anesthesia induction. She was aggressively managed to an uneventful recovery. We present a case of intra-operative post-induction hyperthermia possibly MH, its anesthetic implications, challenges encountered and its management.

  1. Peri- and intra-operative management of the goat during acute surgical experimentation.

    PubMed

    Flaherty, Devin C; Hoxha, Besim; Nelson, Shirley; Sun, Jie; Gurji, Hunaid; Simecka, Jerry W; Mallet, Robert T; Olivencia-Yurvati, Albert H; Daniels, Egeenee Q

    2010-03-01

    Goats are used as animal models for surgery and trauma research. The authors discuss appropriate methods for induction of anesthetics, intubation and surgical maintenance of the goat during acute experimentation. Risks imposed by the Q fever pathogen Coxiella burnetii are described, as well as measures that have proven effective in minimizing zoonotic transmission of this pathogen to laboratory personnel. With appropriate knowledge of its applications, peri- and intra-operative management and limitations, the goat is a suitable animal model for a variety of biomedical research applications.

  2. The Correlation of Indices in r-TEG with Intra-operative Blood Loss in Neurosurgical Patients.

    PubMed

    Zhang, Xue; Yu, Xuerong; Huang, Yuguang

    2017-06-10

    Objective Intra-operative coagulopathy has a close relationship with blood loss and the prognosis of patients. Rapid-thrombelastography (r-TEG) is a comprehensive assessment of coagulation abnormalities and also an effective way for constructing blood transfusion. This study attempts to investigate the correlation of r-TEG indices with intra-operative hemorrhage.Methods Patients who underwent transphenoidal hypophysectomy and craniotomy from January 15 to April 30, 2013 in Peking Union Medical College hospital were recruited. All patients had pre- and post-operative r-TEG and conventional coagulation tests (CCTs). Patients' information and intra-operative blood loss as a percentage of estimated blood volume were recorded. Spearman's correlation analyses were used for discovering the relationship between indices in r-TEG or CCTs and the intra-operative blood loss. The significant correlated index of r-TEG was further investigated using linear regression analysis. Results A total of 181 patients participated in this study. Intra-operative change of α-angle, which reflects the fibrinogen level and function, was the only r-TEG index that correlated with blood loss significantly (P=0.013, r= -0.184), thus challenging the current empirical cognition of the effects of intra-operative hemorrhage on coagulation. As intra-operative blood loss increased, α-angle decreased, and every 1% loss of estimated blood volume (EBV) led to 0.60 degree decrease of α-angle. As for CCT results, changes of fibrinogen and platelet count were also significantly correlated with blood loss (P=0.015 and P=0.001, respectively).Conclusions Peri-operative change of α-angle, as an index of r-TEG, exhibited a significant negative correlation with intra-operative blood loss. The impact of hemorrhage on fibrinogen, instead of clotting factors, should be scrutinized.

  3. Achieving Adequate Margins in Ameloblastoma Resection: The Role for Intra-Operative Specimen Imaging. Clinical Report and Systematic Review

    PubMed Central

    Ramakrishnan, Anand; Mirkazemi, Mansoor; Baillieu, Charles; Ptasznik, Ronnie; Leong, James

    2012-01-01

    Background Ameloblastoma is a locally aggressive odontogenic neoplasm. With local recurrence rates reaching 90%, only completeness of excision can facilitate cure. Surgical clearance has widely been based on pre-operative imaging to guide operative excision margins, however use of intra-operative specimen x-ray or frozen-section has been sought to improve clearance rates, and advanced imaging technologies in this role have been proposed. This manuscript aims to quantify the evidence for evaluating intra-operative resection margins and present the current standard in this role. Method The current study comprises the first reported comparison of imaging modalities for assessing ameloblastoma margins. A case is presented in which margins are assessed with each of clinical assessment based on preoperative imaging, intra-operative specimen x-ray, intra-operative specimen computed tomography (CT) and definitive histology. Each modality is compared quantitatively. These results are compared to the literature through means of systematic review of current evidence. Results A comparative study highlights the role for CT imaging over plain radiography. With no other comparative studies and a paucity of high level evidence establishing a role for intra-operative margin assessment in ameloblastoma in the literature, only level 4 evidence supporting the use of frozen section and specimen x-ray, and only one level 4 study assesses intra-operative CT. Conclusion The current study suggests that intra-operative specimen CT offers an improvement over existing techniques in this role. While establishing a gold-standard will require higher level comparative studies, the use of intra-operative CT can facilitate accurate single-stage resection. PMID:23094099

  4. Minimizing shoulder syndrome with intra-operative spinal accessory nerve monitoring for neck dissection.

    PubMed

    Lee, C-H; Huang, N-C; Chen, H-C; Chen, M-K

    2013-04-01

    The objective of this study was to analyze the safety and results of intra-operative SAN (spinal accessary nerve) monitoring during selective neck dissection, with emphasis on shoulder syndrome. Twenty-five consecutive patients with head and neck cancer were studied. Selective neck dissection was performed by a single clinical fellow under the supervision of the department chief using an intra-operative SAN monitor. Electrophysiological data were recorded after initial identification of the SAN and continued until just before closure. Electromyographic evaluation was carried out to assess SAN function one month postoperatively. Shoulder disability was also evaluated at this time using a questionnaire for shoulder syndrome (shrug, flexion, abduction, winging, and pain). No patients had postoperative shoulder syndrome involving shrug, flexion, abduction, or winging. Twenty-two of the 25 (88%) patients had shoulder pain, but the average pain score was low (2.3 ± 1.3). No patients had neck recurrence during at least 1 year of follow up. By using nerve monitoring during selective neck dissection, no patient developed significant "shoulder syndrome", with the exception of slight pain.

  5. The effect of intra-operative transcutaneous electrical nerve stimulation on posterior neck pain following thyroidectomy.

    PubMed

    Park, C; Choi, J B; Lee, Y-S; Chang, H-S; Shin, C S; Kim, S; Han, D W

    2015-04-01

    Posterior neck pain following thyroidectomy is common because full neck extension is required during the procedure. We evaluated the effect of intra-operative transcutaneous electrical nerve stimulation on postoperative neck pain in patients undergoing total thyroidectomy under general anaesthesia. One hundred patients were randomly assigned to one of two groups; 50 patients received transcutaneous electrical nerve stimulation applied to the trapezius muscle and 50 patients acted as controls. Postoperative posterior neck pain and anterior wound pain were evaluated using an 11-point numerical rating scale at 30 min, 6 h, 24 h and 48 h following surgery. The numerical rating scale for posterior neck pain was significantly lower in the transcutaneous electrical nerve stimulation group compared with the control group at all time points (p < 0.05). There were no significant differences in the numerical rating scale for anterior wound pain at any time point. No adverse effects related to transcutaneous electrical nerve stimulation were observed. We conclude that intra-operative transcutaneous electrical nerve stimulation applied to the trapezius muscle reduced posterior neck pain following thyroidectomy.

  6. Intra-operative multi-site stimulation: Expanding methodology for cortical brain mapping of language functions

    PubMed Central

    Korn, Akiva; Kirschner, Adi; Perry, Daniella; Hendler, Talma; Ram, Zvi

    2017-01-01

    Direct cortical stimulation (DCS) is considered the gold-standard for functional cortical mapping during awake surgery for brain tumor resection. DCS is performed by stimulating one local cortical area at a time. We present a feasibility study using an intra-operative technique aimed at improving our ability to map brain functions which rely on activity in distributed cortical regions. Following standard DCS, Multi-Site Stimulation (MSS) was performed in 15 patients by applying simultaneous cortical stimulations at multiple locations. Language functioning was chosen as a case-cognitive domain due to its relatively well-known cortical organization. MSS, performed at sites that did not produce disruption when applied in a single stimulation point, revealed additional language dysfunction in 73% of the patients. Functional regions identified by this technique were presumed to be significant to language circuitry and were spared during surgery. No new neurological deficits were observed in any of the patients following surgery. Though the neuro-electrical effects of MSS need further investigation, this feasibility study may provide a first step towards sophistication of intra-operative cortical mapping. PMID:28700619

  7. Intra-operative multi-site stimulation: Expanding methodology for cortical brain mapping of language functions.

    PubMed

    Gonen, Tal; Gazit, Tomer; Korn, Akiva; Kirschner, Adi; Perry, Daniella; Hendler, Talma; Ram, Zvi

    2017-01-01

    Direct cortical stimulation (DCS) is considered the gold-standard for functional cortical mapping during awake surgery for brain tumor resection. DCS is performed by stimulating one local cortical area at a time. We present a feasibility study using an intra-operative technique aimed at improving our ability to map brain functions which rely on activity in distributed cortical regions. Following standard DCS, Multi-Site Stimulation (MSS) was performed in 15 patients by applying simultaneous cortical stimulations at multiple locations. Language functioning was chosen as a case-cognitive domain due to its relatively well-known cortical organization. MSS, performed at sites that did not produce disruption when applied in a single stimulation point, revealed additional language dysfunction in 73% of the patients. Functional regions identified by this technique were presumed to be significant to language circuitry and were spared during surgery. No new neurological deficits were observed in any of the patients following surgery. Though the neuro-electrical effects of MSS need further investigation, this feasibility study may provide a first step towards sophistication of intra-operative cortical mapping.

  8. Intra-operative 3D imaging system for robot-assisted fracture manipulation.

    PubMed

    Dagnino, G; Georgilas, I; Tarassoli, P; Atkins, R; Dogramadzi, S

    2015-01-01

    Reduction is a crucial step in the treatment of broken bones. Achieving precise anatomical alignment of bone fragments is essential for a good fast healing process. Percutaneous techniques are associated with faster recovery time and lower infection risk. However, deducing intra-operatively the desired reduction position is quite challenging due to the currently available technology. The 2D nature of this technology (i.e. the image intensifier) doesn't provide enough information to the surgeon regarding the fracture alignment and rotation, which is actually a three-dimensional problem. This paper describes the design and development of a 3D imaging system for the intra-operative virtual reduction of joint fractures. The proposed imaging system is able to receive and segment CT scan data of the fracture, to generate the 3D models of the bone fragments, and display them on a GUI. A commercial optical tracker was included into the system to track the actual pose of the bone fragments in the physical space, and generate the corresponding pose relations in the virtual environment of the imaging system. The surgeon virtually reduces the fracture in the 3D virtual environment, and a robotic manipulator connected to the fracture through an orthopedic pin executes the physical reductions accordingly. The system is here evaluated through fracture reduction experiments, demonstrating a reduction accuracy of 1.04 ± 0.69 mm (translational RMSE) and 0.89 ± 0.71 ° (rotational RMSE).

  9. Accuracy of intra-operative frozen section analysis of ovarian tumours.

    PubMed

    Gorisek, B; Stare, M Rebolj; Krajnc, I

    2009-01-01

    During operative treatment for ovarian tumours assistance is frequently required to make decisions regarding malignancy status and the extent of the ensuing procedure. Intra-operative frozen section analysis may be useful, provided there is adequate acquaintance with the correlation between using frozen sections and permanent histopathological sections for diagnosis at the institution where the operation is being undertaken. This retrospective study aimed to determine this correlation. Findings from 131 intra-operative frozen sections were compared with the subsequent diagnosis from permanent histopathological sections for women with benign, borderline and malignant ovarian tumours at the Maribor Teaching Hospital (now the University Clinical Centre Maribor) between 1 January 1993 and 31 December 2001. Frozen-section findings corresponded to histopathological findings in 84.7% of cases, with 15.3% false-negative and no false-positive results. For benign, borderline and malignant ovarian tumours, sensitivity was 100.0%, 76.1% and 89.0%, respectively, and specificity was 90.6%, 90.6% and 100.0%, respectively. The majority of errors occurred in diagnosing mucinous borderline tumours. Precise pre-operative diagnosis is extremely important in the treatment of ovarian tumours.

  10. Unwanted intra-operative penile erection during pediatric hypospadiasis repair. Comparison of propofol and halothane.

    PubMed

    Abbasi, Hamid Reza; Ben Razavi, Seyed Soheil; Hajiesmaeili, Mohammad Reza; Behdad, Shekoufeh; Ghiamat, Mohammad Mehdi; Eghbali, Ahmad

    2013-09-26

    To compare the erectile effect of propofol and halothane on unwanted intraoperative penile erection (UIOPE) during pediatric hypospadiasis repair. One hundred and seventeen boys who were in the age range of 6 months to 6 years and referred for hypospadiasis repair to our referral teaching hospital were included in this randomized clinical trial. Patients were randomly assigned to one of the two study groups before anesthesia induction. Anesthesia was maintained with a continuous intravenous infusion of propofol and inhalational halothane in the propofol (P) and halothane (H) groups, respectively. Data regarding the patients’ age, weight, pre- and intra-operative chordee, UIOPE, anesthesia time, surgery time, hematoma formation, and wound infection were collected. The Chi-Square and Fisher’s exact tests were used for comparison. No statistically significant differences were noted regarding age, weight, and pre and intra-operative chordee between the two groups. The incidence of UIOPE (10.34% versus 57.63%; P = .000), anesthesia time (174.15 +/- 15.02 versus 181.26 +/- 15.19; P =.012), and surgery time (162.34 +/- 12.99 versus 167.69 +/- 13.90 +/- 13.90; P = .034) were significantly lower in group P compared with group H. The use of propofol during hypospadiasis surgical repair is more safe and effective than halothane in preventing UIOPE and reducing surgery and anesthesia time.

  11. Belmont Hyperthermia Pump in the conduct of intra-operative heated chemotherapy.

    PubMed

    Riley, W

    2009-03-01

    Intra-operative heated chemotherapy (IOHC) has been performed in the Thoracic surgical department of Brigham and Women's Hospital (BWH, Boston, MA, USA) for over a decade. A "home-grown" system was developed for this purpose with limited improvements made to it through the years. This technology is used for neo-adjuvant therapy in the conduct of extra-pleural pneumonectomy and pleurectomy for treatment of mesothelioma. Improvements to the traditional BWH system were sought due to the hazardous nature of the chemotherapy solution and the relative complexity of the IOHC circuit. Belmont Instrument (Belmont Instrument Corporation, Billerica, MA, USA) applied their proprietary infusion/warming technology to develop the Belmont Hyperthermia Pump. The Hyperthermia Pump was designed to recirculate large volumes of fluid while maintaining perfusate temperatures up to 46oC at a flow rate of up to 750 ml/min. Approval from the FDA for clinical use of this device was granted June 2007. Parameters were defined and investigated to determine if the Hyperthermia Pump would meet or exceed the performance characteristics of the traditional BWH system. Our investigation resulted in the replacement of the traditional BWH circuit. The Belmont Hyperthermia Pump is a compact, easy to use, extremely safe means to deliver intra-operative hyperthermic chemotherapy in the conduct of surgical treatment of mesothelioma.

  12. The effect of intra-operative skeletal (skull femoral) traction on apical vertebral rotation

    PubMed Central

    Jhaveri, Subir N.; Zeller, Reinhard; Miller, Stephen

    2008-01-01

    The study design is a retrospective review of consecutive case series. Our goal was to identify and quantify the effect of skeletal traction on the apical vertebral rotation (AVR). Intra-operative skeletal traction has been used for the correction of large magnitude idiopathic and neuromuscular scoliosis. The ability of skeletal traction to correct the rotational deformity of the spine has not been characterized. Following REB approval, retrospective analysis of 22 (AIS = 14, neuromuscular = 8) consecutive pediatric patients having surgical posterior instrumented correction and fusion for their scoliosis was performed. Intra-operative skeletal traction with approximately 50% body weight was achieved with smooth distal femoral pins. Counter-traction up to 25% was used through Gardner–Wells tongs. The AVR of the major curve was assessed using the Nash–Moe grading system by a radiologist and a senior spine surgeon not involved in the treatment of these cases. Statistical analysis was performed to determine the significance. The overall mean AVR of the major structural curve was 3.1 ± 0.8 and reduced to 2.4 ± 0.6 (p = 0.0001) following traction. The AVR decreased by one or more Nash–Moe grades with traction in 14/22 (64%) patients. The Cobb angle corrected from a mean of 88.2° to 49.1° (44.3%, p = 0.00001) with traction. The decrease in AVR correlated with the higher magnitude Cobb angles (correlation 0.53, p = 0.014). Patients with pre-traction AVR ≥ 3 showed the largest change with traction (3.4–2.5, p = 0.000004). There was very good association between the radiologist and the spine surgeon, 0.72(standing films) and 0.63(traction films). The minor structural curve corrected from a mean Cobb of 53.5° to 33.8° (37.8%) with AVR decreasing from a mean of 1.9 to 1.4 (p = 0.014). Significant apical derotation occurs with the use of intra-operative skull-skeletal traction in the correction of high magnitude scoliotic curves. This

  13. Cardiac myxoma: clinical characteristics, surgical intervention, intra-operative challenges and outcome.

    PubMed

    Abu Abeeleh, Mahmoud; Saleh, Suhayl; Alhaddad, Emad; Alsmady, Moaath; Alshehabat, Musa; Bani Ismail, Zuhair; Massad, Islam; Bani Hani, Amjad; Abu Halaweh, Sami

    2017-07-01

    The objectives of this retrospective study were to characterize the clinical presentation, diagnostic findings, surgical approaches, intra-operative challenges and complications following the surgical treatment of cardiac myxoma in two of the largest referral hospitals in Jordan. Medical records of all patients presented to the cardiology department during the period between 1984 and 2016 were reviewed. Criteria for inclusion in the study were: (1) patients who were presented for cardiac evaluation due to symptoms suggestive of a primary cardiac problem, (2) completed medical records, including results of echocardiography suggestive of intra-cardiac occupying mass, (3) the surgical operation was undertaken and intra-operative data was available, (4) a histological diagnosis of myxoma was available and (5) the discharge status and follow-up data were available for at least 2 years after initial surgery. A total of 27 patients fulfilled the criteria for inclusion in the study. The average age was 42 years. Thirteen of the patients were females and 14 patients were males. The most common clinical presentations were dyspnea (29.6%) and murmurs (22.2%). Non-specific signs, such as weight loss, fever, fatigue, arthralgia and anemia, were reported in 10 (37%) patients. Signs related to systemic embolization were reported in 9 (33.3%) of the patients, involving the upper and lower extremities (55.6%), brain ischemia and vision loss (54.4%). Tumors in all patients were successfully resected under cardiopulmonary bypass support. The tumor was pedunculated in 17 (62.9%) of the patients and the size of the tumors varied from 1 to 7 centimeters in diameter. The tumor was located in the left atrium in 21 patients (77.7%), in the right atrium in 4 patients (14.8%), in the right ventricular side of the septum in 1 patient (3.7%) and involving the tricuspid valve in 1 patient (3.7%). The left atrial approach was used in 3 patients, a right atrial approach in 4 patients and a bi

  14. Community Events Planning Packet: National Community Education Day, Wednesday, November 16, 1983.

    ERIC Educational Resources Information Center

    National Community Education Association, Washington, DC.

    Developed for community educators interested in planning activities for National Community Education Day, this packet of materials presents planning ideas and examples of activities undertaken during the first National Community Education Day held in 1982. After messages from the National Community Education Assocation (NCEA) and the American…

  15. Intra-operative image update: first experiences with new software in computer-assisted sinus surgery.

    PubMed

    Wurm, Jochen; Bohr, Christopher; Iro, Heinrich; Bumm, Klaus

    2008-09-01

    So far, conventional navigation systems do not provide the opportunity for any modification of acquired image datasets. In particular, the surgical progress in the operating field cannot be visualized unless new imaging scans are performed. In a feasibility study, new software creating intra-operative image updates by virtual means was tested in conjunction with conventional navigation. With this new software, surgically removed tissue volumes can be traced and viewed directly within the diagnostic image data. The new software represents an interesting and helpful amendment to conventional computer-assisted surgery in selected cases. During surgical procedures around bony structures, the surgeon gets an accurate virtual image update of the surgical progress in the operating field and the amount of tissue removed. However, in cases where mobile structures are present or soft tissue shifts are expected, this feature seems to be suitable only to a limited extent.

  16. Intra-operative 2-D ultrasound and dynamic 3-D aortic model registration for magnetic navigation of transcatheter aortic valve implantation.

    PubMed

    Luo, Zhe; Cai, Junfeng; Peters, Terry M; Gu, Lixu

    2013-11-01

    We propose a navigation system for transcatheter aortic valve implantation that employs a magnetic tracking system (MTS) along with a dynamic aortic model and intra-operative ultrasound (US) images. This work is motivated by the desire of our cardiology and cardiac surgical colleagues to minimize or eliminate the use of radiation in the interventional suite or operating room. The dynamic 3-D aortic model is constructed from a preoperative 4-D computed tomography dataset that is animated in synchrony with the real time electrocardiograph input of patient, and then preoperative planning is performed to determine the target position of the aortic valve prosthesis. The contours of the aortic root are extracted automatically from short axis US images in real-time for registering the 2-D intra-operative US image to the preoperative dynamic aortic model. The augmented MTS guides the interventionist during positioning and deployment of the aortic valve prosthesis to the target. The results of the aortic root segmentation algorithm demonstrate an error of 0.92±0.85 mm with a computational time of 36.13±6.26 ms. The navigation approach was validated in porcine studies, yielding fiducial localization errors, target registration errors, deployment distance, and tilting errors of 3.02±0.39 mm, 3.31±1.55 mm, 3.23±0.94 mm, and 5.85±3.06(°) , respectively.

  17. Fast intra-operative non-linear registration of 3D-CT to tracked, selected 2D-ultrasound slices

    NASA Astrophysics Data System (ADS)

    Olesch, Janine; Beuthien, Björn; Heldmann, Stefan; Papenberg, Nils; Fischer, Bernd

    2011-03-01

    In navigated liver surgery it is an important task to align intra-operative data to pre-operative planning data. This work describes a method to register pre-operative 3D-CT-data to tracked intra-operative 2D US-slices. Instead of reconstructing a 3D-volume out of the two-dimensional US-slice sequence we directly apply the registration scheme to the 2D-slices. The advantage of this approach is manyfold. We circumvent the time consuming compounding process, we use only known information, and the complexity of the scheme reduces drastically. As the liver is a non-rigid organ, we apply non-linear techniques to take care of deformations occurring during the intervention. During the surgery, computing time is a crucial issue. As the complexity of the scheme is proportional to the number of acquired slices, we devise a scheme which starts out by selecting a few "key-slices" to be used in the non-linear registration scheme. This step is followed by multi-level/multi-scale strategies and fast optimization techniques. In this abstract we briefly describe the new method and show first convincing results.

  18. An intra-operative positron probe with background rejection capability for FDG-guided surgery.

    PubMed

    Yamamoto, Seiichi; Matsumoto, Keiichi; Sakamoto, Setsu; Tarutani, Kazumasa; Minato, Kotaro; Senda, Michio

    2005-02-01

    For radio-guided surgery on tumors using F-18-FDG, detection of annihilation gamma photons emanating from other parts of the body produces background radiation counts and limits its use in clinical situations. To overcome this limitation, we have developed an intra-operative positron probe with background-rejection capability. The positron probe uses a phoswich detector composed of a plastic scintillator and a bismuth germinate (BGO). A positron from a positron emitter such as F-18 is detected by the plastic scintillator and emits annihilation photons. The BGO detects one of the annihilation photons while a photo-multiplier tube (PMT) detects scintillation photons from both scintillators. The decay time differences of these two scintillators are used to distinguish whether the event is a true event where a positron and a following annihilation photon are detected simultaneously, or a background event. In this configuration, only positrons can be selectively detected, even in an environment of high background gamma photon flux. Spatial resolution was 11-mm full width at half maximum (FWHM) 5 mm from the detector surface. Measured sensitivity for the F-18 point source was 2.6 cps/kBq 5 mm from the detector surface. The background count rate was less than 0.5 cps for a 20-cm diameter cylindrical phantom containing 37 MBq of F-18 solution measured on the phantom surface, while the positron count rate was almost linear over a range of approximately 6 kcps. These results indicate that our developed intra-operative positron probe is valuable for radio-guided surgery on tumors using F-18-FDG in a high flux of background annihilation gamma photons.

  19. A standardized and safe method of sterile field maintenance during intra-operative horizontal plane fluoroscopy

    PubMed Central

    2010-01-01

    Background Intra-operative fluoroscopy for orthopaedic procedures frequently involves imaging in the horizontal plane, which requires the lower portion of the C-arm (x-ray tube) to be rotated from an unsterile zone (beneath the table) into the sterile field. To protect the integrity of the sterile field the C-arm must be draped repeatedly throughout the surgical case. The current, un-standardized, practice employs draping procedures which violate the Association of peri-Operative Registered Nurses (AORN) Standards and Recommended Practices, waste time and material, and pose an increased risk for surgical site infection. Presentation of the hypothesis Use of a novel sterile C-arm drape (C-armor) that maintains the integrity of the sterile field, will improve operating room efficiency and reduce surgical site infection risk factors. This reduction in risk factors may potentially reduce surgical site infections in orthopaedic surgical cases requiring repeated horizontal x-ray imaging. Testing the Hypothesis Savings in time and material and the reduction in surgical site infection risk factors afforded by using C-armor are intuitive to those skilled in the practice of orthopaedic surgery. Testing for a reduction in the number of microorganisms introduced to the surgical site by improved C-arm draping would be challenging due to the multiple confounding factors during a surgical operation. Determination of an absolute reduction in surgical site infections may be possible, but will require accounting for many confounding variables and a large study sample in order to achieve statistical significance. Implications of the Hypothesis Improved intraoperative workflow, healthcare savings and a reduction in surgical site infection risk factors will be achieved by utilizing a standardized and safe method of sterile field maintenance during intra-operative horizontal plane fluoroscopy. PMID:21144027

  20. Validation of Fully Automated VMAT Plan Generation for Library-Based Plan-of-the-Day Cervical Cancer Radiotherapy

    PubMed Central

    Breedveld, Sebastiaan; Voet, Peter W. J.; Heijkoop, Sabrina T.; Mens, Jan-Willem M.; Hoogeman, Mischa S.; Heijmen, Ben J. M.

    2016-01-01

    Purpose To develop and validate fully automated generation of VMAT plan-libraries for plan-of-the-day adaptive radiotherapy in locally-advanced cervical cancer. Material and Methods Our framework for fully automated treatment plan generation (Erasmus-iCycle) was adapted to create dual-arc VMAT treatment plan libraries for cervical cancer patients. For each of 34 patients, automatically generated VMAT plans (autoVMAT) were compared to manually generated, clinically delivered 9-beam IMRT plans (CLINICAL), and to dual-arc VMAT plans generated manually by an expert planner (manVMAT). Furthermore, all plans were benchmarked against 20-beam equi-angular IMRT plans (autoIMRT). For all plans, a PTV coverage of 99.5% by at least 95% of the prescribed dose (46 Gy) had the highest planning priority, followed by minimization of V45Gy for small bowel (SB). Other OARs considered were bladder, rectum, and sigmoid. Results All plans had a highly similar PTV coverage, within the clinical constraints (above). After plan normalizations for exactly equal median PTV doses in corresponding plans, all evaluated OAR parameters in autoVMAT plans were on average lower than in the CLINICAL plans with an average reduction in SB V45Gy of 34.6% (p<0.001). For 41/44 autoVMAT plans, SB V45Gy was lower than for manVMAT (p<0.001, average reduction 30.3%), while SB V15Gy increased by 2.3% (p = 0.011). AutoIMRT reduced SB V45Gy by another 2.7% compared to autoVMAT, while also resulting in a 9.0% reduction in SB V15Gy (p<0.001), but with a prolonged delivery time. Differences between manVMAT and autoVMAT in bladder, rectal and sigmoid doses were ≤ 1%. Improvements in SB dose delivery with autoVMAT instead of manVMAT were higher for empty bladder PTVs compared to full bladder PTVs, due to differences in concavity of the PTVs. Conclusions Quality of automatically generated VMAT plans was superior to manually generated plans. Automatic VMAT plan generation for cervical cancer has been implemented in

  1. Intra-operative correction of Taylor Spatial Frame without a computer.

    PubMed

    Heidari, Nima; Hughes, Andrew; Atkins, Roger M

    2013-02-01

    The Taylor Spatial Frame (TSF) is a circular external fixator used to treat complex fractures and skeletal deformities. The device consists of 2 rings attached to bone by wires or half pins, connected by universal hinge joints to 6 independent telescopic struts, creating a hexapod. The output piece is defined as the movable ring, which has 6 degree of freedom relative to the other ring, which is the base. With 6 degree of freedom, the movable platform is capable of moving in 3 linear directions and 3 angular directions singularly or in any combination. These hexapod devices require complex mathematical software programs to accurately control the output piece. In the case of the TSF, the deformity and positional frame parameters can be indentified on postoperative radiographs. They are then input into internet-based software to calculate strut adjustments required to achieve deformity correction. When treating fractures with the TSF, the rings can be connected using FastFx struts. These struts can be locked in position or left in a sliding mode (unlocked) allowing manual manipulation of the frame to acutely correct the position of the fracture fragments. This reduction is rarely perfect however and often requires further postoperative frame adjustments using software calculations. We describe an intra-operative method for accurately adjusting the frame in its locked mode without the need for software input.

  2. An effective intra-operative neurophysiological monitoring scheme for aneurysm clipping and spinal fusion surgeries

    NASA Astrophysics Data System (ADS)

    Goryawala, Mohammed; Yaylali, Ilker; Cabrerizo, Mercedes; Vedala, Krishnatej; Adjouadi, Malek

    2012-04-01

    Somatosensory-evoked potentials (SSEPs) have been widely used for intra-operative neurophysiological monitoring (IONM). Currently at least 200-300 trials are required to generate a readable SSEP signal. This study introduces a novel approach that yields accurate detection results of the SSEP signal yet with a significantly reduced number of trials, resulting in an effectual monitoring process. The analysis was performed on data recorded in seven patients undergoing surgery, where the posterior tibial nerve was stimulated and the SSEP response was recorded from scalp electroencephalography using two bipolar electrodes, C3-C4 and CZ-FZ. The proposed approach employs an innovative, simple yet effective algorithm based on a patient-specific Gaussian template to detect the SSEP using only 30 trials. The time latencies of the P37 and N45 peaks are detected along with the peak-to-peak amplitudes. The time latencies are detected with a mean accuracy greater than 95%. Also, the P37 and N45 peak latencies and the peak-to-peak amplitude were found to be consistent throughout the surgical procedure within the 10% and 50% acceptable clinical limits, respectively. The results obtained support the assertion that the algorithm is capable of detecting SSEPs with high accuracy and consistency throughout the entire surgical procedure using only 30 trials.

  3. An investigation into the causes of unexpected intra-operative transoesophageal echocardiography findings.

    PubMed

    Skinner, H J; Mahmoud, A; Uddin, A; Mathew, T

    2012-04-01

    There is uncertainty regarding echocardiography before cardiac surgery, especially with regard to timing and disease progression as well as potential errors. We investigated the causes of unexpected intra-operative transoesophageal echocardiography findings by performing a 33-month audit. We found that there were 50/797 (6%) unexpected findings that led to an alteration in surgical strategy in 34 (4%) patients. Of the unexpected findings, 25 (50%) were unrelated to pre-operative pathology. After reviewing pre-operative studies and reports, unexpected findings were found to be due to: reporting errors in 20 patients (44%); limitations in transthoracic compared to transoesophageal echocardiography in 14 patients (30%); disease progression in 10 patients (22%); and inter-observer variability in two patients (4%). We identified six reports out of 797 (0.8%) that contained potentially serious errors. Surgical management changed in 18/20 (90%) patients in whom the unexpected change was due to reporting error, compared to 16/30 (53%) patients whose pre-operative echocardiogram was correctly reported (p = 0.006). Our study suggests that pre-operative echocardiography reporting errors are common and important.

  4. Photo-acoustic imaging of blue nanoparticle targeted brain tumor for intra-operative glioma delineation

    NASA Astrophysics Data System (ADS)

    Ray, Aniruddha; Wang, Xueding; Koo Lee, Yong-Eun; Hah, HoeJin; Kim, Gwangseong; Chen, Thomas; Orrienger, Daniel; Sagher, Oren; Kopelman, Raoul

    2011-07-01

    Distinguishing the tumor from the background neo-plastic tissue is challenging for cancer surgery such as surgical resection of glioma. Attempts have been made to use visible or fluorescent markers to delineate the tumors during surgery. However, the systemic injection of the dyes requires high dose, resulting in negative side effects. A novel method to delineate rat brain tumors intra-operatively, as well as post-operatively, using a highly sensitive photoacoustic imaging technique enhanced by tumor targeting blue nanoparticle as contrast agent is demonstrated. The nanoparticles are made of polyacrylamide (PAA) matrix with covalently linked Coomassie-Blue dye. They contain 7.0% dye and the average size is 80nm. Their surface was conjugated with F3 peptide for active tumor targeting. These nanoparticles are nontoxic, chemically inert and have long plasma circulation lifetime, making them suitable as nanodevices for imaging using photoacoustics. Experiments on phantoms and rat brains tumors ex-vivo demonstrate the high sensitivity of photoacoustic imaging in delineating the tumor, containing contrast agent at concentrations too low to be visualized by eye. The control tumors without nanoparticles did not show any enhanced signal. This study shows that photoacoustic imaging facilitated with the nanoparticle contrast agent could contribute to future surgical procedures for glioma.

  5. 3D global estimation and augmented reality visualization of intra-operative X-ray dose.

    PubMed

    Rodas, Nicolas Loy; Padoy, Nicolas

    2014-01-01

    The growing use of image-guided minimally-invasive surgical procedures is confronting clinicians and surgical staff with new radiation exposure risks from X-ray imaging devices. The accurate estimation of intra-operative radiation exposure can increase staff awareness of radiation exposure risks and enable the implementation of well-adapted safety measures. The current surgical practice of wearing a single dosimeter at chest level to measure radiation exposure does not provide a sufficiently accurate estimation of radiation absorption throughout the body. In this paper, we propose an approach that combines data from wireless dosimeters with the simulation of radiation propagation in order to provide a global radiation risk map in the area near the X-ray device. We use a multi-camera RGBD system to obtain a 3D point cloud reconstruction of the room. The positions of the table, C-arm and clinician are then used 1) to simulate the propagation of radiation in a real-world setup and 2) to overlay the resulting 3D risk-map onto the scene in an augmented reality manner. By using real-time wireless dosimeters in our system, we can both calibrate the simulation and validate its accuracy at specific locations in real-time. We demonstrate our system in an operating room equipped with a robotised X-ray imaging device and validate the radiation simulation on several X-ray acquisition setups.

  6. POCI: A compact high resolution {gamma} camera for intra-operative surgical use

    SciTech Connect

    Menard, L.; Charon, Y.; Solal, M.; Laniece, P.; Mastrippolito, R.; Pinot, L.; Ploux, L.; Valentin, L. |; Ricard, M.

    1998-06-01

    The development of a hand-held {gamma} imaging probe for inside body localization of small tumors is of first interest for radio-guided operative cancer surgery. In that context, the authors have developed a sub-millimeter spatial resolution, small field of view, {gamma} per-operative compact imager (POCI). It consists of a head module composed of a high resolution tungsten collimator and a YAP:Ce crystal plate, optically coupled to an intensified position sensitive diode (IPSD). The authors report here the essential imaging performance characteristics of the POCI camera (spatial resolution, position linearity, efficiency and energy response). These were obtained by studying the influence of the collimator and the crystal design to evaluate the optimal configuration. The present version of POCI has a 24 mm diameter usable field of view and an intrinsic spatial resolution of 0.9 mm to 1.2 mm FWHM at 120 keV. These good detection performance characteristics combined with the small size of the camera make the device well suited to provide intra-operative monitoring in several medical procedures, such as thyroid and breast tumor removal.

  7. Pseudopapillary pattern in intra-operative squash smear preparations of central nervous system germinomas.

    PubMed

    Ates, D; Kosemehmetoglu, K; Onder, S; Soylemezoglu, F

    2014-02-01

    Although the morphology of central nervous system (CNS) germ cell tumours is very similar to that of gonadal germ cell tumours, some architectural changes may dominate the microscopic appearance of CNS germinomas leading to misdiagnosis at low-power magnification. We report five cases of CNS germinoma demonstrating delicate pseudopapillary fronds on squash smear preparations. The age of the patients ranged from 5 to 21 years (mean 14). Three were female and two male. Three patients presented with symptoms of diabetes insipidus, including polydipsia and polyuria, while absence seizures, meaningless speech, hemiparesia, weight loss, insufficient breast development, amenorrhoea and symptoms of raised intracranial pressure were also encountered depending on the location of the tumours. Tumours were located in the hypophysis in two cases and in the suprasellar region in three. During the intra-operative pathological consultation, evenly distributed pseudopapillary or papillary structures formed the dominant pattern in the squash preparations of all cases. The neoplastic cells were characterized by pale variably vacuolated cytoplasm, pleomorphic nuclei with irregular membranes, and several prominent nucleoli. Variable numbers of small lymphocytes were also found. Intracranial germinomas may commonly exhibit a pseudopapillary pattern on squash smears that may cause misdiagnosis as neoplasms with papillary morphology. Careful examination of cellular details is essential in order to reach the correct diagnosis. © 2013 John Wiley & Sons Ltd.

  8. Robust Non-Rigid Registration to Capture Brain Shift from Intra-Operative MRI

    PubMed Central

    Clatz, Olivier; Delingette, Hervé; Talos, Ion-Florin; Golby, Alexandra J.; Kikinis, Ron; Jolesz, Ferenc A.; Ayache, Nicholas; Warfield, Simon K.

    2006-01-01

    We present a new algorithm to register 3D pre-operative Magnetic Resonance (MR) images to intra-operative MR images of the brain which have undergone brain shift. This algorithm relies on a robust estimation of the deformation from a sparse noisy set of measured displacements. We propose a new framework to compute the displacement field in an iterative process, allowing the solution to gradually move from an approximation formulation (minimizing the sum of a regularization term and a data error term) to an interpolation formulation (least square minimization of the data error term). An outlier rejection step is introduced in this gradual registration process using a weighted least trimmed squares approach, aiming at improving the robustness of the algorithm. We use a patient-specific model discretized with the finite element method (FEM) in order to ensure a realistic mechanical behavior of the brain tissue. To meet the clinical time constraint, we parallelized the slowest step of the algorithm so that we can perform a full 3D image registration in 35 seconds (including the image update time) on a heterogeneous cluster of 15 PCs. The algorithm has been tested on six cases of brain tumor resection, presenting a brain shift of up to 14 mm. The results show a good ability to recover large displacements, and a limited decrease of accuracy near the tumor resection cavity. PMID:16279079

  9. Intra-operative radiation therapy with laser-accelerated carbon ions

    NASA Astrophysics Data System (ADS)

    Mur, P.; Bellido, P.; Seimetz, M.; Lera, R.; Ruiz-de la Cruz, A.; Galán, M.; Roso, L.; Sánchez, F.; Benlloch, J. M.

    2017-03-01

    Laser accelerators have long been proposed as beam source for hadron therapy. However, the high energies necessary for the treatment of deep-lying tumours, combined with stringent requirements on the beam quality, are still a severe challenge. In the present work, we discuss the applicability of laser-accelerated carbon ions at moderate energies (100-480 MeV) to the irradiation of superficial lesions. We propose a new therapeutic modality which combines the versatility of Intra-Operative Radiation Therapy with the advantages of carbon ions as compared to photon and electron radiation. To justify this idea a feasibility study has been carried out, focused on the uniformity of dose deposition inside the treatment volume. Physical and biological aspects characteristic to laser-accelerated carbon ion beams are considered. A GATE simulation has been performed, showing an approximately uniform depth-dose profile up to a maximum penetration depth of 5 mm for a single radiation boost of 10 GyE.

  10. a New Mobile Electron Accelerator for Intra Operative Electron Radiation Therapy

    NASA Astrophysics Data System (ADS)

    Adrich, P.; Baczewski, A.; Baran, M.; Drabik, W.; Gryn, K.; Hanke, R.; Jakubowska, E.; Jankowski, E.; Kędzierski, G.; Kielar, N.; Kujawiński, Ł.; Kopeć, J.; Kosiński, K.; Kozioł, R.; Kraszewski, P.; Krawczyk, P.; Kulczycka, E.; Lalik, P.; Marczenko, M.; Masternak, A.; Misiarz, A.; Olszewski, J.; Ozon, K.; Pławski, E.; Polak, A.; Psonka, W.; Rutkowska, M.; Rzadkiewicz, J.; Sienkiewicz, Z.; Staszczak, M.; Swat, K.; Syntfeld-Każuch, A.; Terka, M.; Wasilewski, A.; Wilczek, J.; Wojciechowski, M.; Wójtowicz, M.; Wronka, S.; Wysocka-Rabin, A.; Zalewski, K.

    2014-02-01

    A demonstrator of a new, highly mobile, robotized linear electron accelerator for Intra Operative Electron Radiation Therapy (IOERT) is under construction at National Centre for Nuclear Studies. In an IOERT treatment, a high dose of electron radiation is delivered in a single fraction directly to an exposed location after tumor ablation during oncological surgery. Due to the fact that the tumor can be located anywhere in the body, a high maneuverability of the accelerator and its adaptability to anatomical conditions are required. Moreover, since the treatment is usually executed in an unshielded operation room, the radiation protection issues are of principal importance. To assure safety of the patient and medical personnel, the therapeutic head is designed to constrain the radiation to the volume of the tumor lodge while minimizing leakage and stray radiation. For these reasons, construction of accelerators for IOERT differs considerably from the construction of linear electron accelerators for external beam radiation therapy. This paper presents some challenges and solutions in construction of the accelerator and in particular its therapeutic head with beam forming system.

  11. From pre-operative cardiac modeling to intra-operative virtual environments for surgical guidance: an in vivo study

    NASA Astrophysics Data System (ADS)

    Linte, Cristian A.; Wierzbicki, Marcin; Moore, John; Wedlake, Christopher; Wiles, Andrew D.; Bainbridge, Daniel; Guiraudon, Gérard M.; Jones, Douglas L.; Peters, Terry M.

    2008-03-01

    As part of an ongoing theme in our laboratory on reducing morbidity during minimally-invasive intracardiac procedures, we developed a computer-assisted intervention system that provides safe access inside the beating heart and sufficient visualization to deliver therapy to intracardiac targets while maintaining the efficacy of the procedure. Integrating pre-operative information, 2D trans-esophageal ultrasound for real-time intra-operative imaging, and surgical tool tracking using the NDI Aurora magnetic tracking system in an augmented virtual environment, our system allows the surgeons to navigate instruments inside the heart in spite of the lack of direct target visualization. This work focuses on further enhancing intracardiac visualization and navigation by supplying the surgeons with detailed 3D dynamic cardiac models constructed from high-resolution pre-operative MR data and overlaid onto the intra-operative imaging environment. Here we report our experience during an in vivo porcine study. A feature-based registration technique previously explored and validated in our laboratory was employed for the pre-operative to intra-operative mapping. This registration method is suitable for in vivo interventional applications as it involves the selection of easily identifiable landmarks, while ensuring a good alignment of the pre-operative and intra-operative surgical targets. The resulting augmented reality environment fuses the pre-operative cardiac model with the intra-operative real-time US images with approximately 5 mm accuracy for structures located in the vicinity of the valvular region. Therefore, we strongly believe that our augmented virtual environment significantly enhances intracardiac navigation of surgical instruments, while on-target detailed manipulations are performed under real-time US guidance.

  12. Agreement between pre-operative and intra-operative bacteriological samples in 85 chronic peri-prosthetic infections.

    PubMed

    Matter-Parrat, V; Ronde-Oustau, C; Boéri, C; Gaudias, J; Jenny, J-Y

    2017-04-01

    Whether pre-operative microbiological sampling contributes to the management of chronic peri-prosthetic infection remains controversial. We assessed agreement between the results of pre-operative and intra-operative samples in patients undergoing single-stage prosthesis exchange to treat chronic peri-prosthetic infection. Agreement between pre-operative and intra-operative samples exceeds 75% in patients undergoing single-stage exchange of a hip or knee prosthesis to treat chronic peri-prosthetic infection. This single-centre retrospective study included 85 single-stage prosthesis exchange procedures in 82 patients with chronic peri-prosthetic infection at the hip or knee. Agreement between pre-operative and intra-operative sample results was evaluated. Changes to the initial antibiotic regimen made based on the intra-operative sample results were recorded. Of 149 pre-operative samples, 109 yielded positive cultures, in 75/85 cases. Of 452 intra-operative samples, 354 yielded positive cultures, in 85/85 cases. Agreement was complete in 54 (63%) cases and partial in 9 (11%) cases; there was no agreement in the remaining 22 (26%) cases. The complete agreement rate was significantly lower than 75% (P=0.01). The initial antibiotic regimen was inadequate in a single case. Pre-operative sampling may contribute to the diagnosis of peri-prosthetic infection but is neither necessary nor sufficient to confirm the diagnosis and identify the causative agent. The spectrum of the initial antibiotic regimen cannot be safely narrowed based on the pre-operative sample results. We suggest the routine prescription of a probabilistic broad-spectrum antibiotic regimen immediately after the prosthesis exchange, even when a pathogen was identified before surgery. IV, retrospective study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. NBI utility in the pre-operative and intra-operative assessment of oral cavity and oropharyngeal carcinoma.

    PubMed

    Tirelli, Giancarlo; Piovesana, Marco; Gatto, Annalisa; Torelli, Lucio; Di Lenarda, Roberto; Boscolo Nata, Francesca

    Despite advances in the surgical management of head and neck squamous cell carcinoma, the identification of synchronous lesions, precancerous lesions around the main tumor, or the unknown primary in the case of neck metastasis remains a problem, as these lesions may be invisible to the naked eye or with standard white light (WL) endoscopy. However, the advent of tools such as narrow-band imaging (NBI) could help the clinician. The purpose of this study was to assess the impact of NBI during the pre-operative and intra-operative stages of management of oral and oropharyngeal cancers. NBI was used pre-operatively in 47 patients with oral or oropharyngeal squamous cell carcinoma to identify the involvement of adjacent subsites, multifocality, synchronous lesions or an unknown primary. NBI was used intra-operatively in 30 patients to better define the tumor limits and guide the resection. The advantage of NBI versus WL endoscopy was analyzed by calculating the true and false positive rate pre-operatively, and the need for resection enlargements, histology of the enlargement, and the rate of clear margins at definitive histology, intra-operatively. Pre-operatively, the diagnostic gain of NBI was 8.5%, allowing identification of three synchronous tumors and one unknown primary. Intra-operatively, NBI improved the definition of tumor limits in 67.7% of cases, with resection enlargements showing dysplasia and carcinoma in 8 and 12 patients, respectively; we obtained 74.2% negative margins at histology. NBI could represent an added value in the pre-operative and intra-operative assessment of oral cavity and oropharyngeal carcinoma. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Celebrate Your Freedom--Assuring Equal Justice for All. Law Day 2002 Planning Guide.

    ERIC Educational Resources Information Center

    White, Charles, Ed.

    The theme for Law Day 2002 was set long before the tragic events of September 11, 2001, and its aftermath. The vision of Law Day planners was to plan programs on how the courts and legal system seek to assure equal access to justice for all people. This guide gives planners the tools for programs and discussions on legal aid, the "pro bono…

  15. Celebrate Your Freedom--Assuring Equal Justice for All. Law Day 2002 Planning Guide.

    ERIC Educational Resources Information Center

    White, Charles, Ed.

    The theme for Law Day 2002 was set long before the tragic events of September 11, 2001, and its aftermath. The vision of Law Day planners was to plan programs on how the courts and legal system seek to assure equal access to justice for all people. This guide gives planners the tools for programs and discussions on legal aid, the "pro bono…

  16. Imaging of spatially extended hot spots with coded apertures for intra-operative nuclear medicine applications

    NASA Astrophysics Data System (ADS)

    Kaissas, I.; Papadimitropoulos, C.; Potiriadis, C.; Karafasoulis, K.; Loukas, D.; Lambropoulos, C. P.

    2017-01-01

    Coded aperture imaging transcends planar imaging with conventional collimators in efficiency and Field of View (FOV). We present experimental results for the detection of 141 keV and 122 keV γ-photons emitted by uniformly extended 99mTc and 57Co hot-spots along with simulations of uniformly and normally extended 99mTc hot-spots. These results prove that the method can be used for intra-operative imaging of radio-traced sentinel nodes and thyroid remnants. The study is performed using a setup of two gamma cameras, each consisting of a coded-aperture (or mask) of Modified Uniformly Redundant Array (MURA) of rank 19 positioned on top of a CdTe detector. The detector pixel pitch is 350 μm and its active area is 4.4 × 4.4 cm2, while the mask element size is 1.7 mm. The detectable photon energy ranges from 15 keV up to 200 keV with an energy resolution of 3-4 keV FWHM. Triangulation is exploited to estimate the 3D spatial coordinates of the radioactive spots within the system FOV. Two extended sources, with uniform distributed activity (11 and 24 mm in diameter, respectively), positioned at 16 cm from the system and with 3 cm distance between their centers, can be resolved and localized with accuracy better than 5%. The results indicate that the estimated positions of spatially extended sources lay within their volume size and that neighboring sources, even with a low level of radioactivity, such as 30 MBq, can be clearly distinguished with an acquisition time about 3 seconds.

  17. SU-E-T-756: Tissue Inhomogeneity Corrections in Intra-Operative Radiotherapy

    SciTech Connect

    Sethi, A; Chinsky, B; Gros, S; Diak, A; Roeske, J; Emami, B; Small, W

    2015-06-15

    Purpose: Investigate the impact of tissue inhomogeneities on dose distributions produced by low-energy X-rays in intra-operative radiotherapy (IORT). Methods: A 50-kV INTRABEAM X-ray device with superficial (Flat and Surface) applicators was commissioned at our institution. For each applicator, percent depth-dose (PDD), dose-profiles (DP) and output factors (OF) were obtained. Calibrated GaFchromic (EBT3) films were used to measure dose distributions in solid water phantom at various depths (2, 5, 10, and 15 mm). All recommended precautions for film-handling, film-exposure and scanning were observed. The effects of tissue inhomogeneities on dose distributions were examined by placing air-cavities and bone and tissue equivalent materials of different density (ρ), atomic number (Z), and thickness (t = 0–4mm) between applicator and film detector. All inhomogeneities were modeled as a cylindrical cavity (diameter 25 mm). Treatment times were calculated to deliver 1Gy dose at 5mm depth. Film results were verified by repeat measurements with a thin-window parallel plate ion-chamber (PTW 34013A) in a water tank. Results: For a Flat-4cm applicator, the measured dose rate at 5mm depth in solid water was 0.35 Gy/min. Introduction of a cylindrical air-cavity resulted in an increased dose past the inhomogeneity. Compared to tissue equivalent medium, dose enhancement due to 1mm, 2mm, 3mm and 4mm air cavities was 10%, 16%, 24%, and 35% respectively. X-ray attenuation by 2mm thick cortical bone resulted in a significantly large (58%) dose decrease. Conclusion: IORT dose calculations assume homogeneous tissue equivalent medium. However, soft X-rays are easily affected by non-tissue equivalent materials. The results of this study may be used to estimate and correct IORT dose delivered in the presence of tissue inhomogeneities.

  18. Hemodynamic effects of dexmedetomidine during intra-operative electrocorticography for epilepsy surgery.

    PubMed

    Chaitanya, G; Arivazhagan, A; Sinha, Sanjib; Madhusudan Reddy, K R; Thennarasu, K; Bharath, R D; Rao, M Bhaskara; Chandramouli, B A; Satishchandra, P

    2014-11-01

    Dexmedetomidine, a predominant alpha-2-adrenergic agonist has been used in anesthetic practice to provide good sedation. The drug is being recently used in neuroanesthesia during awake surgery for brain tumors and in functional neurosurgery. This prospective study analyzed the hemodynamic effects of dexmedetomidine infusion during electrocorticography in patients undergoing surgery for mesial temporal sclerosis. Dexmedetomidine infusion was administered during intra-operative electrocorticography recording, 15 minutes after the end tidal MAC of N2O and isoflurane were decreased to zero. Anesthesia was maintained with O2 : air mixture = 50:50, vecuronium and fentanyl. Heart rate (HR), mean arterial pressure (MAP) and end tidal carbon dioxide (ETCO2) were recorded across at induction, 2 min prior to dexmedetomidine (PreDEX), 5 min during dexmedetomidine infusion (DEX; 1 μg/kg), 5 min after stopping dexmedetomidine and 10 minutes after stopping dexmedetomidine. Forty patients with mesial temporal sclerosis (M: F = 27:13, mean age = 28.15 ± 10.9 years; duration of epilepsy = 12.0 ± 7.9 years) underwent anterior temporal lobe resection with amygdalohippocampectomy for drug-resistant epilepsy. Infusion of dexmedetomidine caused a transient fall in HR in 87.5% of patients and an increase in MAP in 62.5% of patients, which showed a tendency to revert back towards PreDEX values within 10 min after stopping the infusion. Sixty-five percent of the patients showed ≤25% reduction and 10% of them showed >25% reduction in HR. 47.5% of the patients showed ≤25% increase and 15% of them showed >25% increase in MAP. These changes were over a narrow range and within physiological limits. The infusion of dexmedetomidine for a short period causes reduction of HR and increase in MAP in patients, however the variations are within acceptable range.

  19. Potential predictors for the amount of intra-operative brain shift during deep brain stimulation surgery

    NASA Astrophysics Data System (ADS)

    Datteri, Ryan; Pallavaram, Srivatsan; Konrad, Peter E.; Neimat, Joseph S.; D'Haese, Pierre-François; Dawant, Benoit M.

    2011-03-01

    A number of groups have reported on the occurrence of intra-operative brain shift during deep brain stimulation (DBS) surgery. This has a number of implications for the procedure including an increased chance of intra-cranial bleeding and complications due to the need for more exploratory electrodes to account for the brain shift. It has been reported that the amount of pneumocephalus or air invasion into the cranial cavity due to the opening of the dura correlates with intraoperative brain shift. Therefore, pre-operatively predicting the amount of pneumocephalus expected during surgery is of interest toward accounting for brain shift. In this study, we used 64 DBS patients who received bilateral electrode implantations and had a post-operative CT scan acquired immediately after surgery (CT-PI). For each patient, the volumes of the pneumocephalus, left ventricle, right ventricle, third ventricle, white matter, grey matter, and cerebral spinal fluid were calculated. The pneumocephalus was calculated from the CT-PI utilizing a region growing technique that was initialized with an atlas-based image registration method. A multi-atlas-based image segmentation method was used to segment out the ventricles of each patient. The Statistical Parametric Mapping (SPM) software package was utilized to calculate the volumes of the cerebral spinal fluid (CSF), white matter and grey matter. The volume of individual structures had a moderate correlation with pneumocephalus. Utilizing a multi-linear regression between the volume of the pneumocephalus and the statistically relevant individual structures a Pearson's coefficient of r = 0.4123 (p = 0.0103) was found. This study shows preliminary results that could be used to develop a method to predict the amount of pneumocephalus ahead of the surgery.

  20. Pose estimation quality assessment for intra-operative image guidance systems

    NASA Astrophysics Data System (ADS)

    Egli, Adrian; Kleinszig, Gerhard; John, Adrian; Fernandez, Alberto; Cardelino, Juan

    2013-03-01

    In trauma and orthopedic surgery screw assessment and trajectory prediction using two-dimensional X-ray images is very difficult due to projected 3D information. However screw assessment can be done with multiple X-ray images. If the X-ray image contains the projected implant geometry it can be used as global coordinate reference. Thereby multiple independent X-ray images can be synchronized by estimating the implant pose in each single image. Consequently high accuracy pose estimation is fundamental. To measure the outcome quality an evaluation process has been designed. The evaluation process investigates in its first step several clinical intra-operative anterior-posterior (AP) and medio-lateral (ML) X-ray images which have been analyzed using a manual pose estimation method. With the manual method the six 3D parameters of the implant pose are estimated. These parameters define as well the camera pose relative to the implant. Based on the pose parameters of all clinical cases the capturing range for typical AP and ML images is statistically defined. The implant was attached to a phantom with 16 steel balls which allows to calculate the ground truth pose. Afterwards several X-ray images of the phantom are taken within the statistically defined capturing range. With the known ground truth different pose estimation methods can be compared. For each method the estimation quality can be calculated. In addition this error calculation can be used to adjust the initial manually determined capturing range. This paper explains the error evaluation process and describes how to validate pose estimation methods for clinical applications.

  1. Protecting Patients from an Unsafe System: The Etiology & Recovery of Intra-Operative Deviations in Care

    PubMed Central

    Hu, Yue-Yung; Arriaga, Alexander F.; Roth, Emilie M.; Peyre, Sarah E.; Corso, Katherine A.; Swanson, Richard S.; Osteen, Robert T.; Schmitt, Pamela; Bader, Angela M.; Zinner, Michael J.; Greenberg, Caprice C.

    2012-01-01

    Objective To understand the etiology and resolution of unanticipated events in the operating room (OR). Background The majority of surgical adverse events occur intra-operatively. The OR represents a complex, high-risk system. The influence of different human, team, and organizational/environmental factors on safety and performance is unknown. Methods We video-recorded and transcribed 10 high-acuity operations, representing 43.7 hours of patient care. Deviations, defined as delays and/or episodes of decreased patient safety, were identified by majority consensus of a multidisciplinary team. Factors that contributed to each event and/or mitigated its impact were determined and attributed to the patient, providers, or environment/organization. Results Thirty-three deviations (10 delays, 17 safety compromises, 6 both) occurred – with a mean of one every 79.4 minutes. These deviations were multifactorial (mean 3.1 factors). Problems with communication and organizational structure appeared repeatedly at the root of both types of deviations. Delays tended to be resolved with vigilance, communication, coordination, and cooperation, while mediation of safety compromises was most frequently accomplished with vigilance, leadership, communication, and/or coordination. The organization/environment was not found to play a direct role in compensation. Conclusions Unanticipated events are common in the OR. Deviations result from poor organizational/environmental design and suboptimal team dynamics, with caregivers compensating to avoid patient harm. While recognized in other high risk domains, such human resilience has not yet been described in surgery and has major implications for the design of safety interventions. PMID:22750753

  2. A novel intra-operative positron imager for rapid localization of tumor margins

    NASA Astrophysics Data System (ADS)

    Sabet, Hamid; Stack, Brendan C.; Nagarkar, Vivek V.

    2014-03-01

    We have developed an intra-operative and compact imaging tool for surgeons to detect PET- positive lesions. Currently, most such probes on the market are non-imaging, and provide no ancillary information of surveyed areas, such as clear delineations of malignant tissues. Our probe consists of a novel hybrid scintillator coupled to a compact silicon photomultiplier (SiPM) array with associated front-end electronics encapsulated in an ergonomic housing. Pulse shape discrimination electronics has been implemented and integrated into the downstream data acquisition system. The hybrid scintillator consists of a 0.4 mm thick layer of CsI:Tl scintillator coupled to a 1 mm thick LYSO crystal. To achieve high spatial resolution, CsI:Tl is pixelated to 0.5×0.5 mm2 pixels using laser ablation technique. While CsI:Tl act as beta-sensitive scintillator, LYSO senses the gamma radiation and can be used to navigate the probe to the locations of interest. The gamma response is also subtracted from the beta image for improved SNR and contrast. To achieve accurate centroid position estimation and uniform beta sensitivity over the entire imaging area, the LYSO thickness is optimized such that it acts as scintillation light diffuser by spreading CsI:Tl light over multiple SiPM pixels. The results show that the response of the two scintillators exposed to radiation could be easily distinguished based on their pulse shapes. The probe's spatial resolution is <1.5 mm FWHM in its 10×10 mm2 effective imaging area. The probe can rapidly detect and localize nCi levels of F-18 beta radiation even in presence of strong gamma background.

  3. Intra-operative vertebroplasty combined with posterior cord decompression. A report of twelve cases.

    PubMed

    Allegretti, Luca; Mavilio, Nicola; Fiaschi, Pietro; Bragazzi, Roberto; Pacetti, Mattia; Castelletti, Lara; Saitta, Laura; Castellan, Lucio

    2014-10-31

    Percutaneous vertebroplasty (VP) is a minimally invasive technique for the treatment of vertebral pathology providing early vertebral stabilization and pain relief. In cases of vertebral pathology complicated by spinal cord compression with associated neurological deficits, VP alone cannot be performed free of risks. We describe a combined approach in which decompressive laminectomy and intra-operative vertebroplasty (IVP) are performed during a single session. Among the 252 VP performed in our centre in the past three years, 12 patients (12 vertebral levels) with different pathologies (six symptomatic haemangiomas, two metastatic fractures, four osteoporotic fractures) were treated with an open procedure combined with surgery. All cases were treated with decompressive laminectomy and IVP (mono/bipeduncular or median-posterior trans-somatic access). Five patients with symptomatic haemangiomas were treated with endovascular embolization prior to the combined approach. A visual analogue scale (VAS) was applied to assess pain intensity before and after surgery. The neurological deficits were evaluated with an ASIA impairment scale. In all cases benefit from pain and neurological deficits was observed. The mean VAS score decreased from 7.8 to 2.5 after surgery. The ASIA score improved in all cases (five cases from D to E and five cases from C to D). No clinical complications were observed. In one case a CT scan performed after the procedure showed a foraminal accumulation of PMMA, but the patient referred no symptoms. IVP can be successfully applied in different pathologies affecting the vertebrae. In our limited series this approach proved safe and efficient to provide decompression of spinal cord and dural sac and vertebral body stabilization in a single session.

  4. Influence of root canal instrumentation and obturation techniques on intra-operative pain during endodontic therapy

    PubMed Central

    Martín-González, Jenifer; Echevarría-Pérez, Marta; Sánchez-Domínguez, Benito; Tarilonte-Delgado, Maria L.; Castellanos-Cosano, Lizett; López-Frías, Francisco J.

    2012-01-01

    Objective: To analyse the influence of root canal instrumentation and obturation techniques on intra-operative pain experienced by patients during endodontic therapy. Method and Materials: A descriptive cross-sectional study was carried out in Ponferrada and Sevilla, Spain, including 80 patients (46 men and 34 women), with ages ranged from 10 to 74 years, randomly recruited. Patient gender and age, affected tooth, pulpal diagnosis, periapical status, previous NSAID or antibiotic (AB) treatment, and root canal instrumentation and obturation techniques were recorded. After root canal treatment (RCT), patients completed a 10-cm visual analogue scale (VAS) that ranked the level of pain. Results were analysed statistically using the Chi-square and ANOVA tests and logistic regression analysis. Results: The mean pain level during root canal treatment was 2.9 ± 3.0 (median = 2) in a VAS between 0 and 10. Forty percent of patients experienced no pain. Gender, age, arch, previous NSAIDs or AB treatment and anaesthetic type did not influence significantly the pain level (p > 0.05). Pain during root canal treatment was significantly greater in molar teeth (OR = 10.1; 95% C.I. = 1.6 - 63.5; p = 0.013). Root canal instrumentation and obturation techniques did not affect significantly patient’s pain during root canal treatment (p > 0.05). Conclusion: Patients feel more pain when RCT is carried out on molar teeth. The root canal instrumentation and obturation techniques do not affect significantly the patients’ pain during RCT. Key words:Anaesthesia, endodontic pain, pulpitis, root canal instrumentation, root canal obturation, rotary files. PMID:22549694

  5. 26 CFR 11.412(c)-7 - Election to treat certain retroactive plan amendments as made on the first day of the plan year.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... amendments as made on the first day of the plan year. 11.412(c)-7 Section 11.412(c)-7 Internal Revenue... treat certain retroactive plan amendments as made on the first day of the plan year. (a) General rule... the date of the close of the first plan year to which the amendment applies and the date on which...

  6. 26 CFR 11.412(c)-7 - Election to treat certain retroactive plan amendments as made on the first day of the plan year.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... amendments as made on the first day of the plan year. 11.412(c)-7 Section 11.412(c)-7 Internal Revenue... treat certain retroactive plan amendments as made on the first day of the plan year. (a) General rule... the date of the close of the first plan year to which the amendment applies and the date on which...

  7. 26 CFR 11.412(c)-7 - Election to treat certain retroactive plan amendments as made on the first day of the plan year.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... amendments as made on the first day of the plan year. 11.412(c)-7 Section 11.412(c)-7 Internal Revenue... treat certain retroactive plan amendments as made on the first day of the plan year. (a) General rule... the date of the close of the first plan year to which the amendment applies and the date on which...

  8. 26 CFR 11.412(c)-7 - Election to treat certain retroactive plan amendments as made on the first day of the plan year.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... amendments as made on the first day of the plan year. 11.412(c)-7 Section 11.412(c)-7 Internal Revenue... treat certain retroactive plan amendments as made on the first day of the plan year. (a) General rule... the date of the close of the first plan year to which the amendment applies and the date on which...

  9. Breast-conserving surgery with intra-operative radiotherapy: the right approach for the 21st century?

    PubMed

    Tobias, J S; Vaidya, J S; Keshtgar, M; Douek, M; Metaxas, M; Stacey, C; Sainsbury, R; D'Souza, D; Baum, M

    2006-04-01

    Wide local excision followed by external beam radiation therapy (EBRT) to the whole breast has become the standard of care for most patients with localised 'early' breast cancer in the UK, Europe, and the USA. Local relapse rates are low, and overall survival figures have improved during the past decade, with the advent of more effective systemic endocrine- and chemo-therapy. A policy of EBRT for every patient undergoing breast conserving surgery (BCS) is however associated with a number of practical difficulties, acute radiation side effects and longer term toxicity, all of which detract from the obvious benefits of EBRT. In addition, with a disease as common as early breast cancer and a treatment programme typically requiring sophisticated radiation planning and many fractions of treatment, the policy of BCS plus EBRT has enormous resource implications within departments of oncology, greatly contributing to lengthy pre-treatment delays. For all these reasons, we and others have developed an increasing interest in techniques of partial breast irradiation, with an emphasis in our own Department on the emerging technique of intra-operative radiotherapy (IORT), which we initially employed as a boost to the tumour bed for use in conjunction with EBRT to the whole breast. To test the possibility of replacing the whole of the EBRT 3-6 week programme by a single application of IORT at the time of surgery, we and others have commenced a large scale prospectively randomised clinical trail in selected patients. Nine international centres are currently participating, and 350 patients have now been randomised to receive either IORT as part of the initial surgical excision or conventional EBRT with a pragmatic dose policy according to the preference of the contributing centre. The majority of patients undergoing IORT receive this at the time of initial surgery but it is also permissible within the trial programme to randomise suitable patients after the excised specimen has

  10. Biomechanics of the intra-operative lateral decubitus position for the scoliotic spine: effect of the pelvic obliquity.

    PubMed

    Lalonde, Nadine M; Aubin, Carl-Eric; Parent, Stefan; Pannetier, Romain; Villemure, Isabelle

    2010-01-01

    The intra-operative prone position used for the posterior instrumentation of scoliotic patients has been shown to reduce the spinal deformities prior to instrumentation by 37% on average. However, the effects of the lateral decubitus position used for anterior approaches and minimally invasive techniques have not been investigated. The objectives were to characterize, model and study the biomechanics of this intra-operative posture. Several clinical indices were measured on the pre- and intra-operative radiographs of six scoliotic patients. A personalized finite element mode (FEM) was developed using the pre-op 3D reconstruction, and a three-step method was developed to simulate the lateral decubitus positioning. Two additional intra-op postures, simulating different pelvic obliquities, were also tested by varying the inclination of L5. The radiographic evaluation of the lateral decubitus position showed a significant reduction of 44% of the major curve with 18 mm of apical vertebra translation. The FEM was able to reproduce the intra-op spine geometry with no significant difference with the measured values. Simulations also showed that the pelvic obliquity had different effects on the lumbar and major Cobb angles depending on the scoliotic curve type. The lateral decubitus posture reduces significantly the scoliotic curvatures prior to instrumentation, which was dependent on the pelvic obliquity.

  11. Intra-operative neurophysiological prediction of upper trunk recovery in obstetric brachial plexus palsy with neuroma in continuity.

    PubMed

    Chin, K F; Misra, V P; Sicuri, G M; Fox, M; Sinisi, M

    2013-05-01

    We investigated the predictive value of intra-operative neurophysiological investigations in obstetric brachial plexus injuries. Between January 2005 and June 2011 a total of 32 infants of 206 referred to our unit underwent exploration of the plexus, including neurolysis. The findings from intra-operative electromyography, sensory evoked potentials across the lesion and gross muscular response to stimulation were evaluated. A total of 22 infants underwent neurolysis alone and ten had microsurgical reconstruction. Of the former, one was lost to follow-up, one had glenoplasty and three had subsequent nerve reconstructions. Of the remaining 17 infants with neurolysis, 13 (76%) achieved a modified Mallet score > 13 at a mean age of 3.5 years (0.75 to 6.25). Subluxation or dislocation of the shoulder is a major confounding factor. The positive predictive value and sensitivity of the intra-operative EMG for C5 were 100% and 85.7%, respectively, in infants without concurrent shoulder pathology. The positive and negative predictive values, sensitivity and specificity of the three investigations combined were 77%, 100%, 100% and 57%, respectively. In all, 20 infants underwent neurolysis alone for C6 and three had reconstruction. All of the former and one of the latter achieved biceps function of Raimondi grade 5. The positive and negative predictive values, sensitivity and specificity of electromyography for C6 were 65%, 71%, 87% and 42%, respectively. Our method is effective in evaluating the prognosis of C5 lesion. Neurolysis is preferred for C6 lesions.

  12. Role of intra-operative contrast-enhanced ultrasound (CEUS) in robotic-assisted nephron-sparing surgery.

    PubMed

    Alenezi, Ahmad N; Karim, Omer

    2015-03-01

    This review examines studies of intra-operative contrast-enhanced ultrasound (CEUS) and its emerging role and advantages in robotic-assisted nephron-sparing surgery. Contrast-enhanced ultrasound is a technology that combines the use of second-generation contrast agents consisting of microbubbles with existent ultrasound techniques. Until now, this novel technology has aided surgeons with procedures involving the liver. However, with recent advances in the CEUS technique and the introduction of robotics in nephron-sparing surgery, CEUS has proven to be efficacious in answering several clinical questions with respect to the kidneys. In addition, the introduction of the microbubble-based contrast agents has increased the image quality and signal uptake by the ultrasound probe. This has led to better, enhanced scanning of the macro and microvasculature of the kidneys, making CEUS a powerful diagnostic modality. This imaging method is capable of further lowering the learning curve and warm ischemia time (WIT) during robotic-assisted nephron-sparing surgery, with its increased level of capillary perfusion and imaging. CEUS has the potential to increase the sensitivity and specificity of intra-operative images, and can significantly improve the outcome of robotic-assisted nephron-sparing surgery by increasing the precision and diagnostic insight of the surgeon. The purpose of this article is to review the practical and potential uses of CEUS as an intra-operative imaging technique during robotic-assisted nephron-sparing surgery.

  13. The Relationship between Intra-Operative Transfusions and Nadir Hematocrit on Post-Operative Outcomes after Cardiac Surgery.

    PubMed

    Goldberg, Joshua B; Shann, Kenneth G; Fitzgerald, David; Fuller, John; Paugh, Theron A; Dickinson, Timothy A; Paone, Gaetano; Prager, Richard L; Likosky, Donald S

    2016-12-01

    Uncertainty exists regarding the optimal strategy for the management of anemia in the setting of cardiac surgery. We sought to improve our understanding of the role of intra-operative hematocrit (HCT) and transfusions on peri-operative outcomes following cardiac surgery. A total of 18,886 patients undergoing on-pump cardiac surgery were identified from a multi-institutional registry including surgical and perfusion data. Patients were divided into four groups based on their intra-operative nadir HCT (<21 or ≥21) and whether or not they received intra-operative red blood cell (+RBC or -RBC) transfusions. Outcomes were adjusted for the Society of Thoracic Surgeons predicted risk of mortality (PROM), pre-operative HCT, and medical center. Regardless of nadir HCT cohort, those who received a transfusion had higher PROM relative to patients who did not receive a transfusion. The mean PROM was significantly higher among those HCT ≥21 + RBC (5.3%) vs. HCT ≥ 21 - RBC (1.9%), p < .001. Similarly, the PROM was significantly higher among HCT <21 + RBC (5.1%) vs. those HCT <21 - RBC (3.1%), p < .001. Adjusted outcomes demonstrated an increased impact of RBC transfusions on adverse outcomes irrespective of nadir HCT including stroke (p < .001), renal failure (p < .001), prolonged ventilation (p < .001), and mortality (p < .001). This study demonstrates that transfusions have a more profound effect on post-operative cardiac surgery outcomes than anemia.

  14. Sub-optimality in motor planning is retained throughout 9 days practice of 2250 trials

    PubMed Central

    Ota, Keiji; Shinya, Masahiro; Kudo, Kazutoshi

    2016-01-01

    Optimality in motor planning, as well as accuracy in motor execution, is required to maximize expected gain under risk. In this study, we tested whether humans are able to update their motor planning. Participants performed a coincident timing task with an asymmetric gain function, in which optimal response timing to gain the highest total score depends on response variability. Their behaviours were then compared using a Bayesian optimal decision model. After 9 days of practicing 2250 trials, the total score increased, and temporal variance decreased. On the other hand, the participants showed consistent risk-seeking or risk-averse behaviour, preserving suboptimal motor planning. These results suggest that a human’s computational ability to calculate an optimal motor plan is limited, and it is difficult to improve it through repeated practice with a score feedback. PMID:27869198

  15. Montecarlo simulation code in optimisation of the IntraOperative Radiation Therapy treatment with mobile dedicated accelerator

    NASA Astrophysics Data System (ADS)

    Catalano, M.; Agosteo, S.; Moretti, R.; Andreoli, S.

    2007-06-01

    The principle of optimisation of the EURATOM 97/43 directive foresees that for all medical exposure of individuals for radiotherapeutic purposes, exposures of target volumes shall be individually planned, taking into account that doses of non-target volumes and tissues shall be as low as reasonably achievable and consistent with the intended radiotherapeutic purpose of the exposure. Treatment optimisation has to be carried out especially in non conventional radiotherapic procedures, as Intra Operative Radiation Therapy (IORT) with mobile dedicated LINear ACcelerator (LINAC), which does not make use of a Treatment Planning System. IORT is carried out with electron beams and refers to the application of radiation during a surgical intervention, after the removal of a neoplastic mass and it can also be used as a one-time/stand alone treatment in initial cancer of small volume. IORT foresees a single session and a single beam only; therefore it is necessary to use protection systems (disks) temporary positioned between the target volume and the underlying tissues, along the beam axis. A single high Z shielding disk is used to stop the electrons of the beam at a certain depth and protect the tissues located below. Electron back scatter produces an enhancement in the dose above the disk, and this can be reduced if a second low Z disk is placed above the first. Therefore two protection disks are used in clinical application. On the other hand the dose enhancement at the interface of the high Z disk and the target, due to back scattering radiation, can be usefully used to improve the uniformity in treatment of thicker target volumes. Furthermore the dose above the disks of different Z material has to be evaluated in order to study the optimal combination of shielding disks that allow both to protect the underlying tissues and to obtain the most uniform dose distribution in target volumes of different thicknesses. The dose enhancement can be evaluated using the electron

  16. 77 FR 23747 - Notice of Availability of the Proposed John Day Basin Resource Management Plan and Final...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-20

    ... Bureau of Land Management Notice of Availability of the Proposed John Day Basin Resource Management Plan... Proposed Resource Management Plan (RMP)/Final Environmental Impact Statement (EIS) for the John Day Basin... Register. ADDRESSES: Copies of the John Day Basin Proposed RMP/Final EIS have been sent to affected Federal...

  17. The Standard Days Method: an addition to the arsenal of family planning method choice in Ethiopia.

    PubMed

    Bekele, Biruhtesfa; Fantahun, Mesganaw

    2012-07-01

    The Standard Days Method ® (SDM) is a fertility awareness-based method of family planning that helps users to identify the fertile days of the reproductive cycle (Days 8-19). To prevent pregnancy users avoid unprotected sexual intercourse during these days. A cross-sectional community-based study was conducted from December 2007 to June 2008 in four operational areas of Pathfinder International Ethiopia. A total of 184 SDM users were included in the study. Quantitative and qualitative methods of data collection were used. The aim of the study was to examine the experience of introducing the SDM at community level in Ethiopia. Of the 184 participants, 80.4% were still using the SDM at the time of the survey, with 35% having used it for between 6 and 12 months, while 42% had used it for more than a year. The majority (83%) knew that a woman is most likely to conceive halfway through her menstrual cycle, and nearly 91% correctly said that the SDM does not confer protection from sexually transmitted infections/AIDS. A substantial majority (75%) had correctly identified what each colour-coded bead represents in the CycleBeads ®, and an aggregate of 90.5% of women practised all the elements of correct use. This study demonstrates the importance of the SDM in increasing the availability and accessibility of family planning, and the potential to improve family planning method choice and method mix by expanding use of the SDM.

  18. Use of auditory evoked potentials for intra-operative awareness in anesthesia: a consciousness-based conceptual model.

    PubMed

    Dong, Xuebao; Suo, Puxia; Yuan, Xin; Yao, Xuefeng

    2015-01-01

    Auditory evoked potentials (AEPs) have been used as a measure of the depth of anesthesia during the intra-operative process. AEPs are classically divided, on the basis of their latency, into first, fast, middle, slow, and late components. The use of auditory evoked potential has been advocated for the assessment of Intra-operative awareness (IOA), but has not been considered seriously enough to universalize it. It is because we have not explored enough the impact of auditory perception and auditory processing on the IOA phenomena as well as on the subsequent psychological impact of IOA on the patient. More importantly, we have seldom tried to look at the phenomena of IOP from the perspective of consciousness itself. This perspective is especially important because many of IOA phenomena exist in the subconscious domain than they do in the conscious domain of explicit recall. Two important forms of these subconscious manifestations of IOA are the implicit recall phenomena and post-operative dreams related to the operation. Here, we present an integrated auditory consciousness-based model of IOA. We start with a brief description of auditory awareness and the factors affecting it. Further, we proceed to the evaluation of conscious and subconscious information processing by auditory modality and how they interact during and after intra-operative period. Further, we show that both conscious and subconscious auditory processing affect the IOA experience and both have serious psychological implications on the patient subsequently. These effects could be prevented by using auditory evoked potential during monitoring of anesthesia, especially the mid-latency auditory evoked potentials (MLAERs). To conclude our model with present hypothesis, we propose that the use of auditory evoked potential should be universal with general anesthesia use in order to prevent the occurrences of distressing outcomes resulting from both conscious and subconscious auditory processing during

  19. Beliefs and values about intra-operative teaching and learning: a case study of surgical teachers and trainees.

    PubMed

    Ong, Caroline C P; Dodds, Agnes; Nestel, Debra

    2016-08-01

    Surgeons require advanced psychomotor skills, critical decision-making and teamwork skills. Much of surgical skills training involve progressive trainee participation in supervised operations where case variability, operating team interaction and environment affect learning, while surgical teachers face the key challenge of ensuring patient safety. Using a theoretical framework of situated learning including cognitive apprenticeship, we explored teachers' and trainees' beliefs and values about intra-operative training and reasons for any differences. A qualitative case study method was used where five teacher-trainee pairs participating in an observed teaching operation were separately interviewed about the same operation. Thematic analysis of transcribed interviews and observations was performed with iterative refinement and a reflexive approach was adopted throughout the study. We found that in all cases, teachers and trainees had shared recognition of learning about technical skills whereas they differed in three cases regarding non-technical skills such as surgical reasoning and team management. Factors contributing to teacher and trainee satisfaction with the process were successful trainee completion of operation without need for surgeon take-over, a positive learning environment and learning new things. Teaching-learning behaviours observed and discussed were modeling, coaching and scaffolding, while exploration, reflection and articulation were less common. Our study reveals differing teacher and trainee perspectives of some aspects of intra-operative training and surfaces new reasons other than amount of feedback and autonomy given. Factors contributing to different perspectives include teacher and trainee abilities, values and situational influences. Targeted teaching-learning strategies could enhance intra-operative learning.

  20. Laser-IORT: a laser-driven source of relativistic electrons suitable for Intra-Operative Radiation Therapy of tumors

    SciTech Connect

    Gamucci, A.; Giulietti, A.; Gizzi, L. A.; Labate, L.; Bourgeois, N.; Marques, J. R.; Ceccotti, T.; Dobosz, S.; D'Oliveira, P.; Monot, P.; Popescu, H.; Reau, F.; Martin, Ph.; Galy, J.; Giulietti, D.; Hamilton, D. J.; Sarri, G.

    2010-02-02

    In a recent experiment [1] a high efficiency regime of stable electron acceleration to kinetic energies ranging from 10 to 40 MeV has been achieved. The main parameters of the electron bunches are comparable with those of bunches provided by commercial Radio-Frequency based Linacs currently used in Hospitals for Intra-Operative Radiation Therapy (IORT). IORT is an emerging technique applied in operating theaters during the surgical treatment of tumors. Performances and structure of a potential laser-driven Hospital accelerator are compared in detail with the ones of several commercial devices. A number of possible advantages of the laser based technique are also discussed.

  1. Multiple Pre-operative and Intra-operative Factors Predict Early Fistula Thrombosis in the Hemodialysis Fistula Maturation Study

    PubMed Central

    Farber, Alik; Imrey, Peter B.; Huber, Thomas S.; Kaufman, James M.; Kraiss, Larry W.; Larive, Brett; Li, Liang; Feldman, Harold I.

    2015-01-01

    OBJECTIVES Early thrombosis (ET) contributes to autogenous arteriovenous fistula (AVF) failure. We studied patients undergoing AVF placement in the Hemodialysis Fistula Maturation (HFM) Study, a prospective, observational cohort study, using a nested case-control analysis to identify pre-operative and intra-operative predictors of ET. METHODS ET cases were compared to controls who were matched on gender, age, diabetes, dialysis status, and surgeon fistula volume. ET was defined as thrombosis diagnosed by physical exam or ultrasound within 18 days of AVF creation. Conditional logistic regression models were fit to identify risk factors for ET. RESULTS Thirty-two ET cases (5.3%) occurred among 602 study participants; 198 controls were matched. ET was associated with female gender (OR=2.75, CI 1.19–6.38, P=0.018), fistula location (forearm vs. upper arm) (OR=2.76, CI 1.05–7.23, P=0.039), feeding artery (radial vs. brachial) (OR=2.64, CI 1.03–6.77, P=0.043) and arterial diameter (OR=1.52, CI 1.02–2.26, P=0.039, per mm smaller). Draining vein diameter was nonlinearly associated with ET, with highest risk in 2–3 mm veins. Surprisingly, ET risk was lower in diabetics (OR=0.19, CI 0.07–0.47, P=0.0004), lower with less nitroglycerin-mediated brachial artery dilatation (NMD%) (OR=0.42, CI 0.20–1.92, P=0.029 for each 10% lower) and higher with lower carotid-femoral pulse wave velocity (OR=1.49, CI 1.02–2.20, P=0.041, for each m/sec lower). Intraoperative protamine use was associated with a higher ET risk (OR 3.26, CI 1.28-∞, P=0.038). Surgeon’s intraoperative perceptions were associated with ET: surgeons’ greater concern about maturation success (likely, marginal, unlikely) was associated with higher thrombosis risk (OR 8.09, CI 4.03-∞, p<0.0001, per category change), as were absence vs. presence of intraoperative thrill (OR 21.0, CI 5.07-∞, P=0.0002) and surgeons’ reported frustration during surgery (OR 6.85, CI 2.70-∞, P=0.0004). Reduced extent

  2. SPY: an innovative intra-operative imaging system to evaluate graft patency during off-pump coronary artery bypass grafting.

    PubMed

    Takahashi, Masao; Ishikawa, Toshihiro; Higashidani, Koichi; Katoh, Hiroki

    2004-09-01

    Off-pump coronary artery bypass grafting (CABG) has been rapidly increased, because of its less invasiveness with low complications. However, graft patency rate highly depends on the operators' capability due to technical difficulties. The SPY system, based on the fluorescence of indocyanine green, is an innovative device that permits validation of graft patency intra-operatively. Real time images of grafts are obtained with no need for catheterization, X-rays or iodine contrast medium. High-quality images could be obtained in all 290 grafts of 72 off-pump CABG cases (mean 4.0 grafts per patient). Four anastomoses (1.4%), including two proximal and two distal, were revised because of defects detected by SPY images. In one case, the SPY system revealed no blood flow in a radial sequential graft, although transit-time flow meter measurements showed a diastolic dominant pattern. SPY images provide critical information to surgeons to detect non-patent grafts, allowing them to be revised while the patient is still on the operating table. Using the SPY system, technical failures could be completely resolved during surgery. The use of the SPY system for intra-operative graft validation during off-pump CABG may become the gold standard for surgical management in the near future.

  3. Semi-automated registration of pre- and intra-operative liver CT for image-guided interventions

    NASA Astrophysics Data System (ADS)

    Gunay, Gokhan; Ha, Luu Manh; van Walsum, Theo; Klein, Stefan

    2016-03-01

    Percutaneous radio frequency ablation is a method for liver tumor treatment when conventional surgery is not an option. It is a minimally invasive treatment and may be performed under CT image guidance if the tumor does not give sufficient contrast on ultrasound images. For optimal guidance, registration of the pre-operative contrast-enhanced CT image to the intra-operative CT image is hypothesized to improve guidance. This is a highly challenging registration task due to large differences in pose and image quality. In this study, we introduce a semi-automated registration algorithm to address this problem. The method is based on a conventional nonrigid intensity-based registration framework, extended with a novel point-to-surface constraint. The point-to-surface constraint serves to improve the alignment of the liver boundary, while requiring minimal user interaction during the operation. The method assumes that a liver segmentation of the pre-operative CT is available. After an initial nonrigid registration without the point-to-surface constraint, the operator clicks a few points on the liver surface at those regions where the nonrigid registration seems inaccurate. In a subsequent registration step, these points on the intra-operative image are driven towards the liver surface on the preoperative image, using a penalty term added to the registration cost function. The method is evaluated on five clinical datasets and it is shown to improve registration compared with conventional rigid and nonrigid registrations in all cases.

  4. Wild Orangutan Males Plan and Communicate Their Travel Direction One Day in Advance

    PubMed Central

    van Schaik, Carel P.; Damerius, Laura; Isler, Karin

    2013-01-01

    The ability to plan for the future beyond immediate needs would be adaptive to many animal species, but is widely thought to be uniquely human. Although studies in captivity have shown that great apes are capable of planning for future needs, it is unknown whether and how they use this ability in the wild. Flanged male Sumatran orangutans (Pongo abelii) emit long calls, which females use to maintain earshot associations with them. We tested whether long calls serve to communicate a male's ever-changing predominant travel direction to facilitate maintaining these associations. We found that the direction in which a flanged male emits his long calls predicts his subsequent travel direction for many hours, and that a new call indicates a change in his main travel direction. Long calls given at or near the night nest indicate travel direction better than random until late afternoon on the next day. These results show that male orangutans make their travel plans well in advance and announce them to conspecifics. We suggest that such a planning ability is likely to be adaptive for great apes, as well as in other taxa. PMID:24040357

  5. Wild orangutan males plan and communicate their travel direction one day in advance.

    PubMed

    van Schaik, Carel P; Damerius, Laura; Isler, Karin

    2013-01-01

    The ability to plan for the future beyond immediate needs would be adaptive to many animal species, but is widely thought to be uniquely human. Although studies in captivity have shown that great apes are capable of planning for future needs, it is unknown whether and how they use this ability in the wild. Flanged male Sumatran orangutans (Pongo abelii) emit long calls, which females use to maintain earshot associations with them. We tested whether long calls serve to communicate a male's ever-changing predominant travel direction to facilitate maintaining these associations. We found that the direction in which a flanged male emits his long calls predicts his subsequent travel direction for many hours, and that a new call indicates a change in his main travel direction. Long calls given at or near the night nest indicate travel direction better than random until late afternoon on the next day. These results show that male orangutans make their travel plans well in advance and announce them to conspecifics. We suggest that such a planning ability is likely to be adaptive for great apes, as well as in other taxa.

  6. A Two-Impulse Plan for Performing Rendezvous on a Once-A-Day Basis

    NASA Technical Reports Server (NTRS)

    Bird, John D.; Thomas, David F., Jr.

    1960-01-01

    An investigation of a two-impulse plan for performing rendezvous on a once-a-day basis with a near-earth satellite station indicates that launch into rendezvous from slightly less than maximum satellite latitude is an unusually favorable circumstance in that no appreciable expense in mass ratio is incurred. In addition, it was found for the two-impulse maneuver employed in this study that the optimum angular travel of the ferry vehicle to rendezvous was considerably less than the 1800 transfer which is optimum for the two-impulse in-plane launch.

  7. Utility of intra-operative ultrasound in choosing the appropriate site for blood pressure monitoring in Takayasu's arteritis.

    PubMed

    Narasimha, Prasad Krishnamurthy; Chaudhuri, Souvik; Joseph, Tim Thomas

    2013-01-01

    Takayasu's arteritis (TA) is rare, chronic progressive, pan-endarteritis involving the aorta and its main branches, with a specific predilection for young Asian women. Anaesthesia for TA patients is complicated by their severe uncontrolled hypertension, extreme arterial blood pressure differentials, aortic regurgitation (AR), end-organ dysfunction, stenosis/aneurysms of major blood vessels and difficulties encountered in monitoring arterial blood pressure. We present the usefulness of ultrasound during anaesthetic management of a 35-year-old woman posted for emergency caesarean section due to intra-uterine growth retardation, foetal tachycardia in active labour, who was already diagnosed to have TA along with moderate AR and uncontrolled hypertension, using epidural technique. The use of intra-operative doppler helped resolve the initial dilemma about the diagnosis and treatment of the differential blood pressure between the affected and the normal upper limb in the absence of prior arteriogram.

  8. Is "intra-operating room" thromboelastometry useful in liver transplantation? A case-control study in 303 patients.

    PubMed

    Alamo, J-M; León, A; Mellado, P; Bernal, C; Marín, L M; Cepeda, C; Suárez, G; Serrano, J; Padillo, J; Gómez, M-Á

    2013-01-01

    Coagulation monitoring during liver transplantation (LT) is, even today, fundamental to reduce blood loss during surgery. Thromboelastometry (TEM) is a proven technique for controlling the various parameters that influence coagulation. However, there are no studies linking "intra-operating room" TEM (orTEM) with LT outcomes. We describe a case-control study in 303 liver graft recipients analyzing variables associated with operative complications and long-term LT outcomes. The results showed that orTEM reduced the use of blood products in patients with Model for End-Stage Liver Disease scores of ≥ 21, retransplantation, and high surgical difficulty and important intraoperative bleeding. In addition, results in survival and postoperative complications were better when orTEM was used. In conclusion, we confirm that use of orTEM is associated with less use of blood products and a lower rate of complications after LT.

  9. Generations of Justice: Law Day U.S.A. May 1, 1990. American Bar Association 1990 Planning Guide.

    ERIC Educational Resources Information Center

    American Bar Association, Chicago, IL.

    Law Day U.S.A. offers an outstanding opportunity for developing public outreach programs to help solve law-related and other community problems through community partnerships. The theme of Law Day U.S.A. in 1990 was "Generations of Justice." This planning guide offers background information about Law Day U.S.A. and suggestions for…

  10. Intra-operative feedback and dynamic compensation for image-guided robotic focal ultrasound surgery.

    PubMed

    Chauhan, S; Amir, H; Chen, G; Hacker, A; Michel, M S; Koehrmann, K U

    2008-11-01

    This paper describes a non-invasive remote temperature measurement technique integrated with a biomechatronic surgery system devised in our laboratory and named FUSBOT (Focal Ultrasound Surgery RoBOT). FUSBOTs use High-Intensity Focused Ultrasound (HIFU) for ablation of cancers/tumors and targets accessible through various soft-tissue acoustic windows in the human body. The focused ultrasound beam parameters are chosen so that biologically significant temperature rises are achieved only within the focal volume. In this paper, FUSBOT(BS), a customized system for breast surgery, is taken as a representative example to demonstrate the implementation and the results of non-invasive feedback during ablation. An 8-axis PC-based controller controls various sub-sections of the system within a safe constrained work envelope. Temperature is a prime target parameter in ablative procedures, and it is of paramount importance that means should be devised for its measurement and control in order to design optimal dose protocols and judge the efficacy of FUS systems. A customized sensory interface is devised and integrated with FUSBOT(BS), and dedicated software algorithms are embedded for surgical planning based on real-time guidance and feedback. Variations in the physical parameters of the tissue interacting with the incident modality are used as surgical feedback. The use of real-time ultrasound imaging and data processed from various sensors to deduce lesion position and thermal feedback during surgery, as integrated with the robotic system for online surgical planning, is described. Dynamic registration algorithms are developed for compensation and re-registration of the robotic end-effector with respect to the target, and representative empirical outcomes for lesion tracking and online temperature estimation in various biological tissues are presented.

  11. The suitability of an uncemented hydroxyapatite coated (HAC) hip hemiarthroplasty stem for intra-capsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal Index, a solution to preventing intra-operative periprosthetic fracture.

    PubMed

    Chana, Rishi; Mansouri, Reza; Jack, Chris; Edwards, Max R; Singh, Ravi; Keller, Carmel; Khan, Farid

    2011-11-18

    This study will seek to identify a measurable radiographic index, the Metaphyseal-Diaphyseal Index (MDI) score to determine whether intra-operative fracture in osteoporotic bone can be predicted.A 5 year prospective cohort of 560 consecutive patients, undergoing hemiarthroplasty (cemented or uncemented), was evaluated. A nested case-control study to determine risk factors affecting intra-operative fracture was carried out. The Vancouver Classification was used to classify periprosthetic fracture. The MDI score was calculated using radiographs from the uncemented group. As a control (gold standard), Yeung et al's Canal Bone Ratio (CBR) score was also calculated. From this, a receiver operating characteristic (ROC) curve was formulated for both scores and area under the curve (AUC) compared. Intra and inter-observer correlations were determined. Cost analysis was also worked out for adverse outcomes. Four hundred and seven uncemented and one hundred and fifty-three cemented stems were implanted. The use of uncemented implants was the main risk factor for intra-operative periprosthetic fracture. Sixty-two periprosthetic fractures occurred in the uncemented group (15.2%), nine occurred in the cemented group (5.9%), P < 0.001. The revision rate for sustaining a periprosthetic fracture (uncemented group) was 17.7%, P < 0.001 and 90 day mortality 19.7%, P < 0.03. MDI's AUC was 0.985 compared to CBR's 0.948, P < 0.001. The MDI score cut-off to predict fracture was 21, sensitivity 98.3%, specificity 99.8%, positive predictive value 90.5% and negative predictive value 98%. Multivariate regression analysis ruled out any other confounding factors as being significant. The intra and inter-observer Pearson correlation scores were r = 0.99, P < 0.001. JRI uncemented hemiarthroplasty has a significantly higher intra-operative fracture rate. We recommend cemented arthroplasty for hip fractures. We propose a radiographic system that may allow surgeons to select patients who are good

  12. The suitability of an uncemented hydroxyapatite coated (HAC) hip hemiarthroplasty stem for intra-capsular femoral neck fractures in osteoporotic elderly patients: the Metaphyseal-Diaphyseal index, a solution to preventing intra-operative periprosthetic fracture

    PubMed Central

    2011-01-01

    This study will seek to identify a measurable radiographic index, the Metaphyseal-Diaphyseal Index (MDI) score to determine whether intra-operative fracture in osteoporotic bone can be predicted. A 5 year prospective cohort of 560 consecutive patients, undergoing hemiarthroplasty (cemented or uncemented), was evaluated. A nested case-control study to determine risk factors affecting intra-operative fracture was carried out. The Vancouver Classification was used to classify periprosthetic fracture. The MDI score was calculated using radiographs from the uncemented group. As a control (gold standard), Yeung et al's Canal Bone Ratio (CBR) score was also calculated. From this, a receiver operating characteristic (ROC) curve was formulated for both scores and area under the curve (AUC) compared. Intra and inter-observer correlations were determined. Cost analysis was also worked out for adverse outcomes. Four hundred and seven uncemented and one hundred and fifty-three cemented stems were implanted. The use of uncemented implants was the main risk factor for intra-operative periprosthetic fracture. Sixty-two periprosthetic fractures occurred in the uncemented group (15.2%), nine occurred in the cemented group (5.9%), P < 0.001. The revision rate for sustaining a periprosthetic fracture (uncemented group) was 17.7%, P < 0.001 and 90 day mortality 19.7%, P < 0.03. MDI's AUC was 0.985 compared to CBR's 0.948, P < 0.001. The MDI score cut-off to predict fracture was 21, sensitivity 98.3%, specificity 99.8%, positive predictive value 90.5% and negative predictive value 98%. Multivariate regression analysis ruled out any other confounding factors as being significant. The intra and inter-observer Pearson correlation scores were r = 0.99, P < 0.001. JRI uncemented hemiarthroplasty has a significantly higher intra-operative fracture rate. We recommend cemented arthroplasty for hip fractures. We propose a radiographic system that may allow surgeons to select patients who are

  13. Prognostic value of intra-operative abnormal muscle response monitoring during microvascular decompression for long-term outcome of hemifacial spasm.

    PubMed

    Li, Jiping; Zhang, Yuqing; Zhu, Hongwei; Li, Yongjie

    2012-01-01

    The reliability of intra-operative abnormal muscle response (AMR) monitoring as an indicator of post-operative outcome in patients with hemifacial spasm (HFS) is under debate. The primary aim of this study was to evaluate the correlation between intra-operative AMR changes and long-term post-operative outcome. We monitored intra-operative AMR during microvascular decompression (MVD) in consecutive patients with HFS (n = 104). Patients in this study were divided into two groups based on whether their AMR disappeared or persisted following MVD. Ninety patients were followed-up, and the mean duration from surgery to final follow-up examination was 3.7 years. Fourteen patients were lost to follow-up. AMR disappeared during surgery for 80 patients; of these, 74 achieved complete resolution of HFS, five had persistent HFS, and one patient developed a recurrence of HFS. Of the 10 patients with persistent AMR despite effective MVD, eight patients achieved complete resolution, one patient had persistent HFS, and one developed recurrent HFS. The long-term clinical outcome of HFS after MVD did not significantly correlate with intra-operative AMR changes (p = 0.791). Therefore, we suggest that intra-operative AMR monitoring may not be a reliable indicator of long-term post-operative outcome for HFS.

  14. Randomized trial for superiority of high field strength intra-operative magnetic resonance imaging guided resection in pituitary surgery.

    PubMed

    Tandon, Vivek; Raheja, Amol; Suri, Ashish; Chandra, P Sarat; Kale, Shashank S; Kumar, Rajinder; Garg, Ajay; Kalaivani, Mani; Pandey, Ravindra M; Sharma, Bhawani S

    2017-03-01

    Till date there are no randomized trials to suggest the superiority of intra-operative magnetic resonance imaging (IOMRI) guided trans-sphenoidal pituitary resection over two dimensional fluoroscopic (2D-F) guided resections. We conducted this trial to establish the superiority of IOMRI in pituitary surgery. Primary objective was to compare extent of tumor resection between the two study arms. It was a prospective, randomized, outcome assessor and statistician blinded, two arm (A: IOMRI, n=25 and B: 2D-F, n=25), parallel group clinical trial. 4 patients from IOMRI group cross-over to 2D-F group and were consequently analyzed in latter group, based on modified intent to treat method. A total of 50 patients were enrolled till completion of trial (n=25 in each study arm). Demographic profile and baseline parameters were comparable among the two arms (p>0.05) except for higher number of endoscopic procedures and experienced neurosurgeons (>10years) in arm B (p=0.02, 0.002 respectively). Extent of resection was similar in both study arms (A, 94.9% vs B, 93.6%; p=0.78), despite adjusting for experience of operating surgeon and use of microscope/endoscope for surgical resection. We observed that use of IOMRI helped optimize the extent of resection in 5/20 patients (25%) for pituitary tumor resection in-group A. Present study failed to observe superiorty of IOMRI over conventional 2D-F guided resection in pituitary macroadenoma surgery. By use of this technology, younger surgeons could validate their results intra-operatively and hence could increase EOR without causing any increase in complications.

  15. Intra-operative preparation of autologous bone marrow-derived CD34-enriched cellular products for cardiac therapy

    PubMed Central

    DONNENBERG, ALBERT D.; DONNENBERG, VERA S.; GRIFFIN, DEBORAH L.; MOORE, LINDA R.; TEKINTURHAN, FERDA; KORMOS, ROBERT L.

    2014-01-01

    Background and Aims With the advent of regenerative therapy, there is renewed interest in the use of bone marrow as a source of adult stem and progenitor cells, including cell subsets prepared by immunomagnetic selection. Cell selection must be rapid, efficient and performed according to current good manufacturing practices. In this report we present a methodology for intra-operative preparation of CD34+ selected autologous bone marrow for autologous use in patients receiving coronary artery bypass grafts or left ventricular assist devices. Methods and Results We developed a rapid erythrocyte depletion method using hydroxyethyl starch and low-speed centrifugation to prepare large-scale (mean 359 mL) bone marrow aspirates for separation on a Baxter Isolex 300i immunomagnetic cell separation device. CD34 recovery after erythrocyte depletion was 68.3 ± 20.2%, with an average depletion of 91.2 ± 2.8% and an average CD34 content of 0.58 ± 0.27%. After separation, CD34 purity was 64.1 ± 17.2%, with 44.3 ± 26.1% recovery and an average dose of 5.0 ± 2.7 × 10 6 CD34+ cells/product. In uncomplicated cases CD34-enriched cellular products could be accessioned, prepared, tested for release and administered within 6 h. Further analysis of CD34+ bone marrow cells revealed a significant proportion of CD45– CD34+ cells. Conclusions Intra-operative immunomagnetic separation of CD34-enriched bone marrow is feasible using rapid low-speed Hetastarch sedimentation for erythrocyte depletion. The resulting CD34-enriched product contains CD45– cells that may represent non-hematopoietic or very early hematopoietic stem cells that participate in tissue regeneration. PMID:21062114

  16. Full-dose intra-operative radiotherapy with electrons (ELIOT) during breast-conserving surgery: experience with 1246 cases.

    PubMed

    Veronesi, U; Orecchia, R; Luini, A; Galimberti, V; Gatti, G; Intra, M; Veronesi, P; Leonardi, M C; Ciocca, M; Lazzari, R; Caldarella, P; Rotmensz, N; Sangalli, C; Silva, L S; Sances, D

    2008-01-01

    Previous studies showed that after breast-conserving surgery for breast cancer, radiotherapy may be applied to the portion of the breast where the primary tumour was removed (partial breast irradiation (PBI), avoiding the irradiation of the whole breast. We developed a procedure of PBI consisting of a single high dose of radiotherapy of 21 Gy with electrons equivalent to 58-60 Gy in fractionated doses, delivered during the surgical session by a mobile linear accelerator, positioned close to the operating table. From July 1999 to December 2006, 1246 patients with primary carcinoma of less than 2.5-cm maximum diameter, mostly over 48 years, were treated with electron intra-operative radiotherapy (ELIOT) at a single dose of 21 Gy. After a follow-up from 0.3 to 94.7 months (median 26), 24 (1.9%) patients showed a local recurrence and 22 developed distant metastases. Sixteen patients died, seven from breast carcinoma and nine from others causes. The five-year crude survival was 96.5%. Six (0.5%) developed severe breast fibrosis, which resolved in 2-3 years. An additional 40 patients suffered for mild fibrosis. Cosmetic results were good. Electron intra-operative radiotherapy is a safe method for treating conservatively operated breasts and avoids the long period of post-operative radiotherapy, greatly improving the quality of life and reduces the cost of radiotherapy. ELIOT markedly reduces the radiation to normal surrounding tissues and deep organs. Results on short- and medium-term toxicity are good. Data on local control are encouraging.

  17. Towards intra-operative diagnosis of tumours during breast conserving surgery by selective-sampling Raman micro-spectroscopy

    NASA Astrophysics Data System (ADS)

    Kong, Kenny; Zaabar, Fazliyana; Rakha, Emad; Ellis, Ian; Koloydenko, Alexey; Notingher, Ioan

    2014-10-01

    Breast-conserving surgery (BCS) is increasingly employed for the treatment of early stage breast cancer. One of the key challenges in BCS is to ensure complete removal of the tumour while conserving as much healthy tissue as possible. In this study we have investigated the potential of Raman micro-spectroscopy (RMS) for automated intra-operative evaluation of tumour excision. First, a multivariate classification model based on Raman spectra of normal and malignant breast tissue samples was built and achieved diagnosis of mammary ductal carcinoma (DC) with 95.6% sensitivity and 96.2% specificity (5-fold cross-validation). The tumour regions were discriminated from the healthy tissue structures based on increased concentration of nucleic acids and reduced concentration of collagen and fat. The multivariate classification model was then applied to sections from fresh tissue of new patients to produce diagnosis images for DC. The diagnosis images obtained by raster scanning RMS were in agreement with the conventional histopathology diagnosis but were limited to long data acquisition times (typically 10 000 spectra mm-2, which is equivalent to ~5 h mm-2). Selective-sampling based on integrated auto-fluorescence imaging and Raman spectroscopy was used to reduce the number of Raman spectra to ~20 spectra mm-2, which is equivalent to an acquisition time of ~15 min for 5 × 5 mm2 tissue samples. This study suggests that selective-sampling Raman microscopy has the potential to provide a rapid and objective intra-operative method to detect mammary carcinoma in tissue and assess resection margins.

  18. Correlation between 3D-MRCP and intra-operative findings in right liver donors

    PubMed Central

    Ragab, Aly; Lopez-Soler, Reyold I.; Oto, Aytekin

    2013-01-01

    A correct preoperative definition of the hepatic duct confluence anatomy of right liver living donors is a pivotal step in determining their candidacy for donation and planning the surgery. The purposes of this study are to evaluate the accuracy of three-dimensional Magnetic Resonance Cholangiography (3D MRCP) when compared with intraoperative cholangiography (IOC) in assessing biliary anatomy and to identify imaging characteristics that may help predict the yield of hepatic duct orifices in the right liver graft. Twenty consecutive right liver donors were imaged with 3D MRCP and IOC. The MRCP and IOC findings were compared, and the results confirmed against actual donor anatomy. Three-D MRCP accurately predicted the biliary anatomy in 18 of 20 cases. Specificity and positive predictive value of 3D MRCP in defining normal biliary anatomy was 100%. In 2 patients, 3D MRCP failed to indentify abnormal anatomy. The yield of more than one hepatic duct was associated with: (I) The presence of abnormal biliary anatomy, (II) The length of the main right hepatic duct, and (III) The presence of an acute angle at the confluence of right and left hepatic duct. In conclusion, 3D MRCP reliably represents normal biliary anatomy. The presence of anatomical variations decreases MRCP sensitivity and makes IOC or duct probing a necessary tool for accurately performing the transection of the right hepatic duct. PMID:24570909

  19. Correlation between 3D-MRCP and intra-operative findings in right liver donors.

    PubMed

    Ragab, Aly; Lopez-Soler, Reyold I; Oto, Aytekin; Testa, Giuliano

    2013-02-01

    A correct preoperative definition of the hepatic duct confluence anatomy of right liver living donors is a pivotal step in determining their candidacy for donation and planning the surgery. The purposes of this study are to evaluate the accuracy of three-dimensional Magnetic Resonance Cholangiography (3D MRCP) when compared with intraoperative cholangiography (IOC) in assessing biliary anatomy and to identify imaging characteristics that may help predict the yield of hepatic duct orifices in the right liver graft. Twenty consecutive right liver donors were imaged with 3D MRCP and IOC. The MRCP and IOC findings were compared, and the results confirmed against actual donor anatomy. Three-D MRCP accurately predicted the biliary anatomy in 18 of 20 cases. Specificity and positive predictive value of 3D MRCP in defining normal biliary anatomy was 100%. In 2 patients, 3D MRCP failed to indentify abnormal anatomy. The yield of more than one hepatic duct was associated with: (I) The presence of abnormal biliary anatomy, (II) The length of the main right hepatic duct, and (III) The presence of an acute angle at the confluence of right and left hepatic duct. In conclusion, 3D MRCP reliably represents normal biliary anatomy. The presence of anatomical variations decreases MRCP sensitivity and makes IOC or duct probing a necessary tool for accurately performing the transection of the right hepatic duct.

  20. Prevention and reversal of lung collapse during the intra-operative period.

    PubMed

    Tusman, Gerardo; Böhm, Stephan H

    2010-06-01

    General anaesthesia induces ventilation/perfusion mismatch by lung collapse. Such lung collapse predisposes patients to preoperative complications since it can persist for several hours or days after surgery. Atelectasis can be partially prevented by using continuous positive airway pressure (CPAP) and/or by lowering FiO2 during anaesthesia induction. However, these manoeuvres are dangerous for patients presenting with challenging airway or ventilator conditions. Lung recruitment manoeuvres (RMs) are ventilatory strategies that aim to restore the aeration of normal lungs. They consist of a brief and controlled increment in airway pressure to open up collapsed areas of the lungs and sufficient positive end-expiratory pressure (PEEP) to keep them open afterward. The application of RMs during anaesthesia normalises lung function along the intraoperative period. There is physiological evidence that patients of all ages and any kind of surgery benefit from such an active intervention. The effect of RMs on patient outcome in the postoperative period is, however, not yet known.

  1. Observation of behavioural markers of non-technical skills in the operating room and their relationship to intra-operative incidents.

    PubMed

    Siu, Joey; Maran, Nikki; Paterson-Brown, Simon

    2016-06-01

    The importance of non-technical skills in improving surgical safety and performance is now well recognised. Better understanding is needed of the impact that non-technical skills of the multi-disciplinary theatre team have on intra-operative incidents in the operating room (OR) using structured theatre-based assessment. The interaction of non-technical skills that influence surgical safety of the OR team will be explored and made more transparent. Between May-August 2013, a range of procedures in general and vascular surgery in the Royal Infirmary of Edinburgh were performed. Non-technical skills behavioural markers and associated intra-operative incidents were recorded using established behavioural marking systems (NOTSS, ANTS and SPLINTS). Adherence to the surgical safety checklist was also observed. A total of 51 procedures were observed, with 90 recorded incidents - 57 of which were considered avoidable. Poor situational awareness was a common area for surgeons and anaesthetists leading to most intra-operative incidents. Poor communication and teamwork across the whole OR team had a generally large impact on intra-operative incidents. Leadership was shown to be an essential set of skills for the surgeons as demonstrated by the high correlation of poor leadership with intra-operative incidents. Team-working and management skills appeared to be especially important for anaesthetists in the recovery from an intra-operative incident. A significant number of avoidable incidents occur during operative procedures. These can all be linked to failures in non-technical skills. Better training of both individual and team in non-technical skills is needed in order to improve patient safety in the operating room. Copyright © 2014 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  2. A day in the life of managed care: Health Alliance Plan's Medicare Appeals Specialist Yolanda Dodson.

    PubMed

    2001-01-01

    Yolanda Dodson began working for Health Alliance Plan (HAP) as a high school co-op student. Through 11 years in HAP's Claims and Claims Processing Departments, as well as six months spent as a telephone customer service representative, she developed a knowledge of managed care and customer service and gained valuable first-hand experience with members' concerns. Now Dodson is a Medicare Appeals Specialist, one of two staff people handling HMO and HAP Senior Plus (HAP's Medicare+Choice program) grievances and appeals. She serves as an "advocate for the member" as she investigates their cases within a tight mandatory deadline, recommends a resolution, and submits them for consideration to HAP medical directors. The following is a glimpse at one her typical days at HAP's Detroit offices.

  3. First Clinical Experience of Intra-Operative High Intensity Focused Ultrasound in Patients with Colorectal Liver Metastases: A Phase I-IIa Study

    PubMed Central

    Dupré, Aurélien; Melodelima, David; Pérol, David; Chen, Yao; Vincenot, Jérémy; Chapelon, Jean-Yves; Rivoire, Michel

    2015-01-01

    Background Surgery is the only curative treatment in patients with colorectal liver metastases (CLM), but only 10–20% of patients are eligible. High Intensity Focused Ultrasound (HIFU) technology is of proven value in several indications, notably prostate cancer. Its intra-operative use in patients with CLM has not previously been studied. Preclinical work suggested the safety and feasibility of a new HIFU device capable of ablating volumes of up to 2cm x 2cm in a few seconds. Methods We conducted a prospective, single-centre phase I-IIa trial. HIFU was delivered immediately before scheduled hepatectomy. To demonstrate the safety and efficacy of rapidly ablating liver parenchyma, ablations were performed on healthy tissue within the areas scheduled for resection. Results In total, 30 ablations were carried out in 15 patients. These ablations were all generated within 40 seconds and on average measured 27.5mm x 21.0mm. The phase I study (n = 6) showed that use of the HIFU device was feasible and safe and did not damage neighbouring tissue. The phase IIa study (n = 9) showed both that the area of ablation could be precisely targeted on a previously implanted metallic mark (used to represent a major anatomical structure) and that ablations could be undertaken deliberately to avoid such a mark. Ablations were achieved with a precision of 1–2 mm. Conclusion HIFU was feasible, safe and effective in ablating areas of liver scheduled for resection. The next stage is a phase IIb study which will attempt ablation of small metastases with a 5 mm margin, again prior to planned resection. Trial Registration ClinicalTrials.govNCT01489787 PMID:25719540

  4. MO-E-BRD-03: Intra-Operative Breast Brachytherapy: Is One Stop Shopping Best? [Non-invasive Image-Guided Breast Brachytherapy

    SciTech Connect

    Libby, B.

    2015-06-15

    Is Non-invasive Image-Guided Breast Brachytherapy Good? – Jess Hiatt, MS Non-invasive Image-Guided Breast Brachytherapy (NIBB) is an emerging therapy for breast boost treatments as well as Accelerated Partial Breast Irradiation (APBI) using HDR surface breast brachytherapy. NIBB allows for smaller treatment volumes while maintaining optimal target coverage. Considering the real-time image-guidance and immobilization provided by the NIBB modality, minimal margins around the target tissue are necessary. Accelerated Partial Breast Irradiation in brachytherapy: is shorter better? - Dorin Todor, PhD VCU A review of balloon and strut devices will be provided together with the origins of APBI: the interstitial multi-catheter implant. A dosimetric and radiobiological perspective will help point out the evolution in breast brachytherapy, both in terms of devices and the protocols/clinical trials under which these devices are used. Improvements in imaging, delivery modalities and convenience are among the factors driving the ultrashort fractionation schedules but our understanding of both local control and toxicities associated with various treatments is lagging. A comparison between various schedules, from a radiobiological perspective, will be given together with a critical analysis of the issues. to review and understand the evolution and development of APBI using brachytherapy methods to understand the basis and limitations of radio-biological ‘equivalence’ between fractionation schedules to review commonly used and proposed fractionation schedules Intra-operative breast brachytherapy: Is one stop shopping best?- Bruce Libby, PhD. University of Virginia A review of intraoperative breast brachytherapy will be presented, including the Targit-A and other trials that have used electronic brachytherapy. More modern approaches, in which the lumpectomy procedure is integrated into an APBI workflow, will also be discussed. Learning Objectives: To review past and current

  5. Extended endoscopic endonasal surgery using three-dimensional endoscopy in the intra-operative MRI suite for supra-diaphragmatic ectopic pituitary adenoma.

    PubMed

    Fuminari, Komatsu; Hideki, Atsumi; Manabu, Osakabe; Mitsunori, Matsumae

    2015-01-01

    We describe a supra-diaphragmatic ectopic pituitary adenoma that was safely removed using the extended endoscopic endonasal approach, and discuss the value of three-dimensional (3D) endoscopy and intra-operative magnetic resonance imaging (MRI) to this type of procedure. A 61-year-old-man with bitemporal hemianopsia was referred to our hospital, where MRI revealed an enhanced suprasellar tumor compressing the optic chiasma. The tumor extended on the planum sphenoidale and partially encased the right internal carotid artery. An endocrinological assessment indicated normal pituitary function. The extended endoscopic endonasal approach was taken using a 3D endoscope in the intraoperative MRI suite. The tumor was located above the diaphragma sellae and separated from the normal pituitary gland. The pathological findings indicated non-functioning pituitary adenoma and thus the tumor was diagnosed as a supra-diaphragmatic ectopic pituitary adenoma. Intra-operative MRI provided useful information to minimize dural opening and the supra-diaphragmatic ectopic pituitary adenoma was removed from the complex neurovascular structure via the extended endoscopic endonasal approach under 3D endoscopic guidance in the intra-operative suite. Safe and effective removal of a supra-diaphragmatic ectopic pituitary adenoma was accomplished via the extended endoscopic endonasal approach with visual information provided by 3D endoscopy and intra-operative MRI.

  6. Evaluation of the use of intra-operative radiology for open placement of lag screws for the stabilization of sacroiliac luxation in cats.

    PubMed

    Silveira, Francisco; Quinn, Robert J; Adrian, Anna M; Owen, Martin R; Bush, Mark A

    2017-01-16

    To assess the effect of intra-operative radiology on the quality of lag screw insertion for the management of sacroiliac joint luxations in cats. In this retrospective single-centre study, the surgical, anaesthetic and imaging records of 40 screws (32 cats) placed with lag effect for management of sacroiliac luxation were reviewed. Postoperative radiographs were assessed for sacroiliac joint reduction, screw position, and sacral width purchased by each screw. Cases were divided into two groups according to the use of (IOR) or the absence of intra-operative radiology (NIOR). A total of 23 lag screws were placed with the aid of intra-operative radiology and 17 without. Three of the 23 screws placed in the IOR group exited the sacrum as opposed to eight of 17 screws in the NIOR group (p = 0.03). Mean sacral width purchased by the screws in the IOR group (70.8%) was also significantly higher (p = 0.002) than in the NIOR group (54.6%). Mean general anaesthetic times for unilateral and bilateral screw placement for the IOR group and NIOR group were not significantly different. The use of intra-operative radiology can significantly improve the quality of lag screw insertion for the stabilization of sacroiliac luxations in cats, which should lead to a reduced incidence of postoperative screw loosening.

  7. Improving patient safety in the intra-operative MRI suite using an on-duty safety nurse, safety manual and checklist.

    PubMed

    Matsumae, Mitsunori; Nakajima, Yasuhiro; Morikawa, Eiji; Nishiyama, Jun; Atsumi, Hideki; Tominaga, Jiro; Tsugu, Atsushi; Kenmochi, Isao

    2011-01-01

    This paper describes the use of an on-duty safety nurse, a surgical safety manual and a checklist as an essential precursor to evaluating how these approaches affect surgical quality, communication in surgery crews and contribute to the safety of surgical care in the intra-operative magnetic resonance imaging (MRI) suite.

  8. The use of intra-operative blood gas analysis in the investigation of suspected iatrogenic vascular injury.

    PubMed

    Walcott, Brian P; Kahle, Kristopher T; Nahed, Brian V; Coumans, Jean-Valery C E; Asaad, Wael F

    2012-06-01

    Iatrogenic injury to the vertebral artery during posterior cervical fusion is a rare and potentially disastrous complication. Differentiating arterial from brisk venous bleeding would be ideal to assist in the intra-operative management. Definitive angiography is typically not feasible during most routine spine surgery. We describe the case of a patient undergoing an occipitocervical fusion, where brisk bleeding was encountered during dissection of the CB lateral mass. While the dissection was thought to be superficial to critical structures, the nature of the hemorrhage could not be definitely determined by visual inspection by two senior surgeons. The hemorrhage did not readily cease with standard maneuvers such as, the application of various hemostatic agents. Simultaneous blood gas analysis was performed on samples obtained from the patient's radial artery and from the hemorrhage in the operative bed. Comparative analysis concluded that the bleeding encountered in the surgical field was venous in nature. Blood gas analysis can be a useful adjunct in determining the nature of hemorrhage from vascular structures in spine surgery when visual inspection is indeterminate.

  9. Evidence for photoneutron production in the lead shielding of a dedicated intra-operative electron only facility.

    PubMed

    Biggs, P J

    1998-01-01

    A dedicated electron-only intra-operative suite has just been completed at the Massachusetts General Hospital. This suite is located on the 3rd floor with the shielding consisting entirely of lead and borated polyethylene, except for concrete in the floor and ceiling to support the lead and on the finished floor. The radiation protection barriers for this facility were calculated on the basis of a maximum permissible dose of 10 microSv wk(-1) for photons and 10 microSv wk(-1) for neutrons, based on a quality factor of 10 (this factor is specified in the regulations of the Commonwealth of Massachusetts). This even split was predicated on the basis that, except for the primary beam, the neutron leakage from the machine was generally about the same as for x rays. The initial survey showed that the neutron dose equivalent outside all barriers, except below the floor, was within the calculated values, < 10 microSv wk(-1). However, the neutron dose equivalent measured directly below the floor was found to be 35 microSv wk(-1) for the highest electron energy, a difference of > 25 microSv wk(-1). The neutron dose equivalent, for neutrons produced by bremsstrahlung photon interactions in the lead and based on a 3% photon background in the electron beam, was calculated to be 25 microSv wk(-1), in good agreement with this difference.

  10. In vivo intra-operative breast tumor margin detection using a portable OCT system with a handheld surgical imaging probe

    NASA Astrophysics Data System (ADS)

    Erickson-Bhatt, Sarah J.; Nolan, Ryan; Shemonski, Nathan D.; Adie, Steven G.; Putney, Jeffrey; Darga, Donald; McCormick, Daniel T.; Cittadine, Andrew; Marjanovic, Marina; Chaney, Eric J.; Monroy, Guillermo L.; South, Fredrick; Carney, P. Scott; Cradock, Kimberly A.; Liu, Z. George; Ray, Partha S.; Boppart, Stephen A.

    2014-02-01

    Breast-conserving surgery is a frequent option for women with stage I and II breast cancer, and with radiation treatment, can be as effective as a mastectomy. However, adequate margin detection remains a challenge, and too often additional surgeries are required. Optical coherence tomography (OCT) provides a potential method for real-time, high-resolution imaging of breast tissue during surgery. Intra-operative OCT imaging of excised breast tissues has been previously demonstrated by several groups. In this study, a novel handheld surgical probe-based OCT system is introduced, which was used by the surgeon to image in vivo, within the tumor cavity, and immediately following tumor removal in order to detect the presence of any remaining cancer. Following resection, study investigators imaged the excised tissue with the same probe for comparison. We present OCT images obtained from over 15 patients during lumpectomy and mastectomy surgeries. Images were compared to post-operative histopathology for diagnosis. OCT images with micron scale resolution show areas of heterogeneity and disorganized features indicative of malignancy, compared to more uniform regions of normal tissue. Video-rate acquisition shows the inside of the tumor cavity as the surgeon sweeps the probe along the walls of the surgical cavity. This demonstrates the potential of OCT for real-time assessment of surgical tumor margins and for reducing the unacceptably high re-operation rate for breast cancer patients.

  11. In vivo reflectance confocal microscopy of shave biopsy wounds: feasibility of intra-operative mapping of cancer margins

    PubMed Central

    Scope, A; Mahmood, U; Gareau, DS; Kenkre, M; Lieb, JA; Nehal, KS; Rajadhyaksha, M

    2010-01-01

    Background Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in-vivo. Topical application of Aluminum Chloride (AlCl3) enhances contrast in RCM images by brightening nuclei. Objective To investigate feasibility of RCM imaging of shave biopsy wounds using AlCl3 as a contrast agent. Methods AlCl3 staining was optimized, in terms of concentration versus immersion time, on excised tissue ex-vivo. RCM imaging protocol was tested in patients undergoing shave biopsies. The RCM images were retrospectively analyzed and compared to the corresponding histopathology. Results For 35% AlCl3, routinely used for hemostasis in clinic, minimum immersion time was determined to be 1 minute. We identified 3 consistent patterns of margins on RCM mosaic images by varying depths: epidermal margins, peripheral dermal margins, and deep dermal margins. Tumour islands of basal cell carcinoma were identified at peripheral or deep dermal margins, correlating on histopathology with aggregates of neoplastic basaloid cells. Atypical cobblestone or honeycomb pattern were identified at the epidermal margins, correlating with a proliferation of atypical keratinocytes extending to biopsy margins. Conclusions RCM imaging of shave biopsy wounds is feasible and demonstrates the future possibility of intra-operative mapping in surgical wounds. PMID:20874785

  12. Evaluation of Pediatric Liver Transplantation-Related Artery Complications Using Intra-Operative Multi-Parameter Ultrasonography

    PubMed Central

    Ren, Xiuyun; Guan, Junhui; Gao, Nong; Niu, Hong; Tang, Jie

    2016-01-01

    Background This article discusses the value of using multi-parameter evaluation of intra-operative ultrasonography in evaluating pediatric liver transplantation-related arterial complications. Material/Methods Sixty-eight children receiving a liver transplant underwent intraoperative ultrasonography for monitoring of artery hemodynamics. The ultrasonic measurement parameters included the diameters of the hepatic artery (HA) of the donor and anastomotic stoma, peak systolic velocity (PSV), resistance index (RI), acceleration time (SAT), and blood flow volume. Results After being treated immediately using surgery or other means, blood flow returned to normal in 8 cases, and did not in 3 cases, of whom 2 experienced postoperative HAT. There was a significant difference in HA diameter of the donor, anastomotic stoma diameter, PSV, RI, SAT, and blood flow volume before and after treatment of the donor in the complications group. Postoperative complications occurred in 7 of 68 recipients, including the 2 cases exhibiting complications during the surgery (complication group) and 5 without complications during the surgery (no complication group). There was a statistically significant difference (P<0.05) between the 2 groups in intraoperative ultrasonography parameters of HA diameter, anastomotic stoma diameter, RI, and blood flow volume. Conclusions Through intraoperative multi-parameter ultrasonic measurement, a definite diagnosis of hepatic artery complications can be made in liver transplantation patients. HA diameter of the donor, anastomotic stoma diameter, PSV, RI, SAT, and blood flow volume are important in assessing intraoperative artery complications. PMID:27870825

  13. Dosimetry of a low-kV intra-operative X-ray source using basic analytical beam models.

    PubMed

    Ebert, M A; Carruthers, B; Lanzon, P J; Haworth, A; Clarke, J; Caswell, N M; Siddiqui, S A

    2002-09-01

    The low energy (30-50 kVp) beams from an intra-operative X-ray source are modelled using a basic analytical model considering just primary beam attenuation and absorption. Spatial dosimetry at such low energies is difficult due to the rapid changes in dose-rate from the radiation source. The purpose of the model was to determine the variation with distance in water of coefficients required for beam dosimetry and to validate beam measurements performed in water of high-gradient dose distributions. The model predicts a change in mean mass-energy absorption coefficient of up to 3 % over the range of clinically-relevant distances in water. Distance-dose distributions (variation in dose with distance in water) for the X-ray source were calculated with the model and found to be in agreement with measurement (at clinically-relevant distances), to within a spatial distance comparable to the dimensions and positional accuracy of the ionization chamber used, and comparable to the expected dosimetric anisotropy of the radiation source. Measured and calculated distance-doses begin to diverge at relatively large distances from the radiation source, which is where dose-rates are so low that detector signal levels are comparable with noise.

  14. In Vivo Quantification of Flow Dynamics in Intracranial Aneurysms Using Intra-Operative Contrast-Specific Ultrasound and PIV Techniques

    NASA Astrophysics Data System (ADS)

    CantÓN, G.Á.}Dor

    2005-11-01

    The goal of this study is to assess in vivo the hemodynamics of intracranial aneurysms using ultrasound and Digital Particle Imaging Velocimetry (DPIV) techniques. An ultrasound machine, equipped with an intra-operative transducer, was used to visualize the flow features inside an aneurysm with the aid of microbubbles as ultrasound contrast agent. The ultrasound studies were done using a Phase Inversion technique. Operating in the Doppler mode, the flow velocities in the afferent and the downstream vascular segments as well as inside the aneurysm were recorded and assessed. We analyzed the ultrasound data sets with a DPIV technique using backscattered signals from the microbubbles. The spatial and temporal distribution of velocity, vorticity, and stress fields was measured. These quantities were also measured in an in vitro aneurysmal model using the DPIV system. Our study shows that an advanced contrast-specific ultrasound technique in combination with a DPIV technique can be used to quantify in real time the flow-mechanical patterns inside the aneurysm.

  15. Internal Hernia Following Laparoscopic Roux-en-Y Gastric Bypass: Prevention and Tips for Intra-operative Management.

    PubMed

    Nimeri, Abdelrahman A; Maasher, Ahmed; Al Shaban, Talat; Salim, Elnazeer; Gamaleldin, Maysoon M

    2016-09-01

    Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the golden standard for bariatric surgery. However, the potential risk for internal hernia after LRYGB remains a significant concern to both patients and surgeons. In addition, patients presenting with abdominal pain after LRYGB warrant careful attention to avoid missing or delaying the diagnosis of internal hernia. The aim of this study was to describe our technique to prevent internal hernia after LRYGB, intra-operative findings, and our management strategies for patients with internal hernia after LRYGB. In this video, we review different technical tips and tricks to explore patients with suspected internal hernia after RYGB, how to reduce obstructed small bowel, and effectively close mesenteric defects to prevent internal hernia after LRYGB. A high index of suspicion and evaluation of the CT scan of the patient by an experienced bariatric surgeon is essential to avoid missing cases of internal hernia after LRYGB. In addition, patients presenting with incarcerated small bowel due to an internal hernia are best managed by standing on the left side of the patient with the left arm tucked and starting at the ileocecal valve and running the small bowel backwards towards the ligament of Treitz. Furthermore, patients with bowel obstruction due to internal hernia may need to have a gastrostomy placed at the remnant of the stomach. Recurrent abdominal pain is not uncommon after LRYGB. Systematic closure of mesenteric defects, the use of diagnostic laparoscopy, and high index of suspicion are all necessary to avoid delay in diagnosis.

  16. A multicentre observational study of intra-operative ventilatory management during general anaesthesia: tidal volumes and relation to body weight.

    PubMed

    Jaber, S; Coisel, Y; Chanques, G; Futier, E; Constantin, J-M; Michelet, P; Beaussier, M; Lefrant, J-Y; Allaouchiche, B; Capdevila, X; Marret, E

    2012-09-01

    We conducted an observational prospective multicenter study to describe the practices of mechanical ventilation, to determine the incidence of use of large intra-operative tidal volumes (≥10 ml.kg(-1) of ideal body weight) and to identify patient factors associated with this practice. Of the 2960 patients studied in 97 anaesthesia units from 49 hospitals, volume controlled mode was the most commonly used (85%). The mean (SD) tidal volume was 533 (82) ml; 7.7 (1.3) ml.kg(-1) (actual weight) and 8.8 (1.4) ml.kg(-1) (ideal body weight)). The lungs of 381 (18%) patients were ventilated with a tidal volume>10 ml.kg(-1) ideal body weight. Being female (OR 5.58 (95% CI 4.20-7.43)) and by logistic regression, underweight (OR 0.06 (95% CI 0.01-0.45)), overweight (OR 1.98 (95% CI 1.49-2.65)), obese (OR 5.02 (95% CI 3.51-7.16)), severely obese (OR 10.12 (95% CI 5.79-17.68)) and morbidly obese (OR 14.49 (95% CI 6.99-30.03)) were the significant (p ≤ 0.005) independent factors for the use of large tidal volumes during anaesthesia.

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

    PubMed Central

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

    2016-01-01

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

  18. Correlation of pre-operative MRI and intra-operative 3D ultrasound to measure brain tissue shift

    NASA Astrophysics Data System (ADS)

    Gobbi, David G.; Comeau, Roch M.; Lee, Belinda K. H.; Peters, Terence M.

    2000-04-01

    The usefulness of stereotactic neurosurgery performed via a craniotomy is limited because the craniotomy leads to a brain tissue shift of 10 mm on average. We have recently completed an examination of 2D intra-operative ultrasound as a means of visualization and measurement of brain shift. A commercial 3D tracking system was used for real-time registration of the ultrasound video to pre-operative MR images, and annotation of the images was used to measure the shift. More than 15 surgical cases have been performed thus far with the 2D system. We are now undertaking phantom studies with tracked 3D ultrasound, and have developed sophisticated tools for real- time overlay of ultrasound and MRI volumes. These tools include a virtual-reality view of the ultrasound probe with live ultrasound video superimposed over a 3D -rendered MRI of the brain, as well as 3D ultrasound/MRI transparency overlay views. Algorithms to automatically extract landmarks from MRI and 3D ultrasound images are under development. We aim to use these landmarks to automatically generate nonlinear warp transformations to correct the pre-operative MRI as well as surgical target coordinates for brain shift. Portions of the C++ code developed for this project have been contributed to the open-source Visualization Toolkit (VTK).

  19. Phase I/II Study of Neurosurgical Resection and Intra-operative Cesium-131 Radio-isotope Brachytherapy in Patients with Newly Diagnosed Brain Metastases

    PubMed Central

    Wernicke, A. Gabriella; Yondorf, Menachem Z; Peng, Luke; Trichter, Samuel; Nedialkova, Lucy; Sabbas, Albert; Khulidzhanov, Fridon; Parashar, Bhupesh; Nori, Dattatreyudu; Chao, K.S. Clifford; Christos, Paul; Pannullo, Susan; Boockvar, John A.; Stieg, Phillip; Schwartz, Theodore H.

    2014-01-01

    Object Resected brain metastases have a high rate of local recurrence without adjuvant therapy. Adjuvant whole brain radiotherapy (WBRT) remains the standard of care with the rate of local control >90%. However, WBRT is delivered over 10–15 days, which can delay other therapy and is associated with acute and long-term toxicities. Intra-operative permanent Cesium-131 (Cs-131) implants can be performed at the time of surgery, thereby avoiding any additional therapy. We evaluate the safety, feasibility and efficacy of a novel treatment approach of brain metastases with a permanent intra-operative Cs-131 brachytherapy. Methods After IRB approval, 24 patients with a newly diagnosed metastasis to the brain (n=24) were accrued on a prospective protocol between 2010 and 2012. There were 10 frontal, 7 parietal, 4 cerebellar, 2 occipital, and 1 temporal metastases. Histology included lung (16), breast (2), kidney (2), melanoma (2), colon (1), and cervix (1). Cs-131 stranded seeds were placed as a permanent volume implant. Prescription dose was 80Gy at 5mm depth from the resection cavity surface. Distant metastases were treated with stereotactic radiosurgery (SRS) or WBRT, depending on the number of lesions. Primary end point was resection cavity freedom from progression (FFP). Secondary end points included distant metastases FFP, median survival, overall survival (OS), and toxicity. Results Median follow-up was 19.3 months (range, 12.89 – 29.57 months). Median age was 65 years (range, 45–84 years). Median volume of resected tumor was 10.31 cc (range, 1.77 - 87.11 cc). Median number of seeds employed was 12 (range, 4–35) with median activity per seed of 3.82 mCi (range, 3.31–4.83 mCi) and total activity of 46.91 mCi (range, 15.31–130.70 mCi). Local recurrence FFP was 100%. There was 1 adjacent leptomeningeal recurrence, resulting in a 1-year regional FFP of 93.8% (95% CI = 63.2%, 99.1%). Distant metastasis FFP was 48.4% (95% CI = 26.3%, 67.4%). Median OS was 9

  20. Surgical treatment for epilepsy involving language cortices: a combined process of electrical cortical stimulation mapping and intra-operative continuous language assessment.

    PubMed

    Zhang, Xi; Zhang, Guojun; Yu, Tao; Ni, Duanyu; Cai, Lixin; Qiao, Liang; Du, Wei; Li, Yongjie

    2013-11-01

    The purpose of this study was to improve the surgical treatment of epilepsy by maximising seizure control while protecting language function. A combined process of extra-operative electrical cortical stimulation (ECS) mapping, direct ECS and intra-operative continuous language assessment was performed during complicated operative cases. Of the 24 epilepsy patients, nine had a complex relationship between the seizure onset zone and the language cortices. The combined process was used in these nine patients. In the other 15 patients, surgical resection was completed based on extra-operative ECS results alone. Evaluations were performed before and after surgery to assess language function and seizure control. The intra-operative continuous language assessment provided important information at the time of the resection. Seven extra-operative ECS positive language sites were resected without obvious language deficits in two patients. Resection was interrupted by language disturbances in an area where no extra-operative ECS positive site was identified in one patient. In three other patients, functional boundary was undefined in extra-operative ECS result, epileptogenic cortices were maximally resected during the continuous language assessment. In terms of seizure control, 18 of 24 (75%) patients reached Engel's class I, including all nine patients who underwent intra-operative continuous language assessment. One patient had minor surgery-related language deficits three months after resection. Intra-operative continuous language assessment proved to be complementary to extra-operative ECS mappings. The combination of ECS mappings and intra-operative continuous language assessment can maximise the resection of epileptogenic cortices and preserve language function in difficult cases involving the language cortex. Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  1. 76 FR 45645 - 10-Day Notice of Proposed Information Collection: Technology Security/Clearance Plans, Screening...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-29

    ... Notice of Proposed Information Collection: Technology Security/Clearance Plans, Screening Records, and... Reduction Act of 1995. Title of Information Collection: Technology Security/ Clearance Plans, Screening... consignee or end-user. Section 126.18 also provides that the technology security/clearance plan, screening...

  2. 78 FR 38070 - 30-Day Notice of Proposed Information Collection: Affirmative Fair Housing Marketing (AFHM) Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-25

    ... Information Collection: Affirmative Fair Housing Marketing (AFHM) Plan AGENCY: Office of the Chief Information... Title of Information Collection: Affirmative Fair Housing Marketing (AFHM) Plan. OMB Approval Number... Affirmative Fair Housing Marketing (AFHM) Plan (Multifamily), HUD-935.2B Affirmative Fair Housing Marketing...

  3. California Family Planning Health Care Providers' Challenges to Same-Day Long-Acting Reversible Contraception Provision.

    PubMed

    Biggs, M Antonia; Harper, Cynthia C; Brindis, Claire D

    2015-08-01

    To assess the extent to which practices offering family planning services are able to offer intrauterine devices (IUDs) and implants in one visit and to identify the reasons why multiple visits may be required. In the fall of 2011, 1,000 California family planning providers were asked about their long-acting reversible contraception delivery practices in a probability survey. We used multivariable logistic regression to examine practice characteristics associated with same-day provision of IUDs and implants. Among the 636 responding practices, 67% offered an IUD and 40% offered a contraceptive implant onsite. Among those with onsite provision, the majority required two or more visits to place an IUD (58%); almost half required two visits to place an implant (47%). Nearly all Planned Parenthood practices could place an IUD (95%) or implant (95%) at the initial visit, whereas the majority of all other practice types could not. The main reasons for delaying IUD and contraceptive implant provision included the need to screen and wait for test results (68% and 24%, respectively) and clinic flow and scheduling issues (50% and 64%, respectively). Multivariable analyses indicated that Planned Parenthood practices were significantly more likely than private practices to have same-day insertion protocols. Most of the family planning providers surveyed have not adopted same-day long-acting reversible contraception insertion protocols and face barriers to same-day provision. III.

  4. Hospital discharge on the first compared with the second day after a planned cesarean delivery: a randomized controlled trial.

    PubMed

    Tan, Peng Chiong; Norazilah, Mat Jin; Omar, Siti Zawiah

    2012-12-01

    To compare patient satisfaction and exclusive breastfeeding rates for patients discharged from the hospital on postcesarean day 1 (next day) or day 2. Healthy women admitted for planned cesarean delivery were randomized to day 1 or day 2 discharge. Postoperative assessment for suitability for discharge was based on defined criteria. Primary outcomes were patient satisfaction with their discharge timing assessed at 2 weeks and reported exclusive breastfeeding at 6 weeks after discharge. Analyses were based on intention-to-treat and per-protocol discharge. Of the 360 women randomized, results of 170 compared with 172 and 142 compared with 148 (day 1 compared with day 2) were available for intention-to-treat and per-protocol analyses, respectively. Nine women fulfilled discharge criteria but declined day 1 discharge, and 12 women allocated to day 2 discharge took their own discharge on day 1. Intention-to-treat analysis showed that satisfaction with discharge protocol was expressed by 148 of 170 (87.1%) compared with 147 of 172 (85.5%) (relative risk 1.1, 95% confidence interval [CI] 0.6-2.1, P=.75) and exclusive breastfeeding (at 6 weeks) was reported by 76 of 170 (44.7%) compared with 77 of 172 (44.9%) (relative risk 1.0 95% CI 0.7-1.5 P=.99 for day 1 compared with day 2 discharges, respectively). All secondary outcomes assessed at up to 6 weeks after discharge including unscheduled maternal or infant medical consultations, rehospitalizations, maternal antibiotic use, and maternal well-being, anxiety, and depression status, were similar. Results on per-protocol analysis were also similar. Day 1 discharge compared with day 2 discharge after a planned cesarean delivery resulted in equivalent outcomes. ISRCTN Register, ISRCTN.org, ISRCTN27523895.

  5. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty

    PubMed Central

    Sen, T.; Cankaya, D.; Kendir, S.; Basarır, K.; Tabak, Y.

    2016-01-01

    Objectives The purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty. Methods The transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, sd 9.4; 34 to 69). The ratios of the DMAD, PMAD, DLAD and PLAD to TEW were calculated. Results The mean TEW, DMAD, PMAD, DLAD and PLAD were 82.76 mm (standard deviation (sd) 7.74), 28.95 mm (sd 3.3), 28.57 mm (sd 3), 23.97 mm (sd 3.27) and 24.42 mm (sd 3.14), respectively. The ratios between the TEW and the articular distances (DMAD/TEW, DLAD/TEW, PMAD/TEW and PLAD/TEW) were calculated and their means were 0.35 (sd 0.02), 0.34 (sd 0.02), 0.28 (sd 0.03) and 0.29 (sd 0.03), respectively. Conclusion This method provides a simple, reproducible and reliable technique enabling accurate anatomical joint line restoration during revision total knee arthroplasty. Cite this article: B. Ozkurt, T. Sen, D. Cankaya, S. Kendir, K. Basarır, Y. Tabak. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016;5:280–286. DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1. PMID:27388715

  6. Effects of intra-operative ketamine administration on postoperative catheter-related bladder discomfort: a double-blind clinical trial.

    PubMed

    Shariat Moharari, Reza; Lajevardi, Mahbod; Khajavi, Mohammadreza; Najafi, Atabak; Shariat Moharari, Gazelle; Etezadi, Farhad

    2014-02-01

    Urinary catheterization during surgery frequently leads to unfavorable signs and symptoms (ie urgency, discomfort, frequency) during recovery. These signs and symptoms are collectively called catheter-related bladder discomfort (CRBD). We hypothesized that preemptive IV ketamine administration prior to intra-operative catheterization would reduce the incidence of CRBD in the postoperative period when compared to placebo. The study consisted of 114 adult patients undergoing elective nephrectomy. They were randomized to 2 equal groups of 57 subjects. In the intervention group, IV ketamine (0.5 mg/kg) was administered directly after induction of anesthesia, but before urinary catheterization. The control group received an injection of 2 mL of normal saline. The study evaluated the incidence and severity of CRBD at 0, 1, 2, and 6 hours after commencement of the recovery period. The study also compared the incidence of postoperative nausea and vomiting, hallucinations, sedation, and respiratory depression in the 2 groups. At the 0- and 1-hour evaluations, the incidence and severity of CRBD were lower in the intervention group; however, at the 2- and 6-hour evaluations, there were no significant differences in incidence and severity of CRBD between the 2 groups. A decreased incidence of postoperative nausea and vomiting (PONV) was observed at 2- and 6-hour visits in the intervention group. Also, a higher occurrence of sedation was seen at the 0-hour checkup in the intervention group. Preemptive administration of IV ketamine (0.5 mg/kg) can reduce incidence and severity of CRBD in the early postoperative period. © 2013 The Authors Pain Practice © 2013 World Institute of Pain.

  7. Assessment of intra-operative cell salvage haemolysis in the obstetric and orthopaedic clinical setting, in comparison with allogeneic blood.

    PubMed

    Sullivan, I J; Faulds, J N

    2014-10-01

    Haemolysis is still a re-occurring theme in intra-operative cell salvage (ICS) with further haemolysis possibly caused by suction pressure, washing/centrifuging process and aspiration method. Previous investigations, along with manufacturer's reports, state that between 75 and 95% of free haemoglobin (Hb) is removed by the washing and centrifugation process; however, if these results are above the expected levels, excess free Hb may remain after washing. The aim of this article was to quantify haemolysis levels whilst employing different aspiration methods from skimmed (orthopaedics) and pooled (obstetrics) surgery types and comparing this to allogeneic blood. Samples obtained from 50 allogeneic units and 50 ICS cases (25 obstetric and 25 orthopaedic) were tested for plasma free Hb levels. Free Hb testing as a marker of haemolysis was greatest in orthopaedic 17·2 g L(-1) (range: 1·7-57·0 g L(-1) ), obstetric 2·8 g L(-1) (range: 1·0-13·5 g L(-1) ) and allogeneic 0·95 g L(-1) (range: 0·2-4·8 g L(-1) ) cases. ICS involving skimming collection techniques (orthopaedics) had significantly more haemolysis than pooled collections (obstetrics) (P < 0·001). Further analysis of orthopaedic data highlighted a difference between the three machines used with the Haemonetics OrthoPat (Haemonetics Ltd., Watford, UK) significantly higher with a free Hb of 29·8 g L(-1) compared with the other two machines 6·7 g L(-1) (P < 0·001). On comparison of ICS blood to allogeneic blood, free Hb levels obtained from ICS were significantly higher (P < 0·001). © 2014 British Blood Transfusion Society.

  8. Lactate dehydrogenase and Haemolysis Index as quality control markers of haemolysis in intra-operative cell salvage.

    PubMed

    Sullivan, I J; Faulds, J N

    2013-10-01

    The aim of this investigation was to explore the potential use of the tests lactate dehydrogenase (LDH) and Haemolysis Index as haemolysis markers in intra-operative cell salvage (ICS) blood in comparison to plasma free haemoglobin levels. Quality control (QC) should be seen as a fundamental part of any ICS blood conservation programme, however, due to lack of available knowledge, familiarity and experience, QC is still a comparatively new subject. A QC pilot scheme is currently being undertaken by the Royal Cornwall Hospital in association with the UK Cell Salvage Action Group to explore potential markers that can be used to assess the quality of blood obtained from ICS. This test list should be available to all ICS users and achievable within financial budgets. Currently this proposed test list includes a full blood count, a protein marker such as urine albumin/microalbumin and heparin monitoring. Haemolysis testing is another key marker. Samples were collected from ICS processed blood and allogeneic SAGM leucodepleted red cell units and processed for plasma free haemoglobin, LDH and Haemolysis Index. There was a very strong correlation between plasma free haemoglobin and LDH (0.960), and plasma free haemoglobin and the Haemolysis Index (0.944). We have shown that the LDH and Haemolysis Index tests are suitable and reliable alternatives for measuring haemolysis from samples obtained from ICS or allogeneic blood. We have incorporated the LDH test into our Hospital's ICS QC package and recommend that this test is considered for all ICS QC samples. © 2013 The Authors. Transfusion Medicine © 2013 British Blood Transfusion Society.

  9. The Full-Day Kindergarten: Planning and Practicing a Dynamic Themes Curriculum. Early Childhood Education Series. 2nd Edition.

    ERIC Educational Resources Information Center

    Fromberg, Doris Pronin

    Examining problems and questions related to full-day kindergarten, this book deals broadly with early childhood curriculum design and development. It suggests specific step-by-step ways to plan an emergent curriculum based upon integrated, dynamic themes that grow out of children's diverse personal and cultural experiences. Addressed to teachers,…

  10. Solving the Puzzle of Child Care: Quality Enhancement Project Centers. Final Report. Child Day Care Planning Project.

    ERIC Educational Resources Information Center

    Ellison, Carole; Ash, Geraldine

    This report describes the Quality Enhancement Project (QEP), one of four major components of the Child Day Care Planning Project (CDCPP) of Cuyahoga County, Ohio. The major goal of the QEP was to develop a model for improving the quality of funded centers. The quality of care at 65 funded centers in Cleveland and 11 surrounding suburbs was…

  11. Understanding Adherence to 5 Servings of Fruits and Vegetables per Day: A Theory of Planned Behavior Perspective

    ERIC Educational Resources Information Center

    Blanchard, Chris M.; Fisher, Janet; Sparling, Phillip B.; Shanks, Tiffany Hunt; Nehl, Eric; Rhodes, Ryan E.; Courneya, Kerry S.; Baker, Frank

    2009-01-01

    Objective: The primary purpose of the present study was to examine the utility of the Theory of Planned Behavior (TPB) in explaining the 5-A-Day intentions and behavior of college students. A secondary purpose was to determine whether any of the TPB relationships were moderated by gender or ethnicity. Design: A prospective design that asked…

  12. Understanding Adherence to 5 Servings of Fruits and Vegetables per Day: A Theory of Planned Behavior Perspective

    ERIC Educational Resources Information Center

    Blanchard, Chris M.; Fisher, Janet; Sparling, Phillip B.; Shanks, Tiffany Hunt; Nehl, Eric; Rhodes, Ryan E.; Courneya, Kerry S.; Baker, Frank

    2009-01-01

    Objective: The primary purpose of the present study was to examine the utility of the Theory of Planned Behavior (TPB) in explaining the 5-A-Day intentions and behavior of college students. A secondary purpose was to determine whether any of the TPB relationships were moderated by gender or ethnicity. Design: A prospective design that asked…

  13. Frozen section is superior to imprint cytology for the intra-operative assessment of sentinel lymph node metastasis in Stage I Breast cancer patients

    PubMed Central

    Mori, Miki; Tada, Keiichiro; Ikenaga, Motoko; Miyagi, Yumi; Nishimura, Seiichiro; Takahashi, Kaoru; Makita, Masujiro; Iwase, Takuji; Kasumi, Fujio; Koizumi, Mituru

    2006-01-01

    Background A standard intra-operative procedure for assessing sentinel lymph node metastasis in breast cancer patients has not yet been established. Patients and methods One hundred and thirty-eight patients with stage I breast cancer who underwent sentinel node biopsy using both imprint cytology and frozen section were analyzed. Results Seventeen of the 138 patients had sentinel node involvement. Results of imprint cytology included nine false negative cases (sensitivity, 47.1%). In contrast, only two cases of false negatives were found on frozen section (sensitivity, 88.2%). There were two false positive cases identified by imprint cytology (specificity, 98.3%). On the other hand, frozen section had 100% specificity. Conclusion These findings suggest that frozen section is superior to imprint cytology for the intra-operative determination of sentinel lymph node metastasis in stage I breast cancer patients. PMID:16707007

  14. Create your own science planning tool in 3 days with SOA

    NASA Technical Reports Server (NTRS)

    Streiffert, Barbara A.; Polanskey, Carol A.; O'Reilly, Taifun

    2003-01-01

    Scientific discovery and advancement of knowledge has been, and continues to be, the goal for space missions at Jet Propulsion Laboratory. Scientist must plan their observation/experiments to get the maximum data return in order to make those discoveries. However, each mission has different science objectives, a different spacecraft and different instrument payloads, as well as, different routes to different destinations with different spacecraft restrictions and characteristics. In the current reduced cost environment, manageable cost for mission planning software is a must. Science Opportunity Analyzer (SOA), a planning tool for scientists and mission planners, utilizes a simple approach to reduce cost and promote reusability.

  15. Intra-Operative Surgical Irrigation of the Surgical Incision: What Does the Future Hold-Saline, Antibiotic Agents, or Antiseptic Agents?

    PubMed

    Edmiston, Charles E; Leaper, David J

    2016-12-01

    Intra-operative surgical site irrigation (lavage) is common practice in surgical procedures in general, with all disciplines advocating some form of irrigation before incision closure. This practice, however, has been neither standardized nor is there compelling evidence that it effectively reduces the risk of surgical site infection (SSI). This narrative review addresses the laboratory and clinical evidence that is available to support the practice of irrigation of the abdominal cavity and superficial/deep incisional tissues, using specific irrigation solutions at the end of an operative procedure to reduce the microbial burden at wound closure. Review of PubMed and OVID for pertinent, scientific, and clinical publications in the English language was performed. Incision irrigation was found to afford a three-fold benefit: First, to hydrate the bed; second, to assist in allowing better examination of the area immediately before closure; and finally, by removing superficial and deep incisional contamination and lowering the bioburden, expedite the healing process. The clinical practice of intra-operative peritoneal lavage is highly variable and is dependent solely on surgeon preference. By contrast, intra-operative irrigation after device-related procedures has become a standard of care for the prophylaxis of acute peri-prosthetic infection. The clinical evidence that supports the use of antibiotic irrigation is limited and based on retrospective analysis and few acceptable randomized controlled trials. The results of laboratory and animal studies using aqueous 0.05% chlorhexidine gluconate are favorable, suggesting that further studies are justified to determine its clinical efficacy. The adoption of appropriate and standardized intra-operative irrigation practices into peri-operative care bundles, which include other evidence-based strategies (weight-based antimicrobial prophylaxis, antimicrobial sutures, maintenance of normothermia, and glycemic control), offers

  16. Intra-operative fiducial-based CT/fluoroscope image registration framework for image-guided robot-assisted joint fracture surgery.

    PubMed

    Dagnino, Giulio; Georgilas, Ioannis; Morad, Samir; Gibbons, Peter; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

    2017-08-01

    Joint fractures must be accurately reduced minimising soft tissue damages to avoid negative surgical outcomes. To this regard, we have developed the RAFS surgical system, which allows the percutaneous reduction of intra-articular fractures and provides intra-operative real-time 3D image guidance to the surgeon. Earlier experiments showed the effectiveness of the RAFS system on phantoms, but also key issues which precluded its use in a clinical application. This work proposes a redesign of the RAFS's navigation system overcoming the earlier version's issues, aiming to move the RAFS system into a surgical environment. The navigation system is improved through an image registration framework allowing the intra-operative registration between pre-operative CT images and intra-operative fluoroscopic images of a fractured bone using a custom-made fiducial marker. The objective of the registration is to estimate the relative pose between a bone fragment and an orthopaedic manipulation pin inserted into it intra-operatively. The actual pose of the bone fragment can be updated in real time using an optical tracker, enabling the image guidance. Experiments on phantom and cadavers demonstrated the accuracy and reliability of the registration framework, showing a reduction accuracy (sTRE) of about [Formula: see text] (phantom) and [Formula: see text] (cadavers). Four distal femur fractures were successfully reduced in cadaveric specimens using the improved navigation system and the RAFS system following the new clinical workflow (reduction error [Formula: see text], [Formula: see text]. Experiments showed the feasibility of the image registration framework. It was successfully integrated into the navigation system, allowing the use of the RAFS system in a realistic surgical application.

  17. Development of a novel handheld intra-operative laparoscopic Compton camera for 18F-Fluoro-2-deoxy-2-D-glucose-guided surgery

    NASA Astrophysics Data System (ADS)

    Nakamura, Y.; Shimazoe, K.; Takahashi, H.; Yoshimura, S.; Seto, Y.; Kato, S.; Takahashi, M.; Momose, T.

    2016-08-01

    As well as pre-operative roadmapping by 18F-Fluoro-2-deoxy-2-D-glucose (FDG) positron emission tomography, intra-operative localization of the tracer is important to identify local margins for less-invasive surgery, especially FDG-guided surgery. The objective of this paper is to develop a laparoscopic Compton camera and system aimed at use for intra-operative FDG imaging for accurate and less-invasive dissections. The laparoscopic Compton camera consists of four layers of a 12-pixel cross-shaped array of GFAG crystals (2× 2× 3 mm3) and through silicon via multi-pixel photon counters and dedicated individual readout electronics based on a dynamic time-over-threshold method. Experimental results yielded a spatial resolution of 4 mm (FWHM) for a 10 mm working distance and an absolute detection efficiency of 0.11 cps kBq-1, corresponding to an intrinsic detection efficiency of  ˜0.18%. In an experiment using a NEMA-like well-shaped FDG phantom, a φ 5× 10 mm cylindrical hot spot was clearly obtained even in the presence of a background distribution surrounding the Compton camera and the hot spot. We successfully obtained reconstructed images of a resected lymph node and primary tumor ex vivo after FDG administration to a patient having esophageal cancer. These performance characteristics indicate a new possibility of FDG-directed surgery by using a Compton camera intra-operatively.

  18. Law Day U.S.A. 1993. Planning Guide & Resource Manual.

    ERIC Educational Resources Information Center

    American Bar Association, Chicago, IL.

    The stated purpose of Law Day is to call the attention of every U.S. citizen to the principles and the practice of U.S. law and justice. It is a day to reflect on U.S. legal heritage, the role of law in U.S. society, and the rights enjoyed under the U.S. Constitution. The theme of Law Day 1993 (May 1, 1993) was "Justice for All--All for…

  19. E Pluribus Unum. Out of Many, One. 1995. Law Day Planning Guide.

    ERIC Educational Resources Information Center

    American Bar Association, Chicago, IL.

    This booklet introduces ideas and materials for Law Day activities. Celebrated on May 1, Law Day is an annual opportunity to expand awareness of U.S. laws and the justice system and their valuable impact on our lives. The primary purpose of Law Day is to provide the opportunity for the public to reflect on U.S. legal heritage, the role of law in…

  20. Ecological Momentary Assessment of Acute Alcohol Use Disorder Symptoms: Associations With Mood, Motives, and Use on Planned Drinking Days

    PubMed Central

    Dvorak, Robert D.; Pearson, Matthew R.; Day, Anne M.

    2015-01-01

    Several theories posit that alcohol is consumed both in relation to one’s mood and in relation to different motives for drinking. However, there are mixed findings regarding the role of mood and motives in predicting drinking. Ecological momentary assessment (EMA) methods provide an opportunity to evaluate near real-time changes in mood and motives within individuals to predict alcohol use. In addition, endorsement of criteria of an alcohol use disorder (AUD) may also be sensitive to changes within subjects. The current study used EMA with 74 moderate drinkers who responded to fixed and random mood, motive, alcohol use, and AUD criteria prompts over a 21-day assessment period. A temporal pattern of daytime mood, evening drinking motivation, and nighttime alcohol use and acute AUD symptoms on planned drinking days was modeled to examine how these associations unfold throughout the day. The results suggest considerable heterogeneity in drinking motivation across drinking days. Additionally, an affect regulation model of drinking to cope with negative mood was observed. Specifically, on planned drinking days, the temporal association between daytime negative mood and the experience of acute AUD symptoms was mediated via coping motives and alcohol use. The current study found that motives are dynamic, and that changes in motives may predict differential drinking patterns across days. Further, the study provides evidence that emotion-regulation-driven alcohol involvement may need to be examined at the event level to fully capture the ebb and flow of negative affect motivated drinking. PMID:24932896

  1. 3D intra-operative ultrasound and MR image guidance: pursuing an ultrasound-based management of brainshift to enhance neuronavigation.

    PubMed

    Riva, Marco; Hennersperger, Christoph; Milletari, Fausto; Katouzian, Amin; Pessina, Federico; Gutierrez-Becker, Benjamin; Castellano, Antonella; Navab, Nassir; Bello, Lorenzo

    2017-04-08

    Brainshift is still a major issue in neuronavigation. Incorporating intra-operative ultrasound (iUS) with advanced registration algorithms within the surgical workflow is regarded as a promising approach for a better understanding and management of brainshift. This work is intended to (1) provide three-dimensional (3D) ultrasound reconstructions specifically for brain imaging in order to detect brainshift observed intra-operatively, (2) evaluate a novel iterative intra-operative ultrasound-based deformation correction framework, and (3) validate the performance of the proposed image-registration-based deformation estimation in a clinical environment. Eight patients with brain tumors undergoing surgical resection are enrolled in this study. For each patient, a 3D freehand iUS system is employed in combination with an intra-operative navigation (iNav) system, and intra-operative ultrasound data are acquired at three timepoints during surgery. On this foundation, we present a novel resolution-preserving 3D ultrasound reconstruction, as well as a framework to detect brainshift through iterative registration of iUS images. To validate the system, the target registration error (TRE) is evaluated for each patient, and both rigid and elastic registration algorithms are analyzed. The mean TRE based on 3D-iUS improves significantly using the proposed brainshift compensation compared to neuronavigation (iNav) before (2.7 vs. 5.9 mm; [Formula: see text]) and after dural opening (4.2 vs. 6.2 mm, [Formula: see text]), but not after resection (6.7 vs. 7.5 mm; [Formula: see text]). iUS depicts a significant ([Formula: see text]) dynamic spatial brainshift throughout the three timepoints. Accuracy of registration can be improved through rigid and elastic registrations by 29.2 and 33.3%, respectively, after dural opening, and by 5.2 and 0.4%, after resection. 3D-iUS systems can improve the detection of brainshift and significantly increase the accuracy of the navigation in a real

  2. [Feasibility Study of a One-Day Educational Program to Train Advance Care Planning Facilitators(ACPFs)in Regional Areas].

    PubMed

    Nishikawa, Mitsunori; Miura, Hisayuki; Oya, Sanae; Kato, Tomonari; Nagae, Hiroyuki; Osada, Yoshiyuki; Watanabe, Tetsuya; Matsuoka, Sachiko; Otsuka, Yasuro; Yamaguchi, Mie; Watanabe, Kazuko; Kito, Katsutoshi; Ooi, Hatsue; Suzuki, Naoko

    2016-12-01

    Promoting advance care planning in regional areas is important. Education For Implementing End-of-Life Discussion(EFIELD) is a two-day educational program for Advance Care Planning Facilitators(ACPFs)developed by the National Center for Geriatrics and Gerontology. Unfortunately, some trainers experience difficulties implementing the content of the program, and some trainees feel the program is too long for implementation in many regional areas. The purpose of the research is to clarify the feasibility of ACPFs education using a one-day program in regional areas. The methods involved documenting the process of a one-day program from implementation to evaluation from May of 2015 to March of 2016 and then evaluating the effectiveness of the program 3 months after the implementation using meeting minutes from 7 local hospitals. The results indicated a need for 5 steps from program implementation to evaluation as well as 5 categories for final evaluation. The most important finding is that E-FIELD challenged trainers to shorten and simplify their expressions in order to teach the content more efficiently. The second finding is that Group for Promoting Advance Care Planning & End Of Life Discussion in Chita(GACPEL) activities encouraged ACPimplementation within each hospital. The limitations of this research are related to small regional areas. In conclusion, a one-day regional ACPFs educational program is feasible.

  3. A Planning Guide to the Preschool Curriculum: The Child, the Process, the Day.

    ERIC Educational Resources Information Center

    Findlay, Jane; And Others

    This guide to preschool curriculum planning presents a unit approach to preschool education and outlines 44 curriculum units. A discussion of methods and principles involved in the development of this curriculum stresses that it is the child, not the teacher, who determines curriculum. Four principles for good teaching are examined: preparing…

  4. Planning the American Air War, Four Men and Nine Days in 1941. An Inside Narrative

    DTIC Science & Technology

    1982-01-01

    How about verbal skills? Need someone who can capture tough ideas quickly and present them precise- ly? Maybe someone who can do a little of his own...airpower short, but there was little sense in rushing to prepare an all-airpower plan only to have it disapproved. What balance would work best? Which...how- ever, he decided the temporary structure should be built of concrete and steel. A little UK) sturdy to collapse of its own weight and

  5. Starvation Can Result From Inadequate Dietary Planning for a 50-Day Rowing Expedition.

    PubMed

    Reid, Hamish Ab; Dennison, Nicholas C; Quayle, Jonathan; Preston, Tom

    2016-12-14

    Meeting the energy demands of prolonged arduous expeditions and endurance sport may be a significant barrier to success. Expedition rowing is associated with high levels of body mass loss, reflecting the challenge of meeting energy expenditure in this exacting environment. This study used the Doubly Labelled Water (DLW) technique to calculate the Total Energy Expenditure (TEE), and body composition changes of two 28-year-old healthy male athletes during a 50-day continuous and unsupported row around Great Britain. A measured dose of DLW was taken at the start of two separate study periods (days five to 19 and 34 to 48) followed by sequential urine collection, which was analysed on return to land. Mean TEE was 15.3MJ/day: Athlete 1 16.4MJ/day, Athlete 2 14.9MJ/day. Athlete 1 lost 11.2kg and Athlete 2 lost 14.9kg of body mass during the row. Average energy provision was 19.1MJ per 24-hour ration pack. These results highlight the difficulty of maintaining energy balance during expedition rowing. A starvation state was observed despite dietary provision in excess of estimated energy expenditure, indicating nutritional strategy rather than caloric availability was at fault. We recommend future expeditions prioritise thorough testing and the individualisation of rations to ensure they are both palatable and practical during the weeks to months at sea.

  6. Menu Planning, Food Consumption, and Sanitation Practices in Day Care Facilities.

    ERIC Educational Resources Information Center

    Kuratko, Connye N.; Martin, Ruth E.; Lan, William Y.; Chappell, James A.; Ahmad, Mahassen

    2000-01-01

    In 102 day care centers, data were collected on nutritional content of menus, compliance with guidelines, children's food consumption, and safety/sanitation. Although menus exceeded recommended daily allowances, quantities of food were below recommendations. No menu components were consumed by more than 65% of children. Sanitation problems were…

  7. Democracy and Diversity: Celebrate Your Freedom. Law Day 2000 Planning Guide.

    ERIC Educational Resources Information Center

    White, Charles, Ed.

    Every year on May 1st, Law Day celebrates this country's freedoms and the role of law in protecting and preserving them. Noting that 2000 is the first year of a new millennium, this guide urges planners all over the country to pay special attention to the role of citizens in a diverse democracy. Since the year 2000 is also an election year, the…

  8. The ability of intra-operative perfusion mapping with laser-assisted indocyanine green angiography to predict mastectomy flap necrosis in breast reconstruction: a prospective trial.

    PubMed

    Munabi, Naikhoba C O; Olorunnipa, Olushola B; Goltsman, David; Rohde, Christine H; Ascherman, Jeffrey A

    2014-04-01

    Mastectomy skin flap ischaemia leading to necrosis is a common occurrence. Laser-assisted indocyanine green (ICG) angiography can assist to locate these poorly perfused areas intra-operatively. Our study aims to identify specific perfusion values produced by ICG angiography that accurately predict mastectomy flap necrosis. A total of 42 patients undergoing autologous or implant-based breast reconstruction had mastectomy flaps imaged using laser-assisted ICG angiography at the completion of reconstruction. Intra-operative perfusion values were correlated with postoperative skin flap outcomes. Risk factors for abnormal perfusion were recorded and analysed. A total of 62 breast reconstructions were imaged, including 48 tissue expander reconstructions, six transverse rectus abdominis myocutaneous (TRAM) flaps, six deep inferior epigastric perforator (DIEP) flaps and two direct-to-implant reconstructions. Eight cases (13%) of full-thickness skin necrosis were identified postoperatively. A SPY Elite(®) value of ≤ 7 accurately predicted the development of flap necrosis at 88% sensitivity and 83% specificity. False-positive cases (those with perfusion values ≤ 7 which did not develop necrosis) were more likely to have a smoking history and/or to have had an epinephrine-containing tumescent solution used during mastectomy. Excluding patients with smoking or epinephrine use, a SPY value of ≤ 7 predicted flap necrosis with a sensitivity of 83% and specificity of 97%. Thus, these data suggest that laser-assisted ICG angiography predicts postoperative outcomes with high accuracy. In our series, a SPY value of ≤ 7 correlated well with mastectomy flap necrosis. Furthermore, smoking and intra-operative injections containing epinephrine should be considered when evaluating low perfusion values as they can lead to false-positive test results.

  9. Minimally invasive fixation in tibial plateau fractures using an pre-operative and intra-operative real size 3D printing.

    PubMed

    Giannetti, Silvio; Bizzotto, Nicola; Stancati, Andrea; Santucci, Attilio

    2017-03-01

    The purpose of our study was to compare the outcome after minimally invasive reconstruction and internal fixation with and without the use of pre- and intra-operative real size 3D printing for patients with displaced tibial plateau fractures (TPFs). We prospectively followed up 40 consecutive adult patients with closed TPF who underwent surgical treatment of reconstruction of the tibial plateau with the use of minimally invasive fixation. Sixteen patients (group 1) were operated using a pre-operative and intra-operative real size 3D-model, while 24 patients (group 2) were operated without 3D-model printing, but using only pre-operative and intra-operative 3D Tc-scan images. The mean operating time was 148.2±15.9min for group 1 and 174.5±22.2min for group 2 (p=0.041). In addition, the mean intraoperative blood loss was less in group 1 (520mL) than in group 2 (546mL) (p=0.534). After discharge, all patients were followed up at 6 weeks, 12 weeks, 6 months, 1year and then every year post surgically and radiographic evaluation was carried out each time using clinical and radiological Rasmussen's score, with no significant differences between the two groups. Two patients (group 2) developed infection which resolved within 3 weeks after usage of antibiotics. Neither superficial nor deep infections were present in group 1. In all patients, no non-union occurred. No intraoperative, perioperative, or postoperative complications, such as loss of valgus correction, bone fractures, or metallic plate failures were detected at follow-up. In patients operated with the use of 3D-model printing, we found a significant reduction in surgical time. Moreover, the technique without a 3D-model increased the patient's and the surgeon's exposure to radiation.

  10. A novel approach emphasising intra-operative superficial margin enhancement of head-neck tumours with narrow-band imaging in transoral robotic surgery.

    PubMed

    Vicini, C; Montevecchi, F; D'Agostino, G; DE Vito, A; Meccariello, G

    2015-06-01

    The primary goal of surgical oncology is to obtain a tumour resection with disease-free margins. Transoral robotic surgery (TORS) for surgical treatment of head-neck cancer is commensurate with standard treatments. However, the likelihood of positive margins after TORS is up to 20.2% in a recent US survey. The aim of this study is to evaluate the efficacy and the feasibility of narrow-band imaging (NBI) during TORS in order to improve the ability to achieve disease-free margins during tumour excision. The present study was conducted at the ENT, Head- Neck Surgery and Oral Surgery Unit, Department of Special Surgery, Morgagni Pierantoni Hospital, Azienda USL Romagna. From March 2008 to January 2015, 333 TORS were carried out for malignant and benign diseases. For the present study, we retrospectively evaluated 58 biopsy-proven squamous cell carcinoma patients who underwent TORS procedures. Patients were divided into 2 groups: (1) 32 who underwent TORS and intra-operative NBI evaluation (NBI-TORS); (2) 21 who underwent TORS with standard intra-operative white-light imaging (WLITORS). Frozen section analysis of margins on surgical specimens showed a higher rate of negative superficial lateral margins in the NBI-TORS group compared with the WLI-TORS group (87.9% vs. 57.9%, respectively, p = 0.02). The sensitivity and specificity of intra-operative use of NBI, respectively, were 72.5% and 66.7% with a negative predictive value of 87.9%. Tumour margin enhancement provided by NBI associated with magnification and 3-dimensional view of the surgical field might increase the capability to achieve an oncologically-safe resection in challenging anatomical areas where minimal curative resection is strongly recommended for function preservation.

  11. Determination of mitral valve area with echocardiography, using intra-operative 3-dimensional versus intra- & post-operative pressure half-time technique in mitral valve repair surgery

    PubMed Central

    2013-01-01

    Background We hypothesized that mitral valve areas (MVAs) with echocardiography, using 3D planimetry technique (measured at one point at maximal opening of mitral valve) versus pressure half-time technique (PHT, measured during entire diastolic phase) in mitral valve repair surgery (MVR) would be different. Methods Patients who had undergone MVR were retrospectively reviewed, and two different observers measured the MVAs using PHT and 3D planimetry technique. The MVAs derived from recorded medical data, using PHT and 3D planimetry technique were abbreviated to MVA-PHT1 and MVA-3D1, and data from the PHT and 3D planimetry techniques by observer A and observer B were determined as MVA-PHT2 and MVA-3D2, and MVA-PHT3 and MVA-3D3, respectively. The MVA derived by post-operative transthoracic echocardiography using the PHT technique was determined as MVA-TTE. Results Intraclass correlation coefficients were 0.90 for the intra-operative PHT technique and 0.78 for the intra-operative 3D planimetry technique. MVA-3D1 (2.91 ± 0.65 cm2), MVA-3D2 (3.00 ± 0.63 cm2) and MVA-3D3 (2.97 ± 0.88 cm2) were significantly larger than MVA-TTE (2.40 ± 0.59 cm2), but intra-operative MVAs-PHT were not. The biases and precisions were larger, and the correlation coefficients were lower in 3D planimetry technique compared with PHT technique. Conclusions MVA measured by 3D planimetry technique with TEE at the intra-operative post-MVR period was seemed to be larger than that measured by the PHT technique with TTE at the post-operative period. However, it did not mean that the 3D planimetry technique was inaccurate but needs cautions at determination of MVA using different techniques. PMID:23594408

  12. SU-F-BRF-10: Deformable MRI to CT Validation Employing Same Day Planning MRI for Surrogate Analysis

    SciTech Connect

    Padgett, K; Stoyanova, R; Johnson, P; Dogan, N; Pollack, A; Piper, J; Javorek, A

    2014-06-15

    Purpose: To compare rigid and deformable registrations of the prostate in the multi-modality setting (diagnostic-MRI to planning-CT) by utilizing a planning-MRI as a surrogate. The surrogate allows for the direct quantitative analysis which can be difficult in the multi-modality domain where intensity mapping differs. Methods: For ten subjects, T2 fast-spin-echo images were acquired at two different time points, the first several weeks prior to planning (diagnostic-MRI) and the second on the same day in which the planning CT was collected (planning-MRI). Significant effort in patient positioning and bowel/bladder preparation was undertaken to minimize distortion of the prostate in all datasets. The diagnostic-MRI was deformed to the planning-CT utilizing a commercially available deformable registration algorithm synthesized from local registrations. The deformed MRI was then rigidly aligned to the planning MRI which was used as the surrogate for the planning-CT. Agreement between the two MRI datasets was scored using intensity based metrics including Pearson correlation and normalized mutual information, NMI. A local analysis was performed by looking only within the prostate, proximal seminal vesicles, penile bulb and combined areas. A similar method was used to assess a rigid registration between the diagnostic-MRI and planning-CT. Results: Utilizing the NMI, the deformable registrations were superior to the rigid registrations in 9 of 10 cases demonstrating a 15.94% improvement (p-value < 0.001) within the combined area. The Pearson correlation showed similar results with the deformable registration superior in the same number of cases and demonstrating a 6.97% improvement (p-value <0.011). Conclusion: Validating deformable multi-modality registrations using spatial intensity based metrics is difficult due to the inherent differences in intensity mapping. This population provides an ideal testing ground for MRI to CT deformable registrations by obviating the need

  13. Monte Carlo evaluation of the effect of inhomogeneities on dose calculation for low energy photons intra-operative radiation therapy in pelvic area.

    PubMed

    Chiavassa, Sophie; Buge, François; Hervé, Chloé; Delpon, Gregory; Rigaud, Jérome; Lisbona, Albert; Supiot, Sthéphane

    2015-12-01

    The aim of this study was to evaluate the effect of inhomogeneities on dose calculation for low energy photons intra-operative radiation therapy (IORT) in pelvic area. A GATE Monte Carlo model of the INTRABEAM® was adapted for the study. Simulations were performed in the CT scan of a cadaver considering a homogeneous segmentation (water) and an inhomogeneous segmentation (5 tissues from ICRU44). Measurements were performed in the cadaver using EBT3 Gafchromic® films. Impact of inhomogeneities on dose calculation in cadaver was 6% for soft tissues and greater than 300% for bone tissues. EBT3 measurements showed a better agreement with calculation for inhomogeneous media. However, dose discrepancy in soft tissues led to a sub-millimeter (0.65 mm) shift in the effective point dose in depth. Except for bone tissues, the effect of inhomogeneities on dose calculation for low energy photons intra-operative radiation therapy in pelvic area was not significant for the studied anatomy. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  14. THE VALUE OF PRE- AND INTRA-OPERATIVE ADJUNCTS ON THE EXTENT OF RESECTION OF HEMISPHERIC LOW GRADE GLIOMAS; A RETROSPECTIVE ANALYSIS

    PubMed Central

    Incekara, Fatih; Olubiyi, Olutayo; Ozdemir, Aysegul; Lee, Tom; Rigolo, Laura; Golby, Alexandra

    2016-01-01

    Background To achieve maximal resection with minimal risk of postoperative neurological morbidity, different neurosurgical adjuncts are being used during low grade glioma (LGG) surgery. Objectives The goal of this study was to investigate the effect of pre- and intra-operative adjuncts on the extent of resection (EOR) of hemispheric LGGs. Methods Medical records were reviewed to identify patients of any sex, 18 years or older, who underwent LGG surgery at ‘X’ Hospital between January 2005 and July 2013. Patients were divided in 8 subgroups based on the use of neuronavigation system alone (NN), functional MRI-diffusion tensor imaging (fMRI-DTI) guided neuronavigation (FD), intra-operative MRI (MR) and direct electrical stimulation (DES). Initial and residual tumors were measured and mean EOR was compared between groups. Results Of all 128 patients, gross total resection was achieved in 23.4%. Overall mean EOR was 81.3% ± 20.5%. Using DES in combination with fMRI-DTI (mean EOR 86.7% ± 12.4%) on eloquent tumors improved mean EOR significantly after adjustment for potential confounders, when compared with neuronavigation alone (mean EOR 76.4% ± 25.5%, p = 0.001). Conclusions Using DES in combination with fMRI and DTI significantly improves EOR when LGGs are located in eloquent areas, compared with craniotomies were only neuronavigation was used. PMID:26216736

  15. The effect of two cognitive aid designs on team functioning during intra-operative anaphylaxis emergencies: a multi-centre simulation study.

    PubMed

    Marshall, S D; Sanderson, P; McIntosh, C A; Kolawole, H

    2016-04-01

    This multi-centre repeated measures study was undertaken to determine how contrasting designs of cognitive aids affect team performance during simulated intra-operative anaphylaxis crises. A total of 24 teams consisting of a consultant anaesthetist, an anaesthetic trainee and anaesthetic assistant managed three simulated intra-operative anaphylaxis emergencies. Each team was assigned at random to a counterbalanced order of: no cognitive aid; a linear cognitive aid; and a branched cognitive aid, and scored for team functioning. Scores were significantly higher with a linear compared with either a branched version of the cognitive aid or no cognitive aid for 'Team Overall Behavioural Performance', difference between study groups (F-value) 5.8, p = 0.01. Aggregate scores were higher with the linear compared with the branched aid design (p = 0.03). Cognitive aids improve co-ordination of the team's activities and support team members to verbalise their actions. A linear design of cognitive aid improves team functioning more than a branched design. © 2016 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

  16. Irradiation characteristics of BNCT using near-threshold 7Li(p, n)7Be direct neutrons: application to intra-operative BNCT for malignant brain tumours.

    PubMed

    Tanaka, Kenichi; Kobayashi, Tooru; Sakurai, Yoshinori; Nakagawa, Yoshinobu; Ishikawa, Masayori; Hoshi, Masaharu

    2002-08-21

    A calculation method for the dosage of neutrons by near-threshold 7Li(p, n)7Be and gamma rays by 7Li(p, p'gamma)7Li was validated through experiments with variable distance between the Li target and the phantom, focusing on large angular dependence. The production of neutrons and gamma rays in the Li target was calculated by Lee's method and their transport in the phantom was calculated using the MCNP-4B code. The dosage in intra-operative boron neutron capture therapy (BNCT) using near-threshold 7Li(p, n)7Be direct neutrons was evaluated using the validated calculation method. The effectiveness of the usage of the direct neutrons was confirmed from the existence of the region satisfying the requirements of the protocol utilized in intra-operative BNCT for brain tumours in Japan. The boron-dose enhancer (BDE) introduced in this paper to increase the contribution of the 10B(n, alpha)7Li dose in the living body was effective. The void utilized to increase the dose in deep regions was also effective with BDE. For the investigation of 1.900 MeV proton beams, for example, it was found that intraoperative BNCT using near-threshold 7Li(p, n)7Be direct neutrons is feasible.

  17. Intra-operative washing of morcellised bone allograft with pulse lavage: how effective is it in reducing blood and marrow content?

    PubMed

    Ibrahim, T; Qureshi, A; McQuillan, T A; Thomson, J; Galea, G; Power, R A

    2012-03-01

    The use of unprocessed bone carries a risk of transmission of blood borne diseases. Although models of infectivity are unproven, a theoretical risk of transmission of variant Creutzfeld-Jakob Disease, a human prion disease, exists as probable blood borne transmission has been reported in three cases. The aim of our study was to determine the effectiveness of standard operating theatre pulse lavage in removing protein, fat and double stranded Deoxyribonucleic acid (dsDNA) from morcellised bone allograft. Twelve donated femoral heads were divided into halves and milled into bone chips. One half of the bone chips were washed with pulse lavage, whereas, the other half acted as control. In order to determine the amount of protein, fat and dsDNA present in the washed and unwashed samples, a validated multistep washing protocol was used. Using the validated technique, simple intra-operative washing of morcellised unprocessed bone allograft removed a significant amount of the protein (70.5%, range: 39.5-85%), fat (95.2%, range: 87.8-98.8%) and DNA (68.4%, range: 31.4-93.1%) content. Intra-operative washing of morcellised bone allograft with pulse lavage may thereby reduce the theoretical risk of prion and other blood borne disease transmission. Combined with the known improved mechanical characteristics of washed allograft, we would recommend pulse lavage as a routine part of bone allograft preparation.

  18. Maximum Time-to-Rescue After the 1908 Messina-Reggio Calabria Earthquake was 20 Days: Hints for Disaster Planning?

    PubMed

    De Santo, Natale Gaspare; Bisaccia, Carmela; De Santo, Luca Salvatore

    2017-06-01

    Introduction Maximum time-to-rescue has been studied accurately for many earthquakes in the years 1985-2004. No study is available for historical quakes. Hypothesis/Problem This study aimed to evaluate long-term survivors (from the fifth day after the quake) of the Messina-Reggio Calabria earthquake (1908; Italy), which is considered, historically, to be the worst seismic event in Europe. Accurate readings of 11 national newspapers from the fifth day after the quake looking for rescued persons and transferring, to an ad hoc form, all data relating to each rescued person. The maximum time-to rescue was 20 days. There were 225 survivors, among them 51 children (22.6 %). For 23 out 225 rescued persons, there was evidence of availability of foods and drinkable fluids while under the rubble. The maximum time-to-rescue under the debris following this historical earthquake far exceeds that of all other quakes that occurred in the years 1985-2004. The long survival under debris was probably due to the lack of an order to stop search and rescue. Recent strategies reducing the time for search and rescue carry the risk of missing survivors. De Santo NG , Bisaccia C , De Santo LS . Maximum time-to-rescue after the 1908 Messina-Reggio Calabria Earthquake was 20 days: hints for disaster planning? Prehosp Disaster Med. 2017;32(3):249-252.

  19. Understanding adherence to 5 servings of fruits and vegetables per day: a theory of planned behavior perspective.

    PubMed

    Blanchard, Chris M; Fisher, Janet; Sparling, Phillip B; Shanks, Tiffany Hunt; Nehl, Eric; Rhodes, Ryan E; Courneya, Kerry S; Baker, Frank

    2009-01-01

    The primary purpose of the present study was to examine the utility of the Theory of Planned Behavior (TPB) in explaining the 5-A-Day intentions and behavior of college students. A secondary purpose was to determine whether any of the TPB relationships were moderated by gender or ethnicity. A prospective design that asked college students to complete a baseline TPB 5-A-Day questionnaire and a fruit and vegetable consumption measure 1 week later. Undergraduate fitness and health classes at 2 universities in the southern United States. 511 college students with a mean age of 19.8 years (standard deviation = 2.71). TPB variables and fruit and vegetable consumption. Path analyses and invariance (ie, to examine ethnic and gender moderated) analyses. Affective attitude (beta = .16, P < .05) and perceived behavioral control (beta = .59, P < .05) were significant predictors of intention, which in turn was a significant predictor of behavior (beta = .32, P < .05). Follow-up invariance analyses showed that none of the TPB relationships was moderated by gender or ethnicity. The TPB may be a useful framework on which to base a 5-A-Day intervention for male and female college students of different ethnic backgrounds.

  20. A procedure for tissue freezing and processing applicable to both intra-operative frozen section diagnosis and tissue banking in surgical pathology.

    PubMed

    Steu, Susanne; Baucamp, Maya; von Dach, Gabriela; Bawohl, Marion; Dettwiler, Susanne; Storz, Martina; Moch, Holger; Schraml, Peter

    2008-03-01

    Different methods for snap freezing surgical human tissue specimens exist. At pathology institutes with higher work loads, solid carbon dioxide, freezing sprays, and cryostat freezing are commonly used as coolants for diagnosing frozen tissue sections, whereas for tissue banking, liquid nitrogen or isopentane cooled with liquid nitrogen is preferred. Freezing tissues for diagnostic and research purposes are therefore often time consuming, laborious, even hazardous, and not user friendly. In tissue banks, frozen tissue samples are stored in cryovials, capsules, cryomolds, or cryocassettes. Tissues are additionally embedded using freezing media or wrapped in plastic bags or aluminum foils to prevent desiccation. The latter method aggravates enormously further tissue handling and processing. Here, we describe an isopentane-based workflow which concurrently facilitates tissue freezing and processing for both routine intra-operative frozen section and tissue banking and satisfies the qualitative demands of pathologists, cancer researchers, laboratory technicians, and tissue bankers.

  1. Results of employee involvement in planning and implementing the Treatwell 5-a-Day work-site study.

    PubMed

    Hunt, M K; Lederman, R; Potter, S; Stoddard, A; Sorensen, G

    2000-04-01

    When work-site health promotion programs incorporate theories of community organization, it is likely that employee ownership and participation are enhanced. This article reports quantitative indicators of involvement of Employee Advisory Board (EAB) members in the Treatwell 5-a-Day work-site study and examines relationships between EAB member time spent on project activities and work-site size, with indicators of the extent of implementation and variables associated with behavior change and work-site support. The results reported here indicate that a greater number of EAB member hours spent on program activities was associated with a greater number of events implemented. Smaller work-site size was associated with greater employee awareness of the program and greater participation in project activities as reported on the employee survey. These results suggest that the number of hours employee representatives devote to project activities might be an important consideration in planning employee involvement in work-site health promotion programming.

  2. John Day Fall Chinook/Salmon Mitigation Plan Acclimation and Imprinting Site Feasibility Study: Summary Report : Completion Report.

    SciTech Connect

    U.S. Fish and Wildlife Service; Sverdrup Corporation; United States. Bonneville Power Administration.

    1987-09-01

    The purpose of this Plan is to replace upriver bright fall chinook salmon which were lost by construction of the John Day Dam. This will be accomplished by releasing salmon fry and smolts, incubated in the Spring Creek and Bonneville Hatcheries, at several upriver locations. Prior to release it is desired to feed and acclimate the juvenile fish to relieve the stress of truck transport, and to imprint them to the release site. This will ultimately produce adult chinook salmon that return to their historic spawning areas through traditional common property fisheries. It will also provide sexually mature broodstock fish that can be captured and spawned to supplement continued hatchery operation. This report summarizes results of an engineering feasibility study done for 10 potential acclimation sites on the Columbia, Yakima and Walla Walla Rivers. A detailed report has been prepared for each site and each is bound separately.

  3. Outcome of Intra-operative Injected Platelet-rich Plasma Therapy During Follicular Unit Extraction Hair Transplant: A Prospective Randomised Study in Forty Patients

    PubMed Central

    Garg, Suruchi

    2016-01-01

    Context: Platelet-rich plasma (PRP) therapy is finding importance in aesthetic medicine. Aim: The objective of this study was to study efficacy of PRP therapy in follicular unit extraction (FUE) hair transplant. Materials and Methods: It is a single-blind, prospective randomised study on 40 FUE hair transplant subjects, allocated in two groups (PRP and non-PRP) alternately. PRP was injected intra-operatively immediately after creating slits over the recipient area in PRP group; and normal saline in non-PRP group. Two groups were evaluated at 2, 4 and 8 weeks, 3 and 6 months of the procedure. Statistical Analysis: It was done using Chi-square test and test of significance was set as P < 0.05. Results: In PRP group, all subjects had >75% hair regrowth at 6 months, density of >75% grafts was noticed in 12 patients at 4 weeks meaning reduced fall of transplanted hair during catagen phase. New hair growth started at 8 weeks in 16 patients and redness over recipient area completely disappeared in 19 patients at 3 months of surgery and activity in dormant follicles as fine thread like hair was noticed besides the thick transplanted hair in all subjects. In non-PRP group, four patients had >75% hair regrowth at 6 months; none showed >75% graft density at 4 weeks, and 13 subjects showed dormant follicle activity at 4 months. The number of patients having lengthier hairs was significantly more in PRP group. Conclusion: Intra-operative PRP therapy is beneficial in giving faster density, reducing the catagen loss of transplanted hair, recovering the skin faster and activating dormant follicles in FUE transplant subjects. PMID:27761085

  4. The ability of bispectral index to detect intra-operative wakefulness during total intravenous anaesthesia compared with the isolated forearm technique.

    PubMed

    Russell, I F

    2013-05-01

    It has been suggested that monitoring during total intravenous anaesthesia should include aspects of brain function. The current study used a manually adjusted target-controlled infusion of propofol for anaesthesia, guided to a bispectral index range of 55-60. Intra-operative responsiveness, as assessed by the isolated forearm technique, was compared with whether the bispectral index predicted/identified a patient's appropriate hand movements in responses to commands. Twenty-two women underwent major gynaecological surgery with total intravenous anaesthesia, propofol, remifentanil and atracurium. Sixteen women responded, on 80 occasions, with appropriate hand movements to commands during surgery, of which the bispectral index detected 47 (sensitivity 59%). The bispectral index suggested consciousness 220 times in the absence of movement responses (specificity 85%). The positive predictive value of a bispectral index response was 18%. While two women had vague recall about squeezing fingers, none had recall of surgery. For patients who responded more than once during surgery the bispectral index value associated with a response was not constant. Although there was no difference in the median (IQR [range]) effect site propofol concentration between intra-operative responses (2.0 (1.5-2.3 [1.2-4.0]) μg.ml(-1)) and eye opening after surgery (2.1 (1.7-2.8 [1.5-3.9]) μg.ml(-1)), the median (IQR [range]) bispectral index value at eye opening after surgery was significantly higher than that associated with responses during surgery: 75 (70-78 [51-93]) vs 61 (52-67 [37-80]) respectively, (p < 0.001). The manual control of propofol intravenous anaesthesia to target a bispectral index range of 55-60 may result in an unacceptable number of patients who are conscious during surgery (albeit without recall). Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  5. Intra-Operative Fluid Management in Adult Neurosurgical Patients Undergoing Intracranial Tumour Surgery: Randomised Control Trial Comparing Pulse Pressure Variance (PPV) and Central Venous Pressure (CVP)

    PubMed Central

    Salins, Serina Ruth; Kumar, Amar Nandha; Korula, Grace

    2016-01-01

    Introduction Fluid management in neurosurgery presents specific challenges to the anaesthesiologist. Dynamic para-meters like Pulse Pressure Variation (PPV) have been used successfully to guide fluid management. Aim To compare PPV against Central Venous Pressure (CVP) in neurosurgical patients to assess hemodynamic stability and perfusion status. Materials and Methods This was a single centre prospective randomised control trial at a tertiary care centre. A total of 60 patients undergoing intracranial tumour excision in supine and lateral positions were randomised to two groups (Group 1, CVP n=30), (Group 2, PPV n=30). Intra-operative fluid management was titrated to maintain baseline CVP in Group 1(5-10cm of water) and in Group 2 fluids were given to maintain PPV less than 13%. Acid base status, vital signs and blood loss were monitored. Results Although intra-operative hypotension and acid base changes were comparable between the groups, the patients in the CVP group had more episodes of hypotension requiring fluid boluses in the first 24 hours post surgery. {CVP group median (25, 75) 2400ml (1850, 3110) versus PPV group 2100ml (1350, 2200) p=0.03} The patients in the PPV group received more fluids than the CVP group which was clinically significant. {2250 ml (1500, 3000) versus 1500ml (1200, 2000) median (25, 75) (p=0.002)}. The blood loss was not significantly different between the groups The median blood loss in the CVP group was 600ml and in the PPV group was 850 ml; p value 0.09. Conclusion PPV can be used as a reliable index to guide fluid management in neurosurgical patients undergoing tumour excision surgery in supine and lateral positions and can effectively augment CVP as a guide to fluid management. Patients in PPV group had better hemodynamic stability and less post operative fluid requirement. PMID:27437329

  6. Demons deformable registration for cone-beam CT guidance: registration of pre- and intra-operative images

    NASA Astrophysics Data System (ADS)

    Nithiananthan, S.; Brock, K. K.; Daly, M. J.; Chan, H.; Irish, J. C.; Siewerdsen, J. H.

    2010-02-01

    High-quality intraoperative 3D imaging systems such as cone-beam CT (CBCT) hold considerable promise for imageguided surgical procedures in the head and neck. With a large amount of preoperative imaging and planning information available in addition to the intraoperative images, it becomes desirable to be able to integrate all sources of imaging information within the same anatomical frame of reference using deformable image registration. Fast intensity-based algorithms are available which can perform deformable image registration within a period of time short enough for intraoperative use. However, CBCT images often contain voxel intensity inaccuracy which can hinder registration accuracy - for example, due to x-ray scatter, truncation, and/or erroneous scaling normalization within the 3D reconstruction algorithm. In this work, we present a method of integrating an iterative intensity matching step within the operation of a multi-scale Demons registration algorithm. Registration accuracy was evaluated in a cadaver model and showed that a conventional Demons implementation (with either no intensity match or a single histogram match) introduced anatomical distortion and degradation in target registration error (TRE). The iterative intensity matching procedure, on the other hand, provided robust registration across a broad range of intensity inaccuracies.

  7. McConnell's sign in intra-operative acute right ventricle ischaemia: An under-recognized aetiology.

    PubMed

    Longo, S A; Echegaray, A; Acosta, C M; Rinaldi, L I; Cabrera Schulmeyer, M C; Olavide Goya, I

    2016-11-01

    Transoesophageal echocardiography (TEE) has become a fundamental tool in modern cardiothoracic anaesthesia. It has an indisputable role in coronary valve surgery and revascularisations with severe impairment of ventricle function. It helps in making diagnoses that can optimise the surgical strategy and to minimal invasively dynamically monitor volaemia and cardiac function during the post-operative period, detecting complications unobservable by other methods. The McConnell sign, visualised using TEE as an akinesis of the right ventricular free wall, with a normal apex motility and enlargement of the right cavities, is characteristic of right ventricular (RV) dysfunction. This sign has a 77% sensitivity and 94% specificity for the diagnosis of acute pulmonary embolism (APE). The case is presented of a 53-year-old man scheduled for aortic valve and ascending aorta replacement surgery, with a history of severe valve aortic stenosis, aortic root and arch aneurysm, and with normal coronary arteries. Post-cardiopulmonary bypass (CBP), the patient presented with haemodynamic instability, with the TEE showing a typical image of the McConnell sign, with no pulmonary hypertension. This enabled making an early diagnosis of acute RV ischaemia, that led to a change in the surgical plan, the performing of coronary revascularisation surgery. As a result, the McConnell sign, which describes the characteristics of RV dysfunction, led to making a differential diagnosis between APE, RV infarction and acute myocardial ischaemia. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Non-rigid alignment of pre-operative MRI, fMRI, and DT-MRI with intra-operative MRI for enhanced visualization and navigation in image-guided neurosurgery.

    PubMed

    Archip, Neculai; Clatz, Olivier; Whalen, Stephen; Kacher, Dan; Fedorov, Andriy; Kot, Andriy; Chrisochoides, Nikos; Jolesz, Ferenc; Golby, Alexandra; Black, Peter M; Warfield, Simon K

    2007-04-01

    The usefulness of neurosurgical navigation with current visualizations is seriously compromised by brain shift, which inevitably occurs during the course of the operation, significantly degrading the precise alignment between the pre-operative MR data and the intra-operative shape of the brain. Our objectives were (i) to evaluate the feasibility of non-rigid registration that compensates for the brain deformations within the time constraints imposed by neurosurgery, and (ii) to create augmented reality visualizations of critical structural and functional brain regions during neurosurgery using pre-operatively acquired fMRI and DT-MRI. Eleven consecutive patients with supratentorial gliomas were included in our study. All underwent surgery at our intra-operative MR imaging-guided therapy facility and have tumors in eloquent brain areas (e.g. precentral gyrus and cortico-spinal tract). Functional MRI and DT-MRI, together with MPRAGE and T2w structural MRI were acquired at 3 T prior to surgery. SPGR and T2w images were acquired with a 0.5 T magnet during each procedure. Quantitative assessment of the alignment accuracy was carried out and compared with current state-of-the-art systems based only on rigid registration. Alignment between pre-operative and intra-operative datasets was successfully carried out during surgery for all patients. Overall, the mean residual displacement remaining after non-rigid registration was 1.82 mm. There is a statistically significant improvement in alignment accuracy utilizing our non-rigid registration in comparison to the currently used technology (p<0.001). We were able to achieve intra-operative rigid and non-rigid registration of (1) pre-operative structural MRI with intra-operative T1w MRI; (2) pre-operative fMRI with intra-operative T1w MRI, and (3) pre-operative DT-MRI with intra-operative T1w MRI. The registration algorithms as implemented were sufficiently robust and rapid to meet the hard real-time constraints of intra-operative

  9. Non-rigid alignment of preoperative MRI, fMRI, and DT-MRI with intra-operative MRI for enhanced visualization and navigation in image-guided neurosurgery

    PubMed Central

    Archip, Neculai; Clatz, Olivier; Whalen, Stephen; Kacher, Dan; Fedorov, Andriy; Kot, Andriy; Chrisochoides, Nikos; Jolesz, Ferenc; Golby, Alexandra; Black, Peter M.; Warfield, Simon K.

    2012-01-01

    Objective The usefulness of neurosurgical navigation with current visualizations is seriously compromised by brain shift, which inevitably occurs during the course of the operation, significantly degrading the precise alignment between the preoperative MR data and the intra-operative shape of the brain. Our objectives were (i) to evaluate the feasibility of non-rigid registration that compensates for the brain deformations within the time constraints imposed by neurosurgery, and (ii) create augmented reality visualizations of critical structural and functional brain regions during neurosurgery using pre-operatively acquired fMRI and DT-MRI. Materials and Methods Eleven consecutive patients with supratentorial gliomas were included in our study. All underwent surgery at our intra-operative MR imaging–guided therapy facility and have tumors in eloquent brain areas (e.g. precentral gyrus and cortico-spinal tract). Functional MRI and DT-MRI, together with MPRAGE and T2w structural MRI were acquired at 3T prior to surgery. SPGR and T2w images were acquired with a 0.5T magnet during each procedure. Quantitative assessment of the alignment accuracy was carried out and compared with current state-of the-art systems based only on rigid-registration. Results Alignment between preoperative and intra-operative datasets was successfully carried out during surgery for all patients. Overall, the mean residual displacement remaining after non-rigid registration was 1.82 mm. There is a statistically significant improvement in alignment accuracy utilizing our non-rigid registration in comparison to the currently used technology (p<0.001). Conclusions We were able to achieve intra-operative rigid and non-rigid registration of (1) pre-operative structural MRI with intra-operative T1w MRI; (2) pre-operative FMRI with intra-operative T1w MRI, and (3) pre-operative DT-MRI with intra-operative T1w MRI. The registration algorithms as implemented were sufficiently robust and rapid to meet

  10. SU-E-T-537: Comparison of Intra-Operative Soft X-Rays to Low Energy Electron Beams for Treatment of Superficial Lesions

    SciTech Connect

    Chinsky, B; Diak, A; Gros, S; Sethi

    2014-06-01

    Purpose: Superficial soft x-ray applicators have recently been designed for use with existing intra-operative radiotherapy systems. These applicators may be used in treating superficial lesions which are conventionally treated with electron beams. The purpose of this abstract is to compare dose distributions of an intra-operative 50kV x-ray unit with low energy electrons for the treatment of superficial lesions. Methods: Dosimetric parameters for 1 and 3-cm diameter Intrabeam superficial x-ray applicators were measured with EBT3 Gafchromic film in a solid water phantom. Depth dose distributions and profiles (d=2, 5, 10 and 15mm) were obtained by prescribing a dose of 400cGy at 5mm depth below the phantom surface. Corresponding dose profiles for 6-MeV electrons were acquired from a Varian Clinac 21EX at 100 SSD. H and D calibration curves were generated for each modality for 0-800cGy. Results: Dose coverage, penumbra, dose uniformity, surface dose, and dose fall-off were examined. Compared to electrons, Intrabeam lateral dose coverage at 5mm depth was 70% larger with a much sharper (1/4) penumbra. Electron isodose levels bulged with depth, whereas Intrabeam isodose levels exhibited a convex cone shape. The Intrabeam dose profiles demonstrated horns in the dose distribution up to a 5mm depth and an exponential dose fall-off. Relative surface dose was higher for the Intrabeam applicators. Treatment times were comparable for both modalities. Conclusions: The very small penumbra of Intrabeam at shallow depths could be useful in treating superficial lesions adjacent to critical structures. The exponential dose fall-off of Intrabeam makes it appealing in the sparing of structures beyond the lesion. However, for lesions past a depth of 5mm, electrons would be desirable as they penetrate farther and provide skin sparing. Intrabeam may be preferable for sites that are difficult to treat with electrons due to mechanical and physical limitations.

  11. Sub-Tenon injection of 2% lidocaine prevents intra-operative floppy iris syndrome (IFIS) in male patients taking oral α-adrenergic antagonists.

    PubMed

    Klysik, Anna; Korzycka, Dorota

    2014-09-01

      To compare 2% sub-Tenon and 1% intra-cameral lidocaine for cataract surgery in relation to the incidence and severity of IFIS. Prospective randomized clinical study.   From 81 eligible, we included 71 men aged from 59 to 90 years (mean 76.5 ± 6.8) undergoing routine cataract surgery and taking oral α-adrenergic antagonists, for urological reasons, for more than 1 year. Following randomization 34 men, aged from 62 to 90 years (mean 77.4 ± 8.1) received sub-Tenon injection of 2.5 ml of 2% lidocaine and the remaining 37 men aged from 59 to 89 years (mean 75.2 ± 7.2) received 1% preservative free intra-cameral lidocaine. Outcome measures were the incidence of IFIS, severity of intra-operative pupillary constriction and iris prolapse.   Intra-operative floppy iris syndrome (IFIS) was noted in 3 of 34 patients (8.8%) receiving sub-Tenon lidocaine and in 18 of 37 patients (48.6%) receiving intra-cameral lidocaine (p = 0.00). Severe IFIS was observed only in 3 of 37 patients (8.1%) receiving intra-cameral lidocaine. Pupil diameter at the end of surgery was 4.37 ± 1.07 mm in the sub-Tenon lidocaine group and 4.02 ± 1.06 mm in the intra-cameral lidocaine group (p = 0.00). Iris prolapse was noted in two cases in the sub-Tenon lidocaine group and in 10 cases in the intra-cameral lidocaine group (p = 0.00). Twenty-five patients were receiving tamsulosin. The incidence of IFIS in tamsulosin subgroup was 76.9% (10 of 13 patients) in the intra-cameral lidocaine group and 16.6% (2 of 12 patients) in the sub-Tenon lidocaine group (p = 0.00).   Sub-Tenon lidocaine reduces significantly the incidence of IFIS in patients taking oral α-adrenergic inhibitors as compared with intra-cameral lidocaine. © 2013 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  12. Comparison of surgical outcomes after anterior cervical discectomy and fusion: does the intra-operative use of a microscope improve surgical outcomes

    PubMed Central

    Elsamadicy, Aladine; Reiser, Elizabeth; Ziegler, Cole; Freischlag, Kyle; Cheng, Joseph; Bagley, Carlos A.

    2016-01-01

    Background The primary aim of this study was to assess and compare the complications profile as well as long-term clinical outcomes between patients undergoing an Anterior Cervical Discectomy and Fusion (ACDF) procedure with and without the use of an intra-operative microscope. Methods One hundred and forty adult patients (non-microscope cohort: 81; microscope cohort: 59) undergoing ACDF at a major academic medical center were included in this study. Enrollment criteria included available demographic, surgical and clinical outcome data. All patients had prospectively collected patient-reported outcomes measures and a minimum 2-year follow-up. Patients completed the neck disability index (NDI), short-form 12 (SF-12) and visual analog pain scale (VAS) before surgery, then at 3, 6, 12, and 24 months after surgery. Clinical outcomes and complication rates were compared between both patient cohorts. Results Baseline characteristics were similar between both cohorts. The mean ± standard deviation duration of surgery was longer in the microscope cohort (microscope: 169±34 minutes vs. non-microscope: 98±42 minutes, P<0.001). There was no significant difference between cohorts in the incidence of nerve root injury (P=0.99) or incidental durotomy (P=0.32). At 3 months post-operatively, both cohorts demonstrated similar improvement in VAS-neck pain (P=0.69), NDI (P=0.86), SF-12 PCS (P=0.84) and SF-12 MCS (P=0.75). At 2-year post-operatively, both the microscope and non-microscope cohorts demonstrated similar improvement from base line in NDI (microscope: 13.52±25.77 vs. non-microscope: 19.51±27.47, P<0.18), SF-12 PCS (microscope: 4.15±26.39 vs. non-microscope: 11.98±22.96, P<0.07), SF-12 MCS (microscope: 9.47±32.38 vs. non-microscope: 16.19±30.44, P<0.21). Interestingly at 2 years, the change in VAS neck pain score was significantly different between cohorts (microscope: 2.22±4.00 vs. non-microscope: 3.69±3.61, P<0.02). Conclusions Our study demonstrates that the

  13. Comparison of surgical outcomes after anterior cervical discectomy and fusion: does the intra-operative use of a microscope improve surgical outcomes.

    PubMed

    Adogwa, Owoicho; Elsamadicy, Aladine; Reiser, Elizabeth; Ziegler, Cole; Freischlag, Kyle; Cheng, Joseph; Bagley, Carlos A

    2016-03-01

    The primary aim of this study was to assess and compare the complications profile as well as long-term clinical outcomes between patients undergoing an Anterior Cervical Discectomy and Fusion (ACDF) procedure with and without the use of an intra-operative microscope. One hundred and forty adult patients (non-microscope cohort: 81; microscope cohort: 59) undergoing ACDF at a major academic medical center were included in this study. Enrollment criteria included available demographic, surgical and clinical outcome data. All patients had prospectively collected patient-reported outcomes measures and a minimum 2-year follow-up. Patients completed the neck disability index (NDI), short-form 12 (SF-12) and visual analog pain scale (VAS) before surgery, then at 3, 6, 12, and 24 months after surgery. Clinical outcomes and complication rates were compared between both patient cohorts. Baseline characteristics were similar between both cohorts. The mean ± standard deviation duration of surgery was longer in the microscope cohort (microscope: 169±34 minutes vs. non-microscope: 98±42 minutes, P<0.001). There was no significant difference between cohorts in the incidence of nerve root injury (P=0.99) or incidental durotomy (P=0.32). At 3 months post-operatively, both cohorts demonstrated similar improvement in VAS-neck pain (P=0.69), NDI (P=0.86), SF-12 PCS (P=0.84) and SF-12 MCS (P=0.75). At 2-year post-operatively, both the microscope and non-microscope cohorts demonstrated similar improvement from base line in NDI (microscope: 13.52±25.77 vs. non-microscope: 19.51±27.47, P<0.18), SF-12 PCS (microscope: 4.15±26.39 vs. non-microscope: 11.98±22.96, P<0.07), SF-12 MCS (microscope: 9.47±32.38 vs. non-microscope: 16.19±30.44, P<0.21). Interestingly at 2 years, the change in VAS neck pain score was significantly different between cohorts (microscope: 2.22±4.00 vs. non-microscope: 3.69±3.61, P<0.02). Our study demonstrates that the intra-operative use of a microscope does

  14. Automatic registration between 3D intra-operative ultrasound and pre-operative CT images of the liver based on robust edge matching

    NASA Astrophysics Data System (ADS)

    Nam, Woo Hyun; Kang, Dong-Goo; Lee, Duhgoon; Lee, Jae Young; Ra, Jong Beom

    2012-01-01

    The registration of a three-dimensional (3D) ultrasound (US) image with a computed tomography (CT) or magnetic resonance image is beneficial in various clinical applications such as diagnosis and image-guided intervention of the liver. However, conventional methods usually require a time-consuming and inconvenient manual process for pre-alignment, and the success of this process strongly depends on the proper selection of initial transformation parameters. In this paper, we present an automatic feature-based affine registration procedure of 3D intra-operative US and pre-operative CT images of the liver. In the registration procedure, we first segment vessel lumens and the liver surface from a 3D B-mode US image. We then automatically estimate an initial registration transformation by using the proposed edge matching algorithm. The algorithm finds the most likely correspondences between the vessel centerlines of both images in a non-iterative manner based on a modified Viterbi algorithm. Finally, the registration is iteratively refined on the basis of the global affine transformation by jointly using the vessel and liver surface information. The proposed registration algorithm is validated on synthesized datasets and 20 clinical datasets, through both qualitative and quantitative evaluations. Experimental results show that automatic registration can be successfully achieved between 3D B-mode US and CT images even with a large initial misalignment.

  15. The use of weekly departmental review of all orthopaedic intra-operative radiographs in order to improve quality, due to standardized peer expectations and the "Hawthorne effect".

    PubMed

    Kennedy, Muiris T; Ong, Joshua C Y; Mitra, Aniruddha; Harty, James A; Reidy, Declan; Dolan, Mark

    2013-02-01

    Clinical governance highlights risk management, clinical effectiveness and use of evidence based practice as key elements in the provision of a quality service. A change in the method of quality control in our orthopaedic trauma unit allowed us the opportunity to study if the quality of operative outcomes had changed as a result. The Hawthorne effect refers to phenomenon whereby employees work quality improves by virtue of their awareness that their labour is being assessed. A new outcome appraisal forum was introduced in our department in 2009. This forum involved a weekly whole department review of all the previous week's intraoperative radiographs. We used the tip apex distance (TAD) of the dynamic hip screw (DHS) procedures in hip fracture patients as a surrogate marker, of any objective change in the quality and consistency of intra-operative radiographs, in the year prior to and after the introduction of this review system. We found that the mean TAD and the number of TAD measurements over 25 mm decreased significantly in the year after the new quality control mechanism was introduced. We would recommend the use of a weekly quality control meeting scrutinizing every intraoperative radiograph as a simple, cost effective method of incorporating many aspects of clinical governance, as well as fostering a culture of quality. Copyright © 2011 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

  16. Multiple Myeloma Presenting as Massive Amyloid Deposition in a Parathyroid Gland Associated with Amyloid Goiter: A Medullary Thyroid Carcinoma Mimic on Intra-operative Frozen Section.

    PubMed

    Hill, Kirk; Diaz, Jason; Hagemann, Ian S; Chernock, Rebecca D

    2017-09-06

    Clinical examples of amyloid deposition in parathyroid glands are exceedingly rare and usually present as an incidental finding in a patient with amyloid goiter. Here, we present the first histologically documented case of parathyroid amyloid deposition that presented as a mass. The patient did not have hyperparathyroidism. The parathyroid gland was submitted for intra-operative frozen section and concern for medullary thyroid carcinoma was raised. An important histologic clue arguing against medullary thyroid carcinoma was the evenly dispersed nature of the amyloid. Histologic perinuclear clearing and parathyroid hormone immunohistochemistry confirmed parathyroid origin on permanent sections. The patient was also found to have associated amyloid goiter. Mass spectrometry of the amyloid showed it to be composed of kappa light chains. On further work-up, the patient was diagnosed with multiple myeloma. Awareness of parathyroid amyloid deposition is important as it is a histologic mimic of medullary thyroid carcinoma, especially on frozen section. Amyloid typing with evaluation for multiple myeloma in any patient with kappa or lambda light chain restriction is also important.

  17. The influence of the tibial slope on intra-operative soft tissue balance in cruciate-retaining and posterior-stabilized total knee arthroplasty.

    PubMed

    Oka, Shinya; Matsumoto, Tomoyuki; Muratsu, Hirotsugu; Kubo, Seiji; Matsushita, Takehiko; Ishida, Kazunari; Kuroda, Ryosuke; Kurosaka, Masahiro

    2014-08-01

    This study aims to make clear the influence of the tibial slope on intra-operative soft tissue balance measurements using a tensor in cruciate-retaining and posterior-stabilized total knee arthroplasty (TKA). Forty patients with osteoarthritis of the knee received TKAs (20 cruciate-retaining TKAs and 20 posterior-stabilized TKA). Soft tissue balance was measured using an offset type tensor at 0, 10, 45, 90, 135 degrees of knee flexion. The tibial slopes were measured by post-operative lateral radiograph. The correlation between the tibial slope and values of soft tissue balance were assessed. Joint component gap at 90° (R = 0.537, p < 0.01) and 135° (R = 0.463, p < 0.05) of flexion and joint component gap change value of 90-0° (R = 0.433, p < 0.05) showed positive correlations with tibial slope in posterior-stabilized TKA. There was no relationship between the tibial slope and the value of soft tissue balances in cruciate-retaining TKA. In the present study, we confirmed that increasing the tibial slope resulted in a larger flexion gap compared to extension gap in posterior-stabilized TKA. Surgeons should be aware that increasing the tibial slope is one factor responsible for widening the flexion-extension gap difference in posterior-stabilized TKA.

  18. Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda.

    PubMed

    Igras, Susan; Sinai, Irit; Mukabatsinda, Marie; Ngabo, Fidele; Jennings, Victoria; Lundgren, Rebecka

    2014-05-01

    There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda. Much of the success of the scale-up effort was due to systematic use of monitoring and evaluation (M&E) data from several sources to make midcourse corrections. Four lessons learned illustrate this crucially important approach. First, ongoing M&E data showed that provider training protocols and client materials that worked in the pilot phase did not work at scale; therefore, we simplified these materials to support integration into the national program. Second, triangulation of ongoing monitoring data with national health facility and population-based surveys revealed serious problems in supply chain mechanisms that affected SDM (and the accompanying CycleBeads client tool) availability and use; new procedures for ordering supplies and monitoring stockouts were instituted at the facility level. Third, supervision reports and special studies revealed that providers were imposing unnecessary medical barriers to SDM use; refresher training and revised supervision protocols improved provider practices. Finally, informal environmental scans, stakeholder interviews, and key events timelines identified shifting political and health policy environments that influenced scale-up outcomes; ongoing advocacy efforts are addressing these issues. The SDM scale-up experience in Rwanda confirms the importance of monitoring and evaluating programmatic efforts continuously, using a variety of data sources, to improve program outcomes.

  19. Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda

    PubMed Central

    Igras, Susan; Sinai, Irit; Mukabatsinda, Marie; Ngabo, Fidele; Jennings, Victoria; Lundgren, Rebecka

    2014-01-01

    There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda. Much of the success of the scale-up effort was due to systematic use of monitoring and evaluation (M&E) data from several sources to make midcourse corrections. Four lessons learned illustrate this crucially important approach. First, ongoing M&E data showed that provider training protocols and client materials that worked in the pilot phase did not work at scale; therefore, we simplified these materials to support integration into the national program. Second, triangulation of ongoing monitoring data with national health facility and population-based surveys revealed serious problems in supply chain mechanisms that affected SDM (and the accompanying CycleBeads client tool) availability and use; new procedures for ordering supplies and monitoring stockouts were instituted at the facility level. Third, supervision reports and special studies revealed that providers were imposing unnecessary medical barriers to SDM use; refresher training and revised supervision protocols improved provider practices. Finally, informal environmental scans, stakeholder interviews, and key events timelines identified shifting political and health policy environments that influenced scale-up outcomes; ongoing advocacy efforts are addressing these issues. The SDM scale-up experience in Rwanda confirms the importance of monitoring and evaluating programmatic efforts continuously, using a variety of data sources, to improve program outcomes. PMID:25276581

  20. The efficacy, safety and cost-effectiveness of intra-operative cell salvage in high-bleeding-risk cardiac surgery with cardiopulmonary bypass: a prospective randomized and controlled trial.

    PubMed

    Xie, Yihong; Shen, Sheliang; Zhang, Jun; Wang, Wenyuan; Zheng, Jiayin

    2015-01-01

    Intra-operative cell salvage (CS) was reported to be ineffective, safe and not cost-effective in low-bleeding-risk cardiac surgery with cardiopulmonary bypass (CPB), but studies in high-bleeding-risk cardiac surgery are limited. The objective of this study is to evaluate the efficacy, safety and cost-effectiveness of intra-operative CS in high-bleeding-risk cardiac surgery with CPB. One hundred and fifty patients were randomly assigned to either with intra-operative CS group (Group CS) or without intra-operative CS group (Group C). Study endpoints were defined as perioperative allogeneic red blood cell (RBC) transfusion, perioperative impairment of blood coagulative function, postoperative adverse events and costs of transfusion-related. Both the proportion and quantity of perioperative allogeneic RBC transfusion were significantly lower in Group CS than that in Group C (p=0.0002, <0.0001, respectively). The incidence of residual heparin and total impairment of blood coagulative function in the 24 hours after surgery, the incidence of postoperative excessive bleeding, were significantly higher in Group CS than that in Group C (p=0.018, 0.042, 0.034, respectively). Cost of both allogeneic RBC transfusion and total allogeneic blood transfusion were significantly lower in Group CS than that in Group C (p<0.001, =0.002, respectively). Cost of total blood transfusion was significantly higher in Group CS than that in Group C (p =0.001). Intra-operative CS in high-bleeding-risk cardiac surgery with CPB is effective, generally safe, and cost-effective in developed countries but not in China.

  1. Clinical Implementation of an Online Adaptive Plan-of-the-Day Protocol for Nonrigid Motion Management in Locally Advanced Cervical Cancer IMRT

    SciTech Connect

    Heijkoop, Sabrina T. Langerak, Thomas R.; Quint, Sandra; Bondar, Luiza; Mens, Jan Willem M.; Heijmen, Ben J.M.; Hoogeman, Mischa S.

    2014-11-01

    Purpose: To evaluate the clinical implementation of an online adaptive plan-of-the-day protocol for nonrigid target motion management in locally advanced cervical cancer intensity modulated radiation therapy (IMRT). Methods and Materials: Each of the 64 patients had four markers implanted in the vaginal fornix to verify the position of the cervix during treatment. Full and empty bladder computed tomography (CT) scans were acquired prior to treatment to build a bladder volume-dependent cervix-uterus motion model for establishment of the plan library. In the first phase of clinical implementation, the library consisted of one IMRT plan based on a single model-predicted internal target volume (mpITV), covering the target for the whole pretreatment observed bladder volume range, and a 3D conformal radiation therapy (3DCRT) motion-robust backup plan based on the same mpITV. The planning target volume (PTV) combined the ITV and nodal clinical target volume (CTV), expanded with a 1-cm margin. In the second phase, for patients showing >2.5-cm bladder-induced cervix-uterus motion during planning, two IMRT plans were constructed, based on mpITVs for empty-to-half-full and half-full-to-full bladder. In both phases, a daily cone beam CT (CBCT) scan was acquired to first position the patient based on bony anatomy and nodal targets and then select the appropriate plan. Daily post-treatment CBCT was used to verify plan selection. Results: Twenty-four and 40 patients were included in the first and second phase, respectively. In the second phase, 11 patients had two IMRT plans. Overall, an IMRT plan was used in 82.4% of fractions. The main reasons for selecting the motion-robust backup plan were uterus outside the PTV (27.5%) and markers outside their margin (21.3%). In patients with two IMRT plans, the half-full-to-full bladder plan was selected on average in 45% of the first 12 fractions, which was reduced to 35% in the last treatment fractions. Conclusions: The implemented

  2. Focused parathyroidectomy without intra-operative parathormone monitoring: The value of PTH assay in preoperative ultrasound guided fine needle aspiration washout

    PubMed Central

    Kuzu, Fatih; Arpaci, Dilek; Cakmak, Guldeniz Karadeniz; Emre, Ali Ugur; Elri, Tarik; Ilikhan, Sevil Uygun; Bahadir, Burak; Bayraktaoglu, Taner

    2016-01-01

    Background The accurate identification of hyperfunctioning parathyroid (HP) gland is the only issue for definitive surgical treatment in primary hyperparathyroidism (pHPT). Various imaging and operative techniques have been proposed to confirm the localization of the diseased gland. Nevertheless, none of these methods proved to be the gold standard. The presented study aimed to assess the value of parathyroid hormone assay in preoperative ultrasound guided fine needle aspiration (FNA)-PTH washout fluid to verify the correct localisation for focused parathyroidectomy without intra-operative PTH monitoring. Material and Methods The retrospective analysis of 57 patients with pHPT who underwent FNA-PTH was conducted from a prospective database. Biochemical assessment together with radiological (ultrasonography) and nuclear (MIBI scan) imaging was reviewed. Associations between FNA-PTH washout values and localization technics were evaluated and compared in terms of operative findings. Results Focused parathyroidectomy without intraoperative PTH monitoring was performed to 45 patients with high FNA-PTH values. The median largest diameter of the target parathyroid lesion identified by ultrasonography was 13 mm (range, 6 to 36). The median serum PTH level was 190 pg/mL (range, 78 to 1709; reference range, 15 to 65) whereas the median washout PTH was 2500 pg/mL (range, 480 to 3389). According to operative findings high FNA-PTH levels correctly identified parathyroid adenoma in 40 cases (89% of sensitivity and 100% of specificity and positive predictive value) whereas MIBI scan localized the lesion in 36 of these cases (80% of sensitivity). Conclusions The higher level of PTH in preoperative ultrasound guided FNA washout is a considerable data to predict the correct localization of HP, particularly in circumstances of greater values than the serum PTH level. However, although its specificity is high, in cases of coexisting nodular thyroid disease, associated additional HP

  3. Neurocognitive function and quality of life in patients with newly diagnosed brain metastasis after treatment with intra-operative cesium-131 brachytherapy: a prospective trial.

    PubMed

    Pham, Anthony; Yondorf, Menachem Z; Parashar, Bhupesh; Scheff, Ronald J; Pannullo, Susan C; Ramakrishna, Rohan; Stieg, Philip E; Schwartz, Theodore H; Wernicke, A Gabriella

    2016-03-01

    Intraoperative permanent Cesium-131 (Cs-131) brachytherapy can provide a viable alternative to WBRT with excellent response rates and minimal toxicity. This study reports the results of the prospective trial of the impact of intraoperative Cs-131 on neurocognitive function and quality of life (QoL) in patients with resected brain metastases. Between 2010 and 2012, 24 patients with newly diagnosed metastasis to the brain were accrued on a prospective protocol and treated with Cs-131 brachytherapy seeds after surgical resection. Physicians administered the mini-mental status examination (MMSE) and functional assessment of cancer therapy-brain (FACT-Br) questionnaire to all patients before treatment and again every 2 months for the duration of 6 months with additional follow-up again at 12 months. Wilcoxon rank sum test was used to analyze statistically significant changes in MMSE over time and paired t test was used to analyze changes in FACT-BR. There was a statistical improvement in overall FACT-BR score at 4 and 6 months of follow-up when compared to baseline (162 vs. 143, P = 0.004; 164 vs. 143, P = 0.005 respectively) with a non-significant trend toward improvement at 2 and 12 months (154 vs. 143, P = 0.067; 159 vs. 149, P = 0.4). MMSE score was statistically improved at 4 and up to 12 months compared to pre-treatment MMSE (30 vs. 29, P = 0.017; 30 vs. 29, P = 0.001 respectively). Patients with brain metastasis who received intra-operative permanent Cs-131 brachytherapy implants saw an improvement of their neurocognitive status and self-assessment of QoL. In addition to the excellent local control of metastasis, this approach may contribute to the improvements in cognitive function and QOL.

  4. Simultaneous multi-scale microscopy as a potential dedicated tool for intra-operative parathyroid identification during thyroid surgery (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    De Montigny, Étienne; Goulamhoussen, Nadir; Madore, Wendy-Julie; Strupler, Mathias; Maniakas, Anastasios; Ayad, Tareck; Boudoux, Caroline

    2016-02-01

    While thyroidectomy is considered a safe surgery, dedicated tools facilitating tissue identification during surgery could improve its outcome. The most common complication following surgery is hypocalcaemia, which results from iatrogenic removal or damage to parathyroid glands. This research project aims at developing and validating an instrument based on optical microscopy modalities to identify tissues in real time during surgery. Our approach is based on a combination of reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) to obtain multi-scale morphological contrast images. The orthogonal field of views provide information to navigate through the sample. To allow simultaneous, synchronized video-rate imaging in both modalities, we designed and built a dual-band wavelength-swept laser which scans a 30 nm band centered at 780 nm and a 90 nm band centered at 1310 nm. We built an imaging setup integrating a custom-made objective lens and a double-clad fibre coupler optimized for confocal microscopy. It features high resolutions in RCM (2µm lateral and 20 µm axial) in a 500 µm x 500 µm field-of-view and a larger field-of-view of 2 mm (lateral) x 5 mm (axial) with 20 µm lateral and axial resolutions in OCT. Imaging of ex vivo animal samples is demonstrated on a bench-top system. Tissues that are visually difficult to distinguish from each other intra-operatively such as parathyroid gland, lymph nodes and adipose tissue are imaged to show the potential of this approach in differentiating neck tissues. We will also provide an update on our ongoing clinical pilot study on patients undergoing thyroidectomy.

  5. Inspire Day

    ERIC Educational Resources Information Center

    Bohach, Barbara M.; Meade, Birgitta

    2014-01-01

    The authors collaborated on hosting a "Spring Inspire Day." planned and delivered by preservice elementary teachers as a social studies/science methods project. Projects that have authentic application opportunities can make learning meaningful for prospective teachers as well as elementary students. With the impetus for an integrated…

  6. Inspire Day

    ERIC Educational Resources Information Center

    Bohach, Barbara M.; Meade, Birgitta

    2014-01-01

    The authors collaborated on hosting a "Spring Inspire Day." planned and delivered by preservice elementary teachers as a social studies/science methods project. Projects that have authentic application opportunities can make learning meaningful for prospective teachers as well as elementary students. With the impetus for an integrated…

  7. The effect of post-traumatic-stress-disorder on intra-operative analgesia in a veteran population during cataract procedures carried out using retrobulbar or topical anesthesia: a retrospective study.

    PubMed

    Rapoport, Yuna; Wayman, Laura L; Chomsky, Amy S

    2017-06-07

    A growing proportion of veterans treated at the Veterans Health Administration (VA) have a history of post-traumatic-stress-disorder (PTSD), and there exists a higher rate of PTSD amongst veterans than the general population. The purpose of this study is to determine the correlation between PTSD and intra-operative analgesia, intra-operative time, and anesthesia type for cataract surgery in a veteran population. Secondary objectives are to determine if patient age, and first or second eye surgery affect intra-operative pain control or are correlated with type of anesthesia modality. A retrospective study of 330 cataract surgeries performed by resident physicians between January and September 2012 at the Veterans Affairs Medical Center Tennessee Valley Healthcare System, Nashville and Murfreesboro Campuses was completed. Three hundred and thirty veteran patients were selected if their cataract surgery was performed between January and September 2012. Combined cases were excluded. The primary outcome evaluated was intra-operative analgesia. Secondary outcomes included history of post-traumatic-stress-disorder, anesthesia type, first or second eye, pain control, intra-operative heart rate and blood pressure, age, and case complexity. Data was analyzed using an unpaired two-sample Welch's t-test assuming unequal variance and Z test of comparison of proportions. Patients with post-traumatic-stress-disorder reported higher pain scores, had longer operative times, and were more likely to have received a retrobulbar block. Operative time was not associated with an increased pain score, irrespective of anesthesia type, when controlled for PTSD. Complex cases had longer operative times, more sedation, and higher pain scores. P < 0.05 was used consistently. Post-traumatic stress disorder and anxiety are more prevalent in the veteran population. Our data suggests that a history of post-traumatic-stress-disorder was correlated with higher pain scores, longer operative times

  8. Multi-catheter interstitial brachytherapy for partial breast irradiation: an audit of implant quality based on dosimetric evaluation comparing intra-operative versus post-operative placement

    PubMed Central

    Gurram, Lavanya; Joshi, Kishor; Phurailatpam, Reena; Paul, Siji; Sarin, Rajiv

    2016-01-01

    Purpose The use of multicatheter interstitial brachytherapy (MIB) for accelerated partial breast irradiation (APBI) in early breast cancer (EBC) patients outside the trial setting has increased. Hence, there is a need to critically evaluate implant quality. Moreover, there is a scarcity of reports using an open cavity technique. We report the dosimetric indices of open and closed cavity MIB techniques. Material and methods The dosimetric parameters of 60 EBC patients treated with MIB (open and closed cavity) who underwent three dimensional, computerized tomography (CT) based planning for APBI from November 2011 to July 2015 were evaluated. Coverage Index (CI), Dose Homogeneity Index (DHI), Conformity Index (COIN), Plan Quality Index (PQI), and Dose Non-uniformity Index (DNR) were assessed. Results Forty-one patients underwent open cavity and 19 patients underwent closed cavity placement of brachytherapy catheters. The median number of planes was 4 and median number of needles was 20. Median dose was 34 Gy with dose per fraction of 3.4 Gy, given twice a day, 6 hours apart. The D90 of the cavity and clinical target volume (CTV) were 105% and 89%, respectively. The median doses to the surgical clips were greater than 100%. The median CI of the cavity and CTV was 0.96 and 0.82, respectively. The DHI and COIN index of the CTV was 0.73 and 0.67. There were no significant differences in the dosimetric parameters based on whether the technique was done open or closed. Conclusions Critical evaluation of the dosimetric parameters of MIB-APBI is important for optimal results. While the open and closed techniques have similar dosimetry, our institutional preference is for an open technique which eases the procedure due to direct visualization of the tumor cavity. PMID:27257415

  9. Individual Plans for Children in Transition to Pre-School: A Case Study in One Finnish Day-Care Centre

    ERIC Educational Resources Information Center

    Turunen, Tuija A.

    2012-01-01

    This paper outlines a case study on teachers' and parents' perspectives on children's individual plans in transition from early childhood education to pre-school in Finland. The study was based on the importance of continuity as a part of positive educational transition experiences. The national curricula, educators' interpretations and parents'…

  10. SU-E-J-73: Extension of a Clinical OIS/EMR/R&V System to Deliver Safe and Efficient Adaptive Plan-Of-The-Day Treatments Using a Fully Customizable Plan-Library-Based Workflow

    SciTech Connect

    Akhiat, A.; Kanis, A.P.; Penninkhof, J.J.; Sodjo, S.; O’Neill, T.; Quint, S.; Doorn, X. van; Schillemans, W.; Heijmen, B.; Hoogeman, M.; Linton, N.; Coleman, A.

    2015-06-15

    Purpose: To extend a clinical Record and Verify (R&V) system to enable a safe and fast workflow for Plan-of-the-Day (PotD) adaptive treatments based on patient-specific plan libraries. Methods: Plan libraries for PotD adaptive treatments contain for each patient several pre-treatment generated treatment plans. They may be generated for various patient anatomies or CTV-PTV margins. For each fraction, a Cone Beam CT scan is acquired to support the selection of the plan that best fits the patient’s anatomy-of-the-day. To date, there are no commercial R&V systems that support PotD delivery strategies. Consequently, the clinical workflow requires many manual interventions. Moreover, multiple scheduled plans have a high risk of excessive dose delivery. In this work we extended a commercial R&V system (MOSAIQ) to support PotD workflows using IQ-scripting. The PotD workflow was designed after extensive risk analysis of the manual procedure, and all identified risks were incorporated as logical checks. Results: All manual PotD activities were automated. The workflow first identifies if the patient is scheduled for PotD, then performs safety checks, and continues to treatment plan selection only if no issues were found. The user selects the plan to deliver from a list of candidate plans. After plan selection, the workflow makes the treatment fields of the selected plan available for delivery by adding them to the treatment calendar. Finally, control is returned to the R&V system to commence treatment. Additional logic was added to incorporate off-line changes such as updating the plan library. After extensive testing including treatment fraction interrupts and plan-library updates during the treatment course, the workflow is running successfully in a clinical pilot, in which 35 patients have been treated since October 2014. Conclusion: We have extended a commercial R&V system for improved safety and efficiency in library-based adaptive strategies enabling a wide

  11. Surgeon-performed touch preparation of breast core needle biopsies may provide accurate same-day diagnosis and expedite treatment planning.

    PubMed

    Gadgil, Pranjali V; Korourian, Soheila; Malak, Sharp; Ochoa, Daniela; Lipschitz, Riley; Henry-Tillman, Ronda; Suzanne Klimberg, V

    2014-04-01

    We aimed to determine the accuracy of surgeon-performed touch-preparation cytology (TPC) of breast core-needle biopsies (CNB) and the ability to use TPC results to initiate treatment planning at the same patient visit. A single-institution retrospective review of TPC results of ultrasound-guided breast CNB was performed. All TPC slides were prepared by surgeons performing the biopsy and interpreted by the pathologist. TPC results were reported as positive/suspicious, atypical, negative/benign, or deferred; these were compared with final pathology of cores to calculate accuracy. Treatment planning was noted as having taken place if the patient had requisition of advanced imaging, referrals, or surgical planning undertaken during the same visit. Four hundred forty-seven CNB specimens with corresponding TPC were evaluated from 434 patient visits, and 203 samples (45.4 %) were malignant on final pathology. When the deferred, atypical, and benign results were considered negative and positive/suspicious results were considered positive, sensitivity and specificity were 83.7 % (77.9-88.5 %) and 98.4 % (95.9-99.6 %), respectively; positive and negative predictive values were 97.7 % (94.2-99.4 %) and 87.9 % (83.4-91.5 %), respectively. In practice, patients with atypical or deferred results were asked to await final pathology. An accurate same-day diagnosis (TPC positive/suspicious) was hence feasible in 83.7 % (170 of 203) of malignant and 79.5 % (194 of 244) of benign cases (TPC negative). Of patients who had a same-day diagnosis of a new malignancy, 77.3 % had treatment planning initiated at the same visit. Surgeon-performed TPC of breast CNB is an accurate method of same-day diagnosis that allows treatment planning to be initiated at the same visit and may serve to expedite patient care.

  12. Soil pollution in day-care centers and playgrounds in Norway: national action plan for mapping and remediation.

    PubMed

    Ottesen, Rolf Tore; Alexander, Jan; Langedal, Marianne; Haugland, Toril; Høygaard, Erik

    2008-12-01

    Systematic geochemical mapping based on sampling and analysis of surface soils (0-2 cm) has been carried out in several Norwegian cities. The soils in the oldest parts of the cities are contaminated with metals (especially Pb) and polycyclic aromatic hydrocarbons (PAH). Due to the fact that children are often in contact with surface soil, it was realized that special focus had to be directed towards soils in day-care centers and playgrounds. The first mapping and remedy program was initiated in Trondheim in 1996. Here, the importance of copper-chromium-arsenic (CCA)-pressure-impregnated wood in playing equipment as a pollution source for soils was documented, and a process was started with the aim to ban this product. Soils from day-care centers in the inner city of Bergen were polluted to a degree that required remediation in 45% out of 87 centers, mainly due to high concentrations of Pb and benzo(a)pyrene. In Oslo, 38% of 700 day-care centers needed remediation due to soil pollution by Pb, BaP, Cd, Hg, Ni and PCB. Removal of CCA-impregnated wood was necessary in more than half of the day-care centers The Norwegian parliament has decided to investigate all outdoor playing areas in day-care centers, playgrounds and schoolyards in Norway, starting in 2007 with day-care centers in the ten largest cities and five most important industrial areas. The Norwegian Institute of Public Health has developed quality criteria for soils in day-care centers and playgrounds for As, Cd, Cr(6+), Hg, Ni, Pb, zinc, PAH(sum16), benzo(a)pyrene, and PCB(sum7). The Geological Survey of Norway has developed guidance for mapping of soil pollution (sampling, chemical analysis and reporting) in day-care centers. Especially the sampling strategy has been developed in the period 1996-2007, and the preferred sampling strategy is to collect at least 10 samples of surface soil (0-2 cm) from (1) "original soil" on the site, (2) artificial man-made "hills", and (3) soils used for growing vegetables

  13. 26 CFR 11.412(c)-7 - Election to treat certain retroactive plan amendments as made on the first day of the plan year.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) TEMPORARY INCOME TAX REGULATIONS UNDER THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 § 11.412(c)-7 Election to... the Secretary of Labor has approved the amendment or he has failed to act within 90 days after...

  14. A Day of Dialogue. Planning & Curriculum Resource Guide. Dealing with Issues of Nuclear War in the Classroom.

    ERIC Educational Resources Information Center

    Educators for Social Responsibility, Cambridge, MA.

    Elementary and secondary teachers and parents can use these resource materials to educate students about the issues related to war and peace. There are three major parts. The first part discusses how to implement a "day of dialogue," during which the dangers of nuclear war are examined. Included are tips on how to organize, meet resistance, and…

  15. Sevoflurane requirement during elective ankle day surgery: the effects of etirocoxib premedication, a prospective randomised study

    PubMed Central

    Turan, Ibrahim; Hein, Anette; Jacobson, Eva; Jakobsson, Jan G

    2008-01-01

    Background Anti-inflammatory drugs, NSAIDs, have become an important part of the pain management in day surgery. The aim of the present study was to evaluate the effect of Coxib premedication on the intra-operative anaesthetic requirements in patients undergoing elective ankle surgery in general anaesthesia. Type of study Prospective, randomized study of the intra-operative anaesthetic-sparing effects of etoricoxib premedication as compared to no NSAID preoperatively. Methods The intra-operative requirement of sevoflurane was studied in forty-four ASA 1–2 patients undergoing elective ankle day surgical in balanced general anaesthesia. Primary study endpoint was end-tidal sevoflurane concentration to maintain Cerebral State Index of 40 – 50 during surgery. Results All anaesthesia and surgery was uneventful, no complications or adverse events were noticed. The mean end-tidal sevoflurane concentration intra-operatively was 1.25 (SD 0.2) and 0.91 (SD 0.2) for the pre and post-operative administered group of patients respectively (p < 0.0001). No other intra-operative differences could be noted. Emergence and recovery was rapid and no difference was noticed in time to discharge-eligible mean 52 minutes in both groups studied. In all 6 patients, 5 in the group receiving etoricoxib post-operatively, after surgery, and one in the pre-operative group required rescue analgesia before discharge from hospital. No difference was seen in pain or need for rescue analgesia, nausea or patients satisfaction during the first 24 postoperative hours. Conclusion Coxib premedication before elective day surgery has an anaesthetic sparing potential. PMID:18786254

  16. Multi-day activity scheduling reactions to planned activities and future events in a dynamic model of activity-travel behavior

    NASA Astrophysics Data System (ADS)

    Nijland, Linda; Arentze, Theo; Timmermans, Harry

    2014-01-01

    Modeling multi-day planning has received scarce attention in activity-based transport demand modeling so far. However, new dynamic activity-based approaches are being developed at the current moment. The frequency and inflexibility of planned activities and events in activity schedules of individuals indicate the importance of incorporating those pre-planned activities in the new generation of dynamic travel demand models. Elaborating and combining previous work on event-driven activity generation, the aim of this paper is to develop and illustrate an extension of a need-based model of activity generation that takes into account possible influences of pre-planned activities and events. This paper describes the theory and shows the results of simulations of the extension. The simulation was conducted for six different activities, and the parameter values used were consistent with an earlier estimation study. The results show that the model works well and that the influences of the parameters are consistent, logical, and have clear interpretations. These findings offer further evidence of face and construct validity to the suggested modeling approach.

  17. Assessment of the learning curves for photoselective vaporization of the prostate using GreenLight™ 180-Watt-XPS laser therapy: defining the intra-operative parameters within a prospective cohort.

    PubMed

    Misraï, Vincent; Faron, Matthieu; Guillotreau, Julien; Bruguière, Eric; Bordier, Benoit; Shariat, Shahrokh F; Rouprêt, Morgan

    2014-04-01

    To assess the learning curves for the intra-operative parameters of the GreenLight™ 180-W XPS for photoselective vaporization of the prostate (PVP). A prospective study was conducted on 200 men who underwent PVP using the GreenLight™ 180-W XPS over 20 months. The population was divided into four consecutive equal groups. Evolution of lasing parameters was the main endpoint to reach an average energy of 5 kJ per prostate volume and to reach a lasing time/operative time (LT/OT) ratio of 66-80 %. Changes in the IPSS and prostate volume were also evaluated 12 weeks later. Total energy delivered (energy/ml of prostate) and the LT/OT ratio significantly increased over time (p < 0.05). Urinary function significantly improved from baseline in all groups. The first lasing parameter endpoint was reached after the 75th patient (group 1) and the second endpoint (LT/OT ratio) after the 125th patient (group 3). Only the PSA level (p = 0.04) and prostate volume (p < 0.0001) decreased significantly in the 3rd and the 4th group. Post-operative complications occurred in 20 % of patients, which were primarily Clavien-Dindo grades 1 and 2, though there were no statistical differences between the four groups (p = 0.62). In-hospital stay and time to catheter removal were significantly shorter in the 3rd and 4th group. The current study assessed the PVP learning curves within multiple intra-operative parameters. The PVP learning curves required at least 120 procedures until it met all intra-operative parameters of experts in this field.

  18. Day to Day

    ERIC Educational Resources Information Center

    Jurecki, Dennis

    2006-01-01

    A clean, healthy and safe school provides students, faculty and staff with an environment conducive to learning and working. However, budget and staff reductions can lead to substandard cleaning practices and unsanitary conditions. Some school facility managers have been making the switch to a day-schedule to reduce security and energy costs, and…

  19. Day to Day

    ERIC Educational Resources Information Center

    Jurecki, Dennis

    2006-01-01

    A clean, healthy and safe school provides students, faculty and staff with an environment conducive to learning and working. However, budget and staff reductions can lead to substandard cleaning practices and unsanitary conditions. Some school facility managers have been making the switch to a day-schedule to reduce security and energy costs, and…

  20. Use of the radial groove view intra-operatively to prevent damage to the extensor pollicis longus tendon by protruding screws during volar plating of a distal radial fracture.

    PubMed

    Lee, S K; Bae, K W; Choy, W S

    2013-10-01

    The aims of this study were to assess the efficacy of a newly designed radiological technique (the radial groove view) for the detection of protrusion of screws in the groove for the extensor pollicis longus tendon (EPL) during plating of distal radial fractures. We also aimed to determine the optimum position of the forearm to obtain this view. We initially analysed the anatomy of the EPL groove by performing three-dimensional CT on 51 normal forearms. The mean horizontal angle of the groove was 17.8° (14° to 23°). We found that the ideal position of the fluoroscopic beam to obtain this view was 20° in the horizontal plane and 5° in the sagittal plane. We then intra-operatively assessed the use of the radial groove view for detecting protrusion of screws in the EPL groove in 93 fractures that were treated by volar plating. A total of 13 protruding screws were detected. They were changed to shorter screws and these patients underwent CT scans of the wrist immediately post-operatively. There remained one screw that was protruding. These findings suggest that the use of the radial groove view intra-operatively is a good method of assessing the possible protrusion of screws into the groove of EPL when plating a fracture of the distal radius.

  1. Living Day by Day

    PubMed Central

    Kaplan, Rachel L.; Khoury, Cynthia El; Field, Emily R. S.; Mokhbat, Jacques

    2016-01-01

    We examined the meaning of living with HIV/AIDS among women in Lebanon. Ten women living with HIV/AIDS (WLWHA) described their experiences via semistructured in-depth interviews. They navigated a process of HIV diagnosis acceptance that incorporated six overlapping elements: receiving the news, accessing care, starting treatment, navigating disclosure decisions, negotiating stigma, and maintaining stability. Through these elements, we provide a framework for understanding three major themes that were constructed during data analysis: Stand by my side: Decisions of disclosure; Being “sick” and feeling “normal”: Interacting with self, others, and society; and Living day by day: focusing on the present. We contribute to the existing literature by providing a theoretical framework for understanding the process of diagnosis and sero-status acceptance among WLWHA. This was the first study of its kind to examine the meaning of living with HIV/AIDS among women in a Middle Eastern country. PMID:28462340

  2. The effect of X-ray scattering by water in the irradiation of cell cultures for the dosimetric characterization of a new prototype of IORT (Intra-Operative Radiation Therapy) device: Monte Carlo simulation and experimental validation.

    PubMed

    Ceccolini, E; Ferrari, P; Castelluccio, D M; Mostacci, D; Sumini, M

    2013-10-01

    The electron beam emitted backward by plasma focus devices is being considered as a radiation source for Intra-Operative Radiation Therapy (IORT) applications. Radiobiological investigations have been conducted to assess the potential of this new prototype of IORT device. A standard x-ray beam, ISO-H60, was used for comparison, irradiating cell cultures in a holder filled with an aqueous solution. The influence of scattering by the culture water and by the walls of the holder was investigated to determine their influence on the dose delivered to the cell culture. MCNPX simulations were run and experimental measurements conducted. The effect of scattering by the holder was found to be negligible; scattering by the culture water was determined to give an increase in dose of the order of 10%.

  3. Clinical utility of intra-operative 6% hydroxyethyl starch (130 / 0.4) supplementation in hypoxemic femur injury patients: a preliminary report of twenty cases.

    PubMed

    Sen, Indu; Kumar, Vinod; Puri, Govedhan Das; Sen, Ramesh K

    2012-01-01

    Posttraumatic intravasation of fat and debris can lead to a cascade of events. Hydroxyethyl starches (HES) markedly suppress neutrophil influx by decreasing pulmonary capillary permeability and facilitating tissue oxygenation by improving microcirculation. It was hypothesized that in hypoxemic femur injury patients undergoing operative stabilization, HES administration will prevent the deterioration of respiratory variables and facilitates recovery. This prospective, double-blind, randomized preliminary study, enrolled twenty posttraumatic hypoxemic patients (room air PaO2 < 70 mmHg, Schonfeld fat embolism index score (SS) > 5) scheduled for femur fracture stabilization under general anesthesia. Patients were allocated to receive either; 6% HES 130/0.42, 15 mL/kg or 0.9% normal saline (NS) to maintain their central venous pressure (CVP) 12 + 2 mm Hg. Blood was transfused according to the maximum allowable blood loss and by serial hematocrit estimations. Perioperative Glasgow Coma Scale (GCS), physiological variables, arterial oxygen saturation (SpO2), arterial blood gas (ABG), SS and P/F ratios were recorded until recovery. The partial pressure of oxygen in arterial blood / fraction of inspired oxygen ratio (PaO2/FiO2) improved from a preoperative value of 273.33 ± 13.05 to 435.70 in the 6% Hydroxyethyl starch group (HES) and from 275.24 ± 15.34 to 302.25 ± 70.35 in the NS group over a period of six days (P values =0.970, 0.791, 0.345, 0.226, 0.855, 0.083, 0.221). Time taken to achieve a P/F ratio > 300 and for persistent reduction of Murray's lung injury score (LIS) were comparable (P = 0.755 and 0.348, respectively). The number of ventilator, intensive care unit (ICU) and hospital stay days, did not differ (P value = 0.234, 1.00, 0. 301, respectively). There were no adverse sequelae or mortalities. A trend showing relatively fast improvement in the P/F ratio and an early reduction in LIS values was observed in hypoxemic, femur injury patients receiving

  4. Changes in smoking prevalence and number of cigarettes smoked per day following the implementation of a comprehensive tobacco control plan in New York City.

    PubMed

    Coady, Micaela H; Jasek, John; Davis, Karen; Kerker, Bonnie; Kilgore, Elizabeth A; Perl, Sarah B

    2012-10-01

    The New York City (NYC) Health Department has implemented a comprehensive tobacco control plan since 2002, and there was a 27% decline in adult smoking prevalence in NYC from 2002 to 2008. There are conflicting reports in the literature on whether residual smoker populations have a larger or smaller share of "hardcore" smokers. Changes in daily consumption and daily and nondaily smoking prevalence, common components used to define hardcore smokers, were evaluated in the context of the smoking prevalence decline. Using the NYC Community Health Survey, an annual random digit dial, cross-sectional survey that samples approximately 10,000 adults, the prevalence of current heavy daily, light daily, and nondaily smokers among NYC adults was compared between 2002 and 2008. A five-level categorical cigarettes per day (CPD) variable was also used to compare the population of smokers between the 2 years. From 2002 to 2008, significant declines were seen in the prevalence of daily smoking, heavy daily smoking, and nondaily smoking. Among daily smokers, there is also evidence of population declines in all but the lowest smoking category (one to five CPD). The mean CPD among daily smokers declined significantly, from 14.6 to 12.5. After an overall decline in smoking since 2002, the remaining smokers may be less nicotine dependent, based on changes in daily consumption and daily and nondaily smoking prevalence. These findings suggest the need to increase media and cessation efforts targeted towards lighter smokers.

  5. Human reponses to historical eruptions of Etna (Sicily) from 1600 to present and their implications for present-day disaster planning

    NASA Astrophysics Data System (ADS)

    Sangster, H.; Chester, D. K.; Duncan, A. M.

    2012-04-01

    Mount Etna in northeastern Sicily (Italy) rises to over 3000 m, covers an area of ca.1750 km2 and is the most active volcano in Europe. Observations of Etna by literate observers stretch back to the classical era and one of the earliest references to an eruption of Etna was by Pindar in his Pythian Odes, to the event of ca. 474-479 B.C. The history of its activity has been reconstructed by scholars up to the present day and records of eruptions are reasonably complete from the early fifteenth century, reliable from 1669, and document the threats and destruction to human settlements and livelihoods. Effusive and explosive activity has occurred continually throughout the historical period and eruptions of Mount Etna have presented numerous eruption styles, from persistent central crater activity, to periodic flank eruptions. From 1600 to 1669 the activity of Etna was characterised by a high volumetric output of lava with a mean eruption rate of 1.19 m3s-1, this was followed by a pause from flank eruptions and the re-establishment of significant activity from the middle of the eighteenth century. After 1750 the output of lava by flank eruptions was lower than in the previous century, with the mean eruption rate falling to 0.18 m3s-1. This paper summarises: the characteristics of the eruptions that occurred between the period of 1600 to present; the particularities of the societal responses over time and the role of the authorities; and, the important lessons this history holds for the management of present-day civil defence planning in the region. People responded to the eruptions at three levels: as members of a family and extended family; as members of a community and, as citizens of the State. The State, however, was a minor player in responding to these eruptions until the early nineteenth century as the State then became more involved in each successive eruption as the responses moved to a more industrial nature rather than pre-industrial. Today emergencies are

  6. [Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera].

    PubMed

    Goñi Gironés, E; Vicente García, F; Serra Arbeloa, P; Estébanez Estébanez, C; Calvo Benito, A; Rodrigo Rincón, I; Camarero Salazar, A; Martínez Lozano, M E

    2013-01-01

    To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2-7.2%, P = 0.0037). The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role. Copyright © 2013 Elsevier España, S.L. and SEMNIM. All rights reserved.

  7. Hazard responses in the pre-industrial era: vulnerability and resilience of traditional societies to volcanic disasters and the implications for present-day disaster planning

    NASA Astrophysics Data System (ADS)

    Sangster, Heather

    2014-05-01

    events and how characteristic methods of coping have developed to enhance resilience, and reduce vulnerability. The aim of this paper is reflective of this research frontier and with the use of Mount Vesuvius, Italy, as a case study, this paper summarises: the characteristics of the eruptions that occurred during the long nineteenth century (i.e. those that occurred in 1794, 1822, 1855, 1861, 1872, 1906 and 1929); the particularities of the societal responses over time and the role of the authorities; and, the important lessons this history holds for the management of present-day disaster planning. In order to reduce disaster susceptibility and increase what is termed, resilience or capacity, the more deep-rooted causes of vulnerability need to be addressed.

  8. 3D surgical planning and navigation for CMF surgery

    NASA Astrophysics Data System (ADS)

    Chapuis, Jonas; Rudolph, Tobias; Borgesson, Blake; De Momi, Elena; Pappas, Ion P.; Hallermann, Wok; Schramm, Alexander; Caversaccio, Marco

    2004-05-01

    In this paper we describe a system for corrective and reconstructive CMF surgery that allows planning of bone segment relocations in 3D and transfer of the goal positions into an intra-operative navigation module, which provides guidance to realize the planned movement. In addition, the pre-operative planning module offers functions of mirroring and allows insertion of distraction devices. We present three clinical cases of CMF surgical procedures planned a posteriori with our application: bimaxillary realignment, involving subcondylar osteotomy of the mandible and LeFort I osteotomy, secondary orbital reconstruction and mandibular reconstruction.

  9. Pre- and/or Intra-Operative Prescription of Diuretics, but Not Renin-Angiotensin-System Inhibitors, Is Significantly Associated with Acute Kidney Injury after Non-Cardiac Surgery: A Retrospective Cohort Study

    PubMed Central

    Tagawa, Miho; Ogata, Ai; Hamano, Takayuki

    2015-01-01

    Background and Objectives Pre- and/or intra-operative use of diuretics, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) constitutes a potentially modifiable risk factor for postoperative acute kidney injury (AKI). It has been studied whether use of these drugs predicts AKI after cardiac surgery. The objective of this study was to examine whether administration of these agents was independently associated with AKI after non-cardiac surgery. Design, Setting, Participants, and Measurements This was a retrospective observational study. Inclusion criteria were adult patients (age ≥ 18) who underwent non-cardiac surgery under general anesthesia from 2007 to 2009 at Kyoto Katsura Hospital. Exclusion criteria were urological surgery, missing creatinine values, and preoperative dialysis. The exposures of interest were pre- and/or intra-operative use of diuretics or ACE-I/ARB. Outcome variables were postoperative AKI as defined by the AKI Network (increase in creatinine ≥ 0.3 mg/dL or 150% within 48 hours, or urine output < 0.5 ml/kg/hour for > 6 hours). Multivariable logistic regression analyses were conducted and adjusted for potential confounders. Propensity scores (PS) for receiving diuretics or ACE-I/ARB therapy were estimated and PS adjustment, PS matching, and inverse probability weighting were performed. Results There were 137 AKI cases (5.0%) among 2,725 subjects. After statistical adjustment for patient and surgical characteristics, odds (95% CI) of postoperative AKI were 2.07 (1.10-3.89) (p = 0.02) and 0.89 (0.56-1.42) (p = 0.63) in users of diuretics and ACE-I/ARB, respectively, compared with non-users. PS adjustment, PS matching, and inverse probability weighting yielded similar results. The effect size of diuretics was significantly greater in the patients with lower propensity for diuretic use (p for interaction < 0.1). Conclusions Prescription of diuretics, but not ACE-I/ARB, was independently associated with

  10. Pre- and/or Intra-Operative Prescription of Diuretics, but Not Renin-Angiotensin-System Inhibitors, Is Significantly Associated with Acute Kidney Injury after Non-Cardiac Surgery: A Retrospective Cohort Study.

    PubMed

    Tagawa, Miho; Ogata, Ai; Hamano, Takayuki

    2015-01-01

    Pre- and/or intra-operative use of diuretics, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II receptor blockers (ARB) constitutes a potentially modifiable risk factor for postoperative acute kidney injury (AKI). It has been studied whether use of these drugs predicts AKI after cardiac surgery. The objective of this study was to examine whether administration of these agents was independently associated with AKI after non-cardiac surgery. This was a retrospective observational study. Inclusion criteria were adult patients (age ≥ 18) who underwent non-cardiac surgery under general anesthesia from 2007 to 2009 at Kyoto Katsura Hospital. Exclusion criteria were urological surgery, missing creatinine values, and preoperative dialysis. The exposures of interest were pre- and/or intra-operative use of diuretics or ACE-I/ARB. Outcome variables were postoperative AKI as defined by the AKI Network (increase in creatinine ≥ 0.3 mg/dL or 150% within 48 hours, or urine output < 0.5 ml/kg/hour for > 6 hours). Multivariable logistic regression analyses were conducted and adjusted for potential confounders. Propensity scores (PS) for receiving diuretics or ACE-I/ARB therapy were estimated and PS adjustment, PS matching, and inverse probability weighting were performed. There were 137 AKI cases (5.0%) among 2,725 subjects. After statistical adjustment for patient and surgical characteristics, odds (95% CI) of postoperative AKI were 2.07 (1.10-3.89) (p = 0.02) and 0.89 (0.56-1.42) (p = 0.63) in users of diuretics and ACE-I/ARB, respectively, compared with non-users. PS adjustment, PS matching, and inverse probability weighting yielded similar results. The effect size of diuretics was significantly greater in the patients with lower propensity for diuretic use (p for interaction < 0.1). Prescription of diuretics, but not ACE-I/ARB, was independently associated with postoperative AKI after non-cardiac surgery, especially in patients with low propensity for

  11. Rainy Day Activities.

    ERIC Educational Resources Information Center

    Texas Child Care, 1997

    1997-01-01

    Experienced caregivers plan ahead for rainy days. This article describes specific rainy day activities for young children, such as books and crafts to learn about rain (rain in a jar, making a rainbow), simple cooking activities (taffy pull, cinnamon candy tea), and games (mummy wrap, hunt the thimble, rain lotto). (EV)

  12. Rainy Day Activities.

    ERIC Educational Resources Information Center

    Texas Child Care, 1997

    1997-01-01

    Experienced caregivers plan ahead for rainy days. This article describes specific rainy day activities for young children, such as books and crafts to learn about rain (rain in a jar, making a rainbow), simple cooking activities (taffy pull, cinnamon candy tea), and games (mummy wrap, hunt the thimble, rain lotto). (EV)

  13. Infarction of middle third posterior cortex of kidney: a complication of extended pyelolithotomy, intra-operative electrohydraulic lithotripsy and extraction of calyceal stones under vision using stone basket and flexible cystoscope in a spinal cord injury patient – a case report

    PubMed Central

    2009-01-01

    Background Spinal cord injury produces multiple systemic and metabolic alterations. A decrease in micro vascular blood flow to liver, spleen and muscle has been described following spinal cord injury. Case presentation We present a 46-year-old male patient with C-4 complete tetraplegia, who developed a large stag horn calculus with branches in upper, middle and lower calyces of left kidney. This patient underwent Gil-Vernet extended pyelolithotomy and required intra-operative electrohydraulic lithotripsy and retrieval of stones from upper, middle and lower calyces using flexible cystoscope and stone basket. Computed tomography, performed eighteen days after surgery, showed multiple areas of non-enhancing cortex posteriorly and in the upper pole, suggestive of focal infarction. Magnetic resonance imaging of left kidney confirmed the presence of an area of infarction in middle third of posterior cortex, but there was no evidence of trauma to posterior division of renal artery. Therefore, we postulate that compression of renal parenchyma by Gil-Vernet retractors during surgery, and firm pressure that was applied over the middle of kidney for prolonged periods while several attempts were being made to retrieve fragments of calculi from renal calyces, led to ischaemia and subsequently, infarction of mid-third posterior cortex of left kidney. Conclusion This case illustrates importance of gentle handling of kidney during extended pyelolithotomy in order to prevent subtle renal trauma, which may be detected only by advanced imaging studies. Further, spinal cord physicians should take a pragmatic approach to management of stones located inside renal calyces. Both spinal cord injury patients and their physicians should remember that in our enthusiasm to achieve complete clearance of stones embedded deeply within renal calyces, we could produce irreversible injury to kidney, as indeed happened in this patient. Therefore, emphasis should be placed on prevention of struvite

  14. Intra-Operative Dosimetry in Prostate Brachytherapy

    DTIC Science & Technology

    2006-11-01

    instrumentation and does not interfere with the workspace. 1 Introduction C-arm fluoroscopy is ubiquitous in general surgery , interventional radiology...toward computational fluoroscopy guidance in general surgery , developing various tools for distortion correction and calibration23,24. However, C-arms...additional error on the reconstruction of small objects. 1 Introduction C-arm fluoroscopy is ubiquitous in general surgery , due to its real-time nature

  15. Intra-Operative Dosimetry in Prostate Brachytherapy

    DTIC Science & Technology

    2007-11-01

    additional cost to the existing clinical installation. 1 Introduction With an approximate annual incidence of 220,000 new cases and 33,000 deaths...isocentric C-arm, at negligible additional cost to the existing clinical installation. Furthermore, the proposed system is the first of its kind that...PC050042, DoD PC050170 and NIH 2R44CA099374. optimal solution has a near-zero cost when the pose error is low , and is actu- ally zero without pose error

  16. [Intra-operative cholangiography in laparoscopic cholecystectomy].

    PubMed

    Neufeld, D; Jessel, J; Freund, U

    1994-01-16

    Intraoperative cholangiography (IC) in laparoscopic cholecystectomy is a controversial issue. According to traditional teaching, the purpose of cholangiography in gallbladder surgery is to discover previously undiscovered common bile duct stones. This examination was extremely important in the era before ERCP. IC enabled surgeons to find stones and remove them at the same operation. With progress in ERCP, the importance of intraoperative cholangiography has diminished. A stone missed during surgery can most often be dealt with by the less invasive ERCP and papillotomy. There has been a difference of opinion in the literature as to whether to perform cholangiography routinely during gallbladder operations or only in cases in which there is a specific indication, such as an enlarged common bile duct, a history of pancreatitis, or elevated enzymes. Routine operative cholangiography prolongs operative time and carries its own inherent risks, such as injury to the bile ducts. The likelihood of stones is not high and over-diagnosis of stones would result in unwarranted common bile duct exploration and the danger of complications from the procedure. The tendency today is towards a more selective approach. In this era of laparoscopic gallbladder surgery, the controversy has come to the fore again, and there is now an additional aspect. In laparoscopic gallbladder surgery there is greater significance to the "road map" provided by X-rays. We rely mainly on the visual sense and have forgone the tactile sense. Therefore, any added visual input in this operation helps avoid the danger of injuring the main bile ducts. It is our contention that the indications for operative cholangiography in laparoscopic cholecystectomy should again be broadened.

  17. Intra-Operative Dosimetry in Prostate Brachytherapy

    DTIC Science & Technology

    2008-04-01

    4 A INTRODUCTION For several decades, the definitive treatment for low and medium risk prostate cancer was radical prostatectomy or external...with reduced morbidity. In contemporary practice, however, faulty needle and source placement often cause insufficient dose to the cancer and/or...seeds if the pose of a C-arm is known. The algorithm was validated using phantom and clinical patient data. Index Terms— Tomosynthesis, prostate cancer

  18. Evaluation of the effect of intra-operative intravenous fluid on post-operative pain and pulmonary function: a randomized trial comparing 10 and 30 ml kg(-1) of crystalloid.

    PubMed

    Straub, B D; Aslani, A; Enohumah, K; Rahore, R; Conrick-Martin, I; Kumar, D; Campbell, M; Dicker, P; Mocanu, E; Loughrey, J P; Hayes, N E; McCaul, C L

    2014-12-01

    Existing evidence suggests that administration of intravenous fluids has been shown to improve outcomes including pain in gynecological laparoscopic surgery but the optimum fluid dose has not been determined. To determine the effect of administration of intravenous fluids on post-operative pain and pulmonary function after gynecological laparoscopy. In a prospective randomized double-blinded study 100 ASA 1 and 2 elective patients undergoing gynecological laparoscopy were randomized to receive intravenous compound sodium lactate 10 ml kg(-1) (CSL10-restrictive) or 30 ml kg(-1) (CSL30-liberal) administered intra-operatively. The primary outcome measure was the post-operative pain score at 24, 48 and 72 h, assessed by 0-10 verbal rating scale (VRS). Pulmonary function (FEV1, FVC, PEFR) and oxygen saturation were also measured. Patients who received CSL 30 had lower post-operative pain scores than CSL 10 (ANCOVA-mean difference = 0.47, 95 % CI 0.11-0.83, P = 0.01). Post-operative pain VRS was lower in CSL30 than CSL10 at 48 h (mean difference 0.56, 95 % CI 0.04-1.09, P = 0.036). Patients in CSL30 reported shoulder tip pain less frequently than those in CSL10 (30.4 vs. 43.9 % of assessments, P = 0.03, OR 0.58) but reported wound pain more frequently 39.0 vs. 24.2 %, P = 0.01, OR 2.0). Indices of pulmonary function did not differ between groups at any time. Liberal compared to restrictive administration of i.v. crystalloid is associated with a clinical modest reduction in pain. Pulmonary dysfunction was not increased with liberal fluid administration.

  19. Attenuation measurements show that the presence of a TachoSil surgical patch will not compromise target irradiation in intra-operative electron radiation therapy or high-dose-rate brachytherapy.

    PubMed

    Sarmento, Sandra; Costa, Filipa; Pereira, Alexandre; Lencart, Joana; Dias, Anabela; Cunha, Luís; Sousa, Olga; Silva, José Pedro; Santos, Lúcio

    2015-01-09

    Surgery of locally advanced and/or recurrent rectal cancer can be complemented with intra-operative electron radiation therapy (IOERT) to deliver a single dose of radiation directly to the unresectable margins, while sparing nearby sensitive organs/structures. Haemorrhages may occur and can affect the dose distribution, leading to an incorrect target irradiation. The TachoSil (TS) surgical patch, when activated, creates a fibrin clot at the surgical site to achieve haemostasis. The aim of this work was to determine the effect of TS on the dose distribution, and ascertain whether it could be used in combination with IOERT. This characterization was extended to include high dose rate (HDR) intraoperative brachytherapy, which is sometimes used at other institutions instead of IOERT. CT images of the TS patch were acquired for initial characterization. Dosimetric measurements were performed in a water tank phantom, using a conventional LINAC with a hard-docking system of cylindrical applicators. Percentage Depth Dose (PDD) curves were obtained, and measurements made at the depth of dose maximum for the three clinically used electron energies (6, 9 and 12MeV), first without any attenuator and then with the activated patch of TS completely covering the tip of the IOERT applicator. For HDR brachytherapy, a measurement setup was improvised using a solid water phantom and a Farmer ionization chamber. Our measurements show that the attenuation of a TachoSil patch is negligible, both for high energy electron beams (6 to 12MeV), and for a HDR (192)Ir brachytherapy source. Our results cannot be extrapolated to lower beam energies such as 50 kVp X-rays, which are sometimes used for breast IORT. The TachoSil surgical patch can be used in IORT procedures using 6MeV electron energies or higher, or HDR (192)Ir brachytherapy.

  20. Dinosaur Day!

    ERIC Educational Resources Information Center

    Nakamura, Sandra; Baptiste, H. Prentice

    2006-01-01

    In this article, the authors describe how they capitalized on their first-grade students' love of dinosaurs by hosting a fun-filled Dinosaur Day in their classroom. On Dinosaur Day, students rotated through four dinosaur-related learning stations that integrated science content with art, language arts, math, and history in a fun and time-efficient…

  1. CEMI Days

    SciTech Connect

    2015-07-01

    CEMI Days are an important channel of engagement between DOE and the manufacturing industry to identify challenges and opportunities for increasing U.S. manufacturing competitiveness. CEMI Days that are held at manufacturing companies’ facilities can include tours of R&D operations or other points of interest determined by the host company.

  2. Dinosaur Day!

    ERIC Educational Resources Information Center

    Nakamura, Sandra; Baptiste, H. Prentice

    2006-01-01

    In this article, the authors describe how they capitalized on their first-grade students' love of dinosaurs by hosting a fun-filled Dinosaur Day in their classroom. On Dinosaur Day, students rotated through four dinosaur-related learning stations that integrated science content with art, language arts, math, and history in a fun and time-efficient…

  3. Career Day

    NASA Image and Video Library

    NASA's 2013 Career Days was a joint collaboration between NASA Langley and the Newport News Shipbuilding where 600 high school students from Virginia took on two design challenges -- designing a ca...

  4. Zoo Day.

    ERIC Educational Resources Information Center

    Warden, Marian

    1978-01-01

    Zoo Day was one of the culminating activities of Art Extravaganza, a pilot summer art program for high ability first-and second-graders. Field trips, art history lessons, box sculpture, and a study of cavemen were included. (SJL)

  5. Pi Day.

    ERIC Educational Resources Information Center

    Waldner, Bruce C.

    1994-01-01

    Presents a day of activities to encourage students to participate in mathematics. Five contests include poster; model; mathematics puzzle; mathematics problem challenge; and essay. Some student entries and the rules for each contest are described. (MKR)

  6. Marketing Your Day Camp.

    ERIC Educational Resources Information Center

    Coleman, George

    1997-01-01

    Marketing strategies for day camps include encouraging camp staff to get involved in organizations involving children, families, and communities; holding camp fairs; offering the use of camp facilities to outside groups; hosting sport leagues and local youth outings; planning community fairs; and otherwise involving the camp in the community. (LP)

  7. Intra-operative sentinel lymph node identification using a novel receptor-binding agent (technetium-99m neomannosyl human serum albumin, 99mTc-MSA) in stage I non-small cell lung cancer.

    PubMed

    Kim, Sungeun; Kim, Hyun Koo; Kang, Du-Young; Jeong, Jae Min; Choi, Young Ho

    2010-06-01

    of 40 patients (72.5%). Intra-operative sentinel lymph node identification using 99mTc-MSA appears to be feasible and reliable in stage I non-small cell lung cancer. Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  8. 34 CFR 300.11 - Day; business day; school day.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false Day; business day; school day. 300.11 Section 300.11... CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.11 Day; business day; school day. (a) Day means calendar day unless otherwise indicated as business day or school day. (b) Business day...

  9. [Planning orthodontic surgery with the Hexapod system].

    PubMed

    Vollmer, D; Ehmer, U; Bourauel, C; Linss, G

    2001-03-01

    Treatment of maxillofacial dysgnathia using a combined surgical/orthodontic approach requires careful orthodontic and orthognathic diagnosis and treatment planning. In the present study, a system enabling on-line presentation of the necessary displacements of the jaw during surgery, while improving the accuracy of the planning, is described. Using the hexapod principle, it is possible to plan operations with six degrees of freedom and to measure the three-dimensional movements of jaws and jaw segments within the planning stage. Routinely prepared casts are employed for simulation of the operation. The displacements of the jaw are presented in a manner familiar to the orthodontic surgeon, namely in a surgical record. The accuracy achieved with the hexapod is superior to that achievable intra-operatively.

  10. Capitol Day

    NASA Image and Video Library

    2009-02-19

    Stennis Space Center Director Gene Goldman visits with Mississippi Gov. Haley Barbour during NASA Day at the Capitol activities on Feb. 19. During the visit, Goldman presented the governor with a model of the J-2X rocket engine currently in development. Stennis engineers did early component testing for the new engine.

  11. Capitol Day

    NASA Technical Reports Server (NTRS)

    2009-01-01

    Stennis Space Center Director Gene Goldman visits with Mississippi Gov. Haley Barbour during NASA Day at the Capitol activities on Feb. 19. During the visit, Goldman presented the governor with a model of the J-2X rocket engine currently in development. Stennis engineers did early component testing for the new engine.

  12. 34 CFR 300.11 - Day; business day; school day.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 34 Education 2 2012-07-01 2012-07-01 false Day; business day; school day. 300.11 Section 300.11... CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.11 Day; business day; school day. (a) Day means calendar day unless otherwise indicated as business day or school day. (b) Business...

  13. 34 CFR 300.11 - Day; business day; school day.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 34 Education 2 2011-07-01 2010-07-01 true Day; business day; school day. 300.11 Section 300.11... CHILDREN WITH DISABILITIES General Definitions Used in This Part § 300.11 Day; business day; school day. (a) Day means calendar day unless otherwise indicated as business day or school day. (b) Business...

  14. Day of Surgery Admission in Total Joint Arthroplasty: Why Are Surgeries Cancelled? An Analysis of 3195 Planned Procedures and 114 Cancellations

    PubMed Central

    Kelly, Enda G.; Murphy, Terence P.; McCoy, Gerry F.; Glynn, Aaron A.

    2016-01-01

    Background. Day of surgery admission (DOSA) is becoming standard practice as a means of reducing cost in total joint arthroplasty. Aims. The aim of our study was to audit the use of DOSA in a specialty hospital and identify reasons for cancellation. Methods. A retrospective study of patients presenting for hip or knee arthroplasty between 2008 and 2013 was performed. All patients were assessed at the preoperative assessment clinic (PAC). Results. Of 3195 patients deemed fit for surgery, 114 patients (3.5%) had their surgery cancelled. Ninety-two cancellations (80%) were due to the patient being deemed medically unsuitable for surgery by the anaesthetist. Cardiac disease was the most common reason for cancellation (n = 27), followed by pulmonary disease (n = 22). 77 patients (67.5%) had their operation rescheduled and successfully performed in our institution at a later date. Conclusion. DOSA is associated with a low rate of cancellations on the day of surgery. Patients with cardiorespiratory comorbidities are at greatest risk of cancellation. PMID:27974973

  15. Valentine's Day

    NASA Technical Reports Server (NTRS)

    2006-01-01

    [figure removed for brevity, see original site] Context image for PIA02174 Valentine's Day

    This isolated mesa [lower left center of the image] has an almost heart-shaped margin. Happy Valentine's Day from Mars.

    Image information: VIS instrument. Latitude 29.4N, Longitude 79.1E. 18 meter/pixel resolution.

    Note: this THEMIS visual image has not been radiometrically nor geometrically calibrated for this preliminary release. An empirical correction has been performed to remove instrumental effects. A linear shift has been applied in the cross-track and down-track direction to approximate spacecraft and planetary motion. Fully calibrated and geometrically projected images will be released through the Planetary Data System in accordance with Project policies at a later time.

    NASA's Jet Propulsion Laboratory manages the 2001 Mars Odyssey mission for NASA's Office of Space Science, Washington, D.C. The Thermal Emission Imaging System (THEMIS) was developed by Arizona State University, Tempe, in collaboration with Raytheon Santa Barbara Remote Sensing. The THEMIS investigation is led by Dr. Philip Christensen at Arizona State University. Lockheed Martin Astronautics, Denver, is the prime contractor for the Odyssey project, and developed and built the orbiter. Mission operations are conducted jointly from Lockheed Martin and from JPL, a division of the California Institute of Technology in Pasadena.

  16. Human responses to eruptions of Etna (Sicily) during the late-Pre-Industrial Era and their implications for present-day disaster planning

    NASA Astrophysics Data System (ADS)

    Chester, David K.; Duncan, Angus M.; Sangster, Heather

    2012-05-01

    This paper summarises: the characteristics of eruptions that occurred between 1792/3 and 1923; the ways in which human responses evolved during the period and the lessons this history holds for the management of present-day volcanic and volcano-related disasters. People responded to eruptions at three levels: as members of a family and extended family; through the mutual support of a village or larger settlement and as citizens of the State. During the study period and with the exception of limited financial aid and preservation of law and order, the State was a minor player in responding to eruptions. Families and extended families provided shelter, accommodation and often alternative agricultural employment; whilst supportive villages communities displayed a well developed tendency to learn from experience (e.g. innovating techniques to bring land back into cultivation and avoiding the risks of phreatic activity as lava encountered water and saturated ground) and providing labour to enable household chattels and agricultural crops to be salvaged from land threatened with lava incursion. Eruptions were widely believed to be 'Acts of God', with divine punishment frequently being invoked as a primary cause of human suffering. Elaborate rituals of propitiation were performed to appease a supposed angry God, but this world-view did not produce a fatalistic attitude amongst the population preventing people from coping with disasters in a generally effective manner. Despite present day emergencies being handled by the State and its agencies, some features of nineteenth century responses remain in evidence, including salvaging all that may be easily removed from a building and/or agricultural holding, and explanations of disaster which are theistic in character. Lessons from eruptions that occurred between 1792/3 to 1923 are that the former should be encouraged, whilst the latter does not prevent people acting to preserve life and property or obeying the authorities

  17. The content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) and its potential application in accommodation and day-support services for adults with intellectual disability.

    PubMed

    McVilly, K; Webber, L; Sharp, G; Paris, M

    2013-08-01

    The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide the development of BSPs for children in school settings, and evaluated its application for use in accommodation and day-support services for adults with intellectual disability. A three-round Delphi study involving a purposive sample of experienced behaviour support practitioners (n = 30) was conducted over an 8-week period. The analyses included deductive content analysis and descriptive statistics. The 12 quality domains of the BSP-QEII were affirmed as valid for application in adult accommodation and day-support service settings. Two additional quality domains were suggested, relating to the provision of detailed background on the client and the need for plans to reflect contemporary service philosophy. Furthermore, the results suggest that some issues previously identified in the literature as being important for inclusion in BSPs might not currently be a priority for practitioners. These included: the importance of specifying replacement or alternative behaviours to be taught, descriptions of teaching strategies to be used, reinforcers, and the specification of objective goals against which to evaluate the success of the intervention programme. The BSP-QEII provides a potentially useful framework to guide and evaluate the development of BSPs in services for adults with intellectual disability. Further research is warranted to investigate why practitioners are potentially giving greater attention to some areas of intervention practice than others, even where research has demonstrated these others areas of practice could be important to achieving quality outcomes. © 2012 The Authors. Journal of Intellectual Disability Research

  18. Zoning for Day Care (from Models for Day Care Licensing).

    ERIC Educational Resources Information Center

    Day Care and Child Development Council of America, Inc., Washington, DC.

    Recommendations and regulations regarding the zoning of child development day care programs are discussed. Zoning in general is discussed, as is the treatment of child development day care in zoning ordinance, the background of program planning, modular housing, the impelmentation of zoning, and model provisions regarding characteristics of…

  19. District Level Plans: Computer Science Education, Palo Alto Unified School District; Computer Education Foundation Program, Los Angeles Unified School District, Office of Instruction; Microcomputers in the Public Schools, A Management Plan, Keene, New Hampshire, School District; [and] School Level Plans: Technology Plan, Cincinnati Country Day School, Cincinnati, Ohio.

    ERIC Educational Resources Information Center

    Learning Tomorrow: Journal of the Apple Education Advisory Council, 1986

    1986-01-01

    The first report details the computer education plans of the school district in Palo Alto (California), where the use of the computer is part of normal school activities in grades K-6, all seventh grade students participate in a computer awareness unit, and students in grades 9-12 are encouraged to enroll for one quarter in a computer studies…

  20. First Day Lesson Plan: Concentrating on Communicating

    ERIC Educational Resources Information Center

    Forecast for Home Economics, 1977

    1977-01-01

    Presents student exercises designed to demonstrate the importance of speaking and listening carefully; a self-test for the teacher to evaluate his/her communication skills; and examples of ways to teach communication in a variety of topics related to home economics (family relationships, child care, foods and nutrition, personal care, home…

  1. Effects of Intra-Operative Total Intravenous Anaesthesia with Propofol versus Inhalational Anaesthesia with Sevoflurane on Post-Operative Pain in Liver Surgery: A Retrospective Case-Control Study

    PubMed Central

    Choi, Siu Wai; Wong, Stanley Sau Ching; Chan, Albert Chi Yan; Irwin, Michael G; Cheung, Chi Wai

    2016-01-01

    Background Patients receiving total intravenous anesthesia (TIVA) with propofol have been shown to experience less postoperative pain. We evaluated the post-operative analgesic effects of propofol compared with sevoflurane maintenance of anesthesia in liver surgery. This study was registered at ClinicalTrials.gov (NCT02179437). Methods In this retrospective study, records of patients who underwent liver surgery between 2010 and 2013 were reviewed. Ninety-five patients anesthetized with propofol TIVA were matched with 95 patients anesthetized with sevoflurane. Numeric pain rating scale (NRS) pain scores, postoperative morphine consumption, side effects and patients’ satisfaction with pain relief were evaluated. Results The TIVA group reported lower NRS pain scores during coughing on postoperative days 1 and 2 but not 3 (p = 0.0127, p = 0.0472, p = 0.4556 respectively). They also consumed significantly less daily (p = 0.001 on day 1, p = 0.0231 on day 2, p = 0.0004 on day 3), accumulative (p = 0.001 on day 1, p<0.0001 on day 2 and p = 0.0064 on day 3) and total morphine (p = 0.03) when compared with the sevoflurane group. There were no differences in total duration of intravenous patient controlled analgesia (PCA) morphine use and patient satisfaction. No difference was found in reported side effects. Conclusion Patients anesthetized with propofol TIVA reported less pain during coughing and consumed less daily, accumulative and total morphine after liver surgery. PMID:26901037

  2. Sun-Earth Day, 2001

    NASA Technical Reports Server (NTRS)

    Adams, Mitzi L.; Mortfield, P.; Hathaway, D. H.; Whitaker, Ann F. (Technical Monitor)

    2001-01-01

    To promote awareness of the Sun-Earth connection, NASA's Marshall Space Flight Center, in collaboration with the Stanford SOLAR Center, sponsored a one-day Sun-Earth Day event on April 27, 2001. Although "celebrated" on only one day, teachers and students from across the nation, prepared for over a month in advance. Workshops were held in March to train teachers. Students performed experiments, results of which were shared through video clips and an internet web cast. Our poster includes highlights from student experiments (grades 2 - 12), lessons learned from the teacher workshops and the event itself, and plans for Sun-Earth Day 2002.

  3. The Final Days

    NASA Image and Video Library

    2015-04-28

    Though NASA MESSENGER days are numbered, the spacecraft will continue to acquire new data sets and transmit them back to Earth during its final days. Shown here is a high-resolution view snapped near Heemskerck Rupes, named for the Dutch ship that explored Australia and New Zealand in 1642-1643. The total number of images that MDIS has acquired and returned to Earth since entering Mercury orbit in March 2011 is currently 277,447, which is many more than originally planned for MESSENGER's one-year primary mission! In the next few days, approximately 500 additional images are planned to be received back at Earth, though the spacecraft is expected to impact the planet on April 30 with more than a thousand images still on its recorder, never to be seen. This is by design, as it is better to collect more data than can be transmitted than end the mission having been able to possibly have done more! Check out some highlights from the MESSENGER mission by visiting this image collection, or watch MESSENGER team members discuss the mission in these recently posted videos. Date acquired: April 26, 2015 Image Mission Elapsed Time (MET): 72384761 Image ID: 8400449 Instrument: Narrow Angle Camera (NAC) of the Mercury Dual Imaging System (MDIS) Center Latitude: 25.1° Center Longitude: 234.4° E Resolution: 6.7 meters/pixel Scale: The bottom of this image is about 7 kilometers (4.3 miles) across Incidence Angle: 57.9° Emission Angle: 56.5° Phase Angle: 40.7° http://photojournal.jpl.nasa.gov/catalog/PIA19438

  4. STS-79 Flight Day 5

    NASA Technical Reports Server (NTRS)

    1996-01-01

    On this fifth day of the STS-79 mission, the flight crew, Cmdr. William F. Readdy, Pilot Terrence W. Wilcutt, Mission Specialists, Thomas D. Akers, Shannon Lucid, Jay Apt, and Carl E. Walz, in the first full day of joint Shuttle/Mir operations begin in with the transfer of a biotechnology investigation and logistical supplies from Atlantis to Mir. The Biotechnology System, an investigation that will study the long-term development of cartilage cells in microgravity, was transported to Mir early this morning. During his planned four-month stay on Mir, John Blaha will take weekly samples of the culture which may provide researchers with information on engineering cartilage cells for possible use in transplantation. They also took time out of their schedules to talk with Good Morning America's Elizabeth Vargas in a brief interview. Prior to beginning the day's transfer activities, all nine astronauts and cosmonauts participated in a joint planning session to outline the day's schedule.

  5. Starting a Day Care Center: The Day Care Center Handbook.

    ERIC Educational Resources Information Center

    Checkett, Donald

    Designed to be of help to individuals and groups seeking to establish a day care center in the metropolitan St. Louis area, this manual calls attention to important and basic information which must be taken into account if planning is to produce tangible results. Following a brief section defining commonly used terms referring to organized…

  6. Can the rapid identification of mature spermatozoa during microdissection testicular sperm extraction guide operative planning?

    PubMed

    Alrabeeah, K; Doucet, R; Boulet, E; Phillips, S; Al-Hathal, N; Bissonnette, F; Kadoch, I J; Zini, A

    2015-05-01

    The minimum sperm count and quality that must be identified during microdissection testicular sperm extraction (micro-TESE) to deem the procedure successful remains to be established. We conducted a retrospective study of 81 consecutive men with non-obstructive azoospermia who underwent a primary (first) micro-TESE between March 2007 and October 2013. Final assessment of sperm recovery [reported on the day of (intracytoplasmic sperm injection) ICSI] was recorded as (i) successful (available spermatozoa for ICSI) or (ii) unsuccessful (no spermatozoa for ICSI). The decision to perform a unilateral (with limited or complete microdissection) or bilateral micro-TESE was guided by the intra-operative identification of sperm recovery (≥5 motile or non-motile sperm) from the first testicle. Overall, sperm recovery was successful in 56% (45/81) of the men. A unilateral micro-TESE was performed in 47% (38/81) of the men (based on intra-operative identification of sperm) and in 100% (38/38) of these men, spermatozoa was found on final assessment. In 42% (16/38) of the unilateral cases, a limited microdissection was performed (owing to the rapid intra-operative identification of sperm). The remaining 43 men underwent a bilateral micro-TESE and 16% (7/43) of these men had sperm identified on final assessment. The cumulative ICSI pregnancy rates (per cycle started and per embryo transfer) were 47% (21/45) and 60% (21/35), respectively, with a mean (±SD) of 1.9 ± 1.0 embryos transferred. The data demonstrate that intra-operative assessment of sperm recovery can correctly identify those men that require a unilateral micro-TESE. Moreover, the rapid identification of sperm recovery can allow some men to undergo a limited unilateral micro-TESE and avoid the need for complete testicular microdissection.

  7. 34 CFR 300.11 - Day; business day; school day.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 34 Education 2 2014-07-01 2013-07-01 true Day; business day; school day. 300.11 Section 300.11 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION...

  8. 34 CFR 300.11 - Day; business day; school day.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 34 Education 2 2013-07-01 2013-07-01 false Day; business day; school day. 300.11 Section 300.11 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION ASSISTANCE TO STATES FOR THE EDUCATION...

  9. Reduction of blood loss with the use of a new combined intra-operative and post-operative autologous blood transfusion system compared with no drainage in primary total hip replacement.

    PubMed

    Horstmann, W G; Swierstra, M J; Ohanis, D; Castelein, R M; Kollen, B J; Verheyen, C C P M

    2013-05-01

    Autologous retransfusion and no-drainage are both blood-saving measures in total hip replacement (THR). A new combined intra- and post-operative autotransfusion filter system has been developed especially for primary THR, and we conducted a randomised controlled blinded study comparing this with no-drainage. A total of 204 THR patients were randomised to autologous blood transfusion (ABT) (n = 102) or no-drainage (n = 102). In the ABT group, a mean of 488 ml (sd 252) of blood was retransfused. The mean lowest post-operative haemoglobin level during the hospital stay was higher in the autotransfusion group (10.6 g/dl (7.8 to 13.9) vs 10.2 g/dl (7.5 to 13.3); p = 0.01). The mean haemoglobin levels for the ABT and no-drainage groups were not significantly different on the first day (11.3 g/dl (7.8 to 13.9) vs 11.0 g/dl (8.1 to 13.4); p = 0.07), the second day (11.1 g/dl (8.2 to 13.8) vs 10.8 g/dl (7.5 to 13.3); p = 0.09) or the third day (10.8 g/dl (8.0 to 13.0) vs 10.6 g/dl (7.5 to 14.1); p = 0.15). The mean total peri-operative net blood loss was 1464 ml (sd 505) in the ABT group and 1654 ml (sd 553) in the no-drainage group (p = 0.01). Homologous blood transfusions were needed in four patients (3.9%) in the ABT group and nine (8.8%) in the no-drainage group (p = 0.15). No statistically significant difference in adverse events was found between the groups. The use of a new intra- and post-operative autologous blood transfusion filter system results in less total blood loss and a smaller maximum decrease in haemoglobin levels than no-drainage following primary THR.

  10. When Every Day Is Professional Development Day

    ERIC Educational Resources Information Center

    Tienken, Christopher H.; Stonaker, Lew

    2007-01-01

    In the Monroe Township (New Jersey) Public Schools, teachers' learning occurs daily, not just on one day in October and February. Central office and school-level administrators foster job-embedded teacher growth. Every day is a professional development day in the district, but that has not always been so. How did the district become a system with…

  11. Treatment Planning and Image Guidance for Radiofrequency Ablations of Large Tumors

    PubMed Central

    Ren, Hongliang; Campos-Nanez, Enrique; Yaniv, Ziv; Banovac, Filip; Abeledo, Hernan; Hata, Nobuhiko; Cleary, Kevin

    2014-01-01

    This article addresses the two key challenges in computer-assisted percutaneous tumor ablation: planning multiple overlapping ablations for large tumors while avoiding critical structures, and executing the prescribed plan. Towards semi-automatic treatment planning for image-guided surgical interventions, we develop a systematic approach to the needle-based ablation placement task, ranging from pre-operative planning algorithms to an intra-operative execution platform. The planning system incorporates clinical constraints on ablations and trajectories using a multiple objective optimization formulation, which consists of optimal path selection and ablation coverage optimization based on integer programming. The system implementation is presented and validated in phantom studies and on an animal model. The presented system can potentially be further extended for other ablation techniques such as cryotherapy. PMID:24235279

  12. The Content Validity of the Behaviour Support Plan Quality Evaluation Tool (BSP-QEII) and its Potential Application in Accommodation and Day-Support Services for Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    McVilly, K.; Webber, L.; Sharp, G.; Paris, M.

    2013-01-01

    Background: The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide…

  13. The Content Validity of the Behaviour Support Plan Quality Evaluation Tool (BSP-QEII) and its Potential Application in Accommodation and Day-Support Services for Adults with Intellectual Disability

    ERIC Educational Resources Information Center

    McVilly, K.; Webber, L.; Sharp, G.; Paris, M.

    2013-01-01

    Background: The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide…

  14. PlanHab: the combined and separate effects of 16 days of bed rest and normobaric hypoxic confinement on circulating lipids and indices of insulin sensitivity in healthy men.

    PubMed

    Simpson, Elizabeth J; Debevec, Tadej; Eiken, Ola; Mekjavic, Igor; Macdonald, Ian A

    2016-04-15

    PlanHab is a planetary habitat simulation study. The atmosphere within future space habitats is anticipated to have reduced Po2, but information is scarce as to how physiological systems may respond to combined exposure to moderate hypoxia and reduced gravity. This study investigated, using a randomized-crossover design, how insulin sensitivity, glucose tolerance, and circulating lipids were affected by 16 days of horizontal bed rest in normobaric normoxia [NBR: FiO2 = 0.209; PiO2 = 133.1 (0.3) mmHg], horizontal bed rest in normobaric hypoxia [HBR: FiO2 = 0.141 (0.004); PiO2 = 90.0 (0.4) mmHg], and confinement in normobaric hypoxia combined with daily moderate intensity exercise (HAMB). A mixed-meal tolerance test, with arterialized-venous blood sampling, was performed in 11 healthy, nonobese men (25-45 yr) before (V1) and on the morning ofday 17of each intervention (V2). Postprandial glucose and c-peptide response were increased at V2 of both bed rest interventions (P< 0.05 in each case), with c-peptide:insulin ratio higher at V2 in HAMB and HBR, both in the fed and fasted state (P< 0.005 in each case). Fasting total cholesterol was reduced at V2 in HAMB [-0.47 (0.36) mmol/l;P< 0.005] and HBR [-0.55 (0.41) mmol/l;P< 0.005]. Fasting HDL was lower at V2 in all interventions, with the reduction observed in HBR [-0.30 (0.21) mmol/l] greater than that measured in HAMB [-0.13 (0.14) mmol/l;P< 0.005] and NBR [-0.17 (0.15) mmol/l;P< 0.05]. Hypoxia did not alter the adverse effects of bed rest on insulin sensitivity and glucose tolerance but appeared to increase insulin clearance. The negative effect of bed rest on HDL was compounded in hypoxia, which may have implications for long-term health of those living in future space habitats.

  15. Family Day Care Zoning. Local Officials Guide.

    ERIC Educational Resources Information Center

    Cohen, Abby; And Others

    This guide discusses city planning issues related to family day care zoning. The guide is divided into five sections. The first section discusses child care as a planning issue and focuses on changes in working patterns of families and in residential neighborhoods. The second section describes components of the child care delivery system, which…

  16. Schoolwide Literacy Days.

    ERIC Educational Resources Information Center

    Polder, Darlene D.

    2000-01-01

    Describes 10 "literacy day" activities that one California elementary school has used successfully schoolwide, typically one such day per month, to make reading fun and purposeful, while developing a sense of community. Includes: spread-a-quilt day; teacher exchange day; turn off the TV; Dr. Seuss day; community readers; schoolwide…

  17. Schoolwide Literacy Days.

    ERIC Educational Resources Information Center

    Polder, Darlene D.

    2000-01-01

    Describes 10 "literacy day" activities that one California elementary school has used successfully schoolwide, typically one such day per month, to make reading fun and purposeful, while developing a sense of community. Includes: spread-a-quilt day; teacher exchange day; turn off the TV; Dr. Seuss day; community readers; schoolwide…

  18. Adult Day Care

    MedlinePlus

    ... Page Resize Text Printer Friendly Online Chat Adult Day Care Adult Day Care Centers are designed to provide care and ... adults who need assistance or supervision during the day. Programs offer relief to family members and caregivers, ...

  19. Feasibility and safety of same-day discharge after laparoscopic radical hysterectomy for cervix cancer.

    PubMed

    Philp, Lauren; Covens, Allan; Vicus, Danielle; Kupets, Rachel; Pulman, Katherine; Gien, Lilian T

    2017-09-28

    To evaluate the safety and feasibility of same day-discharge (SDD) after laparoscopic radical hysterectomy for cervix cancer by determining complication rates and factors associated with post-operative admission. In this retrospective cohort study, patients undergoing laparoscopic radical hysterectomy for cervix cancer at a single institution from January 2006 to November 2015 were identified. Admitted patients were compared to same-day discharge patients. Rates of post-operative complications and readmission were analyzed and regression analysis used to determine factors associated with admission. 119 patients were identified. 75 (63%) were SDD patients (mean stay 156.7±50.2min) and 44 (37%) were admitted patients (mean stay 1.2±0.6days). Ten (13%) SDD patients sought medical attention within 30days post-operatively vs. nine (20%) admitted patients (p=0.17). Reasons SDD patients sought attention included pain (n=1), wound concerns (n=2), vaginal bleeding (n=2), DVT/VTE (n=1), fever (n=2) and fistula (n=2). All patients developed symptoms and presented between 5 and 13days post-operatively thus no complications could have been detected or prevented through initial admission. Four SDD patients were readmitted within 30days of surgery (p=0.25), two required re-operation (p=0.16). Admitted patients were older (p=0.049), had longer operations (p=0.02), increased blood loss (p=0.0004), increased intra-operative complications (p=0.001), surgery later in the day (p=0.004) and before April 2010 (p=0.001). On multivariate analysis, older age (OR1.05, p=0.03), surgery later in the day (OR 7.22, p=0.002) and presence of an intra-operative complication (OR 10.25, p=0.02) were significantly associated with admission. Same-day discharge after laparoscopic radical hysterectomy for cervix cancer is safe, with a low risk of post-operative morbidity and hospital readmission. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Intra-operative peritoneal lavage for colorectal cancer

    PubMed Central

    Passot, Guillaume; Mohkam, Kayvan; Cotte, Eddy; Glehen, Olivier

    2014-01-01

    Free cancer cells can be detected in peritoneal fluid at the time of colorectal surgery. Peritoneal lavage in colorectal surgery for cancer is not used in routine, and the prognostic significance of intraperitoneal free cancer cells (IPCC) remains unclear. Data concerning the technique of peritoneal lavage to detect IPCC and its timing regarding colorectal resection are scarce. However, positive IPCC might be the first step of peritoneal spread in colorectal cancers, which could lead to early specific treatments. Because of the important heterogeneity of IPCC determination in reported studies, no treatment have been proposed to patients with positive IPCC. Herein, we provide an overview of IPCC detection and its impact on recurrence and survival, and we suggest further multi-institutional studies to evaluate new treatment strategies. PMID:24616569

  1. Intra-operative peritoneal lavage for colorectal cancer.

    PubMed

    Passot, Guillaume; Mohkam, Kayvan; Cotte, Eddy; Glehen, Olivier

    2014-02-28

    Free cancer cells can be detected in peritoneal fluid at the time of colorectal surgery. Peritoneal lavage in colorectal surgery for cancer is not used in routine, and the prognostic significance of intraperitoneal free cancer cells (IPCC) remains unclear. Data concerning the technique of peritoneal lavage to detect IPCC and its timing regarding colorectal resection are scarce. However, positive IPCC might be the first step of peritoneal spread in colorectal cancers, which could lead to early specific treatments. Because of the important heterogeneity of IPCC determination in reported studies, no treatment have been proposed to patients with positive IPCC. Herein, we provide an overview of IPCC detection and its impact on recurrence and survival, and we suggest further multi-institutional studies to evaluate new treatment strategies.

  2. Current perspectives in intra operative airway management in maxillofacial trauma.

    PubMed

    Vidya, B; Cariappa, K M; Kamath, Abhay T

    2012-06-01

    Maxillofacial trauma presents a complex problem due to the disruption of normal anatomy. In such cases, we anticipate a difficult oral intubation that may hinder intraoperative IMF. Nasal and skull base fractures do not advocate use of nasotracheal intubation. Hence, other anesthetic techniques should be considered in management of maxillofacial trauma patients with occlusal derangement and nasal deformity. This study evaluates the indications and outcomes of anesthetic management by retromolar, nasal, submental intubation and tracheostomy. Of the 49 maxillofacial trauma cases reviewed, that required intraoperative IMF, 32 underwent nasal intubation, 9 patients had tracheostomy, 5 patients utilized submental approach and 3 underwent retromolar intubation. Among patients who underwent nasal intubation, eight cases needed fiberoptic assistance. In retromolar approach, though no complication was encountered, constant monitoring was mandatory to avoid risk of tube displacement. Consequently, submental intubation required a surgical procedure which could result in a cosmetically acceptable scar. Though invasive, tracheostomy has its benefits for long term ventilation. Intubation of any form performed in a maxillofacial trauma patient is complex and requires both sound judgement and considerable experience.

  3. Glycine toxicity and unexpected intra-operative death.

    PubMed

    Byard, R W; Harrison, R; Wells, R; Gilbert, J D

    2001-09-01

    A rare complication of the use of glycine irrigation fluid during prostatic surgery in a 69-year-old man is described. Following cystolithopexy and transurethral resection of the prostate for benign prostatomegaly, abdominal distension developed with increasing ventilatory pressures. Despite retroperitoneal fluid evacuation at subsequent urgent laparotomy, cardiac arrest occurred that was not amenable to resuscitation. At autopsy a traumatic defect in the posterior bladder wall filled with calculus debris was confirmed that did not communicate with the peritoneal cavity. Hyponatremia with markedly elevated levels of blood, urine, and body fluid glycine were demonstrated. Death was, therefore, attributed to glycine toxicity following tracking of glycine through a surgical defect in the posterior bladder wall. Careful dissection of surgical sites is required in such cases to demonstrate any additional trauma that may be associated with the fatal episode. Analysis of body fluids for glycine and electrolytes is also necessary to assist in the determination of possible mechanisms of death.

  4. Gamma and beta intra-operative imaging probes

    NASA Astrophysics Data System (ADS)

    Hoffman, Edward J.; Tornai, Martin P.; Levin, Craig S.; MacDonald, Lawrence R.; Siegel, Stefan

    1997-02-01

    Small area (˜1.5 cm 2) scintillation cameras for imaging gammas and betas using inter-changeable detector front ends were built and characterized. Components common to both emission imaging cameras include: (1) fiber optic bundles 2-3 m long, comprised of multi-clad fibers which connect the scintillation detector to (2) an MC-PMT; (3) parallel MC-PMT outputs feed a resistive positioning network and i- V converter/line driver network which produce balanced +X, -X, +Y, and -Y outputs; and (4) four ADCs and a Macintosh PC for system control and image display. The beta and gamma devices used distinct scintillation detectors which were characterized by both simulation and measurement. The beta camera utilized a 0.5 mm by 1.25 cm φ CaF 2(Eu) scintillation crystal coupled, through a diffusing light guide, to 19 2-mm φ optical fibers. These front-end fibers are in turn coupled by a more flexible fiber bundle to the MC-PMT. CaF 2(Eu) has high light output, high beta sensitivity, and low gamma sensitivity. Image signals are histogrammed and displayed after Anger logic computations are performed on digitized signals. The beta camera has <0.6 mm FWHM intrinsic resolution. The gamma camera concept was tested with matrices of discrete 1 × 1 mm 2 and 2 × 2 mm 2 CsI(Tl) and NaI(Tl) crystals of various lengths, and 3 mm thick continuous crystals. Configurations using 4 × 4 element matrices with one-to-one coupling between crystals and fiber channels, and light diffusers between each crystal matrix and fibers were evaluated. The continuous crystals were coupled directly to the fiber optics with signal and data processing analogous to the beta camera. Coupling of discrete crystals to fiber optics by both methods gave essentially perfect identification of the crystal of interaction, allowing spatial resolution to be defined by the crystal size and collimator. The continuous crystal gamma camera gave intrinsic resolution of ˜1.4 mm FWHM.

  5. Fundamentals of Day Camping. An Ideal Reference for Administrators of Day Camps and School-Age Day Care Programs. Revised.

    ERIC Educational Resources Information Center

    Mitchell, Grace; And Others

    This revised edition of a 1961 publication outlines the steps involved in establishing a new day camp, and presents guidelines for day camp operation. Four chapters cover: (1) preliminary decisions and planning for a new camp; (2) site selection, legal and regulatory considerations, and property management; (3) deciding on buildings and equipment…

  6. Fundamentals of Day Camping. An Ideal Reference for Administrators of Day Camps and School-Age Day Care Programs. Revised.

    ERIC Educational Resources Information Center

    Mitchell, Grace; And Others

    This revised edition of a 1961 publication outlines the steps involved in establishing a new day camp, and presents guidelines for day camp operation. Four chapters cover: (1) preliminary decisions and planning for a new camp; (2) site selection, legal and regulatory considerations, and property management; (3) deciding on buildings and equipment…

  7. CGH Supports World Cancer Day Every Day

    Cancer.gov

    We celebrate World Cancer Day every year on February 4th. This year the theme “We can. I can.” invites us to think not only about how we can work with one another to reduce the global burden of cancer, but how we as individuals can make a difference. Every day the staff at CGH work to establish and build upon programs that are aimed at improving the lives of people affected by cancer.

  8. Surgical planning for microsurgical excision of cerebral arterio-venous malformations using virtual reality technology.

    PubMed

    Ng, Ivan; Hwang, Peter Y K; Kumar, Dinesh; Lee, Cheng Kiang; Kockro, Ralf A; Sitoh, Y Y

    2009-05-01

    To evaluate the feasibility of surgical planning using a virtual reality platform workstation in the treatment of cerebral arterio-venous malformations (AVMs) Patient-specific data of multiple imaging modalities were co-registered, fused and displayed as a 3D stereoscopic object on the Dextroscope, a virtual reality surgical planning platform. This system allows for manipulation of 3D data and for the user to evaluate and appreciate the angio-architecture of the nidus with regards to position and spatial relationships of critical feeders and draining veins. We evaluated the ability of the Dextroscope to influence surgical planning by providing a better understanding of the angio-architecture as well as its impact on the surgeon's pre- and intra-operative confidence and ability to tackle these lesions. Twenty four patients were studied. The mean age was 29.65 years. Following pre-surgical planning on the Dextroscope, 23 patients underwent microsurgical resection after pre-surgical virtual reality planning, during which all had documented complete resection of the AVM. Planning on the virtual reality platform allowed for identification of critical feeders and draining vessels in all patients. The appreciation of the complex patient specific angio-architecture to establish a surgical plan was found to be invaluable in the conduct of the procedure and was found to enhance the surgeon's confidence significantly. Surgical planning of resection of an AVM with a virtual reality system allowed detailed and comprehensive analysis of 3D multi-modality imaging data and, in our experience, proved very helpful in establishing a good surgical strategy, enhancing intra-operative spatial orientation and increasing surgeon's confidence.

  9. International Women's Day speech.

    PubMed

    Kazibwe, S W

    1993-01-01

    The objectives of the International Women's Day are: 1) to celebrate the struggle for women's rights in the economic, social, political, and cultural domain; 2) to reaffirm women's solidarity in the struggle for peace; 3) and to show what women have achieved. In 1988, Uganda's government of the National Resistance Movement created the Ministry of Women in Development. The period 1988-1990 was one of consultations, needs assessment, planning, and recruiting staff for the Ministry. From 1990 to 1993, measurable results have been achieved. The Ministry's gender concerns pertained to the sector policies of the Ministries of Agriculture, Animal Industry and Fisheries, Education, Health, Water, Energy, Minerals, and Environment Protection. Under the Umbrella Project for Women in Development, gender sensitization has been achieved with policy makers in ministries, at district level, and in the media. Gender issues have also been incorporated in the National Political School Curriculum. The Ministry has also trained a corps of 73 women trainers from 38 districts. The Ministry, with funding from DANIDA, collected women's views on the constitution through meetings and seminars in all the districts in the country. Recommendations were submitted in a consolidated report to the Constitution Commission. A pilot para-legal scheme is successfully being implemented in Kamuli district. A community-based pool of legal advisors has been developed. Legal matters that affect both women and men are undertaken at the community level. The economic emancipation of women is a crucial part of the Ministry's mandate. In conjunction with NGOs, pilot credit programs are being run in Mukono, Jinja, Mbale, and Kapchorwa districts. Cross-sectoral programs are in close collaboration with the rural water and sanitation program, the Northern Uganda rehabilitation program, and the integrated Basic Education Pilot Project to be implemented in 8 districts.

  10. Day Care for School-Age Children.

    ERIC Educational Resources Information Center

    Diffendal, Elizabeth

    This booklet examines four aspects of day care services for school-age children: (1) national availability and trends, (2) parents' views, (3) program planning, and (4) recommended program models. A nationwide survey of 58 day care programs enrolling school-age children was conducted, and the general findings are presented. Information on parents'…

  11. Consultation in Day Care.

    ERIC Educational Resources Information Center

    Kiester, Dorothy J.

    This handbook clarifies the responsibility, role and functions of the day care consultant. A chapter on the philosophy of day care is intended to stimulate thoughtful consideration of how existing patterns of day care affect children, parents, and the family. A variety of methods and strategies for translating day care philosophy into practice are…

  12. Adult Day Services

    MedlinePlus

    A Smart Choice Adult Day Services Comparison At-a-Glance 1 Adult Day Services Assisted Living Home Care Nursing Homes Live at home with family ... supervision Nursing care available as needed during the day Flexibility to receive care only on days when ...

  13. Monitoring Project CANAL Training Activities: 28 Phase II Schools Training for Core Planning Teams (Day 1, 2, 3, 4 and 5--September 17, 1990 to June 14, 1991). Fourth Quarter, Year 3 Progress Report (Period Ending August 31, 1991).

    ERIC Educational Resources Information Center

    Davidson, Mary E.; Kurtz, Norman R.

    As part of an ongoing effort to monitor the desegregation implementation of the Chicago (Illinois) Public Schools, a study was done to evaluate the participation of Core Planning Teams (CPTs) in 28 Phase II schools in the CANAL training project at the beginning of the third year of Project CANAL in the fall of 1990. Project CANAL provided five…

  14. Oil spill contingency planning

    SciTech Connect

    Kip, S.H. )

    1988-01-01

    Oil spill contingency planning is an essential feature required in present day activities involving oil and gas exploration, production and transportation. A well through out continency plan will not only eliminate or minimize the sense of panic, normally associated with oil spill emergency, but also can minimize damage and cost involved. Oil spill contingency planning is a process of predetermining a response to an oil spill emergency. The process of preparing a contingency plan is discussed in this paper.

  15. 29 CFR 4041A.24 - Annual plan valuations and monitoring.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... monitoring. (a) Annual valuation. Not later than 150 days after the end of the plan year, the plan sponsor... done as of the end of the plan year in which the plan terminates and each plan year thereafter...

  16. Every Day Is National Lab Day

    ERIC Educational Resources Information Center

    Bull, Glen

    2010-01-01

    President Barack Obama recently issued a call for increased hands-on learning in U.S. schools in an address at the National Academy of Sciences. Obama concluded that the future of the United States depends on one's ability to encourage young people to "create, and build, and invent." In this article, the author discusses National Lab Day (NLD)…

  17. 2012 Diversity Day

    NASA Image and Video Library

    2012-10-31

    John C. Stennis Space Center employees enjoyed 2012 Diversity Day activities Oct. 31. During the day, Stennis employees were able to visit exhibits highlighting different cultures and participate in a range of activities.

  18. Computer-aided position planning of miniplates to treat facial bone defects

    PubMed Central

    Wallner, Jürgen; Gall, Markus; Chen, Xiaojun; Schwenzer-Zimmerer, Katja; Reinbacher, Knut; Schmalstieg, Dieter

    2017-01-01

    In this contribution, a software system for computer-aided position planning of miniplates to treat facial bone defects is proposed. The intra-operatively used bone plates have to be passively adapted on the underlying bone contours for adequate bone fragment stabilization. However, this procedure can lead to frequent intra-operatively performed material readjustments especially in complex surgical cases. Our approach is able to fit a selection of common implant models on the surgeon’s desired position in a 3D computer model. This happens with respect to the surrounding anatomical structures, always including the possibility of adjusting both the direction and the position of the used osteosynthesis material. By using the proposed software, surgeons are able to pre-plan the out coming implant in its form and morphology with the aid of a computer-visualized model within a few minutes. Further, the resulting model can be stored in STL file format, the commonly used format for 3D printing. Using this technology, surgeons are able to print the virtual generated implant, or create an individually designed bending tool. This method leads to adapted osteosynthesis materials according to the surrounding anatomy and requires further a minimum amount of money and time. PMID:28817607

  19. 2016 SPD: Day 1

    NASA Astrophysics Data System (ADS)

    Kohler, Susanna

    2016-06-01

    Editors note: This week were in Boulder, Colorado at the 47th meeting of the AAS Solar Physics Division (SPD). Follow along to catch some of the latest news from the field of solar physics!The 2016 SPD meeting was launched this morning from the University of Colorado Boulder campus. Two of the hot topics at this years meeting include celebration of the recent move of the National Solar Observatorys headquarters to Boulder, and discussion of the future Daniel K. Inouye Solar Telescope (DKIST, formerly the Advanced Technology Solar Telescope, ATST). DKIST, planned for a 2019 completion in Hawaii, is the next big telescope on the horizon for solar physics.Todays press conference had an interesting focus: instruments providing new high-energy observations of the Sun. Representatives from four different instruments were here to talk about some of the latest X-ray solar observations.GRIPSThe GRIPS payload flew at 130,000 ft over Antarctica on a giant balloon in January 2016. [NASA/Albert Shih]First up, Albert Shih (NASA Goddard) described the Gamma-Ray Imager/Polarimeter for Solar flares, or GRIPS. GRIPS is a balloon-borne instrument designed to detect X-rays and gamma rays emitted during solar flares. Up to tens of a percent of the energy in solar flares is emitted in the form of accelerated particles, but the physics behind this process is not well understood. GRIPS observes where the highest-energy particles are accelerated, in an effort to learn more about the process.GRIPS was launched on 19 January, 2016 and flew for roughly 12 days gathering ~1 million seconds of data! The logistics of this instruments flight are especially interesting, since it was launched from Antarctica and carried by a balloon at a whopping elevation of 130,000 ft (to get high enough that the atmosphere doesnt absorb all the photons GRIPS is trying to observe). Though the data from the mission has been retrieved, the bulk of the hardware remains where it landed at the end of January. It must

  20. STS-85 Day 10 Highlights

    NASA Technical Reports Server (NTRS)

    1997-01-01

    On this tenth day of the STS-85 mission, the flight crew, Cmdr. Curtis L. Brown, Jr., Pilot Kent V. Rominger, Payload Cmdr. N. Jan Davis (Ph.D.), Mission Specialists Robert L. Curbeam, Jr. and Stephen K. Robinson (Ph.D.), and Payload Specialist Bjarni V. Tryggvason watch over an experiment designed to study how cooling systems operate in space. With operating problems resolved on the Two-Phase Fluid Loop Experiment, or TPFLEX (teepee flex), investigators expect to get all the data planned for the mission. Robinson later assisted, where necessary, with the CRISTA-SPAS rendezvous activities.

  1. STS-72 Flight Day 7

    NASA Technical Reports Server (NTRS)

    1996-01-01

    On this seventh day of the STS-72 mission, the flight crew, Cmdr. Brian Duffy, Pilot Brent W. Jett, and Mission Specialists Leroy Chiao, Daniel T. Barry, Winston E. Scott, and Koichi Wakata (NASDA), awakened to music from the Walt Disney movie, 'Snow White and the Seven Dwarfs.' Chiao and Scott performed the second spacewalk of the mission where they tested equipment and work platforms that will be used in building the planned International Space Station. This spacewalk was almost seven hours long. Wakata conducted an interview with and answered questions from six graders from a Japanese school in Houston, Texas.

  2. Day Care Evaluation Manual.

    ERIC Educational Resources Information Center

    Council for Community Services in Metropolitan Chicago, IL.

    This manual presents instruments for evaluating the program and facilities of day care centers and family day care homes serving nonhandicapped children aged 3-5. Chapter 1 discusses child care evaluation in general and outlines the rationale underlying this evaluation system (including the principle that day care evaluation should assess program…

  3. Growing degree day calculator

    USDA-ARS?s Scientific Manuscript database

    Degree-day benchmarks indicate discrete biological events in the development of insect pests. For the Sparganothis fruitworm, we have isolated all key development events and linked them to degree-day accumulations. These degree-day accumulations can greatly improve treatment timings for cranberry IP...

  4. Every Day Is Mathematical

    ERIC Educational Resources Information Center

    Barger, Rita H.; Jarrah, Adeeb M.

    2012-01-01

    March 14 is special because it is Pi Day. Mathematics is celebrated on that day because the date, 3-14, replicates the first three digits of pi. Pi-related songs, websites, trivia facts, and more are at the fingertips of interested teachers and students. Less celebrated, but still fairly well known, is National Metric Day, which falls on October…

  5. Every Day Is Mathematical

    ERIC Educational Resources Information Center

    Barger, Rita H.; Jarrah, Adeeb M.

    2012-01-01

    March 14 is special because it is Pi Day. Mathematics is celebrated on that day because the date, 3-14, replicates the first three digits of pi. Pi-related songs, websites, trivia facts, and more are at the fingertips of interested teachers and students. Less celebrated, but still fairly well known, is National Metric Day, which falls on October…

  6. Day Care: Everybody's Problem.

    ERIC Educational Resources Information Center

    Office of Child Development (DHEW), Washington, DC.

    This document reports on statistics regarding the need for day care facilities for children under the age of six. It also gives suggestions for making better use of local day care resources. Statistics show that: (1) There are more than 5 million children in this country under the age of 6 whose mothers work; (2) There are licensed day care…

  7. The evolution of computerized treatment planning for brachytherapy: American contributions

    PubMed Central

    Rivard, Mark J.

    2014-01-01

    Purpose To outline the evolution of computerized brachytherapy treatment planning in the United States through a review of technological developments and clinical practice refinements. Material and methods A literature review was performed and interviews were conducted with six participants in the development of computerized treatment planning for brachytherapy. Results Computerized brachytherapy treatment planning software was initially developed in the Physics Departments of New York's Memorial Hospital (by Nelson, Meurk and Balter), and Houston's M. D. Anderson Hospital (by Stovall and Shalek). These public-domain programs could be used by institutions with adequate computational resources; other clinics had access to them via Memorial's and Anderson's teletype-based computational services. Commercial brachytherapy treatment planning programs designed to run on smaller computers (Prowess, ROCS, MMS), were developed in the late 1980s and early 1990s. These systems brought interactive dosimetry into the clinic and surgical theatre. Conclusions Brachytherapy treatment planning has evolved from systems of rigid implant rules to individualized pre- and intra-operative treatment plans, and post-operative dosimetric assessments. Brachytherapy dose distributions were initially calculated on public domain programs on large regionally located computers. With the progression of computer miniaturization and increase in processor speeds, proprietary software was commercially developed for microcomputers that offered increased functionality and integration with clinical practice. PMID:25097560

  8. UNOCAL 76: Parachute Creek Shale Oil Program. Phase 1 (10,000 barrels/day) Environmental Monitoring Plan. Volume 1. Phase 1 project (Unishale B). Report for 1985-1992

    SciTech Connect

    Not Available

    1986-11-10

    The Energy Security Act of 1980 established a program to provide financial assistance to private industry in the construction and operation of commercial-scale synthetic-fuels plants. The Parachute Creek Shale Oil Program is one of four projects awarded financial assistance. The Program agreed to comply with existing environmental-monitoring regulations and to develop an Environmental Monitoring Plan (EMP) incorporating supplemental monitoring in the areas of water, air, solid waste, and worker health and safety during the period 1985-1992. These activities are described and the rationale for Tier I and Tier II monitoring are explained in the EMP.

  9. 45 CFR 302.13 - Plan amendments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 45 Public Welfare 2 2011-10-01 2011-10-01 false Plan amendments. 302.13 Section 302.13 Public... PLAN REQUIREMENTS § 302.13 Plan amendments. (a) The State plan shall provide that the plan will be... expenditures resulting from an amended provision of the State plan as of the first day of the calendar...

  10. 45 CFR 302.13 - Plan amendments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 45 Public Welfare 2 2012-10-01 2012-10-01 false Plan amendments. 302.13 Section 302.13 Public... PLAN REQUIREMENTS § 302.13 Plan amendments. (a) The State plan shall provide that the plan will be... expenditures resulting from an amended provision of the State plan as of the first day of the calendar...

  11. 2016 SPD: Day 3

    NASA Astrophysics Data System (ADS)

    Kohler, Susanna

    2016-06-01

    observe the Sun all have relatively narrow fields of view. But during an eclipse, we can gain the larger context for the corona with ground-based observations, with the Moon conveniently blocking the light from the Suns disk! The cover photo is a spectacular example of this.Observations of the corona during eclipses can provide information on both enormous events, like coronal mass ejections, and faint dynamical features, like plasma instabilities and expanding loops. In addition, we can learn about the plasma properties by examining emission from highly charged ions. The upcoming eclipse should provide a great opportunity to do some coronal science!A Unique OpportunityThe final press-conference speaker for the meeting was Jay Pasachoff (Williams College and Caltech), a veteran solar eclipse observer who was able to speak to what we could expect if we make it into the path of totality next year.Path of totality across the continental US for the August 2017 eclipse. [Fred Espenak/NASA GSFC]Pasachoff pointed out that there are nearly 12 million people located within the band of totality. There are probably another 200 million within a days drive! He strongly encouraged anyone able to make it to the path of totality to do so, pointing out that the experience in person is completely unlike the experience of watching a video. The process of watching the world around you go dark, he says, is something that simply isnt captured when you watch an eclipse on TV.If you plan to travel for the eclipse, Pasachoffs recommendation is to aim for the northwest end of the path of totality, rather than the southeast end surprisingly, weather statistics suggest you have a better chance of not getting clouded out in the northwest.We now have a year left to educate everyone likely to view the eclipse on when and how to view it safely! Accordingly, Pasachoff concluded the conference by providing a series of links on where to find more information:eclipses.infototalsolareclipse.orgGreatAmericanEclipse.comeclipsophile.com

  12. SU-E-T-154: Establishment and Implement of 3D Image Guided Brachytherapy Planning System

    SciTech Connect

    Jiang, S; Zhao, S; Chen, Y; Li, Z; Li, P; Huang, Z; Yang, Z; Zhang, X

    2014-06-01

    Purpose: Cannot observe the dose intuitionally is a limitation of the existing 2D pre-implantation dose planning. Meanwhile, a navigation module is essential to improve the accuracy and efficiency of the implantation. Hence a 3D Image Guided Brachytherapy Planning System conducting dose planning and intra-operative navigation based on 3D multi-organs reconstruction is developed. Methods: Multi-organs including the tumor are reconstructed in one sweep of all the segmented images using the multiorgans reconstruction method. The reconstructed organs group establishs a three-dimensional visualized operative environment. The 3D dose maps of the three-dimentional conformal localized dose planning are calculated with Monte Carlo method while the corresponding isodose lines and isodose surfaces are displayed in a stereo view. The real-time intra-operative navigation is based on an electromagnetic tracking system (ETS) and the fusion between MRI and ultrasound images. Applying Least Square Method, the coordinate registration between 3D models and patient is realized by the ETS which is calibrated by a laser tracker. The system is validated by working on eight patients with prostate cancer. The navigation has passed the precision measurement in the laboratory. Results: The traditional marching cubes (MC) method reconstructs one organ at one time and assembles them together. Compared to MC, presented multi-organs reconstruction method has superiorities in reserving the integrality and connectivity of reconstructed organs. The 3D conformal localized dose planning, realizing the 'exfoliation display' of different isodose surfaces, helps make sure the dose distribution has encompassed the nidus and avoid the injury of healthy tissues. During the navigation, surgeons could observe the coordinate of instruments real-timely employing the ETS. After the calibration, accuracy error of the needle position is less than 2.5mm according to the experiments. Conclusion: The speed and

  13. Open Day at SHMI.

    NASA Astrophysics Data System (ADS)

    Jarosova, M.

    2010-09-01

    During the World Meteorological Day there has been preparing "Open Day" at Slovak Hydrometeorological Institute. This event has more than 10 years traditions. "Open Day" is one of a lot of possibilities to give more information about meteorology, climatology, hydrology too to public. This "Day" is executed in whole Slovakia. People can visit the laboratories, the forecasting room....and meteo and clima measuring points. The most popular is visiting forecasting room. Visitors are interested in e.g. climatologic change in Slovakia territory, preparing weather forecasting, dangerous phenomena.... Every year we have more than 500 visitors.

  14. Lessons of Liberty: Veterans Day 2001 Teacher's Guide.

    ERIC Educational Resources Information Center

    Department of Veterans Affairs, Washington, DC.

    This teacher's guide helps teachers plan a class program for Veterans Day. The guide contains the following components (many with activities): "History of Veterans Day"; "Veterans Day National Ceremony"; "Suggested Veterans Day Programs"; "America's Wars (Statistics)"; "Fly Your Flag Regularly and…

  15. Science Challenge Day

    ERIC Educational Resources Information Center

    Siegel, Deborah

    2013-01-01

    Science fairs can be good motivators, but as extracurricular activities, they leave some students behind. However, by staging a Science Challenge Day at school, educators can involve all students in doing everything from choosing activities to judging projects. This article presents a model for running a successful Science Challenge Day. The…

  16. Family Science Day

    ERIC Educational Resources Information Center

    McCubbins, Sara; Thomas, Bethany; Vetere, Michael

    2014-01-01

    This article describes a family-friendly science day event that encourages scientific discovery through hands-on activities, while also providing an opportunity to learn about scientific careers from actual research scientists and science educators, thereby raising awareness of the importance of STEM in our society. The one-day event bought…

  17. 2011 Earth Day

    NASA Image and Video Library

    2011-04-21

    Pat Drackett of the Crosby Arboretum in Picayune (l) speaks with Helen Robinson and Arlene Brown, both employees of the Naval Oceanographic Office at Stennis Space Center, during Earth Day 2011 activities April 21. During the day, Stennis employees were able to visit various exhibits featuring environmentally friendly and energy-conscious items and information. The activities were coordinated by the Stennis Environmental Office.

  18. RED-LETTER DAYS

    EPA Science Inventory

    The word "red-letter" is an adjective meaning "of special significance." It's origin is from the practice of marking Christian holy days in red letters on calendars. The "red-letter days" to which I refer occurred while I was a graduate student of ...

  19. Day of the Dead

    ERIC Educational Resources Information Center

    Dann, Tammy; Murphy, Amy

    2012-01-01

    Foreign Language in Elementary School (FLES) teachers in the West Des Moines schools incorporate the Day of the Dead into the fourth grade curriculum each year. The teachers discuss the Day of the Dead celebration at the Art Center, and many ask for volunteers from fourth grade to participate in the event. Student presentations include a wide…

  20. National Day of Service

    NASA Image and Video Library

    2013-01-19

    Former first daughter Chelsea Clinton kicks off the National Day of Service on the National Mall, Saturday, January 19, 2013, in Washington. She urged Americans to get involved in service projects in their communities. Clinton will serve as honorary chair of the 2013 National Day of Service. Photo Credit: (NASA/Carla Cioffi)

  1. [Infants in Day Care].

    ERIC Educational Resources Information Center

    Pawl, Jeree, Ed.; And Others

    1990-01-01

    This newsletter theme issue looks at infant day care models including those emphasizing early intervention with special needs infants. The lead article, "Infants in Day Care: Reflections on Experiences, Expectations and Relationships," by Jeree H. Pawl, stresses the importance of understanding infants' and toddlers' capacities and needs in…

  2. Science Challenge Day

    ERIC Educational Resources Information Center

    Siegel, Deborah

    2013-01-01

    Science fairs can be good motivators, but as extracurricular activities, they leave some students behind. However, by staging a Science Challenge Day at school, educators can involve all students in doing everything from choosing activities to judging projects. This article presents a model for running a successful Science Challenge Day. The…

  3. Family Science Day

    ERIC Educational Resources Information Center

    McCubbins, Sara; Thomas, Bethany; Vetere, Michael

    2014-01-01

    This article describes a family-friendly science day event that encourages scientific discovery through hands-on activities, while also providing an opportunity to learn about scientific careers from actual research scientists and science educators, thereby raising awareness of the importance of STEM in our society. The one-day event bought…

  4. The Presidents' Day Game

    ERIC Educational Resources Information Center

    Maxwell, D. Jackson

    2008-01-01

    The history behind the holiday commonly called "Presidents' Day" is a bit confusing. It started as a federal holiday called Washington's Birthday. It was a day set aside to honor George Washington for his accomplishments as a founding father of the country. Later, many northern states began to recognize Abraham Lincoln's Birthday as well for his…

  5. Day of the Dead

    ERIC Educational Resources Information Center

    Dann, Tammy; Murphy, Amy

    2012-01-01

    Foreign Language in Elementary School (FLES) teachers in the West Des Moines schools incorporate the Day of the Dead into the fourth grade curriculum each year. The teachers discuss the Day of the Dead celebration at the Art Center, and many ask for volunteers from fourth grade to participate in the event. Student presentations include a wide…

  6. 2012 Diversity Day

    NASA Image and Video Library

    2012-10-31

    John C. Stennis Space Center employees enjoyed 2012 Diversity Day activities Oct. 31. During the day, Stennis employees were able to visit cultural exhibits and participate such events as an employee talent showcase, a car/motorcycle show, Stennis 'Family Feud' contests and a cultural dress parade.

  7. 2012 Diversity Day

    NASA Image and Video Library

    2012-10-31

    John C. Stennis Space Center employees enjoyed 2012 Diversity Day activities Oct. 31. The day's color-filled schedule included an employee talent showcase, a car/motorcycle show, Stennis 'Family Feud' contests, a cultural dress parade, food vendors and various cultural exhibits.

  8. School Building Day, 2001.

    ERIC Educational Resources Information Center

    Council of Educational Facility Planners, International, Scottsdale, AZ.

    This document presents information and development materials about "School Building Day" (an event spotlighting the school facility and developing support and pride in the community's schools) to help local school districts conduct their own "School Building Day" to be held on April 20th of 2001. Included are lists of suggested…

  9. The Presidents' Day Game

    ERIC Educational Resources Information Center

    Maxwell, D. Jackson

    2008-01-01

    The history behind the holiday commonly called "Presidents' Day" is a bit confusing. It started as a federal holiday called Washington's Birthday. It was a day set aside to honor George Washington for his accomplishments as a founding father of the country. Later, many northern states began to recognize Abraham Lincoln's Birthday as well for his…

  10. [Infants in Day Care].

    ERIC Educational Resources Information Center

    Pawl, Jeree, Ed.; And Others

    1990-01-01

    This newsletter theme issue looks at infant day care models including those emphasizing early intervention with special needs infants. The lead article, "Infants in Day Care: Reflections on Experiences, Expectations and Relationships," by Jeree H. Pawl, stresses the importance of understanding infants' and toddlers' capacities and needs in…

  11. 29 CFR 2520.104b-2 - Summary plan description.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... furnish such updated summary plan description no later than 210 days following the end of the plan year... shall furnish such updated summary plan description no later than 210 days following the end of the plan... under a pension plan on or before the later of: (1) The date which is 90 days after the employee becomes...

  12. 29 CFR 2520.104b-2 - Summary plan description.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... furnish such updated summary plan description no later than 210 days following the end of the plan year... shall furnish such updated summary plan description no later than 210 days following the end of the plan... under a pension plan on or before the later of: (1) The date which is 90 days after the employee becomes...

  13. 2016 America's Recycle Day

    NASA Image and Video Library

    2016-11-15

    Computers, monitors, vacuum cleaners and other electronics have been donated by employees at NASA's Kennedy Space Center in Florida in conjunction with America Recycles Day. America Recycles Day is a nationally recognized initiative dedicated to promoting recycling in the United States. Kennedy partnered with several organizations in order to donate as many of the items as possible to those who could use them the most in the Space Coast community. Space center personnel brought in electronic waste, gently used household goods, clothing and more. The two-day event was sponsored by Kennedy's Sustainability team.

  14. 2016 America's Recycle Day

    NASA Image and Video Library

    2016-11-15

    A sign points the way to the electronic waste collection site, where NASA Kennedy Space Center employees donated computers, monitors, vacuum cleaners and other electronics in conjunction with America Recycles Day. America Recycles Day is a nationally recognized initiative dedicated to promoting recycling in the United States. Kennedy partnered with several organizations in order to donate as many of the items as possible to those who could use them the most in the Space Coast community. Space center personnel brought in electronic waste, gently used household goods, clothing and more. The two-day event was sponsored by Kennedy's Sustainability team.

  15. 2016 America's Recycle Day

    NASA Image and Video Library

    2016-11-15

    A sign tells NASA Kennedy Space Center employees they have come to the right place to donate items for reuse or recycling in conjunction with America Recycles Day. America Recycles Day is a nationally recognized initiative dedicated to promoting recycling in the United States. Kennedy partnered with several organizations in order to donate as many of the items as possible to those who could use them the most in the Space Coast community. Space center personnel brought in electronic waste, gently used household goods, clothing and more. The two-day event was sponsored by Kennedy's Sustainability team.

  16. 2016 America's Recycle Day

    NASA Image and Video Library

    2016-11-15

    Members of the Sustainability team at NASA's Kennedy Space Center in Florida set up giveaway items and sort through donations for reuse or recycling in conjunction with America Recycles Day. America Recycles Day is a nationally recognized initiative dedicated to promoting recycling in the United States. Kennedy partnered with several organizations in order to donate as many of the items as possible to those who could use them the most in the Space Coast community. Space center personnel brought in electronic waste, gently used household goods, clothing and more. The two-day event was sponsored by Kennedy's Sustainability team.

  17. A Universal Day.

    ERIC Educational Resources Information Center

    Swann, Mike; Walsh, Jean

    2001-01-01

    Describes universal challenge programs, in which all participants, regardless of ability or disability, work as an integrated group. Discusses planning for participant needs and creating a physically and emotionally safe environment. Presents brief instructions for 12 universal activities, including games, problem-solving activities, and high and…

  18. Mandible reconstruction with free fibula flaps: Outcome of a cost-effective individual planning concept compared with virtual surgical planning.

    PubMed

    Rommel, Niklas; Kesting, Marco Rainer; Rohleder, Nils Hagen; Bauer, Florian Martin Josef; Wolff, Klaus-Dietrich; Weitz, Jochen

    2017-08-01

    The free osteomyocutaneous fibular flap has become one of the primary options for mandibular reconstruction, because of the later introduction and development of virtual surgical planning (VSP). However, VSP is associated with high additional pre-operative effort and costs. Therefore, the purpose of the study was to develop a new individual cost-effective pre-operative planning concept for free fibula mandible reconstruction and to compare it with VSP regarding clinical parameters and post-operative outcome. 31 patients undergoing mandibular reconstruction with a microvascular free fibular flap were divided into two groups and retrospectively reviewed. For the first group A (18 of 31 patients), an individual method with stererolithographic (STL) models, silicon templates and hand-made cutting guides was used (about 250 € planning costs/patient). For the second group B (13 of 31 patients), VSP including pre-fabricated cutting guides was used (about 2500 € planning costs/patient). We found no statistically significant differences with respect to intra-operative time of mandibular reconstruction, duration of hospitalisation or post-operative complications between the two groups (p ≥ 0.05). The surgical outcomes and operative efficiency of this individual and cost-effective planning concept are comparable with the much more expensive complete VSP concept. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  19. PlanHab (Planetary Habitat Simulation): the combined and separate effects of 21 days bed rest and hypoxic confinement on human skeletal muscle miRNA expression.

    PubMed

    Rullman, Eric; Mekjavic, Igor B; Fischer, Helene; Eiken, Ola

    2016-04-01

    The study concerns effects of 21 days of sustained bedrest and hypoxia, alone and in combination, on skeletal muscle microRNA (miRNA) expression. It is expected that astronauts undertaking long-duration missions will be exposed not only to microgravity but also to a hypoxic environment. The molecular machinery underlying microgravity-induced alterations in skeletal muscle structure and function is still largely unknown. One possible regulatory mechanism is altered expression of miRNAs, a group of noncoding RNAs which down-regulate many different target genes through increased degradation or translation of their messenger RNA Thirteen healthy men underwent three 21-day interventions, interspersed by 4-month washout periods: horizontal bedrest in normoxia, bedrest in hypoxia, ambulation in hypoxia. The level of hypoxia corresponded to 4000 m altitude. miRNAs from v. lateralis muscle biopsies were analyzed using a microarray covering ≈4000 human miRNAs. Sixteen mature miRNAs were up-regulated and three down-regulated after bedrest. The magnitudes of these changes were small and a large portion of the miRNAs affected by bedrest was also differentially expressed after washout periods. In fact, the number of differentially expressed probe sets over time was substantially larger than what could be detected after bedrest. Still, the majority of the miRNAs (let-7, miR-15, miR-25, miR-199, miR-133) that were differentially expressed following bedrest, belong to miRNA families previously reported in the context of muscle physiology, in particular to respond to changes in mechanical loading. Since only minor changes in miRNA expression could be detected after bedrest, our data indicate miRNA to play only a minor role in the substantial change in muscle phenotype seen with unloading. © 2016 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

  20. NASA Earth Day 2014

    NASA Image and Video Library

    2014-04-22

    Students listen intently while NASA's Director, Earth Science Division, Mike Freilich, speaks at NASA's Earth Day event. The event took place at Union Station in Washington, DC on April 22, 2014. Photo Credit: (NASA/Aubrey Gemignani)

  1. Disability Mentoring Day

    NASA Image and Video Library

    2011-04-07

    A student from the Maryland School For the Blind explores an object while learning about Meteorites, Asteroids and Comets during NASA's Disability Mentoring Day, Thursday, April 7, 2011, at NASA Headquarters in Washignton. Photo Credit: (NASA/Paul E. Alers)

  2. Disability Mentoring Day

    NASA Image and Video Library

    2011-04-07

    A student from the Maryland School For the Blind asks a question while learning about Meteorites, Asteroids and Comets during NASA's Disability Mentoring Day, Thursday, April 7, 2011, at NASA Headquarters in Washignton. Photo Credit: (NASA/Paul E. Alers)

  3. Disability Mentoring Day

    NASA Image and Video Library

    2011-04-07

    A student from the Maryland School For the Blind explores a braille map during NASA's Disability Mentoring Day, Thursday, April 7, 2011, at NASA Headquarters in Washignton. Photo Credit: (NASA/Paul E. Alers)

  4. Disability Mentoring Day

    NASA Image and Video Library

    2011-04-07

    Students from the Maryland School for the Blind learn about space food from NASA Public Affairs specialist Nora Normandy, right, during Disability Mentoring Day, Thursday, April 7, 2011, at NASA Headquarters in Washington. Photo Credit (NASA/Paul E. Alers)

  5. Disability Mentoring Day

    NASA Image and Video Library

    2011-04-07

    Students from the Maryland School for the Blind learn about astronauts during NASA's Disability Mentoring Day, Thursday, April 7, 2011, at NASA Headquarters in Washignton. Photo Credit: (NASA/Paul E. Alers)

  6. NASA Earth Day 2014

    NASA Image and Video Library

    2014-04-22

    NASA's Administrator, Charles Bolden, conducts an experiment using circuits at NASA's Earth Day event. The event took place at Union Station in Washington, DC on April 22, 2014. Photo Credit: (NASA/Aubrey Gemignani)

  7. Old Timers' Day

    NASA Image and Video Library

    2012-05-18

    Former Stennis Space Center employees enjoyed a return to the test facility for Old Timers' Day activities May 18, 2012. The annual fellowship was attended by about 150 retirees, guests and employees.

  8. Pregnancy - identifying fertile days

    MedlinePlus

    ... between days 7 and 20 of a woman's menstrual cycle. In order to become pregnant, having sex every ... hours of ovulation. If you have an irregular menstrual cycle, an ovulation predictor kit can help you know ...

  9. Career Day 2012

    NASA Image and Video Library

    More than 200 high school juniors and seniors with interests in science, technology, engineering and math met one-on-one with professionals at NASA's Langley Research Center during Career Day 2012,...

  10. Space Day 2000.

    ERIC Educational Resources Information Center

    Winslow, Joyce

    2000-01-01

    Introduces three design challenges for fourth, fifth, and sixth grade students created by the Challenger Center for Space Science Education. Presents information on Space Day and the National Classroom and provides Internet site addresses. (YDS)

  11. Stennis Day Camper

    NASA Technical Reports Server (NTRS)

    2005-01-01

    Sara Beth Casey, 5, proudly displays her artwork, 'Planets.' Sara Beth created the art as a student of Stennis Day Camp, a free camp for Stennis Space Center employees' children whose schools have not resumed since Hurricane Katrina hit the region on Aug. 29. The camp has registered nearly 200 children and averages 100 children each day. The camp will continue until all schools are back in session.

  12. 2016 America's Recycle Day

    NASA Image and Video Library

    2016-11-15

    Members of the Sustainability team at NASA's Kennedy Space Center in Florida shred a disposed hard drive in conjunction with America Recycles Day. America Recycles Day is a nationally recognized initiative dedicated to promoting recycling in the United States. Kennedy partnered with several organizations in order to donate as many of the items as possible to those who could use them the most in the Space Coast community. Space center personnel brought in electronic waste, gently used household goods, clothing and more.

  13. 2016 America's Recycle Day

    NASA Image and Video Library

    2016-11-15

    Members of the Sustainability team at NASA's Kennedy Space Center in Florida accept items donated by employees in conjunction with America Recycles Day. America Recycles Day is a nationally recognized initiative dedicated to promoting recycling in the United States. Kennedy partnered with several organizations in order to donate as many of the items as possible to those who could use them the most in the Space Coast community. Space center personnel brought in electronic waste, gently used household goods, clothing and more.

  14. Stennis Day Camper

    NASA Image and Video Library

    2005-10-05

    Sara Beth Casey, 5, proudly displays her artwork, 'Planets.' Sara Beth created the art as a student of Stennis Day Camp, a free camp for Stennis Space Center employees' children whose schools have not resumed since Hurricane Katrina hit the region on Aug. 29. The camp has registered nearly 200 children and averages 100 children each day. The camp will continue until all schools are back in session.

  15. Sun-Earth Days

    NASA Astrophysics Data System (ADS)

    Thieman, J.; Ng, C.; Lewis, E.; Cline, T.

    2010-08-01

    Sun-Earth Day is a well-coordinated series of programs, resources and events under a unique yearly theme highlighting the fundamentals of heliophysics research and missions. A menu of activities, conducted throughout the year, inspire and educate participants. Sun-Earth Day itself can vary in date, but usually is identified by a celebration on or near the spring equinox. Through the Sun-Earth Day framework we have been able to offer a series of coordinated events that promote and highlight the Sun, its connection to Earth and the other planets. Sun-Earth Day events are hosted by educators, museums, amateur astronomers and scientists and occur at schools, community groups, parks, planetaria and science centers around the globe. Sun-Earth Day raises the awareness and knowledge of formal and informal education audiences concerning space weather and heliophysics. By building on the success of Sun-Earth Day yearly celebrations, we seek to affect people of all backgrounds and ages with the wonders of heliophysics science, discovery, and exploration in ways that are both tangible and meaningful to their lives.

  16. 42 CFR 430.20 - Effective dates of State plans and plan amendments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Effective dates of State plans and plan amendments... State Plans § 430.20 Effective dates of State plans and plan amendments. For purposes of FFP, the... first day of the quarter in which an approvable plan is submitted to the regional office; and (2)...

  17. Building Consensus in the First 100 Days.

    ERIC Educational Resources Information Center

    Ritchey, David

    2001-01-01

    During the Bush Administration's first 100 days, Congress introduced the No Child Left Behind reform plan, Secretary of Education Rod Paige visited school campuses in 15 states, and the education budget was increased by 11.5 percent. Accountability for results, maximum local control, and results-driven funding are the new catchwords. (MLH)

  18. Facilities and Equpment for Day Care Centers.

    ERIC Educational Resources Information Center

    Campbell, Sheila D.

    This guide provides assistance in selecting and designing the day care center's building and grounds and in planning and arranging the center's playroom. In regard to the building and grounds, discussion considers program and support service functions, highly desirable features of buildings and grounds, playroom space, outdoor space, and…

  19. The Family Day Care Providers' Legal Handbook.

    ERIC Educational Resources Information Center

    Treadwell, Lujuana Wolfe

    Designed specifically for family day care providers in Alameda County, California, this handbook provides legal and business advice thought to be useful as well to providers throughout the United States. A wide range of legal and business issues is covered in 15 brief chapters. Advice is offered on provider-parent contracts, planning for accidents…

  20. Facilities and Equpment for Day Care Centers.

    ERIC Educational Resources Information Center

    Campbell, Sheila D.

    This guide provides assistance in selecting and designing the day care center's building and grounds and in planning and arranging the center's playroom. In regard to the building and grounds, discussion considers program and support service functions, highly desirable features of buildings and grounds, playroom space, outdoor space, and…

  1. Rainy Day Fun: Rain-Inspired Activities.

    ERIC Educational Resources Information Center

    Stanger, Annie Moretz

    1999-01-01

    Rainy days are opportunities to teach campers about weather and to plan activities around a rain theme. Indoor and outdoor science-based activities concerned with rain, water, or water conservation are suggested for specific age groups from ages 5-7 through 11-14. Campers can also develop ideas for activities using questions provided. (CDS)

  2. AAS 227: Day 2

    NASA Astrophysics Data System (ADS)

    Kohler, Susanna

    2016-01-01

    Editors Note:This week were at the 227th AAS Meeting in Kissimmee, FL. Along with several fellow authors from astrobites.com, I will bewritingupdates on selectedevents at themeeting and posting at the end of each day. Follow along here or atastrobites.com, or catch ourlive-tweeted updates from the@astrobites Twitter account. The usual posting schedule for AAS Nova will resumenext week.Welcome to Day 2 of the winter American Astronomical Society (AAS) meeting in Kissimmee! Several of us are attending the conference this year, and we will report highlights from each day here on astrobites. If youd like to see more timely updates during the day, we encourage you to follow @astrobites on twitter or search the #aas227 hashtag.Plenary Session: Black Hole Physics with the Event Horizon Telescope (by Susanna Kohler)If anyone needed motivation to wake up early this morning, they got it in the form of Feryal Ozel (University of Arizona) enthralling us all with exciting pictures, videos, and words about black holes and the Event Horizon Telescope. Ozel spoke to a packed room (at 8:30am!) about where the project currently stands, and where its heading in the future.The EHT has pretty much the coolest goal ever: actually image the event horizons of black holes in our universe. The problem is that the largest black hole we can look at (Sgr A*, in the center of our galaxy) has an event horizon size of 50 as. For this kind of resolution roughly equivalent to trying to image a DVD on the Moon! wed need an Earth-sized telescope. EHT has solved this problem by linking telescopes around the world, creating one giant, mm-wavelength effective telescope with a baseline the size of Earth.Besides producing awesome images, the EHT will be able to test properties of black-hole spacetime, the no-hair theorem, and general relativity (GR) in new regimes.Ozel walked us through some of the theory prep work we need to do now in order to get the most science out of the EHT, including devising new

  3. Jupiter Night and Day

    NASA Technical Reports Server (NTRS)

    2001-01-01

    Day and night side narrow angle images taken on January 1, 2001 illustrating storms visible on the day side which are the sources of visible lightning when viewed on the night side. The images have been enhanced in contrast. Note the two day-side occurrences of high clouds, in the upper and lower parts of the image, are coincident with lightning storms seen on the darkside. The storms occur at 34.5 degrees and 23.5 degrees North latitude, within one degree of the latitudes at which similar lightning features were detected by the Galileo spacecraft. The images were taken at different times. The storms' longitudinal separation changes from one image to the next because the winds carrying them blow at different speeds at the two latitudes.

  4. 2016 America's Recycle Day

    NASA Image and Video Library

    2016-11-15

    Members of the Sustainability team at NASA's Kennedy Space Center in Florida look over appliances donated for reuse or recycling in conjunction with America Recycles Day. America Recycles Day is a nationally recognized initiative dedicated to promoting recycling in the United States. Kennedy partnered with several organizations in order to donate as many of the items as possible to those who could use them the most in the Space Coast community. Space center personnel brought in electronic waste, gently used household goods, clothing and more.

  5. 2016 America's Recycle Day

    NASA Image and Video Library

    2016-11-15

    Members of the Sustainability team at NASA's Kennedy Space Center in Florida take a bin of disposed hard drives to be shredded in conjunction with America Recycles Day. America Recycles Day is a nationally recognized initiative dedicated to promoting recycling in the United States. Kennedy partnered with several organizations in order to donate as many of the items as possible to those who could use them the most in the Space Coast community. Space center personnel brought in electronic waste, gently used household goods, clothing and more.

  6. 2016 America's Recycle Day

    NASA Image and Video Library

    2016-11-15

    Computers, monitors, vacuum cleaners and other electronics have been donated by employees at NASA's Kennedy Space Center in Florida in conjunction with America Recycles Day. America Recycles Day is a nationally recognized initiative dedicated to promoting recycling in the United States. Kennedy partnered with several organizations in order to donate as many of the items as possible to those who could use them the most in the Space Coast community. Space center personnel brought in electronic waste, gently used household goods, clothing and more.

  7. 2016 America's Recycle Day

    NASA Image and Video Library

    2016-11-15

    Members of the Sustainability team at NASA's Kennedy Space Center in Florida sort through items donated for reuse or recycling in conjunction with America Recycles Day. America Recycles Day is a nationally recognized initiative dedicated to promoting recycling in the United States. Kennedy partnered with several organizations in order to donate as many of the items as possible to those who could use them the most in the Space Coast community. Space center personnel brought in electronic waste, gently used household goods, clothing and more.

  8. External validation of the Revised Cardiac Risk Index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study.

    PubMed

    Roshanov, Pavel S; Walsh, Michael; Devereaux, P J; MacNeil, S Danielle; Lam, Ngan N; Hildebrand, Ainslie M; Acedillo, Rey R; Mrkobrada, Marko; Chow, Clara K; Lee, Vincent W; Thabane, Lehana; Garg, Amit X

    2017-01-09

    The Revised Cardiac Risk Index (RCRI) is a popular classification system to estimate patients' risk of postoperative cardiac complications based on preoperative risk factors. Renal impairment, defined as serum creatinine >2.0 mg/dL (177 µmol/L), is a component of the RCRI. The estimated glomerular filtration rate has become accepted as a more accurate indicator of renal function. We will externally validate the RCRI in a modern cohort of patients undergoing non-cardiac surgery and update its renal component. The Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation (VISION) study is an international prospective cohort study. In this prespecified secondary analysis of VISION, we will test the risk estimation performance of the RCRI in ∼34 000 participants who underwent elective non-cardiac surgery between 2007 and 2013 from 29 hospitals in 15 countries. Using data from the first 20 000 eligible participants (the derivation set), we will derive an optimal threshold for dichotomising preoperative renal function quantified using the Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) glomerular filtration rate estimating equation in a manner that preserves the original structure of the RCRI. We will also develop a continuous risk estimating equation integrating age and CKD-Epi with existing RCRI risk factors. In the remaining (approximately) 14 000 participants, we will compare the risk estimation for cardiac complications of the original RCRI to this modified version. Cardiac complications will include 30-day non-fatal myocardial infarction, non-fatal cardiac arrest and death due to cardiac causes. We have examined an early sample to estimate the number of events and the distribution of predictors and missing data, but have not seen the validation data at the time of writing. The research ethics board at each site approved the VISION protocol prior to recruitment. We will publish our results and make our models available online at http

  9. External validation of the Revised Cardiac Risk Index and update of its renal variable to predict 30-day risk of major cardiac complications after non-cardiac surgery: rationale and plan for analyses of the VISION study

    PubMed Central

    Walsh, Michael; Devereaux, P J; MacNeil, S Danielle; Lam, Ngan N; Hildebrand, Ainslie M; Acedillo, Rey R; Mrkobrada, Marko; Chow, Clara K; Lee, Vincent W; Thabane, Lehana; Garg, Amit X

    2017-01-01

    Introduction The Revised Cardiac Risk Index (RCRI) is a popular classification system to estimate patients' risk of postoperative cardiac complications based on preoperative risk factors. Renal impairment, defined as serum creatinine >2.0 mg/dL (177 µmol/L), is a component of the RCRI. The estimated glomerular filtration rate has become accepted as a more accurate indicator of renal function. We will externally validate the RCRI in a modern cohort of patients undergoing non-cardiac surgery and update its renal component. Methods and analysis The Vascular Events in Non-cardiac Surgery Patients Cohort Evaluation (VISION) study is an international prospective cohort study. In this prespecified secondary analysis of VISION, we will test the risk estimation performance of the RCRI in ∼34 000 participants who underwent elective non-cardiac surgery between 2007 and 2013 from 29 hospitals in 15 countries. Using data from the first 20 000 eligible participants (the derivation set), we will derive an optimal threshold for dichotomising preoperative renal function quantified using the Chronic Kidney Disease Epidemiology Collaboration (CKD-Epi) glomerular filtration rate estimating equation in a manner that preserves the original structure of the RCRI. We will also develop a continuous risk estimating equation integrating age and CKD-Epi with existing RCRI risk factors. In the remaining (approximately) 14 000 participants, we will compare the risk estimation for cardiac complications of the original RCRI to this modified version. Cardiac complications will include 30-day non-fatal myocardial infarction, non-fatal cardiac arrest and death due to cardiac causes. We have examined an early sample to estimate the number of events and the distribution of predictors and missing data, but have not seen the validation data at the time of writing. Ethics and dissemination The research ethics board at each site approved the VISION protocol prior to recruitment. We will

  10. STS-85 Day 09 Highlights

    NASA Technical Reports Server (NTRS)

    1997-01-01

    On this ninth day of the STS-85 mission, the flight crew, Cmdr. Curtis L. Brown, Jr., Pilot Kent V. Rominger, Payload Cmdr. N. Jan Davis (Ph.D.), Mission Specialists Robert L. Curbeam, Jr. and Stephen K. Robinson (Ph.D.), and Payload Specialist Bjarni V. Tryggvason watch over the Manipulator Flight Demonstration (MFD) experiment while Japanese investigators again maneuvere the Small Fine Arm remotely from a control room near Mission Control. It is the final planned work with the arm during this mission. While MFD operations are ongoing, Robinson again uses the Southwest Ultraviolet Imaging System's ultraviolet imaging telescope to observe Comet Hale-Bopp and Curbeam continue his work with the Bioreactor Demonstration System designed to perform cell biology experiments under controlled conditions. Tryggvason spends his day supporting data gathering with the Microgravity Vibration Isolation Mount experiment. Before the crew's workday began, they discussed the mission's progress with reporters in the U.S. and Canada as part of the traditional crew news conference. Questions ranged from life in space for the first time space travelers to providing a report card on the more than 24 experiments being conducted throughout the mission.

  11. Disability Mentoring Day

    NASA Image and Video Library

    2011-04-07

    A student from the Maryland School For the Blind touches a piece of moon rock while learning about Meteorites, Asteroids and Comets during NASA's Disability Mentoring Day, Thursday, April 7, 2011, at NASA Headquarters in Washignton. Photo Credit: (NASA/Paul E. Alers)

  12. Dog Day Afternoon.

    ERIC Educational Resources Information Center

    Filipczak, Bob

    1997-01-01

    Discusses the problem faced by trainers who are "on stage" for eight hours a day. Offers tips to relieve the stress caused by continuous training, including maintaining personal space, taking a lunch break, keeping physically energized, and avoiding burnout when teaching the same thing over and over. (JOW)

  13. Expedition 23 Launch Day

    NASA Image and Video Library

    2010-04-01

    Expedition 23 Flight Engineer Tracy Caldwell Dyson performs the traditional door signing Friday, April 2, 2010 at the Cosmonaut Hotel in Baikonur, Kazakhstan. Caldwell Dyson was launched onboard the Soyuz rocket later that day with Expedition 23 Soyuz Commander Alexander Skvortsov and Flight Engineer Mikhail Kornienko on a mission to the International Space Station (ISS). Photo Credit: (NASA/Carla Cioffi)

  14. 2012 Earth Day

    NASA Image and Video Library

    2012-04-24

    Bonnie Humphrey of NASA (l to r), Van Ward of NASA, Kim Maddox of the Naval Oceanographic Office, and Al Bryden of the NASA Shared Services Center learn about the Crosby Arboretum in Picayune, Miss., during the Earth Day celebration at Stennis Space Center on April 24, 2012.

  15. 2012 Day of Remembrance

    NASA Image and Video Library

    2012-01-25

    Stennis Space Center Director Patrick Scheuermann (left) and Associate Director Ken Human place a wreath in the Roy S. Estess Building on Jan. 25, 2012, in memory of the NASA family who lost their lives while furthering the cause of exploration and discovery. The wreath was placed during NASA's 2012 Day of Remembrance, which is observed each January.

  16. First Day of School

    ERIC Educational Resources Information Center

    Bort, Nancy

    2004-01-01

    In this brief article, the author, a science teacher at F. C. Hammond Middle School in Alexandria, Virginia, describes how the setting up of a simple science experiment on the first day of school can get students excited about learning science. The experiment involves heating a small amount of water in a flask, then covering the opening of the…

  17. Day Of Remembrance

    NASA Image and Video Library

    2008-01-31

    NASA Deputy Administrator Shana Dale, left, and other NASA senior management participate in a wreath laying ceremony as part of NASA's Day of Remembrance, Thursday, Jan. 31 2008, at Arlington National Cemetery. The wreaths were laid in the memory of those men and women who lost their lives in the quest of space exploration. Photo Credit: (NASA/Bill Ingalls)

  18. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    The Space Shuttle Challenger Memorial is seen after a wreath laying ceremony that was part of NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. Wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  19. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    Remembrances are seen left at the base of the Space Shuttle Challenger Crew Memorial during NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. Wreaths were also laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  20. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    The Space Shuttle Columbia and Space Shuttle Challenger memorials are seen after a wreath laying ceremony that was part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  1. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    NASA Administrator Charles Bolden and his wife Alexis lay a wreath at the Tomb of the Unknowns as part of NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  2. Day of Remembrance

    NASA Image and Video Library

    2011-01-27

    NASA Administrator Charles Bolden and other NASA personnel participate in a wreath laying ceremony as part of NASA's Day of Remembrance, Thursday, Jan. 27, 2011, at Arlington National Cemetery. Wreathes were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  3. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    NASA Administrator Charles Bolden participates in a wreath laying ceremony as part of NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  4. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    NASA Administrator Charles Bolden speaks to NASA personnel and others during a wreath laying ceremony as part of NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  5. Day of Remembrance

    NASA Image and Video Library

    2010-01-29

    NASA Administrator Charles Bolden participates in a wreath laying ceremony as part of NASA's Day of Remembrance, Friday, Jan. 29, 2010, at Arlington National Cemetery. The wreathes were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  6. Day Of Remembrance

    NASA Image and Video Library

    2013-02-01

    The headstones of Virgil "Gus" Grissom, left, and Roger Chaffee are seen after a wreath laying ceremony that was part of NASA's Day of Remembrance, Friday, Feb. 1, 2013, at Arlington National Cemetery. Wreathes were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  7. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    The Space Shuttle Challenger Memorial is seen after a wreath laying ceremony that was part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  8. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    NASA Administrator Charles Bolden and his wife Alexis lay a wreath at the Tomb of the Unknowns as part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  9. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    NASA personnel watch as a wreath is laid at the Tomb of the Unknowns by NASA Administrator Charles Bolden as part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  10. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    The Space Shuttle Columbia Memorial is seen after a wreath laying ceremony that was part of NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. Wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  11. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    NASA personnel watch as a wreath is laid at the Tomb of the Unknowns by NASA Administrator Charles Bolden as part of NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  12. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    NASA Administrator Charles Bolden speaks to NASA personnel and others during a wreath laying ceremony as part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  13. Day Of Remembrance

    NASA Image and Video Library

    2008-01-31

    NASA Deputy Administrator Shana Dale participates in a wreath laying ceremony as part of NASA's Day of Remembrance, Thursday, Jan. 31, 2008, at Arlington National Cemetery. The wreaths were laid in the memory of those men and women who lost their lives in the quest of space exploration. Photo Credit: (NASA/Bill Ingalls)

  14. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    NASA Administrator Charles Bolden visits the Space Shuttle Columbia Memorial during a wreath laying ceremony that was part of NASA's Day of Remembrance, Friday, Jan. 31, 2014 at Arlington National Cemetery. Wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  15. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    The Space Shuttle Columbia Memorial is seen after a wreath laying ceremony that was part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  16. Day of Remembrance

    NASA Image and Video Library

    2011-01-27

    NASA Administrator Charles Bolden participates in a wreath laying ceremony as part of NASA's Day of Remembrance, Thursday, Jan. 27, 2011, at Arlington National Cemetery. Wreathes were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  17. Day of Remembrance

    NASA Image and Video Library

    2009-01-29

    NASA Acting Administrator Christopher Scolese, left, and other NASA senior leaders participate in a wreath laying ceremony as part of NASA's Day of Remembrance, Thursday, Jan. 29, 2009, at Arlington National Cemetery. The wreathes were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  18. Day Of Remembrance

    NASA Image and Video Library

    2013-02-01

    Apollo 11 astronaut Buzz Aldrin salutes as NASA Administrator Charles Bolden looks on during a wreath laying ceremony as part of NASA's Day of Remembrance, Friday, Feb. 1, 2013, at Arlington National Cemetery. Wreathes were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  19. Scheduling: Seven Period Day

    ERIC Educational Resources Information Center

    Williamson, Ronald

    2010-01-01

    Driven by stable or declining financial resources many school districts are considering the costs and benefits of a seven-period day. While there is limited evidence that any particular scheduling model has a greater impact on student learning than any other, it is clear that the school schedule is a tool that can significantly impact teacher…

  20. Word of the Day

    ERIC Educational Resources Information Center

    Abrar-Ul-Hassan, Shahid

    2010-01-01

    Independent lexical development initiatives empower and equip language learners with skills to boost their lexical repertoires. Language instructors can train learners to be autonomous word learners. A sample activity, namely word of the day, is presented in this article. The activity is an independent lexical learning task, which aims to develop…

  1. 90-Day Cycle Handbook

    ERIC Educational Resources Information Center

    Park, Sandra; Takahashi, Sola

    2013-01-01

    90-Day Cycles are a disciplined and structured form of inquiry designed to produce and test knowledge syntheses, prototyped processes, or products in support of improvement work. With any type of activity, organizations inevitably encounter roadblocks to improving performance and outcomes. These barriers might include intractable problems at…

  2. We Love Science Day.

    ERIC Educational Resources Information Center

    Kepler, Lynne

    1986-01-01

    Describes the goals and outcomes of the "We Love Science Day" programs that resulted from the inservice course, "Creative Integration of Science in Elementary Education" for Pennsylvania teachers. Provides samples of the hands-on activities that were offered to students, parents, and teachers. Includes a calendar of…

  3. National Day of Service

    NASA Image and Video Library

    2013-01-19

    Actress Eva Longoria, Co-Chair of the Presidential Inaugural Committee, speaks at the National Day of Service on the National Mall, Saturday, January 19, 2013, in Washington. NASA along with other federal agencies set up along the Mall as part of events surrounding the inauguration of President Barack Obama. Photo Credit: (NASA/Carla Cioffi)

  4. Sun-Earth Day

    NASA Image and Video Library

    2007-04-11

    Michael Sandras, a member of the Pontchartrain Astronomical Society, explains his solar telescope to students of Second Street in Bay St. Louis, Hancock County and Nicholson elementary schools in StenniSphere's Millennium Hall on April 10. The students participated in several hands-on activities at Stennis Space Center's Sun-Earth Day celebration.

  5. Make a Splash Day

    ERIC Educational Resources Information Center

    Coverdale, Greg; Rust, April; Jensen, Belinda

    2004-01-01

    At the annual, all-day events-sponsored by Project WET (Water Education for Teachers) and held in nearly every state across the country each September--students participate in interactive activities and exhibits to learn about water resources and explore how human behaviors, such as development and recreation, can affect the quality of the…

  6. Seize the Day

    ERIC Educational Resources Information Center

    Berkey, Tim

    2008-01-01

    In order to improve what happens in classrooms, a considerable amount of work needs to take place between teachers and principals. This can only happen if campus leaders make dramatic shifts in how and where they spend their daily time. Principals can have a greater impact on teaching and learning by transforming their work one day at a time. The…

  7. We Love Science Day.

    ERIC Educational Resources Information Center

    Kepler, Lynne

    1986-01-01

    Describes the goals and outcomes of the "We Love Science Day" programs that resulted from the inservice course, "Creative Integration of Science in Elementary Education" for Pennsylvania teachers. Provides samples of the hands-on activities that were offered to students, parents, and teachers. Includes a calendar of…

  8. 21-Day Content Screen

    EPA Pesticide Factsheets

    Under PRIA, EPA has 21 days after it receives the pesticide application and the fee to conduct an initial screen of the application’s contents for completeness and for the applicant to make necessary corrections. This page provides the checklists we use.

  9. Sun-Earth Day

    NASA Technical Reports Server (NTRS)

    2007-01-01

    Michael Sandras, a member of the Pontchartrain Astronomical Society, explains his solar telescope to students of Second Street in Bay St. Louis, Hancock County and Nicholson elementary schools in StenniSphere's Millennium Hall on April 10. The students participated in several hands-on activities at Stennis Space Center's Sun-Earth Day celebration.

  10. Every Child, Every Day

    ERIC Educational Resources Information Center

    Allington, Richard L.; Gabriel, Rachael E.

    2012-01-01

    We know more now than we ever did before about how to make every child a successful reader, write Allington and Gabriel in this research review. Yet, few students regularly receive the best reading instruction we know how to give. The authors present research supporting their recommendation that every child, every day, should (1) read something he…

  11. NASA Day of Remembrance

    NASA Image and Video Library

    2009-01-29

    Stennis Space Center Director Gene Goldman (left) and Deputy Director Patrick Scheuermann place a wreath in StenniSphere in memory of the 17 astronauts lost in service of the space program since 1967. The wreath was placed during NASA's 2009 Day of Remembrance, observed each year on the last Thursday of January.

  12. Fabulous Weather Day

    ERIC Educational Resources Information Center

    Marshall, Candice; Mogil, H. Michael

    2007-01-01

    Each year, first graders at Kensington Parkwood Elementary School in Kensington, Maryland, look forward to Fabulous Weather Day. Students learn how meteorologists collect data about the weather, how they study wind, temperature, precipitation, basic types/characteristics of clouds, and how they forecast. The project helps the students grow in…

  13. Day Care: Nutrition.

    ERIC Educational Resources Information Center

    Foster, Florence P.; And Others

    This collection of 12 short, bilingual papers on nutrition and preschool children is part of a series of papers on various aspects of day care published by the Canadian Department of Health and Welfare. Each paper is presented in both English and French. Topics dealt with include an overview of children's nutritional needs; development of…

  14. Day Care: Nutrition.

    ERIC Educational Resources Information Center

    Foster, Florence P.; And Others

    This collection of 12 short, bilingual papers on nutrition and preschool children is part of a series of papers on various aspects of day care published by the Canadian Department of Health and Welfare. Each paper is presented in both English and French. Topics dealt with include an overview of children's nutritional needs; development of…

  15. A Day of Remembrance

    NASA Image and Video Library

    2017-01-26

    A wreath is placed near the Space Mirror Memorial at the Kennedy Space Center Visitor Complex in preparation for Kennedy Space Center's Day of Remembrance ceremony. The annual event honors the contributions of all astronauts who lost their lives in the quest for space exploration.

  16. Fabulous Weather Day

    ERIC Educational Resources Information Center

    Marshall, Candice; Mogil, H. Michael

    2007-01-01

    Each year, first graders at Kensington Parkwood Elementary School in Kensington, Maryland, look forward to Fabulous Weather Day. Students learn how meteorologists collect data about the weather, how they study wind, temperature, precipitation, basic types/characteristics of clouds, and how they forecast. The project helps the students grow in…

  17. A Day of Remembrance

    NASA Image and Video Library

    2017-01-26

    Early morning sunlight illuminates the Space Mirror Memorial at Kennedy Space Center Visitor Complex in Florida, where a wreath-laying ceremony will take place as part of Kennedy Space Center's Day of Remembrance. The annual event honors the contributions of all astronauts who lost their lives in the quest for space exploration.

  18. Sun-Earth Day

    NASA Technical Reports Server (NTRS)

    2007-01-01

    Michael Sandras, a member of the Pontchartrain Astronomical Society, explains his solar telescope to students of Second Street in Bay St. Louis, Hancock County and Nicholson elementary schools in StenniSphere's Millennium Hall on April 10. The students participated in several hands-on activities at Stennis Space Center's Sun-Earth Day celebration.

  19. An Earth Day Reader.

    ERIC Educational Resources Information Center

    Moser, Don, Ed.

    1990-01-01

    Presents what the author believes to be some of the most important environmental books published since Earth Day 1970. Discusses each selection and how it provides the historical background, basic information, and appreciation necessary to understand the character of our environmental dilemma and our need to address it. (MCO)

  20. One Play a Day

    ERIC Educational Resources Information Center

    Blankenship, Mark

    2007-01-01

    Undergraduate theater students rarely get the chance to work on a major world premiere, but this year hundreds of them will. Currently, more than 70 colleges and universities are participating in "365 Days/365 Plays," an ambitious project from Pulitzer Prize-winning playwright Suzan-Lori Parks. Every week, as they mount their portion of this epic…

  1. One Play a Day

    ERIC Educational Resources Information Center

    Blankenship, Mark

    2007-01-01

    Undergraduate theater students rarely get the chance to work on a major world premiere, but this year hundreds of them will. Currently, more than 70 colleges and universities are participating in "365 Days/365 Plays," an ambitious project from Pulitzer Prize-winning playwright Suzan-Lori Parks. Every week, as they mount their portion of this epic…

  2. Yearbook Signing Day.

    ERIC Educational Resources Information Center

    Dempsey, Chris

    1996-01-01

    Presents a creative writing teacher's reminiscence on one of the last days of school as students gather in a stadium to socialize and write a few words in their yearbooks which they have just received. Discusses particular students, their pain, their fearlessness, and the hazards and disappointments that are an inevitable part of life. (TB)

  3. 2016 Energy Awareness Day

    NASA Image and Video Library

    2016-10-20

    Michelle Sipe Exaros, with Lutron Electronics Co., is seen behind pamphlets and brochures of information during Energy Awareness Day at the Multi-Function Facility on Oct. 20. Every third Thursday of October, civil servants, contractors and several energy utilities promote the awareness of our sustainability goals at Kennedy Space Center and at home. Photo credit: Cory Huston

  4. 2016 Energy Awareness Day

    NASA Image and Video Library

    2016-10-20

    Shown are some of the devices from Lutron Electronics Co., a lighting control company, during Energy Awareness Day at the Multi-Function Facility on Oct. 20. Every third Thursday of October, civil servants, contractors and several energy utilities promote the awareness of our sustainability goals at Kennedy Space Center and at home. Photo credit: Cory Huston

  5. There's still time to make a pledge for Change Day.

    PubMed

    Last Saturday was World Thinking Day, the next couple of weeks have been designated Fairtrade Fortnight and celebrations are planned throughout March to mark National Bed Month. Staff in marketing departments across the land spend their lives dreaming up such awareness days, weeks and months, to the point where every day we are asked to think about something different.

  6. Spontaneous levitation of dropped nucleus on first post-operative day.

    PubMed

    Naik, Mayuresh P; Sethi, Harindersingh; Mehta, Anuj; Bhalla, Abhinav; Saluja, Komal

    2017-01-01

    A 60-year-old male patient presenting with gradual painless progressive diminution of vision was diagnosed with nuclear sclerosis grade III (LOCS). Intra-operatively, there was a nuclear drop into the vitreous cavity. The patient was left aphakic and was deferred for further vitreoretinal procedure the next day. On first post-op day, the nucleus fragment (of roughly the same size that had dropped into the vitreous) was seen in the anterior chamber. A gentle ultrasonography B-Scan done for posterior segment evaluation was anechoic. Incision was enlarged and viscoexpression of the nucleus fragment was done followed by thorough anterior vitrectomy. Post-operatively, dilated full fundus examination showed clear vitreous cavity without any evidence of retinal tear or detachment. This was later confirmed by an anechoic ultrasonography B-Scan. After 2 weeks, three-piece foldable IOL was placed in the sulcus with posterior optic capture and the patient attained a best-corrected visual acuity of 6/9P.

  7. Expedition 11 Launch Day

    NASA Image and Video Library

    2005-04-15

    Unidentified family members of NASA astronaut John Phillips waves offers up best wishes for a safe mission and a happy birthday prior to launch, Friday, April 15, 2005, aboard the Soyuz TMA-6 spacecraft from the Baikonur Cosmodrome in Kazakhstan for a two-day trip to the International Space Station where he will spend six months living in space. Photo Credit: (NASA/Bill Ingalls)

  8. Microgravity Day for Educators

    NASA Technical Reports Server (NTRS)

    2001-01-01

    The arnual conference for the Educator Resource Center Network (ERCN) Coordinators was held at Glenn Research Center at Lewis Field in Cleveland, Ohio. The conference included participants from NASA's Educator Resource Centers located throughout the country. The Microgravity Science Division at Glenn sponsored a Microgravity Day for all the conference participants. Kathy Higgins of the National Center for Microgravity Research at GRC explains educational resources to teachers. This image is from a digital still camera; higher resolution is not available.

  9. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    NASA Administrator Charles Bolden and his wife Alexis watch as Tomb guards with The Old Guard, the 3rd U.S. Infantry Regiment, perform a changing of the guard prior to a wreath-laying ceremony as part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  10. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    June Scobee Rodgers, widow of Challenger Space Shuttle Commander Dick Scobee, visits the Space Shuttle Challenger Memorial durring a wreath laying ceremony that was part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  11. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    Taps is played by the Honor Guard after NASA Administrator Charles Bolden and his wife Alexis laid a wreath at the Tomb of the Unknowns as part of NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  12. Day Of Remembrance

    NASA Image and Video Library

    2008-01-31

    A wreath placed by NASA Deputy Administrator Shana Dale and other NASA senior management is seen in front of the Columbia memorial Thursday, Jan. 31 2008, at Arlington National Cemetery. The wreath laying ceremony is part of NASA's Day of Remembrance. Wreaths were laid in the memory of those men and women who lost their lives in the quest of space exploration, including the astronaut crews of Columbia, Challenger and Apollo 1. Photo Credit: (NASA/Bill Ingalls)

  13. Day Of Remembrance

    NASA Image and Video Library

    2013-02-01

    The Space Shuttle Columbia Memorial is seen after June Scobee Rodgers, widow of Challenger Space Shuttle Commander Dick Scobee and NASA Administrator Charles Bolden, along with others from NASA, participated in a wreath laying ceremony that was part of NASA's Day of Remembrance, Friday, Feb. 1, 2013, at Arlington National Cemetery. Wreathes were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  14. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    Taps is played by the Honor Guard after NASA Administrator Charles Bolden, left, and his wife Alexis laid a wreath at the Tomb of the Unknowns as part of NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  15. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    NASA Administrator Charles Bolden and his wife Alexis participate in a wreath laying ceremony at the graves of Apollo 1 crewmembers Virgil "Gus" Grissom and Roger Chaffee as part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. Wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  16. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    The grave markers of Virgil "Gus" Grissom and Roger Chaffee, from Apollo 1, are seen after a wreath laying ceremony that was part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. Wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  17. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    NASA personnel and members of the public watch as a wreath is laid at the Tomb of the Unknowns by NASA Administrator Charles Bolden as part of NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  18. Day Of Remembrance

    NASA Image and Video Library

    2008-01-31

    A wreath placed by NASA Deputy Administrator Shana Dale and other NASA senior management is seen in front of the Challenger memorial Thursday, Jan. 31 2008, at Arlington National Cemetery. The wreath laying ceremony is part of NASA's Day of Remembrance. Wreaths were laid in the memory of those men and women who lost their lives in the quest of space exploration, including the astronaut crews of Columbia, Challenger and Apollo 1. Photo Credit: (NASA/Bill Ingalls)

  19. Day of Remembrance

    NASA Image and Video Library

    2015-01-28

    NASA personnel watch as a wreath is laid at the Tomb of the Unknowns by NASA Administrator Charles Bolden and his wife Alexis as part of NASA's Day of Remembrance, Wednesday, Jan. 28, 2015, at Arlington National Cemetery in Arlington, Va. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Joel Kowsky)

  20. Day Of Remembrance

    NASA Image and Video Library

    2013-02-01

    The Space Shuttle Challenger Memorial is seen after June Scobee Rodgers, widow of Challenger Space Shuttle Commander Dick Scobee and NASA Administrator Charles Bolden, along with others from NASA, participated in a wreath laying ceremony that was part of NASA's Day of Remembrance, Friday, Feb. 1, 2013, at Arlington National Cemetery. Wreathes were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  1. Day of Remembrance

    NASA Image and Video Library

    2014-01-31

    NASA personnel, family members of those lost in Challenger, Columbia, Apollo 1 and members of the public watch as a wreath is laid at the Tomb of the Unknowns by NASA Administrator Charles Bolden as part of NASA's Day of Remembrance, Friday, Jan. 31, 2014, at Arlington National Cemetery. The wreaths were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  2. Day Of Remembrance

    NASA Image and Video Library

    2008-01-31

    A wreath placed by NASA Deputy Administrator Shana Dale and other NASA senior management is seen in between Astronauts Virgil Grissom and Roger Chaffee memorials Thursday, Jan. 31, 2008, at Arlington National Cemetery. The wreath laying ceremony is part of NASA's Day of Remembrance. Wreaths were laid in the memory of those men and women who lost their lives in the quest of space exploration, including the astronaut crews of Columbia, Challenger and Apollo 1. Photo Credit: (NASA/Bill Ingalls)

  3. Day Of Remembrance

    NASA Image and Video Library

    2013-02-01

    June Scobee Rodgers, widow of Challenger Space Shuttle Commander Dick Scobee and NASA Administrator Charles Bolden, along with others from NASA, visit the Space Shuttle Columbia Memorial during a wreath laying ceremony that was part of NASA's Day of Remembrance, Friday, Feb. 1, 2013, at Arlington National Cemetery. Wreathes were laid in memory of those men and women who lost their lives in the quest for space exploration. Photo Credit: (NASA/Bill Ingalls)

  4. Flight Day 2 Highlights

    NASA Technical Reports Server (NTRS)

    2003-01-01

    The STS-107 second flight day begins with a shot of the Spacehab Research Double Module. Live presentations of experiments underway inside of the Spacehab Module are presented. Six experiments are shown. As part of the Space Technology and Research Student Payload, students from Australia, China, Israel, Japan, New York, and Liechtenstein are studying the effect that microgravity has on ants, spiders, silkworms, fish, bees, granular materials, and crystals. Mission Specialist Kalpana Chawla is seen working with the zeolite crystal growth experiment.

  5. 2015 Day of Remembrance

    NASA Image and Video Library

    2015-01-29

    LIGHTING A MEMORIAL CANDLE DURING THE JAN. 29 DAY OF REMEMBRANCE OBSERVANCE AT NASA'S MARSHALL SPACE FLIGHT CENTER ARE, FROM LEFT, PATRICK SCHEUERMANN, MARSHALL DIRECTOR; JOHN HONEYCUTT, DEPUTY MANAGER OF THE SPACE LAUNCH SYSTEM; AND RETIRED ASTRONAUT ROBERT “HOOT” GIBSON. THE CEREMONY IN BUILDING 4200 PAID TRIBUTE TO THE CREWS OF APOLLO 1 AND SPACE SHUTTLES CHALLENGER AND COLUMBIA, AS WELL AS OTHER NASA COLLEAGUES.

  6. Flight Day 2 Highlights

    NASA Technical Reports Server (NTRS)

    2003-01-01

    The STS-107 second flight day begins with a shot of the Spacehab Research Double Module. Live presentations of experiments underway inside of the Spacehab Module are presented. Six experiments are shown. As part of the Space Technology and Research Student Payload, students from Australia, China, Israel, Japan, New York, and Liechtenstein are studying the effect that microgravity has on ants, spiders, silkworms, fish, bees, granular materials, and crystals. Mission Specialist Kalpana Chawla is seen working with the zeolite crystal growth experiment.

  7. 2016 Energy Awareness Day

    NASA Image and Video Library

    2016-10-20

    Cory Taylor, an energy and water conservation specialist at Kennedy Space Center, absorbs information from Mark Gonzalez, a sales engineer with MC2 during Energy Awareness Day at the Multi-Function Facility on Oct. 20. Every third Thursday of October, civil servants, contractors and several energy utilities promote the awareness of our sustainability goals at Kennedy Space Center and at home. Photo credit: Cory Huston

  8. Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

    PubMed Central

    Owojuyigbe, Afolabi Muyiwa; Komolafe, Edward O.; Adenekan, Anthony T.; Dada, Muyiwa A.; Onyia, Chiazor U.; Ogunbameru, Ibironke O.; Owagbemi, Oluwafemi F.; Talabi, Ademola O.; Faponle, Fola A.

    2016-01-01

    Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved. PMID:27251657

  9. Kindergarten Evaluation Study: Full-Day Alternate Day Programs.

    ERIC Educational Resources Information Center

    Minnesota State Dept. of Education, St. Paul.

    In this evaluation study, two groups of children who attended kindergarten either one-half day every day or full-day on alternate days were compared. An opinion survey was conducted to obtain the observations of parents, kindergarten teachers, and elementary principals in relation to the all-day alternate day schedule in 55 school districts. Data…

  10. National immunisation day.

    PubMed

    Carlisle, D

    1997-11-01

    National immunization days (NIDs) are key components of the eradication of polio. On Zambia's polio day in July 1997, 8000 vaccination points were set up around the country, each staffed by 1 nurse and 2 volunteer workers, who worked from thatched huts built for the day, churches, health centers, and house-to-house to reach the target of 2.1 million children. With about half of Zambia's 10 million people living in rural communities poorly served by roads and without main electricity, it was a particular challenge to maintain the cold chain. The cold chain began at Lusaka airport with the arrival of 5.4 million doses of frozen vaccine from Copenhagen, Denmark. The vaccines were then stored in freezers at a central location in Lusaka until they were eventually trucked out to the regional and district centers. The Flying Doctor Service and air force were used, as well as ox and carts, to get vaccines to hard to reach communities. The vaccines arrived at such sites on the NID packed in ice carried over the shoulders of the nurses who delivered them. The NID was deemed successful by the minister of health the morning after it occurred even though some districts ran short of vaccine. Two annual NIDs will continue as long as polio is present in that part of Africa. The global effort to eradicate polio is discussed.

  11. Nepal prepares for national quake safety day

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    When Nepal's annual Earthquake Safety Day rolls around next January 16, the National Society for Earthquake Technology-Nepal plans a weeklong program of earthquake drills by school children, a safety exhibitions risk management symposium, and a report on the achievements of the Kathmandu Valley Earthquake Risk Management Project. The 18-month project of NSET-Nepal and GeoHazards International has several objectives: assess earthquake risk and devise an action plan to manage the risk; reduce vulnerability of Kathmandu Valley's approximately 650 public schools; raise public awareness; and build local institutions that can sustain the work of the project.

  12. 26 CFR 1.430(g)-1 - Valuation date and valuation of plan assets.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... provided in paragraph (b)(2) of this section, the valuation date for any plan year is the first day of the plan year. (2) Exception for small plans—(i) In general. If, on each day during the preceding plan year... plan may designate any day during the plan year as its valuation date for that plan year and succeeding...

  13. EDUCATIONAL PLANNING.

    ERIC Educational Resources Information Center

    ADAMS, DON

    SIX ARTICLES CRITICALLY EXAMINE THE PROCESS OF EDUCATIONAL PLANNING FROM THE UNDERLYING ASSUMPTIONS TO THE PRACTICAL PROBLEMS OF IMPLEMENTATION. ANDERSON AND BOWMAN IN "THEORETICAL CONSIDERATIONS IN EDUCATIONAL PLANNING" DISCUSS SUCH TOPICS AS THE DEFINITION OF PLANNING, EDUCATIONAL PLANNING AND SOCIAL DEMOCRATIZATION, PLANNING FOR…

  14. Martian Valentine's Day

    NASA Technical Reports Server (NTRS)

    2005-01-01

    14 February 2005 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows a heart-shaped hill surrounded by cracked terrain within a depression in far northwestern Arabia Terra, near the Cydonia region of Mars. Happy St. Valentine's Day from the MGS MOC team!

    Location near: 39.1oN, 358.1oW Image width: 3.0 km (1.9 mi) Illumination from: lower left Season: Northern Spring

  15. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 NASA Astronaut Scott Kelly, left in mirror, and Russian Cosmonaut Mikhail Kornienko, of the Russian Federal Space Agency (Roscosmos) are seen exercising during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Kornienko, Kelly and Russian Cosmonaut Gennady Padalka of Roscosmos are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingall

  16. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 NASA Astronaut Scott Kelly takes part in the spin chair training during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Kelly, and Russian Cosmonauts Gennady Padalka, and Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos) are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  17. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Media wait to be escorted to the next event during the Expedition 43 prime and backup crew media day on Saturday, March 21, 2015 at the Cosmonaut Hotel in Baikonur, Kazakhstan. Expedition 43 NASA Astronaut Scott Kelly, and Russian Cosmonauts Gennady Padalka, and Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos) are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  18. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 Russian Cosmonauts Gennady Padalka, left, and Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos) take part the tilt table training during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Padalka, Kornienko, and Expedition 43 NASA Astronaut Scott Kelly are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  19. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 prime and backup crews arrive at the Cosmonaut Hotel during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Expedition 43 NASA Astronaut Scott Kelly, and Russian Cosmonauts Gennady Padalka, and Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos) are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  20. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 NASA Astronaut Scott Kelly answers questions from the press during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Expedition 43 NASA Astronaut Scott Kelly, and Russian Cosmonauts Gennady Padalka, and Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos) are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  1. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 backup crew member NASA Astronaut Jeff Williams, reflected in mirror, Russian Cosmonauts Mikhail Kornienko, on elliptical, Gennady Padalka of the Russian Federal Space Agency (Roscosmos), and NASA Astronaut Scott Kelly, right, are seen exercising during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Padalka, Kornienko, and Kelly are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  2. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 NASA Astronaut Scott Kelly, left, Russian Cosmonauts Gennady Padalka, center, and Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos) take in the view from a overlook during media day, Saturday, March 21, 2015 at the Cosmonaut Hotel in Baikonur, Kazakhstan. Kelly, Padalka, and Kornienko are preparing for launch to the International Space Station in their Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  3. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Gagarin Cosmonaut Training Center (GCTC) Flight Surgeon Alexey Grishin, left, and Russian Cosmonaut Gennady Padalka of the Russian Federal Space Agency (Roscosmos) play a game of chess during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Padalka, fellow Russian Cosmonaut Mikhail Kornienko of Roscosmos, and NASA Astronaut Scott Kelly are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  4. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 Russian Cosmonauts Gennady Padalka, background, and Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos) take part the tilt table training during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Padalka, Kornienko, and Expedition 43 NASA Astronaut Scott Kelly are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  5. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Media document Expedition 43 Russian Cosmonaut Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos), left, and NASA Astronaut Scott Kelly, right, as they play billiards during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Kelly, and Russian Cosmonauts Gennady Padalka, and Mikhail Kornienko of Roscosmos are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  6. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Media document Expedition 43 NASA Astronaut Scott Kelly as he plays billiards during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Kelly, and Russian Cosmonauts Gennady Padalka, and Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos) are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  7. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 NASA Astronaut Scott Kelly, left, and Russian Cosmonaut Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos) pose for a photo near a model of the Soyuz rocket during media day, Saturday, March 21, 2015 at the Cosmonaut Hotel in Baikonur, Kazakhstan. Kelly, Kornienko, and Russian Cosmonaut Gennady Padalka of Roscosmos are preparing for launch to the International Space Station in their Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  8. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 Russian Cosmonaut Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos), left, NASA Astronaut Scott Kelly, center, and Russian Cosmonaut Gennady Padalka are seen during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Kelly, Padalka, and Kornienko are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  9. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Russian Cosmonaut Gennady Padalka of the Russian Federal Space Agency (Roscosmos) plays badminton during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Padalka, fellow Russian Cosmonaut Mikhail Kornienko of Roscosmos, and NASA Astronaut Scott Kelly are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  10. STS-135 Launch Day

    NASA Image and Video Library

    2011-07-07

    NASA Chief, Astronaut Office, Johnson Space Center Peggy Whitson deals cards during a traditional game that is played at the NASA Kennedy Space Center Operations and Checkout Building with the shuttle crew prior to them leaving for the launch pad, on Friday, July 8, 2011 in Cape Canaveral, Fla. The point of the game is that the commander must use up all his or her bad luck before launch, so the crew can only leave for the pad after the commander loses. The launch of Atlantis, STS-135, is the final flight of the shuttle program, a 12-day mission to the International Space Station. Photo Credit: (NASA/Jerry Ross)

  11. Expedition 43 Media Day

    NASA Image and Video Library

    2015-03-21

    Expedition 43 prime and backup crews walk from the Cosmonaut Hotel over to the Zvjozdnyj Hotel for a short break during media day, Saturday, March 21, 2015, Baikonur, Kazakhstan. Expedition 43 NASA Astronaut Scott Kelly, and Russian Cosmonauts Gennady Padalka, and Mikhail Kornienko of the Russian Federal Space Agency (Roscosmos) are scheduled to launch to the International Space Station in the Soyuz TMA-16M spacecraft from the Baikonur Cosmodrome in Kazakhstan March 28, Kazakh time (March 27 Eastern time.) As the one-year crew, Kelly and Kornienko will return to Earth on Soyuz TMA-18M in March 2016. Photo Credit: (NASA/Bill Ingalls)

  12. Preventing 30-day readmissions.

    PubMed

    Stevens, Sherri

    2015-03-01

    Preventing 30-day readmissions to hospitals is a top priority in the era of health care reform. New regulations will be costly to health care facilities because of payment guidelines. The most frequently readmitted medical conditions are acute myocardial infarction, heart failure, and pneumonia. The transition from the hospital and into the home has been classified as a vulnerable time for many patients. During this time of transition patients may fail to fully understand their discharge instructions. Ineffective communication, low health literacy, and compliance issues contribute to readmissions. Telehealth and the use of technology may be used to prevent some readmissions. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. An aspirin a day.

    PubMed

    Majerus, Philip W

    2014-01-01

    The title of this article is also its punch line. The thesis that I will prove is that every adult, with a few exceptions, should take one 325 mg aspirin tablet each day. The drug is extraordinary and is beneficial in myriad ways. In this dosage the toxicity of the treatment is minimal. Since the drug is sold "over the counter", not requiring prescription, it is cheap and its benefits are easily underestimated. I do not use extensive reference citations; but just tell the story of aspirin.

  14. 2010 Day of Remembrance

    NASA Technical Reports Server (NTRS)

    2010-01-01

    Patrick Scheuermann (left), deputy director at NASA's John C. Stennis Space Center, and Richard Gilbrech, associate director, place a wreath in memory of the 17 astronauts lost in service of the space program since 1967. The wreath was placed during NASA's 2010 Day of Remembrance, observed each year in January. The annual observance memorializes the three astronauts lost in the Apollo 1 launch pad fire in 1967, the seven astronauts lost in the Challenger tragedy in 1986 and the seven astronauts lost in the Columbia accident in 2003. During the Stennis observance, Scheuermann praised the fallen astronauts as 'brave space pioneers who gave their lives in the cause of exploration and discovery.'

  15. Super Safety and Health Day at KSC

    NASA Technical Reports Server (NTRS)

    2000-01-01

    During Super Safety and Health Day at KSC, keynote speaker Dr. Beck Weathers grimaces over the satellite photo of Mt. Everest being presented by Center Director Roy Bridges. Weathers spoke about his ordeal of surviving the 1996 Mt. Everest disaster and the lessons learned from the experience. Safety Day is a full day of NASA-sponsored, KSC and 45th Space Wing events involving a number of health and safety related activities: Displays, vendors, technical paper sessions, panel discussions, a keynote speaker, etc. The entire Center and Wing stand down to participate in the planned events. Safety Day is held annually to proactively increase awareness in safety and health among the government and contractor workforce population. The first guiding principle at KSC is '''Safety and Health First.''' KSC's number one goal is to '''Assure sound, safe and efficient practices and processes are in place for privatized/commercialized launch site processing.'''

  16. Super Safety and Health Day at KSC

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Center Director Roy Bridges talks to workers outside the Hazardous Maintenance Facility during Super Safety and Health Day at KSC. Safety Day is a full day of NASA-sponsored, KSC and 45th Space Wing events involving a number of health and safety related activities: Displays, vendors, technical paper sessions, panel discussions, a keynote speaker, etc. The entire Center and Wing stand down to participate in the planned events. Safety Day is held annually to proactively increase awareness in safety and health among the government and contractor workforce population. The first guiding principle at KSC is '''Safety and Health First.''' KSC's number one goal is to '''Assure sound, safe and efficient practices and processes are in place for privatized/commercialized launch site processing.'''

  17. Super Safety and Health Day at KSC

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Employees gather around a demonstration by Florida Power and Light during Super Safety and Health Day at KSC. Safety Day is a full day of NASA-sponsored, KSC and 45th Space Wing events involving a number of health- and safety-related activities: Displays, vendors, technical paper sessions, panel discussions, a keynote speaker, etc. The entire Center and Wing stand down to participate in the planned events. Safety Day is held annually to proactively increase awareness in safety and health among the government and contractor workforce population. The first guiding principle at KSC is '''Safety and Health First.''' KSC's number one goal is to '''Assure sound, safe and efficient practices and processes are in place for privatized/commercialized launch site processing.'''

  18. Super Safety and Health Day at KSC

    NASA Technical Reports Server (NTRS)

    2000-01-01

    In an exhibit tent during Super Safety and Health Day at KSC, employees sample iced tea from a vendor. Safety Day is a full day of NASA-sponsored, KSC and 45th Space Wing events involving a number of health- and safety-related activities: Displays, vendors, technical paper sessions, panel discussions, a keynote speaker, etc. The entire Center and Wing stand down to participate in the planned events. Safety Day is held annually to proactively increase awareness in safety and health among the government and contractor workforce population. The first guiding principle at KSC is '''Safety and Health First.''' KSC's number one goal is to '''Assure sound, safe and efficient practices and processes are in place for privatized/commercialized launch site processing.'''

  19. Super Safety and Health Day at KSC

    NASA Technical Reports Server (NTRS)

    2000-01-01

    Vendor tents and displays filled the grounds in the Industrial Area as well as LC 39 Area during Super Safety and Health Day at KSC. Safety Day is a full day of NASA-sponsored, KSC and 45th Space Wing events involving a number of health and safety related activities: Displays, vendors, technical paper sessions, panel discussions, a keynote speaker, etc. The entire Center and Wing stand down to participate in the planned events. Safety Day is held annually to proactively increase awareness in safety and health among the government and contractor workforce population. The first guiding principle at KSC is '''Safety and Health First.''' KSC's number one goal is to '''Assure sound, safe and efficient practices and processes are in place for privatized/commercialized launch site processing.'''

  20. Super Safety and Health Day at KSC

    NASA Technical Reports Server (NTRS)

    2000-01-01

    In an exhibit tent during Super Safety and Health Day at KSC, employees sample iced tea from a vendor. Safety Day is a full day of NASA-sponsored, KSC and 45th Space Wing events involving a number of health- and safety-related activities: Displays, vendors, technical paper sessions, panel discussions, a keynote speaker, etc. The entire Center and Wing stand down to participate in the planned events. Safety Day is held annually to proactively increase awareness in safety and health among the government and contractor workforce population. The first guiding principle at KSC is '''Safety and Health First.''' KSC's number one goal is to '''Assure sound, safe and efficient practices and processes are in place for privatized/commercialized launch site processing.'''