Image-guided robotic surgery.

PubMed

Marescaux, Jacques; Solerc, Luc

2004-06-01

Medical image processing leads to an improvement in patient care by guiding the surgical gesture. Three-dimensional models of patients that are generated from computed tomographic scans or magnetic resonance imaging allow improved surgical planning and surgical simulation that offers the opportunity for a surgeon to train the surgical gesture before performing it for real. These two preoperative steps can be used intra-operatively because of the development of augmented reality, which consists of superimposing the preoperative three-dimensional model of the patient onto the real intraoperative view. Augmented reality provides the surgeon with a view of the patient in transparency and can also guide the surgeon, thanks to the real-time tracking of surgical tools during the procedure. When adapted to robotic surgery, this tool tracking enables visual serving with the ability to automatically position and control surgical robotic arms in three dimensions. It is also now possible to filter physiologic movements such as breathing or the heart beat. In the future, by combining augmented reality and robotics, these image-guided robotic systems will enable automation of the surgical procedure, which will be the next revolution in surgery.

Implementation of a documentation model comprising nursing terminologies--theoretical and methodological issues.

PubMed

von Krogh, Gunn; Nåden, Dagfinn

2008-04-01

To describe and discuss theoretical and methodological issues of implementation of a nursing services documentation model comprising NANDA nursing diagnoses, Nursing Intervention Classification and Nursing Outcome Classification terminologies. The model is developed for electronic patient record and was implemented in a psychiatric hospital on an organizational level and on five test wards in 2001-2005. The theory of Rogers guided the process of innovation, whereas the implementation procedure of McCloskey and Bulecheck combined with adult learning principals guided the test site implementation. The test wards managed in different degrees to adopt the model. Two wards succeeded fully, including a ward with high percentage of staff with interdisciplinary background. Better planning regarding the impact of the organization's innovative aptitude, the innovation strategies and the use of differentiated methods regarding the clinician's individual premises for learning nursing terminologies might have enhanced the adoption to the model. To better understand the nature of barriers and the importance of careful planning regarding the implementation of electronic patient record elements in nursing care services, focusing on nursing terminologies. Further to indicate how a theory and specific procedure can be used to guide the process of implementation throughout the different levels of management.

Applications of Panoramic Images: from 720° Panorama to Interior 3d Models of Augmented Reality

NASA Astrophysics Data System (ADS)

Lee, I.-C.; Tsai, F.

2015-05-01

A series of panoramic images are usually used to generate a 720° panorama image. Although panoramic images are typically used for establishing tour guiding systems, in this research, we demonstrate the potential of using panoramic images acquired from multiple sites to create not only 720° panorama, but also three-dimensional (3D) point clouds and 3D indoor models. Since 3D modeling is one of the goals of this research, the location of the panoramic sites needed to be carefully planned in order to maintain a robust result for close-range photogrammetry. After the images are acquired, panoramic images are processed into 720° panoramas, and these panoramas which can be used directly as panorama guiding systems or other applications. In addition to these straightforward applications, interior orientation parameters can also be estimated while generating 720° panorama. These parameters are focal length, principle point, and lens radial distortion. The panoramic images can then be processed with closerange photogrammetry procedures to extract the exterior orientation parameters and generate 3D point clouds. In this research, VisaulSFM, a structure from motion software is used to estimate the exterior orientation, and CMVS toolkit is used to generate 3D point clouds. Next, the 3D point clouds are used as references to create building interior models. In this research, Trimble Sketchup was used to build the model, and the 3D point cloud was added to the determining of locations of building objects using plane finding procedure. In the texturing process, the panorama images are used as the data source for creating model textures. This 3D indoor model was used as an Augmented Reality model replacing a guide map or a floor plan commonly used in an on-line touring guide system. The 3D indoor model generating procedure has been utilized in two research projects: a cultural heritage site at Kinmen, and Taipei Main Station pedestrian zone guidance and navigation system. The results presented in this paper demonstrate the potential of using panoramic images to generate 3D point clouds and 3D models. However, it is currently a manual and labor-intensive process. A research is being carried out to Increase the degree of automation of these procedures.

Kinematic analysis and simulation of a substation inspection robot guided by magnetic sensor

NASA Astrophysics Data System (ADS)

Xiao, Peng; Luan, Yiqing; Wang, Haipeng; Li, Li; Li, Jianxiang

2017-01-01

In order to improve the performance of the magnetic navigation system used by substation inspection robot, the kinematic characteristics is analyzed based on a simplified magnetic guiding system model, and then the simulation process is executed to verify the reasonability of the whole analysis procedure. Finally, some suggestions are extracted out, which will be helpful to guide the design of the inspection robot system in the future.

The Taba Curriculum Development Project in Social Studies; Development of a Comprehensive Curriculum Model for Social Studies for Grades One Through Eight Inclusive of Procedures for Implementation and Dissemination. Final Report.

ERIC Educational Resources Information Center

Wallen, Norman E.; And Others

One of the major focuses of this project was the revision of existing curriculum guides for grades one through six (the Contra Costa Social Studies Guides) and the development of guides for grades seven and eight. The emphases were: organization of learning activities under significant generalizations of main concepts; sequential treatment;…

Optimizing modality selection for image-guided procedures: an analysis of the challenges to ultrasound guidance.

PubMed

Beland, Michael D; Sternick, Laura A; Baird, Grayson L; Dupuy, Damian E; Cronan, John J; Mayo-Smith, William W

2016-04-01

Selection of the most appropriate modality for image guidance is essential for procedural success. We identified specific factors contributing to failure of ultrasound-guided procedures that were subsequently performed using CT guidance. This single-center, retrospective study included 164 patients who underwent a CT-guided biopsy, aspiration/drainage, or ablation after initially having the same procedure attempted unsuccessfully with ultrasound guidance. Review of the procedure images, reports, biopsy results, and clinical follow-up was performed and the reasons for inability to perform the procedure with ultrasound guidance were recorded. Patient cross-sectional area and depth to target were calculated. Differences in area and depth were compared using general linear modeling. Depth as a predictor of an unfavorable body habitus designation was modeled using logistic regression. US guidance was successful in the vast majority of cases (97%). Of the 164 procedures, there were 92 (56%) biopsies, 63 (38%) aspirations/drainages, and 9 (5%) ablations. The most common reason for procedure failure was poor acoustic window (83/164, 51%). Other reasons included target lesion being poorly discerned from adjacent tissue (61/164, 37%), adjacent bowel gas (34/164, 21%), body habitus (27/164, 16%), and gas-containing collection (22/164, 13%). Within the biopsy subgroup, patients for whom body habitus was a limiting factor were found to have on average a larger cross-sectional area and lesion depth relative to patients whose body habitus was not a complicating factor (p < 0.0001 and p = 0.0009). Poor acoustic window was the most common reason for procedural failure with ultrasound guidance. In addition, as lesion depth increased, the odds that body habitus would limit the procedure also increased. If preliminary imaging suggests a limited sonographic window, particularly for deeper lesions, proceeding directly to CT guidance should be considered.

A novel Bayesian respiratory motion model to estimate and resolve uncertainty in image-guided cardiac interventions.

PubMed

Peressutti, Devis; Penney, Graeme P; Housden, R James; Kolbitsch, Christoph; Gomez, Alberto; Rijkhorst, Erik-Jan; Barratt, Dean C; Rhode, Kawal S; King, Andrew P

2013-05-01

In image-guided cardiac interventions, respiratory motion causes misalignments between the pre-procedure roadmap of the heart used for guidance and the intra-procedure position of the heart, reducing the accuracy of the guidance information and leading to potentially dangerous consequences. We propose a novel technique for motion-correcting the pre-procedural information that combines a probabilistic MRI-derived affine motion model with intra-procedure real-time 3D echocardiography (echo) images in a Bayesian framework. The probabilistic model incorporates a measure of confidence in its motion estimates which enables resolution of the potentially conflicting information supplied by the model and the echo data. Unlike models proposed so far, our method allows the final motion estimate to deviate from the model-produced estimate according to the information provided by the echo images, so adapting to the complex variability of respiratory motion. The proposed method is evaluated using gold-standard MRI-derived motion fields and simulated 3D echo data for nine volunteers and real 3D live echo images for four volunteers. The Bayesian method is compared to 5 other motion estimation techniques and results show mean/max improvements in estimation accuracy of 10.6%/18.9% for simulated echo images and 20.8%/41.5% for real 3D live echo data, over the best comparative estimation method. Copyright © 2013 Elsevier B.V. All rights reserved.

Development of a Meso-Scale SMA-Based Torsion Actuator for Image-Guided Procedures.

PubMed

Sheng, Jun; Gandhi, Dheeraj; Gullapalli, Rao; Simard, J Marc; Desai, Jaydev P

2017-02-01

This paper presents the design, modeling, and control of a meso-scale torsion actuator based on shape memory alloy (SMA) for image-guided surgical procedures. Developing a miniature torsion actuator is challenging, but it opens the possibility of significantly enhancing the robot agility and maneuverability. The proposed torsion actuator is bi-directionally actuated by a pair of antagonistic SMA torsion springs through alternate Joule heating and natural cooling. The torsion actuator is integrated into a surgical robot prototype to demonstrate its working performance in the humid environment under C-Arm CT image guidance.

Development of a Meso-Scale SMA-Based Torsion Actuator for Image-Guided Procedures

PubMed Central

Sheng, Jun; Gandhi, Dheeraj; Gullapalli, Rao; Simard, J. Marc; Desai, Jaydev P.

2016-01-01

This paper presents the design, modeling, and control of a meso-scale torsion actuator based on shape memory alloy (SMA) for image-guided surgical procedures. Developing a miniature torsion actuator is challenging, but it opens the possibility of significantly enhancing the robot agility and maneuverability. The proposed torsion actuator is bi-directionally actuated by a pair of antagonistic SMA torsion springs through alternate Joule heating and natural cooling. The torsion actuator is integrated into a surgical robot prototype to demonstrate its working performance in the humid environment under C-Arm CT image guidance. PMID:28210189

Evaluation of a novel, hybrid model (Mumbai EUS II) for stepwise teaching and training in EUS-guided biliary drainage and rendezvous procedures.

PubMed

Dhir, Vinay; Itoi, Takao; Pausawasdi, Nonthalee; Khashab, Mouen A; Perez-Miranda, Manuel; Sun, Siyu; Park, Do Hyun; Iwashita, Takuji; Teoh, Anthony Y B; Maydeo, Amit P; Ho, Khek Yu

2017-11-01

 EUS-guided biliary drainage (EUS-BD) and rendezvous (EUS-RV) are acceptable rescue options for patients with failed endoscopic retrograde cholangiopancreatography (ERCP). However, there are limited training opportunities at most centers owing to low case volumes. The existing models do not replicate the difficulties encountered during EUS-BD. We aimed to develop and validate a model for stepwise learning of EUS-BD and EUS-RV, which replicates the actual EUS-BD procedures.  A hybrid model was created utilizing pig esophagus and stomach, with a synthetic duodenum and biliary system. The model was objectively assessed on a grade of 1 - 4 by two experts. Twenty-eight trainees were given initial training with didactic lectures and live procedures. This was followed by hands-on training in EUS-BD and EUS-RV on the hybrid model. Trainees were assessed for objective criteria of technical difficulties.  Both the experts graded the model as very good or above for all parameters. All trainees could complete the requisite steps of EUS-BD and EUS-RV in a mean time of 11 minutes (8 - 18 minutes). Thirty-six technical difficulties were noted during the training (wrong scope position, 13; incorrect duct puncture, 12; guidewire related problems, 11). Technical difficulties peaked for EUS-RV, followed by hepaticogastrostomy (HGS) and choledochoduodenostomy (CDS) (20, 9, and 7, P  = 0.001). At 10 days follow-up, nine of 28 trainees had successfully performed three EUS-RV and seven EUS-BD procedures independently.  The Mumbai EUS II hybrid model replicates situations encountered during EUS-RV and EUS-BD. Stepwise mentoring improves the chances of success in EUS-RV and EUS-BD procedures.

Comprehensive Approach to Pupil Planning: Stage I - Classroom Support (Includes Classroom Support Procedures). Experimental Edition.

ERIC Educational Resources Information Center

Mabry, Ann; Kaufman, Martin J.

Presented is Stage I of the Comprehensive Approach to Pupil Planning (CAPP) System, a three-stage model for planning educational interventions in the regular and special education classrooms and for guiding placement decisions. The guide consists of the following: an overview of the CAPP System; an introduction to Stage I on classroom support…

77 FR 38338 - Proposal and Award Policies and Procedures Guide; Comments Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

... NATIONAL SCIENCE FOUNDATION Proposal and Award Policies and Procedures Guide; Comments Request AGENCY: National Science Foundation. ACTION: Notification of extension of public comment period. SUMMARY... on the National Science Foundation Proposal and Award Policies and Procedures Guide. The original...

Preclinical Feasibility of a Technology Framework for MRI-guided Iliac Angioplasty

PubMed Central

Rube, Martin A.; Fernandez-Gutierrez, Fabiola; Cox, Benjamin F.; Holbrook, Andrew B.; Houston, J. Graeme; White, Richard D.; McLeod, Helen; Fatahi, Mahsa; Melzer, Andreas

2015-01-01

Purpose Interventional MRI has significant potential for image guidance of iliac angioplasty and related vascular procedures. A technology framework with in-room image display, control, communication and MRI-guided intervention techniques was designed and tested for its potential to provide safe, fast and efficient MRI-guided angioplasty of the iliac arteries. Methods A 1.5T MRI scanner was adapted for interactive imaging during endovascular procedures using new or modified interventional devices such as guidewires and catheters. A perfused vascular phantom was used for testing. Pre-, intra- and post-procedural visualization and measurement of vascular morphology and flow was implemented. A detailed analysis of X-Ray fluoroscopic angiography workflow was conducted and applied. Two interventional radiologists and one physician in training performed 39 procedures. All procedures were timed and analyzed. Results MRI-guided iliac angioplasty procedures were successfully performed with progressive adaptation of techniques and workflow. The workflow, setup and protocol enabled a reduction in table time for a dedicated MRI-guided procedure to 6 min 33 s with a mean procedure time of 9 min 2 s, comparable to the mean procedure time of 8 min 42 s for the standard X-Ray guided procedure. Conclusions MRI-guided iliac vascular interventions were found to be feasible and practical using this framework and optimized workflow. In particular the real-time flow analysis was found to be helpful for pre- and post-interventional assessments. Design optimization of the catheters and in vivo experiments are required before clinical evaluation. PMID:25102933

Thirty-day emergency room visits and hospital admissions after outpatient non-vascular image-guided procedures.

PubMed

Nguyen, Quang; Mehta, Sahil V; Fang, Jieming; Sheiman, Robert; Kane, Robert; Ahmed, Muneeb; Sarwar, Ammar; Siewert, Bettina; Brook, Olga R

2017-10-01

To evaluate the rate of post-procedure emergency department (ED) visits and hospital admissions following outpatient non-vascular image-guided interventions performed under moderate sedation and to identify common and preventable causes of emergency department visits and hospital admissions. Institutional review board approval was acquired for this HIPAA-compliant retrospective study with waiver of informed consent. 1426 consecutive patients undergoing 1512 outpatient image-guided procedures under moderate sedation from November 2012 to August 2014 were included. The average patient age was 57.2 ± 15.2 years, and 602 (42%) patients were women. Major procedure categories included ultrasound-guided liver biopsies, ultrasound-guided kidney biopsies, and CT-guided lung biopsies/fiducial placement. Procedure details and medical follow-up within and after 30 days of the procedure were analyzed. A total of 168 (11.8%) patients were admitted to the hospital within 30 days of the procedure, with 29 of the admissions (17.3% of total admissions and 1.9% of total procedures) being procedure related. The most common procedure-related complication that required admission was hemorrhage (10/29, 34.5% of procedure-related admissions, 6.0% of total admissions, and 0.7% of total procedures), followed by pneumothorax (9/29, 31%, 5.4%, 0.6%), infection (4/29, 13.8%, 2.4%, 0.3%), and pain (3/29, 10.3%, 1.8%, 0.2%). Eighteen (62.1%) procedure-related admissions were immediately indicated. Thirty patients visited the ED and were subsequently discharged without admission with eight of the visits being procedure related (8/1512, 0.5%). All the procedure-related ED visits were due to pain. There were two deaths (2/1512, 0.1%) related to procedures, one from a thromboembolic event and another from post-biopsy hemorrhage. Outpatient non-vascular image-guided procedures result in a 30-day 1.9% hospital admission, 30-day 0.5% emergency room visit, and 30-day 0.1% mortality rate.

3D Printed Abdominal Aortic Aneurysm Phantom for Image Guided Surgical Planning with a Patient Specific Fenestrated Endovascular Graft System

PubMed Central

Meess, Karen M.; Izzo, Richard L.; Dryjski, Maciej L.; Curl, Richard E.; Harris, Linda M.; Springer, Michael; Siddiqui, Adnan H.; Rudin, Stephen; Ionita, Ciprian N.

2017-01-01

Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. Results With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. Conclusions With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging. PMID:28638171

3D Printed Abdominal Aortic Aneurysm Phantom for Image Guided Surgical Planning with a Patient Specific Fenestrated Endovascular Graft System.

PubMed

Meess, Karen M; Izzo, Richard L; Dryjski, Maciej L; Curl, Richard E; Harris, Linda M; Springer, Michael; Siddiqui, Adnan H; Rudin, Stephen; Ionita, Ciprian N

2017-02-11

Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.

3D printed abdominal aortic aneurysm phantom for image guided surgical planning with a patient specific fenestrated endovascular graft system

NASA Astrophysics Data System (ADS)

Meess, Karen M.; Izzo, Richard L.; Dryjski, Maciej L.; Curl, Richard E.; Harris, Linda M.; Springer, Michael; Siddiqui, Adnan H.; Rudin, Stephen; Ionita, Ciprian N.

2017-03-01

Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. Results: With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. Conclusions: With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.

A Fresh Cadaver Model for the Instruction of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules.

PubMed

McCrary, Hilary C; Faucett, Erynne A; Hurbon, Audriana N; Milinic, Tijana; Cervantes, Jose A; Kent, Sean L; Adamas-Rappaport, William J

2017-07-01

Objective The aim of our study is to determine if a fresh cadaver model (FCM) for the instruction of ultrasound (US)-guided fine-needle aspiration (FNA) of thyroid nodules is a practical method for instruction. Study Design Pre- and postinstruction assessment of medical students' ability to perform US-guided FNA of artificially created thyroid nodules placed adjacent to the thyroid gland of a fresh cadaver. Setting University-based fresh cadaver laboratory. Subjects and Methods Study participants included a total of 17 first- and second-year medical students with minimal US training. Technical skills were assessed using a 10-item checklist. In addition, a cognitive assessment regarding the indications, contraindications, and complications of the procedure was completed. A postinstruction assessment was provided for participants 5 weeks after their initial assessment. Differences between pre- and postinstruction assessment scores of technical skills were analyzed using McNemar's test. The mean cognitive knowledge gain was analyzed using a paired 2-sample t test. Results Eight of 10 items on the skills checklist were statistically significant between pre- and postinstruction skills assessment ( P < .05). There was a statistically significant change in cognitive knowledge gain regarding the contraindications of the procedure ( P = .001), but not for indications or complications ( P = .104 and P = .111, respectively). Conclusion US-guided FNA continues to be an important diagnostic procedure in the workup of thyroid nodules, making it an essential skill to integrate into surgical skills lab. Our FCM for the instruction of US-guided FNA is the first of its kind, and this pilot study shows this is a viable method for instruction.

A Theoretical Model for the Practice of Residential Treatment.

ERIC Educational Resources Information Center

Miskimins, R. W.

1990-01-01

Presents theoretical model describing practice of psychiatric residential treatment for children and adolescents. Emphasis is on 40 practice principles, guiding concepts which dictate specific treatment techniques and administrative procedures for Southern Oregon Adolescent Study and Treatment Center. Groups principles into six clusters: program…

Implementing Endobronchial Ultrasound-Guided (EBUS) for Staging and Diagnosis of Lung Cancer: A Cost Analysis

PubMed Central

Slavova-Azmanova, Neli S.; Phillips, Martin; Trevenen, Michelle L.; Li, Ian W.; Johnson, Claire E.

2018-01-01

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and guide sheath (EBUS-GS) are gaining popularity for diagnosis and staging of lung cancer compared to CT-guided transthoracic needle aspiration (CT-TTNA), blind fiber-optic bronchoscopy, and mediastinoscopy. This paper aimed to examine predictors of higher costs for diagnosing and staging lung cancer, and to assess the effect of EBUS techniques on hospital cost. Material/Methods Hospital costs for diagnosis and staging of new primary lung cancer patients presenting in 2007–2008 and 2010–2011 were reviewed retrospectively. Multiple linear regression was used to determine relationships with hospital cost. Results We reviewed 560 lung cancer patient records; 100 EBUS procedures were performed on 90 patients. Higher hospital costs were associated with: EBUS-TBNA performed (p<0.0001); increasing inpatient length of stay (p<0.0001); increasing number of other surgical/diagnostic procedures (p<0.0001); whether the date of management decision fell within an inpatient visit (p<0.0001); and if the patient did not have a CT-TTNA, then costs increased as the number of imaging events increased (interaction p<0.0001). Cohort was not significantly related to cost. Location of the procedure (outside vs. inside theater) was a predictor of lower one-day EBUS costs (p<0.0001). Cost modelling revealed potential cost saving of $1506 per EBUS patient if all EBUS procedures were performed outside rather than in the theater ($66,259 per annum). Conclusions EBUS-TBNA only was an independent predictor of higher cost for diagnosis and staging of lung cancer. Performing EBUS outside compared to in the theater may lower costs for one-day procedures; potential future savings are considerable if more EBUS procedures could be performed outside the operating theater. PMID:29377878

A Methodological Framework for Instructional Design Model Development: Critical Dimensions and Synthesized Procedures

ERIC Educational Resources Information Center

Lee, Jihyun; Jang, Seonyoung

2014-01-01

Instructional design (ID) models have been developed to promote understandings of ID reality and guide ID performance. As the number and diversity of ID practices grows, implicit doubts regarding the reliability, validity, and usefulness of ID models suggest the need for methodological guidance that would help to generate ID models that are…

Francis-99: Transient CFD simulation of load changes and turbine shutdown in a model sized high-head Francis turbine

NASA Astrophysics Data System (ADS)

Mössinger, Peter; Jester-Zürker, Roland; Jung, Alexander

2017-01-01

With increasing requirements for hydropower plant operation due to intermittent renewable energy sources like wind and solar, numerical simulations of transient operations in hydraulic turbo machines become more important. As a continuation of the work performed for the first workshop which covered three steady operating conditions, in the present paper load changes and a shutdown procedure are investigated. The findings of previous studies are used to create a 360° model and compare measurements with simulation results for the operating points part load, high load and best efficiency. A mesh motion procedure is introduced, allowing to represent moving guide vanes for load changes from best efficiency to part load and high load. Additionally an automated re-mesh procedure is added for turbine shutdown to ensure reliable mesh quality during guide vane closing. All three transient operations are compared to PIV velocity measurements in the draft tube and pressure signals in the vaneless space. Simulation results of axial velocity distributions for all three steady operation points, during both load changes and for the shutdown correlated well with the measurement. An offset at vaneless space pressure is found to be a result of guide vane corrections for the simulation to ensure similar velocity fields. Short-time Fourier transformation indicating increasing amplitudes and frequencies at speed-no load conditions. Further studies will discuss the already measured start-up procedure and investigate the necessity to consider the hydraulic system dynamics upstream of the turbine by means of a 1D3D coupling between the 3D flow field and a 1D system model.

3D imaging, 3D printing and 3D virtual planning in endodontics.

PubMed

Shah, Pratik; Chong, B S

2018-03-01

The adoption and adaptation of recent advances in digital technology, such as three-dimensional (3D) printed objects and haptic simulators, in dentistry have influenced teaching and/or management of cases involving implant, craniofacial, maxillofacial, orthognathic and periodontal treatments. 3D printed models and guides may help operators plan and tackle complicated non-surgical and surgical endodontic treatment and may aid skill acquisition. Haptic simulators may assist in the development of competency in endodontic procedures through the acquisition of psycho-motor skills. This review explores and discusses the potential applications of 3D printed models and guides, and haptic simulators in the teaching and management of endodontic procedures. An understanding of the pertinent technology related to the production of 3D printed objects and the operation of haptic simulators are also presented.

Computer-Aided Design/Computer-Assisted Manufacture-Derived Needle Guide for Injection of Botulinum Toxin into the Lateral Pterygoid Muscle in Patients with Oromandibular Dystonia.

PubMed

Yoshida, Kazuya

2018-01-01

To evaluate the effectiveness and safety of botulinum toxin administration into the inferior head of the lateral pterygoid muscle of patients with jaw opening dystonia by using a computer-aided design/computer-assisted manufacture (CAD/CAM)-derived needle guide. A total of 17 patients with jaw opening dystonia were enrolled. After the patient's computed tomography (CT) scan was imported and fused with a scan of a plaster cast model of the maxilla, the optimal needle insertion site over the lateral pterygoid muscle was determined using the NobelClinician software. A total of 13 patients were injected both with and without the guide, and 4 patients underwent guided injection alone. The therapeutic effects of botulinum toxin injection and its associated complications were statistically compared between the guided and unguided procedures using paired t test. Botulinum toxin therapy was performed 42 and 32 times with and without the guides, respectively. The needle was easily inserted without any complications in all procedures. There was a significant difference (P < .001) between the mean comprehensive improvements observed with (66.3%) and without (54.4%) the guides. The findings suggest that the use of needle guides during the injection of botulinum toxin into the inferior head of the lateral pterygoid muscle is very useful for aiding the accurate and safe administration of botulinum toxin therapy for jaw opening dystonia.

Articulation in Business Education for Secondary and Postsecondary Levels. Office Procedures Articulation Guide.

ERIC Educational Resources Information Center

Formby, Ronnie J.

Focusing on courses in office procedures, this guide is one of a set of four articulation guides designed for articulating between secondary and postsecondary business education courses. (The other three guides focus on courses in typewriting, accounting, and shorthand.) Each guide presents a general course description, outlines of the major units…

The effect of bench model fidelity on fluoroscopy-guided transforaminal epidural injection training: a randomized control study.

PubMed

Gonzalez-Cota, Alan; Chiravuri, Srinivas; Stansfield, R Brent; Brummett, Chad M; Hamstra, Stanley J

2013-01-01

The purpose of this study was to determine whether high-fidelity simulators provide greater benefit than low-fidelity models in training fluoroscopy-guided transforaminal epidural injection. This educational study was a single-center, prospective, randomized 3-arm pretest-posttest design with a control arm. Eighteen anesthesia and physical medicine and rehabilitation residents were instructed how to perform a fluoroscopy-guided transforaminal epidural injection and assessed by experts on a reusable injectable phantom cadaver. The high- and low-fidelity groups received 30 minutes of supervised hands-on practice according to group assignment, and the control group received 30 minutes of didactic instruction from an expert. We found no differences at posttest between the high- and low-fidelity groups on global ratings of performance (P = 0.17) or checklist scores (P = 0.81). Participants who received either form of hands-on training significantly outperformed the control group on both the global rating of performance (control vs low-fidelity, P = 0.0048; control vs high-fidelity, P = 0.0047) and the checklist (control vs low-fidelity, P = 0.0047; control vs high-fidelity, P = 0.0047). Training an epidural procedure using a low-fidelity model may be equally effective as training on a high-fidelity model. These results are consistent with previous research on a variety of interventional procedures and further demonstrate the potential impact of simple, low-fidelity training models.

16 CFR 260.4 - Review procedure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Commercial Practices FEDERAL TRADE COMMISSION GUIDES AND TRADE PRACTICE RULES GUIDES FOR THE USE OF ENVIRONMENTAL MARKETING CLAIMS § 260.4 Review procedure. The Commission will review the guides as part of its... to alter or amend these guides in light of substantial new evidence regarding consumer interpretation...

Development of a fresh cadaver model for instruction of ultrasound-guided breast biopsy during the surgery clerkship: pre-test and post-test results among third-year medical students.

PubMed

McCrary, Hilary C; Krate, Jonida; Savilo, Christine E; Tran, Melissa H; Ho, Hang T; Adamas-Rappaport, William J; Viscusi, Rebecca K

2016-11-01

The aim of our study was to determine if a fresh cadaver model is a viable method for teaching ultrasound (US)-guided breast biopsy of palpable breast lesions. Third-year medical students were assessed both preinstruction and postinstruction on their ability to perform US-guided needle aspiration or biopsy of artificially created masses using a 10-item checklist. Forty-one third-year medical students completed the cadaver laboratory as part of the surgery clerkship. Eight items on the checklist were found to be significantly different between pre-testing and post-testing. The mean preinstruction score was 2.4, whereas the mean postinstruction score was 7.10 (P < .001). Fresh cadaver models have been widely used in medical education. However, there are few fresh cadaver models that provide instruction on procedures done in the outpatient setting. Our model was found to be an effective method for the instruction of US-guided breast biopsy among medical students. Copyright © 2016 Elsevier Inc. All rights reserved.

Procedural Guide for International Gauging Stations on Boundary Waters Between Canada and the United States of America

USGS Publications Warehouse

Huberman, S.; Slater, James; Condes, A.

1985-01-01

INTRODUCTION Since 1909, the United States of America (U.S.A.) and Canada have employed a system of monitoring stream-flow and water levels for shared waters based upon professionalism, trust and goodwill. This document has been prepared in considerable detail for use by managers and field officers at all levels of government in Canada and the United States. Its purpose is to serve as a guide in attaining uniform procedures in the designation and operation of International Gauging Stations. For special situations where these procedures do not apply, specific mention is made in appropriate sections of the guide. This guide supersedes that of November 4, 1969, and the guide entitled 'The Procedural Guide for Operation of International Gauging Stations, St. Mary- Milk Rivers,' dated March 12, 1979.

Prosthetically guided maxillofacial surgery: evaluation of the accuracy of a surgical guide and custom-made bone plate in oncology patients after mandibular reconstruction.

PubMed

Mazzoni, Simona; Marchetti, Claudio; Sgarzani, Rossella; Cipriani, Riccardo; Scotti, Roberto; Ciocca, Leonardo

2013-06-01

The aim of the present study was to evaluate the accuracy of prosthetically guided maxillofacial surgery in reconstructing the mandible with a free vascularized flap using custom-made bone plates and a surgical guide to cut the mandible and fibula. The surgical protocol was applied in a study group of seven consecutive mandibular-reconstructed patients who were compared with a control group treated using the standard preplating technique on stereolithographic models (indirect computer-aided design/computer-aided manufacturing method). The precision of both surgical techniques (prosthetically guided maxillofacial surgery and indirect computer-aided design/computer-aided manufacturing procedure) was evaluated by comparing preoperative and postoperative computed tomographic data and assessment of specific landmarks. With regard to midline deviation, no significant difference was documented between the test and control groups. With regard to mandibular angle shift, only one left angle shift on the lateral plane showed a statistically significant difference between the groups. With regard to angular deviation of the body axis, the data showed a significant difference in the arch deviation. All patients in the control group registered greater than 8 degrees of deviation, determining a facial contracture of the external profile at the lower margin of the mandible. With regard to condylar position, the postoperative condylar position was better in the test group than in the control group, although no significant difference was detected. The new protocol for mandibular reconstruction using computer-aided design/computer-aided manufacturing prosthetically guided maxillofacial surgery to construct custom-made guides and plates may represent a viable method of reproducing the patient's anatomical contour, giving the surgeon better procedural control and reducing procedure time. Therapeutic, III.

Guidelines for Implementing NCHRP 1-37A M-E Design Procedures in Ohio : Volume 4 -- MEPDG Models Validation & Recalibration

DOT National Transportation Integrated Search

2009-11-01

The development of the Mechanistic-Empirical Pavement Design Guide (MEPDG) under National Cooperative Highway Research Program (NCHRP) projects 1-37A and 1-40D has significantly improved the ability of pavement designers to model and simulate the eff...

77 FR 36017 - Regulatory Guide 7.3, Procedures for Picking Up and Receiving Packages of Radioactive Material

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-15

... Receiving Packages of Radioactive Material AGENCY: Nuclear Regulatory Commission. ACTION: Notice of... Guide (RG) 7.3, ``Procedures for Picking Up and Receiving Packages of Radioactive Material.'' The guide..., ``Administrative Guide for Verifying Compliance with Packaging Requirements for Shipment and Receipt of Radioactive...

[Guided maxillofacial surgery: Simulation and surgery aided by stereolithographic guides and custom-made miniplates.

PubMed

Philippe, B

2013-08-05

We present a new model of guided surgery, exclusively using computer assistance, from the preoperative planning of osteotomies to the actual surgery with the aid of stereolithographic cutting guides and osteosynthetic miniplates designed and made preoperatively, using custom-made titanium miniplates thanks to direct metal laser sintering. We describe the principles that guide the designing and industrial manufacturing of this new type of osteosynthesis miniplates. The surgical procedure is described step-by-step using several representative cases of dento-maxillofacial dysmorphosis. The encouraging short-term results demonstrate the wide range of application of this new technology for cranio-maxillofacial surgery, whatever the type of osteotomy performed, and for plastic reconstructive surgery. Copyright © 2013. Published by Elsevier Masson SAS.

Evaluation of a novel, hybrid model (Mumbai EUS II) for stepwise teaching and training in EUS-guided biliary drainage and rendezvous procedures

PubMed Central

Dhir, Vinay; Itoi, Takao; Pausawasdi, Nonthalee; Khashab, Mouen A.; Perez-Miranda, Manuel; Sun, Siyu; Park, Do Hyun; Iwashita, Takuji; Teoh, Anthony Y. B.; Maydeo, Amit P.; Ho, Khek Yu

2017-01-01

Background and aims  EUS-guided biliary drainage (EUS-BD) and rendezvous (EUS-RV) are acceptable rescue options for patients with failed endoscopic retrograde cholangiopancreatography (ERCP). However, there are limited training opportunities at most centers owing to low case volumes. The existing models do not replicate the difficulties encountered during EUS-BD. We aimed to develop and validate a model for stepwise learning of EUS-BD and EUS-RV, which replicates the actual EUS-BD procedures. Methods  A hybrid model was created utilizing pig esophagus and stomach, with a synthetic duodenum and biliary system. The model was objectively assessed on a grade of 1 – 4 by two experts. Twenty-eight trainees were given initial training with didactic lectures and live procedures. This was followed by hands-on training in EUS-BD and EUS-RV on the hybrid model. Trainees were assessed for objective criteria of technical difficulties. Results  Both the experts graded the model as very good or above for all parameters. All trainees could complete the requisite steps of EUS-BD and EUS-RV in a mean time of 11 minutes (8 – 18 minutes). Thirty-six technical difficulties were noted during the training (wrong scope position, 13; incorrect duct puncture, 12; guidewire related problems, 11). Technical difficulties peaked for EUS-RV, followed by hepaticogastrostomy (HGS) and choledochoduodenostomy (CDS) (20, 9, and 7, P  = 0.001). At 10 days follow-up, nine of 28 trainees had successfully performed three EUS-RV and seven EUS-BD procedures independently. Conclusions  The Mumbai EUS II hybrid model replicates situations encountered during EUS-RV and EUS-BD. Stepwise mentoring improves the chances of success in EUS-RV and EUS-BD procedures. PMID:29250585

Automated dental implantation using image-guided robotics: registration results.

PubMed

Sun, Xiaoyan; McKenzie, Frederic D; Bawab, Sebastian; Li, Jiang; Yoon, Yongki; Huang, Jen-K

2011-09-01

One of the most important factors affecting the outcome of dental implantation is the accurate insertion of the implant into the patient's jaw bone, which requires a high degree of anatomical accuracy. With the accuracy and stability of robots, image-guided robotics is expected to provide more reliable and successful outcomes for dental implantation. Here, we proposed the use of a robot for drilling the implant site in preparation for the insertion of the implant. An image-guided robotic system for automated dental implantation is described in this paper. Patient-specific 3D models are reconstructed from preoperative Cone-beam CT images, and implantation planning is performed with these virtual models. A two-step registration procedure is applied to transform the preoperative plan of the implant insertion into intra-operative operations of the robot with the help of a Coordinate Measurement Machine (CMM). Experiments are carried out with a phantom that is generated from the patient-specific 3D model. Fiducial Registration Error (FRE) and Target Registration Error (TRE) values are calculated to evaluate the accuracy of the registration procedure. FRE values are less than 0.30 mm. Final TRE values after the two-step registration are 1.42 ± 0.70 mm (N = 5). The registration results of an automated dental implantation system using image-guided robotics are reported in this paper. Phantom experiments show that the practice of robot in the dental implantation is feasible and the system accuracy is comparable to other similar systems for dental implantation.

Design of high-fidelity haptic display for one-dimensional force reflection applications

NASA Astrophysics Data System (ADS)

Gillespie, Brent; Rosenberg, Louis B.

1995-12-01

This paper discusses the development of a virtual reality platform for the simulation of medical procedures which involve needle insertion into human tissue. The paper's focus is the hardware and software requirements for haptic display of a particular medical procedure known as epidural analgesia. To perform this delicate manual procedure, an anesthesiologist must carefully guide a needle through various layers of tissue using only haptic cues for guidance. As a simplifying aspect for the simulator design, all motions and forces involved in the task occur along a fixed line once insertion begins. To create a haptic representation of this procedure, we have explored both physical modeling and perceptual modeling techniques. A preliminary physical model was built based on CT-scan data of the operative site. A preliminary perceptual model was built based on current training techniques for the procedure provided by a skilled instructor. We compare and contrast these two modeling methods and discuss the implications of each. We select and defend the perceptual model as a superior approach for the epidural analgesia simulator.

Office Procedures 20-30. Business Education Curriculum Guide.

ERIC Educational Resources Information Center

Alberta Dept. of Education, Edmonton. Curriculum Branch.

This curriculum guide is one of nine such guides developed for an Alberta high school business education program. Its content covers the main subject area or strand of office procedures. Subject to the constraints outlined in the guide, the modules are to be formatted into three- or four-credit courses within each strand. Introductory materials…

A Single-Institution Experience in Percutaneous Image-Guided Biopsy of Malignant Pleural Mesothelioma

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

Welch, B. T., E-mail: Welch.brian@mayo.edu; Eiken, P. W.; Atwell, T. D.

PurposeMesothelioma has been considered a difficult pathologic diagnosis to achieve via image-guided core needle biopsy. The purpose of this study was to assess the diagnostic sensitivity of percutaneous image-guided biopsy for diagnosis of pleural mesothelioma.Materials and MethodsRetrospective review was performed to identify patients with a confirmed diagnosis of pleural mesothelioma and who underwent image-guided needle biopsy between January 1, 2002, and January 1, 2016. Thirty-two patients with pleural mesothelioma were identified and included for analysis in 33 image-guided biopsy procedures. Patient, procedural, and pathologic characteristics were recorded. Complications were characterized via standardized nomenclature [Common Terminology for Clinically Adverse Events (CTCAE)].ResultsPercutaneousmore » image-guided biopsy was associated with an overall sensitivity of 81%. No CTCAE clinically significant complications were observed. No image-guided procedures were complicated by pneumothorax or necessitated chest tube placement. No patients had tumor seeding of the biopsy tract.ConclusionPercutaneous image-guided biopsy can achieve high sensitivity for pathologic diagnosis of pleural mesothelioma with a low procedural complication rate, potentially obviating need for surgical biopsy.« less

Characterizing a porous road pavement using surface impedance measurement: a guided numerical inversion procedure.

PubMed

Benoit, Gaëlle; Heinkélé, Christophe; Gourdon, Emmanuel

2013-12-01

This paper deals with a numerical procedure to identify the acoustical parameters of road pavement from surface impedance measurements. This procedure comprises three steps. First, a suitable equivalent fluid model for the acoustical properties porous media is chosen, the variation ranges for the model parameters are set, and a sensitivity analysis for this model is performed. Second, this model is used in the parameter inversion process, which is performed with simulated annealing in a selected frequency range. Third, the sensitivity analysis and inversion process are repeated to estimate each parameter in turn. This approach is tested on data obtained for porous bituminous concrete and using the Zwikker and Kosten equivalent fluid model. This work provides a good foundation for the development of non-destructive in situ methods for the acoustical characterization of road pavements.

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

PubMed

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

2017-04-25

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

Impacts of suppressing guide on information spreading

NASA Astrophysics Data System (ADS)

Xu, Jinghong; Zhang, Lin; Ma, Baojun; Wu, Ye

2016-02-01

It is quite common that guides are introduced to suppress the information spreading in modern society for different purposes. In this paper, an agent-based model is established to quantitatively analyze the impacts of suppressing guides on information spreading. We find that the spreading threshold depends on the attractiveness of the information and the topology of the social network with no suppressing guides at all. Usually, one would expect that the existence of suppressing guides in the spreading procedure may result in less diffusion of information within the overall network. However, we find that sometimes the opposite is true: the manipulating nodes of suppressing guides may lead to more extensive information spreading when there are audiences with the reversal mind. These results can provide valuable theoretical references to public opinion guidance on various information, e.g., rumor or news spreading.

Incoming Population: Where Will the People Live? Coping with Growth.

ERIC Educational Resources Information Center

Siegler, Theodore R.

The guide describes an assessment procedure that can be used by sparsely populated communities located near a potential development to help predict where the incoming population will choose to live and shop. First, a numerical model, the "gravity model," is presented which utilizes community size and the distance from the community to…

Ergonomic task analysis of ultrasound-guided femoral nerve block: a pilot study.

PubMed

Ajmal, Muhammad; Power, Susan; Smith, Tim; Shorten, George D

2011-02-01

To apply ergonomic task analysis to the performance of ultrasound-guided (US-guided) femoral nerve block (FNB) in an acute hospital setting. Pilot prospective observational study. Orthopedic operating room of a regional trauma hospital. 15 anesthesiologists of various levels of experience in US-guided FNB (estimated minimum experience < 10 procedures; maximum about 50 procedures, and from basic trainees to consultants); and 15 patients (5 men and 10 women), aged 77 ± 15 (mean ± SD yrs) years. MEASUREMENTS/OBSERVATIONS: A data capture "tool", which was modified from one previously developed for ergonomic study of spinal anesthesia, was studied. Patient, operator, and heterogeneous environmental factors related to ergonomic performance of US-guided FNB were identified. The observation period started immediately before commencement of positioning the patient and ended on completion of perineural injection. Data were acquired using direct observations, photography, and application of a questionnaire. The quality of ergonomic performance was generally suboptimal and varied greatly among operators. Eight (experience < 10 procedures) of 15 operators excessively rotated their head, neck, and/or back to visualize the image on the ultrasound machine. Eight operators (experience < 10 procedures) performed the procedure with excessive thoracolumbar flexion. Performance of US-guided FNB presents ergonomic challenges and was suboptimal during most of the procedures observed. Formal training in US-guided peripheral nerve blockade should include reference to ergonomic factors. Copyright © 2011 Elsevier Inc. All rights reserved.

Projects procedure guide : sampling frequencies for materials testing and inspection

DOT National Transportation Integrated Search

2002-02-01

The Bureau of Materials and Physical Research's Project Procedures Guide (PPG) is used as a resource for determining reasonable inspection procedures and sampling frequencies for materials used in highway construction. This Manual seeks to establish ...

WSSDA's Guide to Parliamentary Procedures. Revised

ERIC Educational Resources Information Center

Randolph, Mary

2004-01-01

This guide to parliamentary procedures is presented by the Washington State School Directors' Association (WSSDA) for use by local school boards within the State of Washington. Parliamentary law and parliamentary procedure is the key to order and to provide justice and fairness to all. Through both formal and informal parliamentary procedures,…

Quality of Widely Available Video Instructional Materials for Point-of-Care Ultrasound-Guided Procedure Training in Internal Medicine.

PubMed

Khandelwal, Aditi; Devine, Luke A; Otremba, Mirek

2017-07-01

Many instructional materials for point-of-care ultrasound (US)-guided procedures exist; however, their quality is unknown. This study assessed widely available educational videos for point-of-care US-guided procedures relevant to internal medicine: central venous catheterization, thoracentesis, and paracentesis. We searched Ovid MEDLINE, YouTube, and Google to identify videos for point-of-care US-guided paracentesis, thoracentesis, and central venous catheterization. Videos were evaluated with a 5-point scale assessing the global educational value and a checklist based on consensus guidelines for competencies in point-of-care US-guided procedures. For point-of-care US-guided central venous catheterization, 12 videos were found, with an average global educational value score ± SD of 4.5 ± 0.7. Indications to abort the procedure were discussed in only 3 videos. Five videos described the indications and contraindications for performing central venous catheterization. For point-of-care US-guided thoracentesis, 8 videos were identified, with an average global educational value score of 4.0 ± 0.9. Only one video discussed indications to abort the procedure, and 3 videos discussed sterile technique. For point-of-care US-guided paracentesis, 7 videos were included, with an average global educational value score of 4.1 ± 0.9. Only 1 video discussed indications to abort the procedure, and 2 described the location of the inferior epigastric artery. The 27 videos reviewed contained good-quality general instruction. However, we noted a lack of safety-related information in most of the available videos. Further development of resources is required to teach internal medicine trainees skills that focus on the safety of point-of-care US guidance. © 2017 by the American Institute of Ultrasound in Medicine.

An inexpensive, easily constructed, reusable task trainer for simulating ultrasound-guided pericardiocentesis.

PubMed

Zerth, Herb; Harwood, Robert; Tommaso, Laura; Girzadas, Daniel V

2012-12-01

Pericardiocentesis is a low-frequency, high-risk procedure integral to the practice of emergency medicine. Ultrasound-guided pericardiocentesis is the preferred technique for providing this critical intervention. Traditionally, emergency physicians learned pericardiocentesis in real time, at the bedside, on critically ill patients. Medical education is moving toward simulation for training and assessment of procedures such as pericardiocentesis because it allows learners to practice time-sensitive skills without risk to patient or learner. The retail market for models for pericardiocentesis practice is limited and expensive. We have developed an ultrasound-guided pericardiocentesis task trainer that allows the physician to insert a needle under ultrasound guidance, pierce the "pericardial sac" and aspirate "blood." Our model can be simply constructed in a home kitchen, and the overall preparation time is 1 h. Our model costs $20.00 (US, 2008). Materials needed for the construction include 16 ounces of plain gelatin, one large balloon, one golf ball, food coloring, non-stick cooking spray, one wooden cooking skewer, surgical iodine solution, and a 4-quart sized plastic food storage container. Refrigeration and a heat source for cooking are also required. Once prepared, the model is usable for 2 weeks at room temperature and may be preserved an additional week if refrigerated. When the model shows signs of wear, it can be easily remade, by simply recycling the existing materials. The self-made model was well liked by training staff due to accessibility of a simulation model, and by learners of the technique as they felt more at ease performing pericardiocentesis on a live patient. Copyright © 2012 Elsevier Inc. All rights reserved.

Outcomes following implementation of a pediatric procedural sedation guide for referral to general anesthesia for magnetic resonance imaging studies.

PubMed

Grunwell, Jocelyn R; Marupudi, Neelima K; Gupta, Rohan V; Travers, Curtis D; McCracken, Courtney E; Williamson, Julie L; Stockwell, Jana A; Fortenberry, James D; Couloures, Kevin; Cravero, Joseph; Kamat, Pradip P

2016-06-01

Guidelines for referral of children to general anesthesia (GA) to complete MRI studies are lacking. We devised a pediatric procedural sedation guide to determine whether a pediatric procedural sedation guide would decrease serious adverse events and decrease failed sedations requiring rescheduling with GA. We constructed a consensus-based sedation guide by combining a retrospective review of reasons for referral of children to GA (n = 221) with published risk factors associated with the inability to complete the MRI study with sedation. An interrupted time series analysis of 11 530 local sedation records from the Pediatric Sedation Research Consortium between July 2008 and March 2013, adjusted for case-mix differences in the pre- and postsedation guide cohorts, evaluated whether a sedation guide resulted in decreased severe adverse events (SAE) and failed sedation rates. A significant increase in referrals to GA following implementation of a sedation guide occurred (P < 0.001), and fewer children with an ASA-PS class ≥III were sedated using procedural sedation (P < 0.001). There was no decrease in SAE (P = 0.874) or in SAE plus airway obstruction with concurrent hypoxia (P = 0.435). There was no change in the percentage of failed sedations (P = 0.169). More studies are needed to determine the impact of a sedation guide on pediatric procedural sedation services. © 2016 John Wiley & Sons Ltd.

Fast 3-T MR-guided transrectal prostate biopsy using an in-room tablet device for needle guide alignment: a feasibility study.

PubMed

Overduin, Christiaan G; Heidkamp, Jan; Rothgang, Eva; Barentsz, Jelle O; de Lange, Frank; Fütterer, Jurgen J

2018-05-22

To assess the feasibility of adding a tablet device inside the scanner room to assist needle-guide alignment during magnetic resonance (MR)-guided transrectal prostate biopsy. Twenty patients with one cancer-suspicious region (CSR) with PI-RADS score ≥ 4 on diagnostic multiparametric MRI were prospectively enrolled. Two orthogonal scan planes of an MR fluoroscopy sequence (~3 images/s) were aligned to the CSR and needle-guide pivoting point. Targeting was achieved by manipulating the needle-guide under MR fluoroscopy feedback on the in-room tablet device. Technical feasibility and targeting success were assessed. Complications and biopsy procedure times were also recorded. Needle-guide alignment with the in-room tablet device was technically successful in all patients and allowed sampling after a single alignment step in 19/20 (95%) CSRs (median size 14 mm, range: 4-45). Biopsy cores contained cancer in 18/20 patients. There were no per-procedural or post-biopsy complications. Using the tablet device, the mean time to first biopsy was 5.8 ± 1.0 min and the mean total procedure time was 23.7 ± 4.1 min. Use of an in-room tablet device to assist needle-guide alignment was feasible and safe during MR-guided transrectal prostate biopsy. Initial experience indicates potential for procedure time reduction. • Performing MR-guided prostate biopsy using an in-room tablet device is feasible. • CSRs could be sampled after a single alignment step in 19/20 patients. • The mean procedure time for biopsy with the tablet device was 23.7 min.

Numerical investigation of nonlinear interactions between multimodal guided waves and delamination in composite structures

NASA Astrophysics Data System (ADS)

Shen, Yanfeng

2017-04-01

This paper presents a numerical investigation of the nonlinear interactions between multimodal guided waves and delamination in composite structures. The elastodynamic wave equations for anisotropic composite laminate were formulated using an explicit Local Interaction Simulation Approach (LISA). The contact dynamics was modeled using the penalty method. In order to capture the stick-slip contact motion, a Coulomb friction law was integrated into the computation procedure. A random gap function was defined for the contact pairs to model distributed initial closures or openings to approximate the nature of rough delamination interfaces. The LISA procedure was coded using the Compute Unified Device Architecture (CUDA), which enables the highly parallelized computation on powerful graphic cards. Several guided wave modes centered at various frequencies were investigated as the incident wave. Numerical case studies of different delamination locations across the thickness were carried out. The capability of different wave modes at various frequencies to trigger the Contact Acoustic Nonlinearity (CAN) was studied. The correlation between the delamination size and the signal nonlinearity was also investigated. Furthermore, the influence from the roughness of the delamination interfaces was discussed as well. The numerical investigation shows that the nonlinear features of wave delamination interactions can enhance the evaluation capability of guided wave Structural Health Monitoring (SHM) system. This paper finishes with discussion, concluding remarks, and suggestions for future work.

Spruce Budworms Handbook: shigometry – a reference guide

Treesearch

Alex L. Shigo; Walter C. Shortle

1985-01-01

This guide explains how to test the condition of living trees or wood products by use of the Shigometer and gives instructions for its use. The guide is in three parts: (1) An introduction on operating principles and applications, (2) an example of the procedure, and (3) a photo guide that gives details on the procedure and background information needed to use it....

Guided-inquiry laboratory experiments to improve students' analytical thinking skills

NASA Astrophysics Data System (ADS)

Wahyuni, Tutik S.; Analita, Rizki N.

2017-12-01

This study aims to improve the experiment implementation quality and analytical thinking skills of undergraduate students through guided-inquiry laboratory experiments. This study was a classroom action research conducted in three cycles. The study has been carried out with 38 undergraduate students of the second semester of Biology Education Department of State Islamic Institute (SII) of Tulungagung, as a part of Chemistry for Biology course. The research instruments were lesson plans, learning observation sheets and undergraduate students' experimental procedure. Research data were analyzed using quantitative-descriptive method. The increasing of analytical thinking skills could be measured using gain score normalized and statistical paired t-test. The results showed that guided-inquiry laboratory experiments model was able to improve both the experiment implementation quality and the analytical thinking skills. N-gain score of the analytical thinking skills was increased, in spite of just 0.03 with low increase category, indicated by experimental reports. Some of undergraduate students have had the difficulties in detecting the relation of one part to another and to an overall structure. The findings suggested that giving feedback the procedural knowledge and experimental reports were important. Revising the experimental procedure that completed by some scaffolding questions were also needed.

Electromechanical Engineering Technology Curriculum.

ERIC Educational Resources Information Center

Georgia State Univ., Atlanta. Dept. of Vocational and Career Development.

This guide offers information and procedures necessary to train electromechanical engineering technicians. Discussed first are the rationale and objectives of the curriculum. The occupational field of electromechanical engineering technology is described. Next, a curriculum model is set forth that contains information on the standard…

A Guide for Developing Standard Operating Job Procedures for the Pump Station Process Wastewater Treatment Facility. SOJP No. 3.

ERIC Educational Resources Information Center

Perley, Gordon F.

This is a guide for standard operating job procedures for the pump station process of wastewater treatment plants. Step-by-step instructions are given for pre-start up inspection, start-up procedures, continuous routine operation procedures, and shut-down procedures. A general description of the equipment used in the process is given. Two…

Electronic-Power-Transformer Design Guide

NASA Technical Reports Server (NTRS)

Schwarze, G. E.; Lagadinos, J. C.; Ahearn, J. F.

1983-01-01

Compilation of information on design procedures, electrical properties, and fabrication. Guide provides information on design procedures; magnetic and insulating material electrical properties; impregnating, encapsulating and processing techniques.

Intravascular Ultrasound in the Creation of Transhepatic Portosystemic Shunts Reduces Needle Passes, Radiation Dose, and Procedure Time: A Retrospective Study of a Single-Institution Experience.

PubMed

Kao, Steven D; Morshedi, Maud M; Narsinh, Kazim H; Kinney, Thomas B; Minocha, Jeet; Picel, Andrew C; Newton, Isabel; Rose, Steven C; Roberts, Anne C; Kuo, Alexander; Aryafar, Hamed

2016-08-01

To assess whether intravascular ultrasound (US) guidance impacts number of needle passes, contrast usage, radiation dose, and procedure time during creation of transjugular intrahepatic portosystemic shunts (TIPS). Intravascular US-guided creation of TIPS in 40 patients was retrospectively compared with conventional TIPS in 49 patients between February 2010 and November 2015 at a single tertiary care institution. Patient sex and age, etiology of liver disease (hepatitis C virus, alcohol abuse, nonalcoholic steatohepatitis), severity of liver disease (mean Model for End-Stage Liver Disease score), and indications for TIPS (variceal bleeding, refractory ascites, refractory hydrothorax) in conventional and intravascular US-guided cases were recorded. The two groups were well matched by sex, age, etiology of liver disease, Child-Pugh class, Model for End-Stage Liver Disease scores, and indication for TIPS (P range = .19-.94). Fewer intrahepatic needle passes were required in intravascular US-guided TIPS creation compared with conventional TIPS (2 passes vs 6 passes, P < .01). Less iodinated contrast material was used in intravascular US cases (57 mL vs 140 mL, P < .01). Radiation exposure, as measured by cumulative dose, dose area product, and fluoroscopy time, was reduced with intravascular US (174 mGy vs 981 mGy, P < .01; 3,793 μGy * m(2) vs 21,414 μGy * m(2), P < .01; 19 min vs 34 min, P < .01). Procedure time was shortened with intravascular US (86 min vs 125 min, P < .01). Intravascular US guidance resulted in fewer intrahepatic needle passes, decreased contrast medium usage, decreased radiation dosage, and shortened procedure time in TIPS creation. Copyright © 2016 SIR. All rights reserved.

Training and certification in endobronchial ultrasound-guided transbronchial needle aspiration

PubMed Central

Konge, Lars; Nayahangan, Leizl Joy; Clementsen, Paul Frost

2017-01-01

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays a key role in the staging of lung cancer, which is crucial for allocation to surgical treatment. EBUS-TBNA is a complicated procedure and simulation-based training is helpful in the first part of the long learning curve prior to performing the procedure on actual patients. New trainees should follow a structured training programme consisting of training on simulators to proficiency as assessed with a validated test followed by supervised practice on patients. The simulation-based training is superior to the traditional apprenticeship model and is recommended in the newest guidelines. EBUS-TBNA and oesophageal ultrasound-guided fine needle aspiration (EUS-FNA or EUS-B-FNA) are complementary to each other and the combined techniques are superior to either technique alone. It is logical to learn and to perform the two techniques in combination, however, for lung cancer staging solely EBUS-TBNA simulators exist, but hopefully in the future simulation-based training in EUS will be possible. PMID:28840013

Cleaning Out the Wheelbarrow: Planning Appropriate Assessments for Transition.

ERIC Educational Resources Information Center

Finn, David M.; Tazioli, Pam

1993-01-01

Examines issues in the transition of young disabled children between programs: ignorance or misinformation about available resources; eligibility criteria; interagency information exchange; and advance planning. Provides a troubleshooting guide to help agencies evaluate transition procedures. Discusses interagency assessment models and tools to…

Mechanical Engineering Technology Curriculum.

ERIC Educational Resources Information Center

Georgia State Univ., Atlanta. Dept. of Vocational and Career Development.

This guide offers information and procedures necessary to train mechanical engineering technicians. Discussed first are the rationale and objectives of the curriculum. The occupational field of mechanical engineering technology is described. Next, a curriculum model is set forth that contains information on the standard mechanical engineering…

TADS Needs Assessment Procedures Manual, Summer 1980.

ERIC Educational Resources Information Center

Black, Talbot; And Others

The TADS (Technical Assistance Development System) Needs Assessment Manual is designed to guide the comprehensive review of Handicapped Children's Early Education Program (HCEEP) demonstration projects in identifying technical assistance needs. An introduction reviews the TADS technical assistance model which includes program planning, needs…

Evaluation and "PACE": A Study of Procedures and Effectiveness of Evaluation Sections in Approved PACE Project, with Recommendations for Improvement.

ERIC Educational Resources Information Center

Miller, Richard I.

This report is based upon an analysis of the evaluation procedures outlined in 21 funded Title III proposals. The proposals were analyzed from a number of points of view. (1) Using the Stufflabeam model as a guide, they were examined to determine what, if any, provisions had been made for each of the four classes of evaluation: context, input,…

Sonographically guided intrasheath percutaneous release of the first annular pulley for trigger digits, part 2: randomized comparative study of the economic impact of 3 surgical models.

PubMed

Rojo-Manaute, Jose Manuel; Capa-Grasa, Alberto; Del Cerro-Gutiérrez, Miguel; Martínez, Manuel Villanueva; Chana-Rodríguez, Francisco; Martín, Javier Vaquero

2012-03-01

Trigger digit surgery can be performed by an open approach using classic open surgery, by a wide-awake approach, or by sonographically guided first annular pulley release in day surgery and office-based ambulatory settings. Our goal was to perform a turnover and economic analysis of 3 surgical models. Two studies were conducted. The first was a turnover analysis of 57 patients allocated 4:4:1 into the surgical models: sonographically guided-office-based, classic open-day surgery, and wide-awake-office-based. Regression analysis for the turnover time was monitored for assessing stability (R(2) < .26). Second, on the basis of turnover times and hospital tariff revenues, we calculated the total costs, income to cost ratio, opportunity cost, true cost, true net income (primary variable), break-even points for sonographically guided fixed costs, and 1-way analysis for identifying thresholds among alternatives. Thirteen sonographically guided-office-based patients were withdrawn because of a learning curve influence. The wide-awake (n = 6) and classic (n = 26) models were compared to the last 25% of the sonographically guided group (n = 12), which showed significantly less mean turnover times, income to cost ratios 2.52 and 10.9 times larger, and true costs 75.48 and 20.92 times lower, respectively. A true net income break-even point happened after 19.78 sonographically guided-office-based procedures. Sensitivity analysis showed a threshold between wide-awake and last 25% sonographically guided true costs if the last 25% sonographically guided turnover times reached 65.23 and 27.81 minutes, respectively. However, this trial was underpowered. This trial comparing surgical models was underpowered and is inconclusive on turnover times; however, the sonographically guided-office-based approach showed shorter turnover times and better economic results with a quick recoup of the costs of sonographically assisted surgery.

Wire-guided sphincterotomy.

PubMed

Sherman, S; Uzer, M F; Lehman, G A

1994-12-01

Guidewire-assisted techniques have acquired an important role in endoscopic interventions in the pancreaticobiliary tree. The wire-guided sphincterotome allows the endoscopist to maintain direct access to the biliary tree before or after the sphincterotomy. It has the additional advantages of allowing for more expeditious placement of accessories and being useful in combined percutaneous-endoscopic procedures. There are two basic designs of wire-guided sphincterotomes. The single-channel model has a single lumen for both the cutting wire and guidewire and requires guidewire removal before the application of power. The double-channel model has two separate lumens for the guidewire and stainless steel cutting wire. In vitro data suggest that significant capacitive coupling currents (or short circuits) may occur on the standard Teflon-coated guidewire when used with a double lumen sphincterotome, resulting in electrosurgical burns. Thus, the manufacturers of the double-lumen models recommend removing the Teflon-coated wire before performing sphincterotomy. Although limited data in humans have been published, it appears that wire-guided sphincterotomy and standard sphincterotomy have similar complication rates. More safety information in humans is awaited.

Listening to music during transrectal ultrasound-guided prostate biopsy decreases anxiety, pain and dissatisfaction in patients: a pilot randomized controlled trial.

PubMed

Chang, Yun Hee; Oh, Tae Hoon; Lee, Jae Whan; Park, Seung Chol; Seo, Ill Young; Jeong, Hee Jong; Kwon, Whi-An

2015-01-01

To determine whether listening to music during transrectal ultrasound (TRUS)-guided 12-core needle prostate biopsy decreases anxiety, pain and dissatisfaction among patients and results in a more comfortable and better tolerated procedure. 76 male patients who underwent TRUS-guided prostate biopsy between March 2013 and June 2014 were randomized into the following groups: no music (group I, n = 38) or classical music (group II, n = 38) during the procedure. Before TRUS-guided prostate biopsy, lidocaine gel was instilled into the rectum. Patient anxiety levels were quantified using the State-Trait Anxiety Inventory. A visual analog scale (0-10) was used for self-assessment of satisfaction, discomfort and willingness among patients to have a repeat TRUS-guided prostate biopsy. Demographic characteristics, mean age, procedure duration and procedure indications did not differ statistically between the two groups. The mean anxiety level and mean pain score of group II were significantly lower than those of group I (p = 0.001 and p = 0.003, respectively). Group II also had a significantly higher mean satisfaction score than group I (p = 0.007). Before the procedure, heart rate and systolic blood pressure were similar in groups I and II; however, after the procedure, levels were lower in group II than in group I (heart rate, p = 0.014; systolic blood pressure, p = 0.011). Listening to music during TRUS-guided prostate biopsy significantly reduced patients' feelings of pain, discomfort and dissatisfaction. Music can serve as a simple, inexpensive and effective adjunct to sedation during TRUS-guided prostate biopsy. We recommend playing music during TRUS-guided prostate biopsy. 2014 S. Karger AG, Basel

Carpentry and Finishing Procedures. Building Maintenance. Module II. Instructor's Guide.

ERIC Educational Resources Information Center

Hawk, Sam; Brunk, Art

This curriculum guide, keyed to the building maintenance competency profile developed by industry and education professionals, provides three units on carpentry and finishing procedures. The first unit, Exterior Carpentry, contains the following lessons: carpentry safety procedures, ladder and scaffolding safety, door installation/repair,…

Extra Luminal Entrapment of Guide Wire; A Rare Complication of Central Venous Catheter Placement in Right Internal Jugular Vein.

PubMed

Ansari, Md Abu Masud; Kumar, Naveen; Kumar, Shailesh; Kumari, Sarita

2016-10-01

Central venous Catheterization (CVC) is a commonly performed procedure for venous access. It is associated with several complications. We report a rare case of extra luminal entrapment of guide wire during CVC placement in right jugular vein. We report a case of 28 years old female patient presented in our emergency with history of entrapped guide wire in right side of neck during CVC. X-ray showed coiling of guide wire in neck. CT Angiography showed guide wire coursing in between common carotid artery and internal jugular vein (IJV), closely abutting the wall of both vessels. The guide wire was coiled with end coursing behind the esophageal wall. Guide wire was removed under fluoroscopic guide manipulation under local anesthesia. We want to emphasize that even though CVC placement is common and simple procedure, serious complication can occur in hands of untrained operator. The procedure should be performed under supervision, if done by trainee. Force should never be applied to advance the guide wire if resistance is encountered.

Evaluation of the clinical benefit of an electromagnetic navigation system for CT-guided interventional radiology procedures in the thoraco-abdominal region compared with conventional CT guidance (CTNAV II): study protocol for a randomised controlled trial.

PubMed

Rouchy, R C; Moreau-Gaudry, A; Chipon, E; Aubry, S; Pazart, L; Lapuyade, B; Durand, M; Hajjam, M; Pottier, S; Renard, B; Logier, R; Orry, X; Cherifi, A; Quehen, E; Kervio, G; Favelle, O; Patat, F; De Kerviler, E; Hughes, C; Medici, M; Ghelfi, J; Mounier, A; Bricault, I

2017-07-06

Interventional radiology includes a range of minimally invasive image-guided diagnostic and therapeutic procedures that have become routine clinical practice. Each procedure involves a percutaneous needle insertion, often guided using computed tomography (CT) because of its availability and usability. However, procedures remain complicated, in particular when an obstacle must be avoided, meaning that an oblique trajectory is required. Navigation systems track the operator's instruments, meaning the position and progression of the instruments are visualised in real time on the patient's images. A novel electromagnetic navigation system for CT-guided interventional procedures (IMACTIS-CT®) has been developed, and a previous clinical trial demonstrated improved needle placement accuracy in navigation-assisted procedures. In the present trial, we are evaluating the clinical benefit of the navigation system during the needle insertion step of CT-guided procedures in the thoraco-abdominal region. This study is designed as an open, multicentre, prospective, randomised, controlled interventional clinical trial and is structured as a standard two-arm, parallel-design, individually randomised trial. A maximum of 500 patients will be enrolled. In the experimental arm (navigation system), the procedures are carried out using navigation assistance, and in the active comparator arm (CT), the procedures are carried out with conventional CT guidance. The randomisation is stratified by centre and by the expected difficulty of the procedure. The primary outcome of the trial is a combined criterion to assess the safety (number of serious adverse events), efficacy (number of targets reached) and performance (number of control scans acquired) of navigation-assisted, CT-guided procedures as evaluated by a blinded radiologist and confirmed by an expert committee in case of discordance. The secondary outcomes are (1) the duration of the procedure, (2) the satisfaction of the operator and (3) the irradiation dose delivered, with (4) subgroup analysis according to the expected difficulty of the procedure, as well as an evaluation of (5) the usability of the device. This trial addresses the lack of published high-level evidence studies in which navigation-assisted CT-guided interventional procedures are evaluated. This trial is important because it addresses the problems associated with conventional CT guidance and is particularly relevant because the number of interventional radiology procedures carried out in routine clinical practice is increasing. ClinicalTrials.gov identifier: NCT01896219 . Registered on 5 July 2013.

NewGate Model.

ERIC Educational Resources Information Center

National Council on Crime and Delinquency, Hackensack, NJ. NewGate Resource Center.

A guide is provided for establishing a college-level education program for inmates of correctional institutions based on the NewGate concept. Necessary first steps are evaluation of current facilities, selection of the sponsoring agency, and selection of the student body. Guidelines for student selection deal with application procedure, record…

Software Maintenance.

ERIC Educational Resources Information Center

Cannon, Glenn; Jobe, Holly

Proper cleaning and storage of audiovisual aids is outlined in this brief guide. Materials and equipment needed for first line maintenance are listed, as well as maintenance procedures for records, audio and video tape, film, filmstrips, slides, realia, models, prints, graphics, maps, and overhead transparencies. A 15-item quiz on software…

Electrical Procedures and Environmental Control Systems. Building Maintenance. Module IV. Instructor's Guide.

ERIC Educational Resources Information Center

Sloan, Garry

This curriculum guide, one of six modules keyed to the building maintenance competency profile developed by industry and education professionals, provides materials for two units on electrical procedures and environmental control systems. Unit 1, on electrical procedures, includes the following lessons: electrical safety; troubleshooting and…

A Modular Set of Mixed Reality Simulators for Blind and Guided Procedures

DTIC Science & Technology

2016-08-01

AWARD NUMBER: W81XWH-14-1-0113 TITLE: A Modular Set of Mixed Reality Simulators for “blind” and Guided Procedures PRINCIPAL INVESTIGATOR...2015 – 07/31/2016 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER A Modular Set of Mixed Reality Simulators for “Blind” and Guided Procedures 5b...editor developed to facilitate creation by non-technical educators of ITs for the set of modular simulators, (c) a curriculum for self-study and self

Using Systematic Screening Procedures to Identify Students Who Are Nonresponsive to Primary Prevention Efforts: Integrating Academic and Behavioral Measures

ERIC Educational Resources Information Center

Kalberg, Jemma Robertson; Lane, Kathleen Lynne; Menzies, Holly Mariah

2010-01-01

Many school systems are adopting three-tiered models of prevention (e.g., Response to Intervention and Positive Behavior Support) to support an increasingly diverse student population (Sugai, Horner, & Gresham, 2002). A central feature of these models is that data are monitored to determine responsiveness. We offer this paper as a guide for…

NASA High-Speed 2D Photogrammetric Measurement System

NASA Technical Reports Server (NTRS)

Dismond, Harriett R.

2012-01-01

The object of this report is to provide users of the NASA high-speed 2D photogrammetric measurement system with procedures required to obtain drop-model trajectory and impact data for full-scale and sub-scale models. This guide focuses on use of the system for vertical drop testing at the NASA Langley Landing and Impact Research (LandIR) Facility.

Treating the Tough Adolescent: A Family-Based, Step-by-Step Guide. The Guilford Family Therapy Series.

ERIC Educational Resources Information Center

Sells, Scott P.

A model for treating difficult adolescents and their families is presented. Part 1 offers six basic assumptions about the causes of severe behavioral problems and presents the treatment model with guidelines necessary to address each of these six causes. Case examples highlight and clarify major points within each of the 15 procedural steps of the…

Helicopter Fatigue Design Guide

DTIC Science & Technology

1983-11-01

for example, glass and carbon fibre reinforced plastics. The general principles behind the substantiation procedures for these materials are...initiating cause of many minor (and sometimes major) cracks that can lead to expensive repair, even though they may not immediately cause a safety...be seen, blade stresses correlated well with both unsteady models. However, push rod loads calculated with the Time Delay Model are much less than

Percutaneous magnetic resonance imaging-guided bone tumor management and magnetic resonance imaging-guided bone therapy.

PubMed

Sequeiros, Roberto Blanco; Fritz, Jan; Ojala, Risto; Carrino, John A

2011-08-01

Magnetic resonance imaging (MRI) is promising tool for image-guided therapy. In musculoskeletal setting, image-guided therapy is used to direct diagnostic and therapeutic procedures and to steer patient management. Studies have demonstrated that MRI-guided interventions involving bone, soft tissue, joints, and intervertebral disks are safe and in selected indications can be the preferred action to manage clinical situation. Often, these procedures are technically similar to those performed in other modalities (computed tomography, fluoroscopy) for bone and soft tissue lesions. However, the procedural perception to the operator can be very different to other modalities because of the vastly increased data.Magnetic resonance imaging guidance is particularly advantageous should the lesion not be visible by other modalities, for selective lesion targeting, intra-articular locations, cyst aspiration, and locations adjacent to surgical hardware. Palliative tumor-related pain management such as ablation therapy forms a subset of procedures that are frequently performed under MRI. Another suitable entity for MRI guidance are the therapeutic percutaneous osseous or joint-related benign or reactive conditions such as osteoid osteoma, epiphyseal bone bridging, osteochondritis dissecans, bone cysts, localized bone necrosis, and posttraumatic lesions. In this article, we will describe in detail the technical aspects of performing MRI-guided therapeutic musculoskeletal procedures as well as the clinical indications.

Laser Guidance in C-Arm Cone-Beam CT-Guided Radiofrequency Ablation of Osteoid Osteoma Reduces Fluoroscopy Time

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

Kroes, Maarten W., E-mail: Maarten.Kroes@radboudumc.nl; Busser, Wendy M. H.; Hoogeveen, Yvonne L.

PurposeTo assess whether laser guidance can reduce fluoroscopy and procedure time of cone-beam computed tomography (CBCT)-guided radiofrequency (RF) ablations of osteoid osteoma compared to freehand CBCT guidance.Materials and Methods32 RF ablations were retrospectively analyzed, 17 laser-guided and 15 procedures using the freehand technique. Subgroup selection of 18 ablations in the hip–pelvic region with a similar degree of difficulty was used for a direct comparison. Data are presented as median (ranges).ResultsComparison of all 32 ablations resulted in fluoroscopy times of 365 s (193–878 s) for freehand and 186 s (75–587 s) for laser-guided procedures (p = 0.004). Corresponding procedure times were 56 min (35–97 min) and 52 min (30–85 min) (p = 0.355).more » The subgroup showed comparable target sizes, needle path lengths, and number of scans between groups. Fluoroscopy times were lower for laser-guided procedures, 215 s (75–413 s), compared to 384 s (193–878 s) for freehand (p = 0.012). Procedure times were comparable between groups, 51 min (30–72 min) for laser guidance and 58 min (35–79 min) for freehand (p = 0.172).ConclusionAdding laser guidance to CBCT-guided osteoid osteoma RF ablations significantly reduced fluoroscopy time without increasing procedure time.Level of EvidenceLevel 4, case series.« less

Assistive technology for ultrasound-guided central venous catheter placement.

PubMed

Ikhsan, Mohammad; Tan, Kok Kiong; Putra, Andi Sudjana

2018-01-01

This study evaluated the existing technology used to improve the safety and ease of ultrasound-guided central venous catheterization. Electronic database searches were conducted in Scopus, IEEE, Google Patents, and relevant conference databases (SPIE, MICCAI, and IEEE conferences) for related articles on assistive technology for ultrasound-guided central venous catheterization. A total of 89 articles were examined and pointed to several fields that are currently the focus of improvements to ultrasound-guided procedures. These include improving needle visualization, needle guides and localization technology, image processing algorithms to enhance and segment important features within the ultrasound image, robotic assistance using probe-mounted manipulators, and improving procedure ergonomics through in situ projections of important information. Probe-mounted robotic manipulators provide a promising avenue for assistive technology developed for freehand ultrasound-guided percutaneous procedures. However, there is currently a lack of clinical trials to validate the effectiveness of these devices.

Development of a 3D ultrasound-guided prostate biopsy system

NASA Astrophysics Data System (ADS)

Cool, Derek; Sherebrin, Shi; Izawa, Jonathan; Fenster, Aaron

2007-03-01

Biopsy of the prostate using ultrasound guidance is the clinical gold standard for diagnosis of prostate adenocarinoma. However, because early stage tumors are rarely visible under US, the procedure carries high false-negative rates and often patients require multiple biopsies before cancer is detected. To improve cancer detection, it is imperative that throughout the biopsy procedure, physicians know where they are within the prostate and where they have sampled during prior biopsies. The current biopsy procedure is limited to using only 2D ultrasound images to find and record target biopsy core sample sites. This information leaves ambiguity as the physician tries to interpret the 2D information and apply it to their 3D workspace. We have developed a 3D ultrasound-guided prostate biopsy system that provides 3D intra-biopsy information to physicians for needle guidance and biopsy location recording. The system is designed to conform to the workflow of the current prostate biopsy procedure, making it easier for clinical integration. In this paper, we describe the system design and validate its accuracy by performing an in vitro biopsy procedure on US/CT multi-modal patient-specific prostate phantoms. A clinical sextant biopsy was performed by a urologist on the phantoms and the 3D models of the prostates were generated with volume errors less than 4% and mean boundary errors of less than 1 mm. Using the 3D biopsy system, needles were guided to within 1.36 +/- 0.83 mm of 3D targets and the position of the biopsy sites were accurately localized to 1.06 +/- 0.89 mm for the two prostates.

Using 3D Printing (Additive Manufacturing) to Produce Low-Cost Simulation Models for Medical Training.

PubMed

Lichtenberger, John P; Tatum, Peter S; Gada, Satyen; Wyn, Mark; Ho, Vincent B; Liacouras, Peter

2018-03-01

This work describes customized, task-specific simulation models derived from 3D printing in clinical settings and medical professional training programs. Simulation models/task trainers have an array of purposes and desired achievements for the trainee, defining that these are the first step in the production process. After this purpose is defined, computer-aided design and 3D printing (additive manufacturing) are used to create a customized anatomical model. Simulation models then undergo initial in-house testing by medical specialists followed by a larger scale beta testing. Feedback is acquired, via surveys, to validate effectiveness and to guide or determine if any future modifications and/or improvements are necessary. Numerous custom simulation models have been successfully completed with resulting task trainers designed for procedures, including removal of ocular foreign bodies, ultrasound-guided joint injections, nerve block injections, and various suturing and reconstruction procedures. These task trainers have been frequently utilized in the delivery of simulation-based training with increasing demand. 3D printing has been integral to the production of limited-quantity, low-cost simulation models across a variety of medical specialties. In general, production cost is a small fraction of a commercial, generic simulation model, if available. These simulation and training models are customized to the educational need and serve an integral role in the education of our military health professionals.

Ultrasound-guided versus computed tomography-scan guided biopsy of pleural-based lung lesions

PubMed Central

Khosla, Rahul; McLean, Anna W; Smith, Jessica A

2016-01-01

Background: Computed tomography (CT) guided biopsies have long been the standard technique to obtain tissue from the thoracic cavity and is traditionally performed by interventional radiologists. Ultrasound (US) guided biopsy of pleural-based lesions, performed by pulmonologists is gaining popularity and has the advantage of multi-planar imaging, real-time technique, and the absence of radiation exposure to patients. In this study, we aim to determine the diagnostic accuracy, the time to diagnosis after the initial consult placement, and the complications rates between the two different modalities. Methods: A retrospective study of electronic medical records was done of patients who underwent CT-guided biopsies and US-guided biopsies for pleural-based lesions between 2005 and 2014 and the data collected were analyzed for comparing the two groups. Results: A total of 158 patients underwent 162 procedures during the study period. 86 patients underwent 89 procedures in the US group, and 72 patients underwent 73 procedures in the CT group. The overall yield in the US group was 82/89 (92.1%) versus 67/73 (91.8%) in the CT group (P = 1.0). Average days to the procedure was 7.2 versus 17.5 (P = 0.00001) in the US and CT group, respectively. Complication rate was higher in CT group 17/73 (23.3%) versus 1/89 (1.1%) in the US group (P < 0.0001). Conclusions: For pleural-based lesions the diagnostic accuracy of US guided biopsy is similar to that of CT-guided biopsy, with a lower complication rate and a significantly reduced time to the procedure. PMID:27625440

Parametrically Guided Generalized Additive Models with Application to Mergers and Acquisitions Data

PubMed Central

Fan, Jianqing; Maity, Arnab; Wang, Yihui; Wu, Yichao

2012-01-01

Generalized nonparametric additive models present a flexible way to evaluate the effects of several covariates on a general outcome of interest via a link function. In this modeling framework, one assumes that the effect of each of the covariates is nonparametric and additive. However, in practice, often there is prior information available about the shape of the regression functions, possibly from pilot studies or exploratory analysis. In this paper, we consider such situations and propose an estimation procedure where the prior information is used as a parametric guide to fit the additive model. Specifically, we first posit a parametric family for each of the regression functions using the prior information (parametric guides). After removing these parametric trends, we then estimate the remainder of the nonparametric functions using a nonparametric generalized additive model, and form the final estimates by adding back the parametric trend. We investigate the asymptotic properties of the estimates and show that when a good guide is chosen, the asymptotic variance of the estimates can be reduced significantly while keeping the asymptotic variance same as the unguided estimator. We observe the performance of our method via a simulation study and demonstrate our method by applying to a real data set on mergers and acquisitions. PMID:23645976

Parametrically Guided Generalized Additive Models with Application to Mergers and Acquisitions Data.

PubMed

Fan, Jianqing; Maity, Arnab; Wang, Yihui; Wu, Yichao

2013-01-01

Generalized nonparametric additive models present a flexible way to evaluate the effects of several covariates on a general outcome of interest via a link function. In this modeling framework, one assumes that the effect of each of the covariates is nonparametric and additive. However, in practice, often there is prior information available about the shape of the regression functions, possibly from pilot studies or exploratory analysis. In this paper, we consider such situations and propose an estimation procedure where the prior information is used as a parametric guide to fit the additive model. Specifically, we first posit a parametric family for each of the regression functions using the prior information (parametric guides). After removing these parametric trends, we then estimate the remainder of the nonparametric functions using a nonparametric generalized additive model, and form the final estimates by adding back the parametric trend. We investigate the asymptotic properties of the estimates and show that when a good guide is chosen, the asymptotic variance of the estimates can be reduced significantly while keeping the asymptotic variance same as the unguided estimator. We observe the performance of our method via a simulation study and demonstrate our method by applying to a real data set on mergers and acquisitions.

Guia para su incorporacion a los Estados Unidos de America (A Guide to Resettlement in the United States. Spanish).

ERIC Educational Resources Information Center

Center for Applied Linguistics, Washington, DC. Refugee Service Center.

This resettlement guide, entirely in Spanish, describes the initial stage of resettlement and the processes that refugees undergo as new arrivals. Subjects covered in this guide include pre-arrival procedures, admissions criteria, immigrant's statement of understanding, travel costs and U.S. Customs; resettlement procedures, immigrants'…

Self-Motivated Personal Career Planning Program. Planner's Guide. [Student Edition].

ERIC Educational Resources Information Center

Walter, Verne

The Self-Motivated Personal Career Planning guide for students presents a process of self-assessment and goal-setting. An overview and rationale of the program and instructions and procedures are discussed in Chapters 1 and 2. The remainder of the guide consists of procedural steps for (1) self-assessment and (2) review and planning.…

Forward-viewing endoscopic ultrasound-guided NOTES interventions: A study on peritoneoscopic potential

PubMed Central

Jeong, Seung Uk; Aizan, Hassanuddin; Song, Tae Jun; Seo, Dong Wan; Kim, Su-Hui; Park, Do Hyun; Lee, Sang Soo; Lee, Sung Koo; Kim, Myung-Hwan

2013-01-01

AIM: To evaluate the feasibility of diagnostic and therapeutic transgastric (TG) peritoneoscopic interventions with a forward-viewing endoscopic ultrasound (FV-EUS). METHODS: This prospective endoscopic experimental study used an animal model. Combined TG peritoneoscopic interventions and EUS examination of the intra-abdominal organs were performed using an FV-EUS on 10 animal models (1 porcine and 9 canine). The procedures carried out include EUS evaluation and endoscopic biopsy of intraperitoneal organs, EUS-guided fine needle aspiration (EUS-FNA), EUS-guided radiofrequency ablation (EUS-RFA), and argon plasma coagulation (APC) for hemostatic control. The animals were kept alive for 7 d, and then necropsy was performed to evaluate results and complications. RESULTS: In all 10 animals, TG peritoneoscopy, followed by endoscopic biopsy for the liver, spleen, abdominal wall, and omentum, was performed successfully. APC helped control minor bleeding. Visualization of intra-abdominal solid organs with real-time EUS was accomplished with ease. Intraperitoneal EUS-FNA was successfully performed on the liver, spleen, and kidney. Similarly, a successful outcome was achieved with EUS-RFA of the hepatic parenchyma. No adverse events were recorded during the study. CONCLUSION: Peritoneoscopic natural orifice transluminal endoscopic surgery (NOTES) interventions through FV-EUS were feasible in providing evaluation and performing endoscopic procedures. It promises potential as a platform for future EUS-based NOTES. PMID:24222961

Handbook of Procedural Guidelines for Implementation of Special Education Curriculum: Critical Skills/Community-Based and Special Education Curriculum Guide.

ERIC Educational Resources Information Center

Riverside County Office of Education, CA. Div. of Special Schools and Services.

The special education procedural handbook and the special education curriculum guide provide guidelines for teachers and other school personnel. The procedural handbook covers the following areas: individual education program process (IEP) and program placement, individual education program team, administrative placements, parent interviews,…

Navigation with Electromagnetic Tracking for Interventional Radiology Procedures

PubMed Central

Wood, Bradford J.; Zhang, Hui; Durrani, Amir; Glossop, Neil; Ranjan, Sohan; Lindisch, David; Levy, Eliott; Banovac, Filip; Borgert, Joern; Krueger, Sascha; Kruecker, Jochen; Viswanathan, Anand; Cleary, Kevin

2008-01-01

PURPOSE To assess the feasibility of the use of preprocedural imaging for guide wire, catheter, and needle navigation with electromagnetic tracking in phantom and animal models. MATERIALS AND METHODS An image-guided intervention software system was developed based on open-source software components. Catheters, needles, and guide wires were constructed with small position and orientation sensors in the tips. A tetrahedral-shaped weak electromagnetic field generator was placed in proximity to an abdominal vascular phantom or three pigs on the angiography table. Preprocedural computed tomographic (CT) images of the phantom or pig were loaded into custom-developed tracking, registration, navigation, and rendering software. Devices were manipulated within the phantom or pig with guidance from the previously acquired CT scan and simultaneous real-time angiography. Navigation within positron emission tomography (PET) and magnetic resonance (MR) volumetric datasets was also performed. External and endovascular fiducials were used for registration in the phantom, and registration error and tracking error were estimated. RESULTS The CT scan position of the devices within phantoms and pigs was accurately determined during angiography and biopsy procedures, with manageable error for some applications. Preprocedural CT depicted the anatomy in the region of the devices with real-time position updating and minimal registration error and tracking error (<5 mm). PET can also be used with this system to guide percutaneous biopsies to the most metabolically active region of a tumor. CONCLUSIONS Previously acquired CT, MR, or PET data can be accurately codisplayed during procedures with reconstructed imaging based on the position and orientation of catheters, guide wires, or needles. Multimodality interventions are feasible by allowing the real-time updated display of previously acquired functional or morphologic imaging during angiography, biopsy, and ablation. PMID:15802449

Ultrasound-Guided Core-Needle Versus Vacuum-Assisted Breast Biopsy: A Cost Analysis Based on the American Society of Breast Surgeons' Mastery of Breast Surgery Registry.

PubMed

Grady, Ian; Vasquez, Tony; Tawfik, Sara; Grady, Sean

2017-03-01

To evaluate the cost-efficacy of vacuum-assisted ultrasound-guided breast biopsy instruments compared to ultrasound-guided 14-gauge spring-loaded core-needle biopsy. The American Society of Breast Surgeons' Mastery of Breast Surgery Registry was reviewed. Biopsy findings, any rebiopsy, and the instrument used were abstracted for 31,451 ultrasound-guided biopsy procedures performed between 2001 and July 2014. Rates of cancer diagnosis and rebiopsy were calculated for each instrument. A linear mathematical model was developed to calculate total cost per cancer diagnosis, including procedural costs and the costs of any additional surgical rebiopsy procedures. Mean cost per cancer diagnosis with confidence limits was then determined for 14-gauge spring-loaded core-needle biopsy and 14 different vacuum-assisted instruments. For 14-gauge spring-loaded core-needle biopsy, mean cost per cancer diagnosis was $4346 (4327-$4366). For the vacuum-assisted instruments, mean cost per cancer diagnosis ranged from a low of $3742 ($3732-$3752) to a high of $4779 ($4750-$4809). Vacuum-assisted instruments overall were more cost-effective than core with a mean cost per cancer diagnosis of $4052 ($4038-$4067) (p < 0.05). Tethered vacuum-assisted instruments performed best with a mean cost per cancer diagnosis of $3978 ($3964-$3991) (p < 0.05). Nontethered devices had a mean cost per cancer diagnosis of $4369 ($4350-$4388), a result no better than core (p < 0.05). Ultrasound-guided vacuum-assisted breast biopsy had a lower mean cost per cancer diagnosis than 14-gauge spring-loaded core-needle biopsy. This advantage was only seen in tethered vacuum-assisted instruments. Within device families, larger instruments tended to outperform smaller instruments.

Implementation guide for monitoring work zone safety and mobility impacts

DOT National Transportation Integrated Search

2009-01-01

This implementation guide describes the conceptual framework, data requirements, and computational procedures for determining the safety and mobility impacts of work zones in Texas. Researchers designed the framework and procedures to assist district...

Sign language in the CT suite: a new approach in communicating between radiologists and radiographers.

PubMed

Wang, Edward H; Sampson, Matthew J

2016-09-01

When performing CT-guided procedures or angiographic procedures, radiologists performing procedures need to communicate with radiographers at a workstation behind radiation shielding glass. As shielding renders verbal communication impossible, we have developed a set of standardised hand signals for use at our department to help us achieve clear and efficient communication between radiologists and radiographers while performing CT-guided or angiographic procedures.

Accelerating orthodontic tooth movement: A new, minimally-invasive corticotomy technique using a 3D-printed surgical template.

PubMed

Cassetta, M; Giansanti, M

2016-07-01

A reduction in orthodontic treatment time can be attained using corticotomies. The aggressive nature of corticotomy due to the elevation of muco-periosteal flaps and to the duration of the surgery raised reluctance for its employ among patients and dental community. This study aims to provide detailed information on the design and manufacture of a 3D-printed CAD-CAM (computer-aided design and computer-aided manufacturing) surgical guide which can aid the clinician in achieving a minimally-invasive, flapless corticotomy. An impression of dental arches was created; the models were digitally-acquired using a 3D scanner and saved as STereoLithography ( STL ) files. The patient underwent cone beam computed tomography (CBCT): images of jaws and teeth were transformed into 3D models and saved as an STL file. An acrylic template with the design of a surgical guide was manufactured and scanned. The STLs of jaws, scanned casts, and acrylic templates were matched. 3D modeling software allowed the view of the 3D models from different perspectives and planes with perfect rendering. The 3D model of the acrylic template was transformed into a surgical guide with slots designed to guide, at first, a scalpel blade and then a piezoelectric cutting insert. The 3D STL model of the surgical guide was printed. This procedure allowed the manufacturing of a 3D-printed CAD/CAM surgical guide, which overcomes the disadvantages of the corticotomy, removing the need for flap elevation. No discomfort, early surgical complications or unexpected events were observed. The effectiveness of this minimally-invasive surgical technique can offer the clinician a valid alternative to other methods currently in use.

3D force/torque characterization of emergency cricothyroidotomy procedure using an instrumented scalpel.

PubMed

Ryason, Adam; Sankaranarayanan, Ganesh; Butler, Kathryn L; DeMoya, Marc; De, Suvranu

2016-08-01

Emergency Cricothyroidotomy (CCT) is a surgical procedure performed to secure a patient's airway. This high-stakes, but seldom-performed procedure is an ideal candidate for a virtual reality simulator to enhance physician training. For the first time, this study characterizes the force/torque characteristics of the cricothyroidotomy procedure, to guide development of a virtual reality CCT simulator for use in medical training. We analyze the upper force and torque thresholds experienced at the human-scalpel interface. We then group individual surgical cuts based on style of cut and cut medium and perform a regression analysis to create two models that allow us to predict the style of cut performed and the cut medium.

PACS for surgery and interventional radiology: features of a Therapy Imaging and Model Management System (TIMMS).

PubMed

Lemke, Heinz U; Berliner, Leonard

2011-05-01

Appropriate use of information and communication technology (ICT) and mechatronic (MT) systems is viewed by many experts as a means to improve workflow and quality of care in the operating room (OR). This will require a suitable information technology (IT) infrastructure, as well as communication and interface standards, such as specialized extensions of DICOM, to allow data interchange between surgical system components in the OR. A design of such an infrastructure, sometimes referred to as surgical PACS, but better defined as a Therapy Imaging and Model Management System (TIMMS), will be introduced in this article. A TIMMS should support the essential functions that enable and advance image guided therapy, and in the future, a more comprehensive form of patient-model guided therapy. Within this concept, the "image-centric world view" of the classical PACS technology is complemented by an IT "model-centric world view". Such a view is founded in the special patient modelling needs of an increasing number of modern surgical interventions as compared to the imaging intensive working mode of diagnostic radiology, for which PACS was originally conceptualised and developed. The modelling aspects refer to both patient information and workflow modelling. Standards for creating and integrating information about patients, equipment, and procedures are vitally needed when planning for an efficient OR. The DICOM Working Group 24 (WG-24) has been established to develop DICOM objects and services related to image and model guided surgery. To determine these standards, it is important to define step-by-step surgical workflow practices and create interventional workflow models per procedures or per variable cases. As the boundaries between radiation therapy, surgery and interventional radiology are becoming less well-defined, precise patient models will become the greatest common denominator for all therapeutic disciplines. In addition to imaging, the focus of WG-24 is to serve the therapeutic disciplines by enabling modelling technology to be based on standards. Copyright © 2011. Published by Elsevier Ireland Ltd.

A Guide for Developing Standard Operating Job Procedures for the Screening & Grinding Process Wastewater Treatment Facility. SOJP No. 1.

ERIC Educational Resources Information Center

Deal, Gerald A.; Montgomery, James A.

This guide describes standard operating job procedures for the screening and grinding process of wastewater treatment facilities. The objective of this process is the removal of coarse materials from the raw waste stream for the protection of subsequent equipment and processes. The guide gives step-by-step instructions for safety inspection,…

A Guide for Developing Standard Operating Job Procedures for the Sludge Thickening Process Wastewater Treatment Facility. SOJP No. 9.

ERIC Educational Resources Information Center

Schwing, Carl M.

This guide describes standard operating job procedures for the screening and grinding process of wastewater treatment facilities. The objective of this process is the removal of coarse materials from the raw waste stream for the protection of subsequent equipment and processes. The guide gives step-by-step instructions for safety inspection,…

A Guide for Developing Standard Operating Job Procedures for the Digestion Process Wastewater Treatment Facility. SOJP No. 10.

ERIC Educational Resources Information Center

Schwing, Carl M.

This guide describes standard operating job procedures for the digestion process of wastewater treatment facilities. This process is for reducing the volume of sludge to be treated in subsequent units and to reduce the volatile content of sludge. The guide gives step-by-step instructions for pre-startup, startup, continuous operating, shutdown,…

A Guide for Developing Standard Operating Job Procedures for the Tertiary Multimedia Filtration Process Wastewater Treatment Facility. SOJP No. 7.

ERIC Educational Resources Information Center

Petrasek, Al, Jr.

This guide describes the standard operating job procedures for the tertiary multimedia filtration process of wastewater treatment plants. The major objective of the filtration process is the removal of suspended solids from the reclaimed wastewater. The guide gives step-by-step instructions for pre-start up, start-up, continuous operation, and…

Including Recently Arrived English Learners in State Accountability Systems: An Empirical Illustration of Models. WCER Working Paper No. 2017-1

ERIC Educational Resources Information Center

Cook, H. Gary; Sahakyan, Narek; Linquanti, Robert

2017-01-01

The authors develop model analyses based on a U.S. Department of Education guide to illustrate procedures a State could use to compare and contrast school-level overall and English Learner accountability determinations for proficiency in reading/language arts under the options allowed by the Every Student Succeeds Act. As a technical reference,…

Guidelines for Implementing NCHRP 1-37A M-E Design Procedures in Ohio : Volume 2 -- Literature Review

DOT National Transportation Integrated Search

2009-11-01

The development of the Mechanistic-Empirical Pavement Design Guide (MEPDG) under National Cooperative Highway Research Program (NCHRP) projects 1-37A and 1-40D has significantly improved the ability of pavement designers to model and simulate the eff...

Southern forest inventory and analysis volume equation user’s guide

Treesearch

Christopher M. Oswalt; Roger C. Conner

2011-01-01

Reliable volume estimation procedures are fundamental to the mission of the Forest Inventory and Analysis (FIA) program. Moreover, public access to FIA program procedures is imperative. Here we present the volume estimation procedures used by the southern FIA program of the U.S. Department of Agriculture Forest Service Southern Research Station. The guide presented...

The Effects of Rationales, Differential Reinforcement, and a Guided Compliance Procedure to Increase Compliance among Preschool Children

ERIC Educational Resources Information Center

Wilder, David A.; Myers, Kristin; Nicholson, Katie; Allison, Janelle; Fischetti, Anthony T.

2012-01-01

Previous research suggests that rationales, or statements describing why a child should comply with a caregiver-delivered instruction, are ineffective at increasing compliance. In the current study, we compared the effects of rationales to a differential reinforcement procedure and a guided compliance procedure. The results indicated that…

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

Ryan, E. Ronan, E-mail: ronan@ronanryan.com; Thornton, Raymond; Sofocleous, Constantinos T.

PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0-0.13) mSv for the primary operator, 0.01 (range 0-0.05) mSv for the nurse anesthetist, and 0.02 (range 0-0.05) mSv for the radiology technologist. The median extremitymore » dose equivalent for the operator was 0.05 (range 0-0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient.« less

Bioassay-guided isolation of wound healing active compounds from Echium species growing in Turkey.

PubMed

Eruygur, Nuraniye; Yılmaz, Gülderen; Kutsal, Osman; Yücel, Gözde; Üstün, Osman

2016-06-05

The roots and root barks of Echium sp. have been used to treat ulcers, burns and wounds in traditional Turkish medicine. On the basis of them traditional use and literature references, four Echium species were selected for evaluation of them wound healing potential. Isolation of active component(s) from the active extracts through the bioassay guided fractionation procedures. In vivo the wound healing activity of the plants was evaluated by linear incision experimental models. The chloroform extract of Echium italicum L. was fractionated by successive chromatographic techniques. Wound healing activity of each fraction was investigated following the bioassay-guided fractionation procedures. Moreover, the tissue samples of isolated compounds were examined histopathologically. The healing potential was comparatively assessed with a reference ointment Madecassol®, which contains 1% extract of Centella asiatica. Significant wound healing activity was observed from the ointment prepared with ethanol extract at 1% concentration. The ethanol root extract treated in groups of animals showed a significant increase (37.38%, 40.97% and 35.29% separately for E. italicum L, Echium vulgare L. and Echium angustifolium Miller) wound tensile strength in the incision wound model. Subfractions showed significant but reduced wound healing activity on in vivo wound models. Shikonin derivatives "Acetylshikonin", "Deoxyshikonin" and "2-methyl-n-butyrylshikonin+Isovalerylshikonin", were isolated and determined as active components of active final subfraction from E. italicum L. roots. The results of histopathological examination supported the outcome of linear incision wound models. The experimental study revealed that Echium species display remarkable wound healing activity. Copyright © 2016. Published by Elsevier Ireland Ltd.

Determining procedures for simulation-based training in radiology: a nationwide needs assessment.

PubMed

Nayahangan, Leizl Joy; Nielsen, Kristina Rue; Albrecht-Beste, Elisabeth; Bachmann Nielsen, Michael; Paltved, Charlotte; Lindorff-Larsen, Karen Gilboe; Nielsen, Bjørn Ulrik; Konge, Lars

2018-06-01

New training modalities such as simulation are widely accepted in radiology; however, development of effective simulation-based training programs is challenging. They are often unstructured and based on convenience or coincidence. The study objective was to perform a nationwide needs assessment to identify and prioritize technical procedures that should be included in a simulation-based curriculum. A needs assessment using the Delphi method was completed among 91 key leaders in radiology. Round 1 identified technical procedures that radiologists should learn. Round 2 explored frequency of procedure, number of radiologists performing the procedure, risk and/or discomfort for patients, and feasibility for simulation. Round 3 was elimination and prioritization of procedures. Response rates were 67 %, 70 % and 66 %, respectively. In Round 1, 22 technical procedures were included. Round 2 resulted in pre-prioritization of procedures. In round 3, 13 procedures were included in the final prioritized list. The three highly prioritized procedures were ultrasound-guided (US) histological biopsy and fine-needle aspiration, US-guided needle puncture and catheter drainage, and basic abdominal ultrasound. A needs assessment identified and prioritized 13 technical procedures to include in a simulation-based curriculum. The list may be used as guide for development of training programs. • Simulation-based training can supplement training on patients in radiology. • Development of simulation-based training should follow a structured approach. • The CAMES Needs Assessment Formula explores needs for simulation training. • A national Delphi study identified and prioritized procedures suitable for simulation training. • The prioritized list serves as guide for development of courses in radiology.

Magnetic navigation in ultrasound-guided interventional radiology procedures.

PubMed

Xu, H-X; Lu, M-D; Liu, L-N; Guo, L-H

2012-05-01

To evaluate the usefulness of magnetic navigation in ultrasound (US)-guided interventional procedures. Thirty-seven patients who were scheduled for US-guided interventional procedures (20 liver cancer ablation procedures and 17 other procedures) were included. Magnetic navigation with three-dimensional (3D) computed tomography (CT), magnetic resonance imaging (MRI), 3D US, and position-marking magnetic navigation were used for guidance. The influence on clinical outcome was also evaluated. Magnetic navigation facilitated applicator placement in 15 of 20 ablation procedures for liver cancer in which multiple ablations were performed; enhanced guidance in two small liver cancers invisible on conventional US but visible at CT or MRI; and depicted the residual viable tumour after transcatheter arterial chemoembolization for liver cancer in one procedure. In four of 17 other interventional procedures, position-marking magnetic navigation increased the visualization of the needle tip. Magnetic navigation was beneficial in 11 (55%) of 20 ablation procedures; increased confidence but did not change management in five (25%); added some information but did not change management in two (10%); and made no change in two (10%). In the other 17 interventional procedures, the corresponding numbers were 1 (5.9%), 2 (11.7%), 7 (41.2%), and 7 (41.2%), respectively (p=0.002). Magnetic navigation in US-guided interventional procedure provides solutions in some difficult cases in which conventional US guidance is not suitable. It is especially useful in complicated interventional procedures such as ablation for liver cancer. Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Modeling Cable and Guide Channel Interaction in a High-Strength Cable-Driven Continuum Manipulator

PubMed Central

Moses, Matthew S.; Murphy, Ryan J.; Kutzer, Michael D. M.; Armand, Mehran

2016-01-01

This paper presents several mechanical models of a high-strength cable-driven dexterous manipulator designed for surgical procedures. A stiffness model is presented that distinguishes between contributions from the cables and the backbone. A physics-based model incorporating cable friction is developed and its predictions are compared with experimental data. The data show that under high tension and high curvature, the shape of the manipulator deviates significantly from a circular arc. However, simple parametric models can fit the shape with good accuracy. The motivating application for this study is to develop a model so that shape can be predicted using easily measured quantities such as tension, so that real-time navigation may be performed, especially in minimally-invasive surgical procedures, while reducing the need for hazardous imaging methods such as fluoroscopy. PMID:27818607

Modeling Cable and Guide Channel Interaction in a High-Strength Cable-Driven Continuum Manipulator.

PubMed

Moses, Matthew S; Murphy, Ryan J; Kutzer, Michael D M; Armand, Mehran

2015-12-01

This paper presents several mechanical models of a high-strength cable-driven dexterous manipulator designed for surgical procedures. A stiffness model is presented that distinguishes between contributions from the cables and the backbone. A physics-based model incorporating cable friction is developed and its predictions are compared with experimental data. The data show that under high tension and high curvature, the shape of the manipulator deviates significantly from a circular arc. However, simple parametric models can fit the shape with good accuracy. The motivating application for this study is to develop a model so that shape can be predicted using easily measured quantities such as tension, so that real-time navigation may be performed, especially in minimally-invasive surgical procedures, while reducing the need for hazardous imaging methods such as fluoroscopy.

A Guide for Developing Standard Operating Job Procedures for the Sludge Conditioning & Dewatering Process Wastewater Treatment Facility. SOJP No. 11.

ERIC Educational Resources Information Center

Schwing, Carl M.

This guide describes standard operating job procedures for the sludge conditioning and dewatering process of wastewater treatment facilities. In this process, sludge is treated with chemicals to make the sludge coagulate and give up its water more easily. The treated sludge is then dewatered using a vacuum filter. The guide gives step-by-step…

A Guide for Developing Standard Operating Job Procedures for the Tertiary Chemical Treatment - Lime Precipitation Process Wastewater Treatment Facility. SOJP No. 6.

ERIC Educational Resources Information Center

Petrasek, Al, Jr.

This guide describes the standard operating job procedures for the tertiary chemical treatment - lime precipitation process of wastewater treatment plants. Step-by-step instructions are given for pre-start up, start-up, continuous operation, and shut-down procedures. In addition, some theoretical material is presented along with some relevant…

A Guide for Developing Standard Operating Job Procedures for the Grit Removal Process Wastewater Treatment Facility. SOJP No. 2.

ERIC Educational Resources Information Center

Deal, Gerald A.; Montgomery, James A.

This guide describes standard operating job procedures for the grit removal process of wastewater treatment plants. Step-by-step instructions are given for pre-start up inspection, start-up, continuous operation, and shut-down procedures. A description of the equipment used in the process is given. Some theoretical material is presented. (BB)

A successful model to learn and implement ultrasound-guided venous catheterization in apheresis.

PubMed

Gopalasingam, Nigopan; Thomsen, Anna-Marie Eller; Folkersen, Lars; Juhl-Olsen, Peter; Sloth, Erik

2017-12-01

Apheresis treatments can be performed with peripheral venous catheters (PVC), although central venous catheters (CVC) are inserted when PVCs fail or patient with history of difficult vascular access prior to the apheresis. Ultrasound guidance for PVC has shown promising results in other settings. To investigate if ultrasound guidance for PVC could be implemented among apheresis nurses. Second, how implementation of ultrasound guidance affected the number of CVCs used for apheresis per patient. Apheresis nurses completed a systematic training program for ultrasound-guided vascular access. All independent catheterizations were registered during the implementation stage. The number of CVCs in the pre- and postimplementation stages of the ultrasound guidance was compared. Six nurses completed the training program within a median of 48 days (range 38-83 days). In 77 patients, 485 independent ultrasound-guided PVC placements were performed during the implementation stage. All apheresis treatments (485/485) were accomplished using PVCs without requiring CVC as rescue. During the preimplementation stage, 125 of 273 (45.8%) procedures required a CVC for completion of apheresis procedures; during the postimplementation stage only 30 of 227 (13.2%) procedures required a CVC (p < 0.001). In the postimplementation stage, no CVCs were placed as rescue caused by failed PVCs but were only placed for patients where the ultrasound machine was unavailable. It indicates an effective success rate of 100% for ultrasound-guided PVC use. This study showed that ultrasound guidance could be implemented among apheresis nurses as a routine tool eliminating the need of CVC as a rescue. © 2017 Wiley Periodicals, Inc.

Asphalt materials characterization in support of implementation of the proposed mechanistic-empirical pavement design guide.

DOT National Transportation Integrated Search

2007-01-01

The proposed Mechanistic-Empirical Pavement Design Guide (MEPDG) procedure is an improved methodology for pavement design and evaluation of paving materials. Since this new procedure depends heavily on the characterization of the fundamental engineer...

Developing an automated database for monitoring ultrasound- and computed tomography-guided procedure complications and diagnostic yield.

PubMed

Itri, Jason N; Jones, Lisa P; Kim, Woojin; Boonn, William W; Kolansky, Ana S; Hilton, Susan; Zafar, Hanna M

2014-04-01

Monitoring complications and diagnostic yield for image-guided procedures is an important component of maintaining high quality patient care promoted by professional societies in radiology and accreditation organizations such as the American College of Radiology (ACR) and Joint Commission. These outcome metrics can be used as part of a comprehensive quality assurance/quality improvement program to reduce variation in clinical practice, provide opportunities to engage in practice quality improvement, and contribute to developing national benchmarks and standards. The purpose of this article is to describe the development and successful implementation of an automated web-based software application to monitor procedural outcomes for US- and CT-guided procedures in an academic radiology department. The open source tools PHP: Hypertext Preprocessor (PHP) and MySQL were used to extract relevant procedural information from the Radiology Information System (RIS), auto-populate the procedure log database, and develop a user interface that generates real-time reports of complication rates and diagnostic yield by site and by operator. Utilizing structured radiology report templates resulted in significantly improved accuracy of information auto-populated from radiology reports, as well as greater compliance with manual data entry. An automated web-based procedure log database is an effective tool to reliably track complication rates and diagnostic yield for US- and CT-guided procedures performed in a radiology department.

Surgical motion characterization in simulated needle insertion procedures

NASA Astrophysics Data System (ADS)

Holden, Matthew S.; Ungi, Tamas; Sargent, Derek; McGraw, Robert C.; Fichtinger, Gabor

2012-02-01

PURPOSE: Evaluation of surgical performance in image-guided needle insertions is of emerging interest, to both promote patient safety and improve the efficiency and effectiveness of training. The purpose of this study was to determine if a Markov model-based algorithm can more accurately segment a needle-based surgical procedure into its five constituent tasks than a simple threshold-based algorithm. METHODS: Simulated needle trajectories were generated with known ground truth segmentation by a synthetic procedural data generator, with random noise added to each degree of freedom of motion. The respective learning algorithms were trained, and then tested on different procedures to determine task segmentation accuracy. In the threshold-based algorithm, a change in tasks was detected when the needle crossed a position/velocity threshold. In the Markov model-based algorithm, task segmentation was performed by identifying the sequence of Markov models most likely to have produced the series of observations. RESULTS: For amplitudes of translational noise greater than 0.01mm, the Markov model-based algorithm was significantly more accurate in task segmentation than the threshold-based algorithm (82.3% vs. 49.9%, p<0.001 for amplitude 10.0mm). For amplitudes less than 0.01mm, the two algorithms produced insignificantly different results. CONCLUSION: Task segmentation of simulated needle insertion procedures was improved by using a Markov model-based algorithm as opposed to a threshold-based algorithm for procedures involving translational noise.

Nonlinear system guidance in the presence of transmission zero dynamics

NASA Technical Reports Server (NTRS)

Meyer, G.; Hunt, L. R.; Su, R.

1995-01-01

An iterative procedure is proposed for computing the commanded state trajectories and controls that guide a possibly multiaxis, time-varying, nonlinear system with transmission zero dynamics through a given arbitrary sequence of control points. The procedure is initialized by the system inverse with the transmission zero effects nulled out. Then the 'steady state' solution of the perturbation model with the transmission zero dynamics intact is computed and used to correct the initial zero-free solution. Both time domain and frequency domain methods are presented for computing the steady state solutions of the possibly nonminimum phase transmission zero dynamics. The procedure is illustrated by means of linear and nonlinear examples.

Three-dimensional prototyping for procedural simulation of transcatheter mitral valve replacement in patients with mitral annular calcification.

PubMed

El Sabbagh, Abdallah; Eleid, Mackram F; Matsumoto, Jane M; Anavekar, Nandan S; Al-Hijji, Mohammed A; Said, Sameh M; Nkomo, Vuyisile T; Holmes, David R; Rihal, Charanjit S; Foley, Thomas A

2018-01-23

Three-dimensional (3D) prototyping is a novel technology which can be used to plan and guide complex procedures such as transcatheter mitral valve replacement (TMVR). Eight patients with severe mitral annular calcification (MAC) underwent TMVR. 3D digital models with digital balloon expandable valves were created from pre-procedure CT scans using dedicated software. Five models were printed. These models were used to assess prosthesis sizing, anchoring, expansion, paravalvular gaps, left ventricular outflow tract (LVOT) obstruction, and other potential procedure pitfalls. Results of 3D prototyping were then compared to post procedural imaging to determine how closely the achieved procedural result mirrored the 3D modeled result. 3D prototyping simulated LVOT obstruction in one patient who developed it and in another patient who underwent alcohol septal ablation prior to TMVR. Valve sizing correlated with actual placed valve size in six out of the eight patients and more than mild paravalvular leak (PVL) was simulated in two of the three patients who had it. Patients who had mismatch between their modeled valve size and post-procedural imaging were the ones that had anterior leaflet resection which could have altered valve sizing and PVL simulation. 3D printed model of one of the latter patients allowed modification of anterior leaflet to simulate surgical resection and was able to estimate the size and location of the PVL after inserting a valve stent into the physical model. 3D prototyping in TMVR for severe MAC is feasible for simulating valve sizing, apposition, expansion, PVL, and LVOT obstruction. © 2018 Wiley Periodicals, Inc.

Ultrasound-Guided Elbow Procedures.

PubMed

Sussman, Walter I; Williams, Christopher J; Mautner, Ken

2016-08-01

High-resolution ultrasonography can help clinicians visualize key anatomic structures of the elbow and guide periarticular and intra-articular injections. Historically, most procedures done around the elbow have been done using landmark guidance, and few studies have reported the accuracy of ultrasonography-guided injections in the elbow region. This article reviews common musculoskeletal disorders about the elbow that can be evaluated with ultrasonography, reviews the literature on ultrasonography-guided injections of the elbow region, and describes the senior author's preferred approach for the most commonly performed elbow region injections. Copyright © 2016 Elsevier Inc. All rights reserved.

Project Physics Teacher Guide 5, Models of the Atom.

ERIC Educational Resources Information Center

Harvard Univ., Cambridge, MA. Harvard Project Physics.

Teaching procedures of Project Physics Unit 5 are presented to help teachers make effective use of learning materials. Unit contents are discussed in connection with teaching aid lists, multi-media schedules, schedule blocks, and resource charts. Brief summaries are made for transparencies, 16mm films, and reader articles. Included is information…

75 FR 54048 - Energy Efficiency Program: Test Procedure for Televisions; Request for Information and Request...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-03

... plasma, cathode ray tube (CRT), and locally dimmed LED-backlit LCD designs. As a result, it can be useful.... This may disadvantage Plasma TVs, and has proven to be unpredictable with LED models. Furthermore, the... by the electronic programming guide, monitoring for emergency messaging/ communications and/or...

Response to Intervention: Using Single-Case Design to Examine the Impact of Tier 2 Mathematics Interventions

ERIC Educational Resources Information Center

Valenzuela, Vanessa V.; Gutierrez, Gabriel; Lambros, Katina M.

2014-01-01

An A-B single-case design assessed at-risk students' responsiveness to mathematics interventions. Four culturally and linguistically diverse second-grade students were given a Tier 2 standard protocol mathematics intervention that included number sense instruction, modeling procedures, guided math drill and practice of addition and subtraction…

A Vocational Program for Recreational Vehicle Maintenance/Repair. A Report, 1977-78.

ERIC Educational Resources Information Center

1978

This report contains a secondary school curriculum guide designed to be used by vocational teachers in a one- or two-year recreational vehicle maintenance/repair program. In the preliminary pages, a description is given of the project that developed the curriculum, outlining its objectives and procedures in formulating the model interdisciplinary…

Model Bloodborne Pathogens: Exposure Control Plan for Wisconsin Public Schools. Bulletin No. 93311.

ERIC Educational Resources Information Center

Wisconsin State Dept. of Public Instruction, Madison.

This document is intended to assist local school districts in complying with the Wisconsin Department of Industry, Labor and Human Relations (DILHR) Health and Safety Standard. Following an overview of the plan, the guide is organized into six chapters: (1) "Exposure Determination" discusses job classifications, tasks, and procedures;…

Action Planning and Recording Achievement.

ERIC Educational Resources Information Center

Green, Muriel

This document examines strategies and procedures that British further education (FE) colleges can use to develop and enhance systems and structures for guiding and supporting learners and learning. It is based on the findings of a field test of the Managing Learning model for planning and recording the process of FE students. First, the importance…

48 CFR 31.002 - Availability of accounting guide.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Availability of accounting... GENERAL CONTRACTING REQUIREMENTS CONTRACT COST PRINCIPLES AND PROCEDURES 31.002 Availability of accounting guide. Contractors needing assistance in developing or improving their accounting systems and procedures...

Evaluation of the UF/NCI hybrid computational phantoms for use in organ dosimetry of pediatric patients undergoing fluoroscopically guided cardiac procedures

NASA Astrophysics Data System (ADS)

Marshall, Emily L.; Borrego, David; Tran, Trung; Fudge, James C.; Bolch, Wesley E.

2018-03-01

Epidemiologic data demonstrate that pediatric patients face a higher relative risk of radiation induced cancers than their adult counterparts at equivalent exposures. Infants and children with congenital heart defects are a critical patient population exposed to ionizing radiation during life-saving procedures. These patients will likely incur numerous procedures throughout their lifespan, each time increasing their cumulative radiation absorbed dose. As continued improvements in long-term prognosis of congenital heart defect patients is achieved, a better understanding of organ radiation dose following treatment becomes increasingly vital. Dosimetry of these patients can be accomplished using Monte Carlo radiation transport simulations, coupled with modern anatomical patient models. The aim of this study was to evaluate the performance of the University of Florida/National Cancer Institute (UF/NCI) pediatric hybrid computational phantom library for organ dose assessment of patients that have undergone fluoroscopically guided cardiac catheterizations. In this study, two types of simulations were modeled. A dose assessment was performed on 29 patient-specific voxel phantoms (taken as representing the patient’s true anatomy), height/weight-matched hybrid library phantoms, and age-matched reference phantoms. Two exposure studies were conducted for each phantom type. First, a parametric study was constructed by the attending pediatric interventional cardiologist at the University of Florida to model the range of parameters seen clinically. Second, four clinical cardiac procedures were simulated based upon internal logfiles captured by a Toshiba Infinix-i Cardiac Bi-Plane fluoroscopic unit. Performance of the phantom library was quantified by computing both the percent difference in individual organ doses, as well as the organ dose root mean square values for overall phantom assessment between the matched phantoms (UF/NCI library or reference) and the patient-specific phantoms. The UF/NCI hybrid phantoms performed at percent differences of between 15% and 30% for the parametric set of irradiation events. Among internal logfile reconstructed procedures, the UF/NCI hybrid phantoms performed with RMS organ dose values between 7% and 29%. Percent improvement in organ dosimetry via the use of hybrid library phantoms over the reference phantoms ranged from 6.6% to 93%. The use of a hybrid phantom library, Monte Carlo radiation transport methods, and clinical information on irradiation events provide a means for tracking organ dose in these radiosensitive patients undergoing fluoroscopically guided cardiac procedures. This work was supported by Advanced Laboratory for Radiation Dosimetry Studies, University of Florida, American Association of University Women, National Cancer Institute Grant 1F31 CA159464.

A guide for the use of digital elevation model data for making soil surveys

USGS Publications Warehouse

Klingebiel, A.A.; Horvath, Emil H.; Reybold, William U.; Moore, D.G.; Fosnight, E.A.; Loveland, Thomas R.

1988-01-01

The intent of this publication is twofold: (1) to serve as a user guide for soil scientists and others interested in learning about the value and use of digital elevation model (DEM) data in making soil surveys and (2) to provide documentation of the Soil Landscape Analysis Project (SLAP). This publication provides a step-by-step guide on how digital slope-class maps are adjusted to topographic maps and orthophotoquads to obtain accurate slope-class maps, and how these derivative maps can be used as a base for soil survey premaps. In addition, guidance is given on the use of aspect-class maps and other resource data in making pre-maps. The value and use of tabular summaries are discussed. Examples of the use of DEM products by the authors and by selected field soil scientists are also given. Additional information on SLAP procedures may be obtained from USDA, Soil Conservation Service, Soil Survey Division, P.O. Box 2890, Washington, D.C. 20013, and from references (Horvath and others, 1987; Horvath and others, 1983; Klingebiel and others, 1987; and Young, 1987) listed in this publication. The slope and aspect products and the procedures for using these products have evolved during 5 years of cooperative research with the USDA, Soil Conservation Service and Forest Service, and the USDI, Bureau of Land Management.

Single-ring ablation compared with standard circumferential pulmonary vein isolation using remote magnetic catheter navigation.

PubMed

Sohns, Christian; Bergau, Leonard; Seegers, Joachim; Lüthje, Lars; Vollmann, Dirk; Zabel, Markus

2014-10-01

In ablation of atrial fibrillation, the single-ring method aims for isolation of the posterior wall of the left atrium (LA) including the pulmonary veins (PVs) but avoiding posterior LA lesions. The aim of this randomized prospective study was to evaluate safety and efficacy of remote magnetic navigation (RMN)-guided single-ring ablation strategy as compared to standard RMN-guided circumferential PV ablation (PVA). Eighty consecutive patients undergoing PVA were enrolled prospectively and randomized equally into two study groups. RMN using the Stereotaxis system and open-irrigated 3.5-mm ablation catheters were used with a 3D mapping system in all procedures. Forty patients underwent RMN-guided single-ring ablation, and 40 patients received RMN-guided circumferential PVA. In the circumferential group, 3.3 ± 1.1 PVs were successfully isolated at the end of the procedure as compared to 3.1 ± 1.3 in the single-ring (box) group (p=0.38). All patients in the box group required additional posterior lesions in order to achieve electrical isolation of the PVs. Single-ring ablation was associated with longer procedure duration (p=0.01) and ablation time (p=0.001). After a single procedure, the proportion of patients free of any atrial tachycardia (AT)/atrial fibrillation (AF) episode at 12-month follow-up was 57 % in the box group and 58 % in the circ group. Using RMN, only minor complications have been observed. RMN-guided single-ring PVA provides comparable acute and long-term success rates as compared to RMN-guided circumferential PVA but requires additional posterior lesions to achieve PV isolation and increased procedure and ablation time. Procedural complication rates are low when using RMN.

Ultrasound-Guided Foot and Ankle Procedures.

PubMed

Henning, P Troy

2016-08-01

This article reviews commonly performed injections about the foot and ankle region. Although not exhaustive in its description of available techniques, general approaches to these procedures are applicable to any injection about the foot and ankle. As much as possible, the procedures described are based on commonly used or published techniques. An in-depth knowledge of the regional anatomy and understanding of different approaches when performing ultrasonography-guided procedures allows clinicians to adapt to any clinical scenario. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparison of Stereotactic and Ultrasound-guided Biopsy of Solid Supratentorial Tumor: A Preliminary Report

PubMed Central

Satyarthee, Guru Dutta; Chandra, P. Sarat; Sharma, Bhawani S.; Mehta, V. S.

2017-01-01

Introduction: The computed tomography (CT) guided stereotactic biopsy (STB) is considered as method of choice for biopsy of intracranial mass lesions. However, it's disadvantages are frame fixation, time requirement for transportation between CT scan suit to the operation theater with added much higher equipment cost in the relatively resource scarred developing country. Ultrasound-guided biopsy (USGB) is relatively simpler, economical, less time consuming, and real-time procedure. Clinical Materials and Methods: Thirty-seven consecutively admitted patients with supratentorial brain tumors, who underwent biopsy of the lesion using CT compatible stereotactic and ultrasound-guided (USGB) procedure formed cohort of the study. Based on location and size of the lesions, the cases were divided into two groups, superficial and deep. Twenty-two patients underwent ultrasound-guided biopsy and 15 with STB. Results: The diagnostic yield of STB was 93% and 91% for ultrasound-guided biopsy. The mean operation time of STB group was 149.00 min and 94 min for USGB, which was statistically significant. Two cases in each group developed hematoma; however, one case in USGB group needed surgical evacuation. The real-time monitoring detected two hematoma intraoperatively, which were further also confirmed on postoperative CT scan head. Conclusions: The ultrasound-guided biopsy procedure (USGB) was simple, relatively shorter time-consuming procedure and equally efficacious and utilizing economical equipment and can act as a safer alternative to CT STB process for biopsy of the intracranial mass lesion. Furthermore, USGB also provided intra-operative real-time monitoring, which provided clue for close monitoring in the postoperative period after completion of biopsy to look for development of fresh hematoma development not only at the biopsy site but also along the biopsy track and adjoining area. Perhaps, a longer period of ultrasonic monitoring following the procedure would be of greater help to detect hematoma formation, which is one of the most common complications of the biopsy procedure. PMID:29114280

Creation of the selection list for the Experiment Scheduling Program (ESP)

NASA Technical Reports Server (NTRS)

Deuermeyer, B. L.; Shannon, R. E.; Underbrink, A. J., Jr.

1986-01-01

The efforts to develop a procedure to construct selection groups to augment the Experiment Scheduling Program (ESP) are summarized. Included is a User's Guide and a sample scenario to guide in the use of the software system that implements the developed procedures.

Arkansas' Office Procedures Curriculum Guide.

ERIC Educational Resources Information Center

Clayton, Dean

This curriculum guide provides teachers of office procedures classes with unit lesson plans and information about resource materials that can be examined, selected, and integrated into the instructional program. Contents are mainly established for the following two types of secondary-level programs: cooperative office education and intensive…

The Use of Laser Guidance Reduces Fluoroscopy Time for C-Arm Cone-Beam Computed Tomography-Guided Biopsies

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

Kroes, Maarten W., E-mail: Maarten.Kroes@radboudumc.nl; Strijen, Marco J. L. van, E-mail: m.van.strijen@antoniusziekenhuis.nl; Braak, Sicco J., E-mail: sjbraak@gmail.com

2016-09-15

PurposeWhen using laser guidance for cone-beam computed tomography (CBCT)-guided needle interventions, planned needle paths are visualized to the operator without the need to switch between entry- and progress-view during needle placement. The current study assesses the effect of laser guidance during CBCT-guided biopsies on fluoroscopy and procedure times.Materials and MethodsProspective data from 15 CBCT-guided biopsies of 8–65 mm thoracic and abdominal lesions assisted by a ceiling-mounted laser guidance technique were compared to retrospective data of 36 performed CBCT-guided biopsies of lesions >20 mm using the freehand technique. Fluoroscopy time, procedure time, and number of CBCT-scans were recorded. All data are presented asmore » median (ranges).ResultsFor biopsies using the freehand technique, more fluoroscopy time was necessary to guide the needle onto the target, 165 s (83–333 s) compared to 87 s (44–190 s) for laser guidance (p < 0.001). Procedure times were shorter for freehand-guided biopsies, 24 min versus 30 min for laser guidance (p < 0.001).ConclusionThe use of laser guidance during CBCT-guided biopsies significantly reduces fluoroscopy time.« less

An analytical procedure and automated computer code used to design model nozzles which meet MSFC base pressure similarity parameter criteria. [space shuttle

NASA Technical Reports Server (NTRS)

Sulyma, P. R.

1980-01-01

Fundamental equations and similarity definition and application are described as well as the computational steps of a computer program developed to design model nozzles for wind tunnel tests conducted to define power-on aerodynamic characteristics of the space shuttle over a range of ascent trajectory conditions. The computer code capabilities, a user's guide for the model nozzle design program, and the output format are examined. A program listing is included.

A GUIDE TO AERATION/CIRCULATION TECHNIQUES FOR ...

EPA Pesticide Factsheets

The application of aeration/circulation techniques to lakes are reviewed from a theoretical and practical viewpoint. The effect of destratification on algal production is related to the mixed depth with the use of a mathematical model. Procedures are given to determine air required to mix lakes of different sizes and shapes. It was found that approximately 30 scfm of air per 1,000,000 sq ft of lake surface area can be used. Hypolimnetic aeration systems that have been used are described in detail. Procedures for design are given.

An Audiovisual Teaching Module to Assist Examiners in the Administration of a Practical Performance Examination for the Emergency Medical Technician-Ambulance (EMT-A). Consisting of a 90-Minute Audiovisual Presentation In Either 16mm Sound or 3/4" Video-Cassette Plus a "User's Guide" Describing in Detail the Total Examination Procedure. Final Report.

ERIC Educational Resources Information Center

National Registry of Emergency Medical Technicians, Columbus, OH.

A structured, time-referenced, performance examination was designed as part of the certification procedure for Emergency Medical Technicians-Ambulance in an attempt to increase objectivity and standardization. This examination is based on a model developed by the University of Southern California, School of Medicine, Department of Emergency…

User's Guide for MetView: A Meteorological Display and Assessment Tool

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

Glantz, Clifford S.; Pelton, Mitchell A.; Allwine, K Jerry

2000-09-27

MetView Version 2.0 is an easy-to-use model for accessing, viewing, and analyzing meteorological data. MetView provides both graphical and numerical displays of data. It can accommodate data from an extensive meteorological monitoring network that includes near-surface monitoring locations, instrumented towers, sodars, and meteorologist observations. MetView is used operationally for both routine, emergency response, and research applications at the U.S. Department of Energy's Hanford Site. At the Site's Emergency Operations Center, MetView aids in the access, visualization, and interpretation of real-time meteorological data. Historical data can also be accessed and displayed. Emergency response personnel at the Emergency Operations Center use MetViewmore » products in the formulation of protective action recommendations and other decisions. In the initial stage of an emergency, MetView can be operated using a very simple, five-step procedure. This first-responder procedure allows non-technical staff to rapidly generate meteorological products and disseminate key information. After first-responder information products are produced, the Emergency Operations Center's technical staff can conduct more sophisticated analyses using the model. This may include examining the vertical variation in winds, assessing recent changes in atmospheric conditions, evaluating atmospheric mixing rates, and forecasting changes in meteorological conditions. This user's guide provides easy-to-follow instructions for both first-responder and routine operation of the model. Examples, with explanations, are provided for each type of MetView output display. Information is provided on the naming convention, format, and contents of each type of meteorological data file used by the model area. This user's guide serves as a ready reference for experienced MetView users and a training manual for new users.« less

CT-Guided Percutaneous Biopsy of Intrathoracic Lesions

PubMed Central

Lal, Hira; Nath, Alok; Borah, Samudra

2012-01-01

Percutaneous CT-guided needle biopsy of mediastinal and pulmonary lesions is a minimally invasive approach for obtaining tissue for histopathological examination. Although it is a widely accepted procedure with relatively few complications, precise planning and detailed knowledge of various aspects of the biopsy procedure is mandatory to avert complications. In this pictorial review, we reviewed important anatomical approaches, technical aspects of the procedure, and its associated complications. PMID:22438689

Program management model study

NASA Technical Reports Server (NTRS)

Connelly, J. J.; Russell, J. E.; Seline, J. R.; Sumner, N. R., Jr.

1972-01-01

Two models, a system performance model and a program assessment model, have been developed to assist NASA management in the evaluation of development alternatives for the Earth Observations Program. Two computer models were developed and demonstrated on the Goddard Space Flight Center Computer Facility. Procedures have been outlined to guide the user of the models through specific evaluation processes, and the preparation of inputs describing earth observation needs and earth observation technology. These models are intended to assist NASA in increasing the effectiveness of the overall Earth Observation Program by providing a broader view of system and program development alternatives.

Pre-procedure ultrasound-guided paramedian spinal anaesthesia at L5–S1: Is this better than landmark-guided midline approach? A randomised controlled trial

PubMed Central

Srinivasan, Karthikeyan Kallidaikurichi; Leo, Anne-Marie; Iohom, Gabriella; Loughnane, Frank; Lee, Peter J

2018-01-01

Background and Aims: Routine use of pre-procedural ultrasound guided midline approach has not shown to improve success rate in administering subarachnoid block. The study hypothesis was that the routine use of pre-procedural (not real time) ultrasound-guided paramedian spinals at L5-S1 interspace could reduce the number of passes (i.e., withdrawal and redirection of spinal needle without exiting the skin) required to enter the subarachnoid space when compared to the conventional landmark-guided midline approach. Methods: After local ethics approval, 120 consenting patients scheduled for elective total joint replacements (Hip and Knee) were randomised into either Group C where conventional midline approach with palpated landmarks was used or Group P where pre-procedural ultrasound was used to perform subarachnoid block by paramedian approach at L5-S1 interspace (real time ultrasound guidance was not used). Results: There was no difference in primary outcome (difference in number of passes) between the two groups. Similarly there was no difference in the number of attempts (i.e., the number of times the spinal needle was withdrawn from the skin and reinserted). The first pass success rates (1 attempt and 1 pass) was significantly greater in Group C compared to Group P [43% vs. 22%, P = 0.02]. Conclusion: Routine use of paramedian spinal anaesthesia at L5-S1 interspace, guided by pre-procedure ultrasound, in patients undergoing lower limb joint arthroplasties did not reduce the number of passes or attempts needed to achieve successful dural puncture. PMID:29416151

Topography-guided transepithelial PRK after intracorneal ring segments implantation and corneal collagen CXL in a three-step procedure for keratoconus.

PubMed

Coskunseven, Efekan; Jankov, Mirko R; Grentzelos, Michael A; Plaka, Argyro D; Limnopoulou, Aliki N; Kymionis, George D

2013-01-01

To present the results of topography-guided transepithelial photorefractive keratectomy (PRK) after intracorneal ring segments implantation followed by corneal collagen cross-linking (CXL) for keratoconus. In this prospective case series, 10 patients (16 eyes) with progressive keratoconus were included. All patients underwent topography-guided transepithelial PRK after Keraring intracorneal ring segments (Mediphacos Ltda) implantation, followed by CXL treatment. The follow-up period was 6 months after the last procedure for all patients. Time interval between both intracorneal ring segments implantation and CXL and between CXL and topography-guided transepithelial PRK was 6 months. LogMAR mean uncorrected distance visual acuity and mean corrected distance visual acuity were significantly improved (P<.05) from 1.14±0.36 and 0.75±0.24 preoperatively to 0.25±0.13 and 0.13±0.06 after the completion of the three-step procedure, respectively. Mean spherical equivalent refraction was significantly reduced (P<.05) from -5.66±5.63 diopters (D) preoperatively to -0.98±2.21 D after the three-step procedure. Mean steep and flat keratometry values were significantly reduced (P<.05) from 54.65±5.80 D and 47.80±3.97 D preoperatively to 45.99±3.12 D and 44.69±3.19 D after the three-step procedure, respectively. Combined topography-guided transepithelial PRK with intracorneal ring segments implantation and CXL in a three-step procedure seems to be an effective, promising treatment sequence offering patients a functional visual acuity and ceasing progression of the ectatic disorder. A longer follow-up and larger case series are necessary to thoroughly evaluate safety, stability, and efficacy of this innovative procedure. Copyright 2013, SLACK Incorporated.

Automation of the guiding center expansion

NASA Astrophysics Data System (ADS)

Burby, J. W.; Squire, J.; Qin, H.

2013-07-01

We report on the use of the recently developed Mathematica package VEST (Vector Einstein Summation Tools) to automatically derive the guiding center transformation. Our Mathematica code employs a recursive procedure to derive the transformation order-by-order. This procedure has several novel features. (1) It is designed to allow the user to easily explore the guiding center transformation's numerous non-unique forms or representations. (2) The procedure proceeds entirely in cartesian position and velocity coordinates, thereby producing manifestly gyrogauge invariant results; the commonly used perpendicular unit vector fields e1,e2 are never even introduced. (3) It is easy to apply in the derivation of higher-order contributions to the guiding center transformation without fear of human error. Our code therefore stands as a useful tool for exploring subtle issues related to the physics of toroidal momentum conservation in tokamaks.

Automation of The Guiding Center Expansion

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

J. W. Burby, J. Squire and H. Qin

2013-03-19

We report on the use of the recently-developed Mathematica package VEST (Vector Einstein Summation Tools) to automatically derive the guiding center transformation. Our Mathematica code employs a recursive procedure to derive the transformation order-by-order. This procedure has several novel features. (1) It is designed to allow the user to easily explore the guiding center transformation's numerous nonunique forms or representations. (2) The procedure proceeds entirely in cartesian position and velocity coordinates, thereby producing manifestly gyrogauge invariant results; the commonly-used perpendicular unit vector fields e1, e2 are never even introduced. (3) It is easy to apply in the derivation of higher-ordermore » contributions to the guiding center transformation without fear of human error. Our code therefore stands as a useful tool for exploring subtle issues related to the physics of toroidal momentum conservation in tokamaks« less

[A simplified occupational health and safety management system designed for small enterprises. Initial validation results].

PubMed

Bacchi, Romana; Veneri, L; Ghini, P; Caso, Maria Alessandra; Baldassarri, Giovanna; Renzetti, F; Santarelli, R

2009-01-01

Occupational Health and Safety Management Systems (OHSMS) are known to be effective in improving safety at work. Unfortunately they are often too resource-heavy for small businesses. The aim of this project was to develop and test a simplified model of OHSMS suitable for small enterprises. The model consists of 7 procedures and various operating forms and check lists, that guide the enterprise in managing safety at work. The model was tested in 15 volunteer enterprises. In most of the enterprises two audits showed increased awareness and participation of workers; better definition and formalisation of respon sibilities in 8 firms; election of Union Safety Representatives in over one quarter of the enterprises; improvement of safety equipment. The study also helped identify areas where the model could be improved by simplification of unnecessarily complex and redundant procedures.

PET/CT-guided interventions: Indications, advantages, disadvantages and the state of the art.

PubMed

Cazzato, Roberto Luigi; Garnon, Julien; Shaygi, Behnam; Koch, Guillaume; Tsoumakidou, Georgia; Caudrelier, Jean; Addeo, Pietro; Bachellier, Philippe; Namer, Izzie Jacques; Gangi, Afshin

2018-02-01

Positron emission tomography/computed tomography (PET/CT) represents an emerging imaging guidance modality that has been applied to successfully guide percutaneous procedures such as biopsies and tumour ablations. The aim of the present narrative review is to report the indications, advantages and disadvantages of PET/CT-guided procedures in the field of interventional oncology and to briefly describe the experience gained with this new emerging technique while performing biopsies and tumor ablations.

Grounds Maintenance Equipment and Procedures. Building Maintenance. Module VI. Instructor's Guide.

ERIC Educational Resources Information Center

Crank, Virgil

This curriculum guide, one of six modules keyed to the building maintenance competency profile developed by industry and education professionals, provides materials for two units on grounds maintenance equipment and procedures. The first unit deals with grounds maintenance equipment and includes the following lessons: safety; changing oil/filter…

Masonry Procedures. Building Maintenance. Module V. Instructor's Guide.

ERIC Educational Resources Information Center

Eck, Francis

This curriculum guide, one of six modules keyed to the building maintenance competency profile developed by industry and education professionals, provides materials for a masonry procedures unit containing eight lessons. Lesson topics are masonry safety practices; set forms; mix concrete; patch and/or repair concrete; pour and finish concrete; mix…

Using the Traffic monitoring guide to develop a truck weight sampling procedure for use in Virginia : final report.

DOT National Transportation Integrated Search

1992-01-01

The Traffic Monitoring Guide (TMG) provides a method for the development of a statistically based procedure to monitor traffic characteristics such as traffic loadings. Truck weight data in particular are a major element of the pavement management pr...

Students with Attentional Disorders: Meeting Their Needs. A Guide for Schools and Families. Second Edition.

ERIC Educational Resources Information Center

Rhode Island State Dept. of Education, Providence.

This guide is designed to provide Rhode Island educators and families with information about appropriate interventions, recommended referral procedures, recommended diagnostic procedures, and legal issues regarding students with attention deficit disorders. It begins by answering frequently asked questions about attentional disorders and…

Toward Best Practices in Analyzing Datasets with Missing Data: Comparisons and Recommendations

ERIC Educational Resources Information Center

Johnson, David R.; Young, Rebekah

2011-01-01

Although several methods have been developed to allow for the analysis of data in the presence of missing values, no clear guide exists to help family researchers in choosing among the many options and procedures available. We delineate these options and examine the sensitivity of the findings in a regression model estimated in three random…

A data collection and processing procedure for evaluating a research program

Treesearch

Giuseppe Rensi; H. Dean Claxton

1972-01-01

A set of computer programs compiled for the information processing requirements of a model for evaluating research proposals are described. The programs serve to assemble and store information, periodically update it, and convert it to a form usable for decision-making. Guides for collecting and coding data are explained. The data-processing options available and...

School District Information Study. Planning for the Management of Information through Technology. A Planning and Staff Development Project.

ERIC Educational Resources Information Center

New York State Education Dept., Albany. Div. of Elementary and Secondary Education Planning.

Designed to provide assistance to school district personnel who seek to develop a plan for information management and related applications of technology, this guide presents the School District Information Study (SDIS) model for the review of management policies, procedures, and activities related to information processing done by school district…

A rheological model for immersed corrugated elastic plates.

PubMed

Meier, D; Franklin, H; Predoi, M V; Rousseau, M; Izbicki, J L

2017-03-01

The influence of surface imperfections on the propagation of guided waves in an immersed elastic plate can be interpreted by means of a rheological model. The corrugated surface is modeled by a very thin interface, similar to a Jones spring model, which replaces the continuity boundary conditions at the liquid - corrugated solid-plate interface. As the surrounding liquid is considered to be perfect, only one complex stiffness is used for the model of Jones. The selection of the plate guided mode and the test frequency are motivated by the detectability and non-interference with other modes. The spring stiffness is obtained by a best fit procedure, between the analytical solution and the results obtained by the finite elements method (FEM). One way ensuring the agreement of the two approaches, rheological and FEM, is to consider angular resonances provided by the transmission coefficients. Small changes in the parameters of the roughness keep the positions of the angular resonances of the plate practically unchanged, while at the same time large variations of the half width of the transmission coefficient curve is observed. The effect of corrugation parameters on the guided modes in the plate can be predicted by using the rheological model with the deduced spring complex stiffness. Copyright © 2016. Published by Elsevier B.V.

Quick Tips Guide for Small Manufacturing Businesses

EPA Pesticide Factsheets

Small manufacturing businesses can use this Quick Tips Guide to be better prepared for future extreme weather events. This guide discusses keeping good records, improving housekeeping procedures, and training employees.

Adapting Gel Wax into an Ultrasound-Guided Pericardiocentesis Model at Low Cost

PubMed Central

Daly, Robert; Planas, Jason H.; Edens, Mary Ann

2017-01-01

Cardiac tamponade is a life-threatening emergency for which pericardiocentesis may be required. Real-time bedside ultrasound has obviated the need for routine blind procedures in cardiac arrest, and the number of pericardiocenteses being performed has declined. Despite this fact, pericardiocentesis remains an essential skill in emergency medicine. While commercially available training models exist, cost, durability, and lack of anatomical landmarks limit their usefulness. We sought to create a pericardiocentesis model that is realistic, simple to build, reusable, and cost efficient. We constructed the model using a red dye-filled ping pong ball (simulating the right ventricle) and a 250cc normal saline bag (simulating the effusion) encased in an artificial rib cage and held in place by gel wax. The inner saline bag was connected to a 1L saline bag outside of the main assembly to act as a fluid reservoir for repeat uses. The entire construction process takes approximately 16–20 hours, most of which is attributed to cooling of the gel wax. Actual construction time is approximately four hours at a cost of less than $200. The model was introduced to emergency medicine residents and medical students during a procedure simulation lab and compared to a model previously described by dell’Orto.1 The learners performed ultrasound-guided pericardiocentesis using both models. Learners who completed a survey comparing realism of the two models felt our model was more realistic than the previously described model. On a scale of 1–9, with 9 being very realistic, the previous model was rated a 4.5. Our model was rated a 7.8. There was also a marked improvement in the perceived recognition of the pericardium, the heart, and the pericardial sac. Additionally, 100% of the students were successful at performing the procedure using our model. In simulation, our model provided both palpable and ultrasound landmarks and held up to several months of repeated use. It was less expensive than commercial models ($200 vs up to $16,500) while being more realistic in simulation than other described “do-it-yourself models.” This model can be easily replicated to teach the necessary skill of pericardiocentesis. PMID:28116020

Objective assessment of operator performance during ultrasound-guided procedures.

PubMed

Tabriz, David M; Street, Mandie; Pilgram, Thomas K; Duncan, James R

2011-09-01

Simulation permits objective assessment of operator performance in a controlled and safe environment. Image-guided procedures often require accurate needle placement, and we designed a system to monitor how ultrasound guidance is used to monitor needle advancement toward a target. The results were correlated with other estimates of operator skill. The simulator consisted of a tissue phantom, ultrasound unit, and electromagnetic tracking system. Operators were asked to guide a needle toward a visible point target. Performance was video-recorded and synchronized with the electromagnetic tracking data. A series of algorithms based on motor control theory and human information processing were used to convert raw tracking data into different performance indices. Scoring algorithms converted the tracking data into efficiency, quality, task difficulty, and targeting scores that were aggregated to create performance indices. After initial feasibility testing, a standardized assessment was developed. Operators (N = 12) with a broad spectrum of skill and experience were enrolled and tested. Overall scores were based on performance during ten simulated procedures. Prior clinical experience was used to independently estimate operator skill. When summed, the performance indices correlated well with estimated skill. Operators with minimal or no prior experience scored markedly lower than experienced operators. The overall score tended to increase according to operator's clinical experience. Operator experience was linked to decreased variation in multiple aspects of performance. The aggregated results of multiple trials provided the best correlation between estimated skill and performance. A metric for the operator's ability to maintain the needle aimed at the target discriminated between operators with different levels of experience. This study used a highly focused task model, standardized assessment, and objective data analysis to assess performance during simulated ultrasound-guided needle placement. The performance indices were closely related to operator experience.

Iterated unscented Kalman filter for phase unwrapping of interferometric fringes.

PubMed

Xie, Xianming

2016-08-22

A fresh phase unwrapping algorithm based on iterated unscented Kalman filter is proposed to estimate unambiguous unwrapped phase of interferometric fringes. This method is the result of combining an iterated unscented Kalman filter with a robust phase gradient estimator based on amended matrix pencil model, and an efficient quality-guided strategy based on heap sort. The iterated unscented Kalman filter that is one of the most robust methods under the Bayesian theorem frame in non-linear signal processing so far, is applied to perform simultaneously noise suppression and phase unwrapping of interferometric fringes for the first time, which can simplify the complexity and the difficulty of pre-filtering procedure followed by phase unwrapping procedure, and even can remove the pre-filtering procedure. The robust phase gradient estimator is used to efficiently and accurately obtain phase gradient information from interferometric fringes, which is needed for the iterated unscented Kalman filtering phase unwrapping model. The efficient quality-guided strategy is able to ensure that the proposed method fast unwraps wrapped pixels along the path from the high-quality area to the low-quality area of wrapped phase images, which can greatly improve the efficiency of phase unwrapping. Results obtained from synthetic data and real data show that the proposed method can obtain better solutions with an acceptable time consumption, with respect to some of the most used algorithms.

Near-infrared fluorescence goggle system with complementary metal–oxide–semiconductor imaging sensor and see-through display

PubMed Central

Liu, Yang; Njuguna, Raphael; Matthews, Thomas; Akers, Walter J.; Sudlow, Gail P.; Mondal, Suman; Tang, Rui

2013-01-01

Abstract. We have developed a near-infrared (NIR) fluorescence goggle system based on the complementary metal–oxide–semiconductor active pixel sensor imaging and see-through display technologies. The fluorescence goggle system is a compact wearable intraoperative fluorescence imaging and display system that can guide surgery in real time. The goggle is capable of detecting fluorescence of indocyanine green solution in the picomolar range. Aided by NIR quantum dots, we successfully used the fluorescence goggle to guide sentinel lymph node mapping in a rat model. We further demonstrated the feasibility of using the fluorescence goggle in guiding surgical resection of breast cancer metastases in the liver in conjunction with NIR fluorescent probes. These results illustrate the diverse potential use of the goggle system in surgical procedures. PMID:23728180

3D/2D model-to-image registration by imitation learning for cardiac procedures.

PubMed

Toth, Daniel; Miao, Shun; Kurzendorfer, Tanja; Rinaldi, Christopher A; Liao, Rui; Mansi, Tommaso; Rhode, Kawal; Mountney, Peter

2018-05-12

In cardiac interventions, such as cardiac resynchronization therapy (CRT), image guidance can be enhanced by involving preoperative models. Multimodality 3D/2D registration for image guidance, however, remains a significant research challenge for fundamentally different image data, i.e., MR to X-ray. Registration methods must account for differences in intensity, contrast levels, resolution, dimensionality, field of view. Furthermore, same anatomical structures may not be visible in both modalities. Current approaches have focused on developing modality-specific solutions for individual clinical use cases, by introducing constraints, or identifying cross-modality information manually. Machine learning approaches have the potential to create more general registration platforms. However, training image to image methods would require large multimodal datasets and ground truth for each target application. This paper proposes a model-to-image registration approach instead, because it is common in image-guided interventions to create anatomical models for diagnosis, planning or guidance prior to procedures. An imitation learning-based method, trained on 702 datasets, is used to register preoperative models to intraoperative X-ray images. Accuracy is demonstrated on cardiac models and artificial X-rays generated from CTs. The registration error was [Formula: see text] on 1000 test cases, superior to that of manual ([Formula: see text]) and gradient-based ([Formula: see text]) registration. High robustness is shown in 19 clinical CRT cases. Besides the proposed methods feasibility in a clinical environment, evaluation has shown good accuracy and high robustness indicating that it could be applied in image-guided interventions.

Endoscopic ultrasound-guided choledochoduodenostomy after a failed or impossible ERCP.

PubMed

Mora Soler, Ana María; Álvarez Delgado, Alberto; Piñero Pérez, María Concepción; Velasco-Guardado, Antonio; Marcos Prieto, Héctor; Rodríguez Pérez, Antonio

2018-05-01

endoscopic ultrasound-guided biliary drainage (EUS-BD) is an alternative to percutaneous trans-hepatic biliary drainage (PTBD) in cases of failed endoscopic retrograde cholangiopancreatography (ERCP). this is a retrospective description of six cases of endoscopic ultrasound-guided biliary drainage via choledochoduodenostomy (EUCD), as well as the clinical characteristics, endoscopic procedure, complications and monitoring. all cases had malignant distal biliary obstruction. The procedure was concluded with good drainage in four out of six patients. Two late complications were recorded that were caused by stent migration and there were no deaths related with the procedure. The average monitoring period was six months. EUCD can be considered as a valid therapeutic choice in some selected cases and when performed by a team of expert endoscopists in cases of failed ERCP drainage or as an alternative to PTBD. However, the procedure has some associated complications.

A haptic device for guide wire in interventional radiology procedures.

PubMed

Moix, Thomas; Ilic, Dejan; Bleuler, Hannes; Zoethout, Jurjen

2006-01-01

Interventional Radiology (IR) is a minimally invasive procedure where thin tubular instruments, guide wires and catheters, are steered through the patient's vascular system under X-ray imaging. In order to perform these procedures, a radiologist has to be trained to master hand-eye coordination, instrument manipulation and procedure protocols. The existing simulation systems all have major drawbacks: the use of modified instruments, unrealistic insertion lengths, high inertia of the haptic device that creates a noticeably degraded dynamic behavior or excessive friction that is not properly compensated for. In this paper we propose a quality training environment dedicated to IR. The system is composed of a virtual reality (VR) simulation of the patient's anatomy linked to a robotic interface providing haptic force feedback. This paper focuses on the requirements, design and prototyping of a specific haptic interface for guide wires.

Validation of model-based deformation correction in image-guided liver surgery via tracked intraoperative ultrasound: preliminary method and results

NASA Astrophysics Data System (ADS)

Clements, Logan W.; Collins, Jarrod A.; Wu, Yifei; Simpson, Amber L.; Jarnagin, William R.; Miga, Michael I.

2015-03-01

Soft tissue deformation represents a significant error source in current surgical navigation systems used for open hepatic procedures. While numerous algorithms have been proposed to rectify the tissue deformation that is encountered during open liver surgery, clinical validation of the proposed methods has been limited to surface based metrics and sub-surface validation has largely been performed via phantom experiments. Tracked intraoperative ultrasound (iUS) provides a means to digitize sub-surface anatomical landmarks during clinical procedures. The proposed method involves the validation of a deformation correction algorithm for open hepatic image-guided surgery systems via sub-surface targets digitized with tracked iUS. Intraoperative surface digitizations were acquired via a laser range scanner and an optically tracked stylus for the purposes of computing the physical-to-image space registration within the guidance system and for use in retrospective deformation correction. Upon completion of surface digitization, the organ was interrogated with a tracked iUS transducer where the iUS images and corresponding tracked locations were recorded. After the procedure, the clinician reviewed the iUS images to delineate contours of anatomical target features for use in the validation procedure. Mean closest point distances between the feature contours delineated in the iUS images and corresponding 3-D anatomical model generated from the preoperative tomograms were computed to quantify the extent to which the deformation correction algorithm improved registration accuracy. The preliminary results for two patients indicate that the deformation correction method resulted in a reduction in target error of approximately 50%.

Septic bursitis after ultrasound-guided percutaneous treatment of rotator cuff calcific tendinopathy.

PubMed

Sconfienza, Luca Maria; Randelli, Filippo; Sdao, Silvana; Sardanelli, Francesco; Randelli, Pietro

2014-08-01

Calcific tendinopathy of the rotator cuff is a common condition. Ultrasound-guided percutaneous aspiration is one of several options to treat this condition. The main advantages of this procedure are short duration, good outcome, and low cost. Furthermore, only minor complications have been reported in the literature, namely, vagal reactions during the procedure and mild postprocedural pain. We report the first case of septic bursitis after ultrasound-guided percutaneous treatment of calcific tendinopathy. Although this is generally considered a very safe procedure, a risk of infection should be taken into account. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Articulation in Business Education for Secondary and Postsecondary Levels. Accounting Articulation Guide.

ERIC Educational Resources Information Center

Formby, Ronnie J.

Focusing on courses in accounting, this guide is one of a set of four articulation guides designed for articulating between secondary and postsecondary business education courses. (The other three guides focus on courses in typewriting, shorthand, and office procedures.) Each guide presents a general course description, outlines of the major units…

CT fluoroscopy-guided preoperative short hook wire placement for small pulmonary lesions: evaluation of safety and identification of risk factors for pneumothorax.

PubMed

Iguchi, Toshihiro; Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Matsui, Yusuke; Miyoshi, Shinichiro; Kanazawa, Susumu

2016-01-01

To retrospectively evaluate the safety of computed tomography (CT) fluoroscopy-guided short hook wire placement for video-assisted thoracoscopic surgery and the risk factors for pneumothorax associated with this procedure. We analyzed 267 short hook wire placements for 267 pulmonary lesions (mean diameter, 9.9 mm). Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for pneumothorax. Complications (219 grade 1 and 4 grade 2 adverse events) occurred in 196 procedures. No grade 3 or above adverse events were observed. Univariate analysis revealed increased vital capacity (odds ratio [OR], 1.518; P = 0.021), lower lobe lesion (OR, 2.343; P =0.001), solid lesion (OR, 1.845; P = 0.014), prone positioning (OR, 1.793; P = 0.021), transfissural approach (OR, 11.941; P = 0.017), and longer procedure time (OR, 1.036; P = 0.038) were significant predictors of pneumothorax. Multivariate analysis revealed only the transfissural approach (OR, 12.171; P = 0.018) and a longer procedure time (OR, 1.048; P = 0.012) as significant independent predictors. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occurred, but all complications were minor. A transfissural approach and longer procedure time were significant independent predictors of pneumothorax. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occur. Complications are usually minor and asymptomatic. A transfissural approach and longer procedure time are significant independent predictors of pneumothorax.

Automation of the guiding center expansion

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

Burby, J. W.; Squire, J.; Qin, H.

2013-07-15

We report on the use of the recently developed Mathematica package VEST (Vector Einstein Summation Tools) to automatically derive the guiding center transformation. Our Mathematica code employs a recursive procedure to derive the transformation order-by-order. This procedure has several novel features. (1) It is designed to allow the user to easily explore the guiding center transformation's numerous non-unique forms or representations. (2) The procedure proceeds entirely in cartesian position and velocity coordinates, thereby producing manifestly gyrogauge invariant results; the commonly used perpendicular unit vector fields e{sub 1},e{sub 2} are never even introduced. (3) It is easy to apply in themore » derivation of higher-order contributions to the guiding center transformation without fear of human error. Our code therefore stands as a useful tool for exploring subtle issues related to the physics of toroidal momentum conservation in tokamaks.« less

Using Guided Notes, Choral Responding, and Response Cards to Increase Student Performance

ERIC Educational Resources Information Center

Blackwell, Ann J.; McLaughlin, T. F.

2005-01-01

This paper presents and selectively reviews the data-based literature regarding guided notes, choral responding, and response cards (ASR). These ASR procedures as designed to increase the opportunities for students to respond and improve their academic performance. Each of these procedures were effective in increasing student performance in…

Value of Artisanal Simulators to Train Veterinary Students in Performing Invasive Ultrasound-Guided Procedures

ERIC Educational Resources Information Center

Hage, Maria Cristina F. N. S.; Massaferro, Ana Beatriz; Lopes, Érika Rondon; Beraldo, Carolina Mariano; Daniel, Jéssika

2016-01-01

Pericardial effusion can lead to cardiac tamponade, which endangers an animal's life. Ultrasound-guided pericardiocentesis is used to remove abnormal liquid; however, it requires technical expertise. In veterinary medical education, the opportunity to teach this procedure to save lives during emergencies is rare; therefore, simulators are…

Food Products Procurement, Receiving and Storage Guide.

ERIC Educational Resources Information Center

Kansas Association of School Business Officials, Haysville.

This guide is intended as a resource document for the beginner in food services and food purchasing. The publication is divided topically by (1) purchasing procedures, (2) specifications and evaluation, (3) sources for purchasing food products, (4) storage of food products and inventory procedures, (5) type of food service management, and (6)…

Teacher's Guide to Accompany Living Latin: A Contemporary Approach.

ERIC Educational Resources Information Center

Masciantonio, Rudolph

This guide, designed to assist teachers in the classroom use of "Living Latin: A Contemporary Approach", emphasizes procedures to be followed in each chapter of Book One; special procedures for teaching the introduction and first chapter are treated separately. Use of the text as a supplement to Sweet's "Artes Latinae" is discussed. Appendixes…

System administrator`s guide to CDPS. Version 1.0

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

Didier, B.T.; Portwood, M.H.

The System Administrator`s Guide to CDPS is intended for those responsible for setting up and maintaining the hardware and software of a Common Mapping Standard (CMS) Date Production System (CDPS) installation. This guide assists the system administrator in performing typical administrative functions. It is not intended to replace the Ultrix Documentation Set that should be available for a DCPS installation. The Ultrix Documentation Set will be required to provide details on referenced Ultrix commands as well as procedures for performing Ultrix maintenance functions. There are six major sections in this guide. Section 1 introduces the system administrator to CDPS andmore » describes the assumptions that are made by this guide. Section 2 describes the CDPS platform configuration. Section 3 describes the platform preparation that is required to install the CDPS software. Section 4 describes the CPS software and its installation procedures. Section 5 describes the CDS software and its installation procedures. Section 6 describes various operation and maintenance procedures. Four appendices are also provided. Appendix A contains a list of used acronyms. Appendix B provides a terse description of common Ultrix commands that are used in administrative functions. Appendix C provides sample CPS and CDS configuration files. Appendix D provides a required list and a recommended list of Ultrix software subsets for installation on a CDPS platform.« less

MRI-guided stereotactic neurosurgical procedures in a diagnostic MRI suite: Background and safe practice recommendations.

PubMed

Larson, Paul S; Willie, Jon T; Vadivelu, Sudhakar; Azmi-Ghadimi, Hooman; Nichols, Amy; Fauerbach, Loretta Litz; Johnson, Helen Boehm; Graham, Denise

2017-07-01

The development of navigation technology facilitating MRI-guided stereotactic neurosurgery has enabled neurosurgeons to perform a variety of procedures ranging from deep brain stimulation to laser ablation entirely within an intraoperative or diagnostic MRI suite while having real-time visualization of brain anatomy. Prior to this technology, some of these procedures required multisite workflow patterns that presented significant risk to the patient during transport. For those facilities with access to this technology, safe practice guidelines exist only for procedures performed within an intraoperative MRI. There are currently no safe practice guidelines or parameters available for facilities looking to integrate this technology into practice in conventional MRI suites. Performing neurosurgical procedures in a diagnostic MRI suite does require precautionary measures. The relative novelty of technology and workflows for direct MRI-guided procedures requires consideration of safe practice recommendations, including those pertaining to infection control and magnet safety issues. This article proposes a framework of safe practice recommendations designed for assessing readiness and optimization of MRI-guided neurosurgical interventions in the diagnostic MRI suite in an effort to mitigate patient risk. The framework is based on existing clinical evidence, recommendations, and guidelines related to infection control and prevention, health care-associated infections, and magnet safety, as well as the clinical and practical experience of neurosurgeons utilizing this technology. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

US-Guided, Direct Puncture Retrograde Thoracic Duct Access, Lymphangiography, and Embolization: Feasibility and Efficacy.

PubMed

Guevara, Carlos J; Rialon, Kristy L; Ramaswamy, Raja S; Kim, Seung K; Darcy, Michael D

2016-12-01

To describe technical details, success rate, and advantages of direct puncture of the thoracic duct (TD) under direct ultrasound (US) guidance at venous insertion in the left neck. All patients who underwent attempted thoracic duct embolization (TDE) via US-guided retrograde TD access in the left neck were retrospectively reviewed. Indications for lymphangiography were iatrogenic chyle leak, pulmonary lymphangiectasia, and plastic bronchitis. Ten patients with mean age 41.4 years (range, 21 d to 72 y) underwent US-guided TD access via the left neck. Technical details, procedural times, and clinical outcomes were evaluated. TD access time was defined as time from start of procedure to successful access of TD, and total procedural time was defined from start of procedure until TDE. All attempts at TD access via the neck were successful. Technical and clinical success of TDE was 60%. There were no complications. Mean TD access time was 17 minutes (range, 2-47 min), and mean total procedure time was 49 minutes (range, 25-69 min). Mean follow-up time was 5.4 months (range, 3-10 months). TDE via US-guided access in the left neck is technically feasible and safe with a potential decrease in procedure time and elimination of oil-based contrast material. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

Ultrasonography-guided central venous catheterisation in haematological patients with severe thrombocytopenia

PubMed Central

Napolitano, Mariasanta; Malato, Alessandra; Raffaele, Francesco; Palazzolo, Manuela; Iacono, Giorgio Lo; Pinna, Roberto; Geraci, Girolamo; Modica, Giuseppe; Saccullo, Giorgia; Siragusa, Sergio; Cajozzo, Massimo

2013-01-01

Background Cannulation of the internal jugular vein (CVC) is a blind surface landmark-guided technique that could be potentially dangerous in patients with very low platelet counts. In such patients, ultrasonography (US)-guided CVC may be a valid approach. There is a lack of published data on the efficacy and safety of urgent US-guided CVC performed in haematological patients with severe thrombocytopenia. Materials and methods We retrospectively studied the safety of urgent CVC procedures in haematological patients including those with severe thrombocytopenia (platelet count <30×109/L). From January 1999 to June 2009, 431 CVC insertional procedures in 431 consecutive patients were evaluated. Patients were included in the study if they had a haematological disorder and required urgent CVC insertion. Patients were placed in Trendelenburg's position, an 18-gauge needle and guide-wire were advanced under real-time US guidance into the last part of the internal jugular vein; central venous cannulation of the internal jugular vein was performed using the Seldinger technique in all the procedures. Major and minor procedure-related complications were recorded. Results All 431 patients studied had haematological disorders: 39 had severe thrombocytopenia, refractory to platelet transfusion (group 1), while 392 did not have severe thrombocytopenia (group 2). The general characteristics of the patients in the two groups differed only for platelet count. The average time taken to perform the procedure was 4 minutes. Success rates were 97.4% and 97.9% in group 1 and group 2, respectively. No major complications occurred in either group. Discussion US-guided CVC is a safe and effective approach in haematological patients with severe thrombocytopenia requiring urgent cannulation for life support, plasma-exchange, chemotherapy and transfusion. PMID:23399356

Real-Time flare detection using guided filter

NASA Astrophysics Data System (ADS)

Lin, Jiaben; Deng, Yuanyong; Yuan, Fei; Guo, Juan

2017-04-01

A procedure is introduced for the automatic detection of solar flare using full-disk solar images from Huairou Solar Observing Station (HSOS), National Astronomical Observatories of China. In image preprocessing, median filter is applied to remove the noises. And then we adopt guided filter, which is first introduced into the astronomical image detection, to enhance the edges of flares and restrain the solar limb darkening. Flares are then detected by modified Otsu algorithm and further threshold processing technique. Compared with other automatic detection procedure, the new procedure has some advantages such as real time and reliability as well as no need of image division and local threshold. Also, it reduces the amount of computation largely, which is benefited from the efficient guided filter algorithm. The procedure has been tested on one month sequences (December 2013) of HSOS full-disk solar images and the result of flares detection shows that the number of flares detected by our procedure is well consistent with the manual one.

Automatic detection of solar features in HSOS full-disk solar images using guided filter

NASA Astrophysics Data System (ADS)

Yuan, Fei; Lin, Jiaben; Guo, Jingjing; Wang, Gang; Tong, Liyue; Zhang, Xinwei; Wang, Bingxiang

2018-02-01

A procedure is introduced for the automatic detection of solar features using full-disk solar images from Huairou Solar Observing Station (HSOS), National Astronomical Observatories of China. In image preprocessing, median filter is applied to remove the noises. Guided filter is adopted to enhance the edges of solar features and restrain the solar limb darkening, which is first introduced into the astronomical target detection. Then specific features are detected by Otsu algorithm and further threshold processing technique. Compared with other automatic detection procedures, our procedure has some advantages such as real time and reliability as well as no need of local threshold. Also, it reduces the amount of computation largely, which is benefited from the efficient guided filter algorithm. The procedure has been tested on one month sequences (December 2013) of HSOS full-disk solar images and the result shows that the number of features detected by our procedure is well consistent with the manual one.

Prediction task guided representation learning of medical codes in EHR.

PubMed

Cui, Liwen; Xie, Xiaolei; Shen, Zuojun

2018-06-18

There have been rapidly growing applications using machine learning models for predictive analytics in Electronic Health Records (EHR) to improve the quality of hospital services and the efficiency of healthcare resource utilization. A fundamental and crucial step in developing such models is to convert medical codes in EHR to feature vectors. These medical codes are used to represent diagnoses or procedures. Their vector representations have a tremendous impact on the performance of machine learning models. Recently, some researchers have utilized representation learning methods from Natural Language Processing (NLP) to learn vector representations of medical codes. However, most previous approaches are unsupervised, i.e. the generation of medical code vectors is independent from prediction tasks. Thus, the obtained feature vectors may be inappropriate for a specific prediction task. Moreover, unsupervised methods often require a lot of samples to obtain reliable results, but most practical problems have very limited patient samples. In this paper, we develop a new method called Prediction Task Guided Health Record Aggregation (PTGHRA), which aggregates health records guided by prediction tasks, to construct training corpus for various representation learning models. Compared with unsupervised approaches, representation learning models integrated with PTGHRA yield a significant improvement in predictive capability of generated medical code vectors, especially for limited training samples. Copyright © 2018. Published by Elsevier Inc.

Accuracy Considerations in Image-guided Cardiac Interventions: Experience and Lessons Learned

PubMed Central

Linte, Cristian A.; Lang, Pencilla; Rettmann, Maryam E.; Cho, Daniel S.; Holmes, David R.; Robb, Richard A.; Peters, Terry M.

2014-01-01

Motivation Medical imaging and its application in interventional guidance has revolutionized the development of minimally invasive surgical procedures leading to reduced patient trauma, fewer risks, and shorter recovery times. However, a frequently posed question with regards to an image guidance system is “how accurate is it?” On one hand, the accuracy challenge can be posed in terms of the tolerable clinical error associated with the procedure; on the other hand, accuracy is bound by the limitations of the system’s components, including modeling, patient registration, and surgical instrument tracking, all of which ultimately impact the overall targeting capabilities of the system. Methods While these processes are not unique to any interventional specialty, this paper discusses them in the context of two different cardiac image-guidance platforms: a model-enhanced ultrasound platform for intracardiac interventions and a prototype system for advanced visualization in image-guided cardiac ablation therapy. Results Pre-operative modeling techniques involving manual, semi-automatic and registration-based segmentation are discussed. The performance and limitations of clinically feasible approaches for patient registration evaluated both in the laboratory and operating room are presented. Our experience with two different magnetic tracking systems for instrument and ultrasound transducer localization is reported. Ultimately, the overall accuracy of the systems is discussed based on both in vitro and preliminary in vivo experience. Conclusion While clinical accuracy is specific to a particular patient and procedure and vastly dependent on the surgeon’s experience, the system’s engineering limitations are critical to determine whether the clinical requirements can be met. PMID:21671097

17 CFR 202.8 - Small entity compliance guides.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 17 Commodity and Securities Exchanges 2 2010-04-01 2010-04-01 false Small entity compliance guides. 202.8 Section 202.8 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION INFORMAL AND OTHER PROCEDURES § 202.8 Small entity compliance guides. The following small entity compliance guides...

17 CFR 202.8 - Small entity compliance guides.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 17 Commodity and Securities Exchanges 2 2011-04-01 2011-04-01 false Small entity compliance guides. 202.8 Section 202.8 Commodity and Securities Exchanges SECURITIES AND EXCHANGE COMMISSION INFORMAL AND OTHER PROCEDURES § 202.8 Small entity compliance guides. The following small entity compliance guides...

Innovative procedure for computer-assisted genioplasty: three-dimensional cephalometry, rapid-prototyping model and surgical splint.

PubMed

Olszewski, R; Tranduy, K; Reychler, H

2010-07-01

The authors present a new procedure of computer-assisted genioplasty. They determined the anterior, posterior and inferior limits of the chin in relation to the skull and face with the newly developed and validated three-dimensional cephalometric planar analysis (ACRO 3D). Virtual planning of the osteotomy lines was carried out with Mimics (Materialize) software. The authors built a three-dimensional rapid-prototyping multi-position model of the chin area from a medical low-dose CT scan. The transfer of virtual information to the operating room consisted of two elements. First, the titanium plates on the 3D RP model were pre-bent. Second, a surgical guide for the transfer of the osteotomy lines and the positions of the screws to the operating room was manufactured. The authors present the first case of the use of this model on a patient. The postoperative results are promising, and the technique is fast and easy-to-use. More patients are needed for a definitive clinical validation of this procedure. Copyright 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Use of the Job Model Concept to Guide Job Description Procedures for Army Officers.

ERIC Educational Resources Information Center

Whitmore, Paul G.

The objective of Work Unit SKYGUARD has been to facilitate the development of an improved Air Defense Officers Advanced Course (C-22) by the U.S. Army Air Defense School. Focus is on techniques for improving the completeness and relevance of the instructional objectives with respect to future job requirements. The job description procedures…

Hanford internal dosimetry program manual

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

Carbaugh, E.H.; Sula, M.J.; Bihl, D.E.

1989-10-01

This document describes the Hanford Internal Dosimetry program. Program Services include administrating the bioassay monitoring program, evaluating and documenting assessments of internal exposure and dose, ensuring that analytical laboratories conform to requirements, selecting and applying appropriate models and procedures for evaluating internal radionuclide deposition and the resulting dose, and technically guiding and supporting Hanford contractors in matters regarding internal dosimetry. 13 refs., 16 figs., 42 tabs.

Louisiana State University Health Sciences Center Katrina Inspired Disaster Screenings (KIDS): Psychometric Testing of the National Child Traumatic Stress Network Hurricane Assessment and Referral Tool

ERIC Educational Resources Information Center

Hansel, Tonya Cross; Osofsky, Joy D.; Osofsky, Howard J.

2015-01-01

Background: Post disaster psychosocial surveillance procedures are important for guiding effective and efficient recovery. The Louisiana State University Health Sciences Center Katrina Inspired Disaster Screenings (KIDS) is a model designed with the goal of assisting recovering communities in understanding the needs of and targeting services…

Development of a Procedural Guide to Implement Response to Intervention (RtI) with High-Ability Learners

ERIC Educational Resources Information Center

Robertson, Stephanie; Pfeiffer, Steven

2016-01-01

In recent years, a focus on individual student needs has set the stage for tailoring educational interventions to address issues of students who are not working up to educational proficiency standards outlined in the No Child Left Behind (NCLB) legislation. This new pedagogical model may provide a unique opportunity to meet the needs of…

PROTEUS two-dimensional Navier-Stokes computer code, version 1.0. Volume 2: User's guide

NASA Technical Reports Server (NTRS)

Towne, Charles E.; Schwab, John R.; Benson, Thomas J.; Suresh, Ambady

1990-01-01

A new computer code was developed to solve the two-dimensional or axisymmetric, Reynolds averaged, unsteady compressible Navier-Stokes equations in strong conservation law form. The thin-layer or Euler equations may also be solved. Turbulence is modeled using an algebraic eddy viscosity model. The objective was to develop a code for aerospace applications that is easy to use and easy to modify. Code readability, modularity, and documentation were emphasized. The equations are written in nonorthogonal body-fitted coordinates, and solved by marching in time using a fully-coupled alternating direction-implicit procedure with generalized first- or second-order time differencing. All terms are linearized using second-order Taylor series. The boundary conditions are treated implicitly, and may be steady, unsteady, or spatially periodic. Simple Cartesian or polar grids may be generated internally by the program. More complex geometries require an externally generated computational coordinate system. The documentation is divided into three volumes. Volume 2 is the User's Guide, and describes the program's general features, the input and output, the procedure for setting up initial conditions, the computer resource requirements, the diagnostic messages that may be generated, the job control language used to run the program, and several test cases.

Proteus three-dimensional Navier-Stokes computer code, version 1.0. Volume 2: User's guide

NASA Technical Reports Server (NTRS)

Towne, Charles E.; Schwab, John R.; Bui, Trong T.

1993-01-01

A computer code called Proteus 3D was developed to solve the three-dimensional, Reynolds-averaged, unsteady compressible Navier-Stokes equations in strong conservation law form. The objective in this effort was to develop a code for aerospace propulsion applications that is easy to use and easy to modify. Code readability, modularity, and documentation were emphasized. The governing equations are solved in generalized nonorthogonal body-fitted coordinates, by marching in time using a fully-coupled ADI solution procedure. The boundary conditions are treated implicitly. All terms, including the diffusion terms, are linearized using second-order Taylor series expansions. Turbulence is modeled using either an algebraic or two-equation eddy viscosity model. The thin-layer or Euler equations may also be solved. The energy equation may be eliminated by the assumption of constant total enthalpy. Explicit and implicit artificial viscosity may be used. Several time step options are available for convergence acceleration. The documentation is divided into three volumes. This User's Guide describes the program's features, the input and output, the procedure for setting up initial conditions, the computer resource requirements, the diagnostic messages that may be generated, the job control language used to run the program, and several test cases.

Surface mesh to voxel data registration for patient-specific anatomical modeling

NASA Astrophysics Data System (ADS)

de Oliveira, Júlia E. E.; Giessler, Paul; Keszei, András.; Herrler, Andreas; Deserno, Thomas M.

2016-03-01

Virtual Physiological Human (VPH) models are frequently used for training, planning, and performing medical procedures. The Regional Anaesthesia Simulator and Assistant (RASimAs) project has the goal of increasing the application and effectiveness of regional anesthesia (RA) by combining a simulator of ultrasound-guided and electrical nerve-stimulated RA procedures and a subject-specific assistance system through an integration of image processing, physiological models, subject-specific data, and virtual reality. Individualized models enrich the virtual training tools for learning and improving regional anaesthesia (RA) skills. Therefore, we suggest patient-specific VPH models that are composed by registering the general mesh-based models with patient voxel data-based recordings. Specifically, the pelvis region has been focused for the support of the femoral nerve block. The processing pipeline is composed of different freely available toolboxes such as MatLab, the open Simulation framework (SOFA), and MeshLab. The approach of Gilles is applied for mesh-to-voxel registration. Personalized VPH models include anatomical as well as mechanical properties of the tissues. Two commercial VPH models (Zygote and Anatomium) were used together with 34 MRI data sets. Results are presented for the skin surface and pelvic bones. Future work will extend the registration procedure to cope with all model tissue (i.e., skin, muscle, bone, vessel, nerve, fascia) in a one-step procedure and extrapolating the personalized models to body regions actually being out of the captured field of view.

3D patient-specific models for left atrium characterization to support ablation in atrial fibrillation patients.

PubMed

Valinoti, Maddalena; Fabbri, Claudio; Turco, Dario; Mantovan, Roberto; Pasini, Antonio; Corsi, Cristiana

2018-01-01

Radiofrequency ablation (RFA) is an important and promising therapy for atrial fibrillation (AF) patients. Optimization of patient selection and the availability of an accurate anatomical guide could improve RFA success rate. In this study we propose a unified, fully automated approach to build a 3D patient-specific left atrium (LA) model including pulmonary veins (PVs) in order to provide an accurate anatomical guide during RFA and without PVs in order to characterize LA volumetry and support patient selection for AF ablation. Magnetic resonance data from twenty-six patients referred for AF RFA were processed applying an edge-based level set approach guided by a phase-based edge detector to obtain the 3D LA model with PVs. An automated technique based on the shape diameter function was designed and applied to remove PVs and compute LA volume. 3D LA models were qualitatively compared with 3D LA surfaces acquired during the ablation procedure. An expert radiologist manually traced the LA on MR images twice. LA surfaces from the automatic approach and manual tracing were compared by mean surface-to-surface distance. In addition, LA volumes were compared with volumes from manual segmentation by linear and Bland-Altman analyses. Qualitative comparison of 3D LA models showed several inaccuracies, in particular PVs reconstruction was not accurate and left atrial appendage was missing in the model obtained during RFA procedure. LA surfaces were very similar (mean surface-to-surface distance: 2.3±0.7mm). LA volumes were in excellent agreement (y=1.03x-1.4, r=0.99, bias=-1.37ml (-1.43%) SD=2.16ml (2.3%), mean percentage difference=1.3%±2.1%). Results showed the proposed 3D patient-specific LA model with PVs is able to better describe LA anatomy compared to models derived from the navigation system, thus potentially improving electrograms and voltage information location and reducing fluoroscopic time during RFA. Quantitative assessment of LA volume derived from our 3D LA model without PVs is also accurate and may provide important information for patient selection for RFA. Copyright © 2017 Elsevier Inc. All rights reserved.

Ultrasound-guided percutaneous fine-needle aspiration of 545 focal pancreatic lesions.

PubMed

Zamboni, Giulia A; D'Onofrio, Mirko; Idili, Antonio; Malagò, Roberto; Iozzia, Roberta; Manfrin, Erminia; Mucelli, Roberto Pozzi

2009-12-01

The purpose of this study was to assess the accuracy and short-term complication rate of ultrasound-guided fine-needle aspiration cytologic sampling of focal pancreatic lesions. We reviewed 545 consecutive ultrasound-guided fine-needle aspiration cytologic sampling procedures for focal pancreatic lesions from January 2004 through June 2008. The procedures were performed with a 20- or 21-gauge needle. The onsite cytopathologist evaluated the appropriateness of the sample and made a diagnosis. We reviewed the final diagnosis and the radiologic and medical records of all patients for onset of complications during or within 7 days of the procedure. The study sample included 262 women and 283 men (mean age, 62 years; range, 25-86 years). The head or uncinate process of the pancreas was the location of 63.0% of the lesions, and 35.2% of the lesions were located in the body or tail of the pancreas. The site of 10 lesions (1.8%) was not specified. Sampling was diagnostic in 509 of the 545 cases (93.4%). Excluding the 36 nondiagnostic samples, ultrasound-guided fine-needle aspiration cytologic sampling had 99.4% sensitivity, 100% specificity, and 99.4% accuracy. In 537 of the 545 cases (98.5%), the procedure was uneventful. In two cases, abdominal fluid was found after the procedure that was not present before the procedure. Six patients experienced postprocedural pain without abnormal findings at subsequent imaging. No major complications occurred. Ultrasound-guided cytologic sampling is safe and accurate for the diagnosis and planning of management of focal pancreatic lesions. With a cytologist on site, the rate of acquisition of samples adequate for diagnosis is high, reducing the need for patient recall.

Image-guided endobronchial ultrasound

NASA Astrophysics Data System (ADS)

Higgins, William E.; Zang, Xiaonan; Cheirsilp, Ronnarit; Byrnes, Patrick; Kuhlengel, Trevor; Bascom, Rebecca; Toth, Jennifer

2016-03-01

Endobronchial ultrasound (EBUS) is now recommended as a standard procedure for in vivo verification of extraluminal diagnostic sites during cancer-staging bronchoscopy. Yet, physicians vary considerably in their skills at using EBUS effectively. Regarding existing bronchoscopy guidance systems, studies have shown their effectiveness in the lung-cancer management process. With such a system, a patient's X-ray computed tomography (CT) scan is used to plan a procedure to regions of interest (ROIs). This plan is then used during follow-on guided bronchoscopy. Recent clinical guidelines for lung cancer, however, also dictate using positron emission tomography (PET) imaging for identifying suspicious ROIs and aiding in the cancer-staging process. While researchers have attempted to use guided bronchoscopy systems in tandem with PET imaging and EBUS, no true EBUS-centric guidance system exists. We now propose a full multimodal image-based methodology for guiding EBUS. The complete methodology involves two components: 1) a procedure planning protocol that gives bronchoscope movements appropriate for live EBUS positioning; and 2) a guidance strategy and associated system graphical user interface (GUI) designed for image-guided EBUS. We present results demonstrating the operation of the system.

78 FR 57916 - Self-Regulatory Organizations; Financial Industry Regulatory Authority, Inc.; Order Approving...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-20

... Relating to Amendments to the Discovery Guide Used in Customer Arbitration Proceedings, as Modified by... update the Discovery Guide (``Guide'') used in customer arbitration proceedings.\\1\\ According to FINRA, the Guide supplements the discovery rules contained in the FINRA Code of Arbitration Procedure for...

A Guide for Developing Standard Operating Job Procedures for the Primary Sedimentation Process Wastewater Treatment Facility. SOJP No. 4.

ERIC Educational Resources Information Center

Charles County Community Coll., La Plata, MD.

This guide describes standard operating job procedures for the primary sedimentation process of wastewater treatment plants. The primary sedimentation process involves removing settleable and suspended solids, in part, from wastewater by gravitational forces, and scum and other floatable solids from wastewater by mechanical means. Step-by-step…

Parent's Guide to Special Education in Washington State, 1985-86 [and] Guia para Padres: Para Educacion Especial en el Estado de Washington.

ERIC Educational Resources Information Center

Washington Office of the State Superintendent of Public Instruction, Olympia.

This pamphlet guides parents of children with disabilities through the procedures for acquiring special education services in the state of Washington. Following an overview of special education, the pamphlet presents information on notice and consent procedures, confidentiality of records, individualized education programs (IEP), the placement…

Alzheimer disease in a mouse model: MR imaging-guided focused ultrasound targeted to the hippocampus opens the blood-brain barrier and improves pathologic abnormalities and behavior.

PubMed

Burgess, Alison; Dubey, Sonam; Yeung, Sharon; Hough, Olivia; Eterman, Naomi; Aubert, Isabelle; Hynynen, Kullervo

2014-12-01

To validate whether repeated magnetic resonance (MR) imaging-guided focused ultrasound treatments targeted to the hippocampus, a brain structure relevant for Alzheimer disease ( AD Alzheimer disease ), could modulate pathologic abnormalities, plasticity, and behavior in a mouse model. All animal procedures were approved by the Animal Care Committee and are in accordance with the Canadian Council on Animal Care. Seven-month-old transgenic (TgCRND8) (Tg) mice and their nontransgenic (non-Tg) littermates were entered in the study. Mice were treated weekly with MR imaging-guided focused ultrasound in the bilateral hippocampus (1.68 MHz, 10-msec bursts, 1-Hz burst repetition frequency, 120-second total duration). After 1 month, spatial memory was tested in the Y maze with the novel arm prior to sacrifice and immunohistochemical analysis. The data were compared by using unpaired t tests and analysis of variance with Tukey post hoc analysis. Untreated Tg mice spent 61% less time than untreated non-Tg mice exploring the novel arm of the Y maze because of spatial memory impairments (P < .05). Following MR imaging-guided focused ultrasound, Tg mice spent 99% more time exploring the novel arm, performing as well as their non-Tg littermates. Changes in behavior were correlated with a reduction of the number and size of amyloid plaques in the MR imaging-guided focused ultrasound-treated animals (P < .01). Further, after MR imaging-guided focused ultrasound treatment, there was a 250% increase in the number of newborn neurons in the hippocampus (P < .01). The newborn neurons had longer dendrites and more arborization after MR imaging-guided focused ultrasound, as well (P < .01). Repeated MR imaging-guided focused ultrasound treatments led to spatial memory improvement in a Tg mouse model of AD Alzheimer disease . The behavior changes may be mediated by decreased amyloid pathologic abnormalities and increased neuronal plasticity. © RSNA, 2014.

Comparison between splines and fractional polynomials for multivariable model building with continuous covariates: a simulation study with continuous response.

PubMed

Binder, Harald; Sauerbrei, Willi; Royston, Patrick

2013-06-15

In observational studies, many continuous or categorical covariates may be related to an outcome. Various spline-based procedures or the multivariable fractional polynomial (MFP) procedure can be used to identify important variables and functional forms for continuous covariates. This is the main aim of an explanatory model, as opposed to a model only for prediction. The type of analysis often guides the complexity of the final model. Spline-based procedures and MFP have tuning parameters for choosing the required complexity. To compare model selection approaches, we perform a simulation study in the linear regression context based on a data structure intended to reflect realistic biomedical data. We vary the sample size, variance explained and complexity parameters for model selection. We consider 15 variables. A sample size of 200 (1000) and R(2)  = 0.2 (0.8) is the scenario with the smallest (largest) amount of information. For assessing performance, we consider prediction error, correct and incorrect inclusion of covariates, qualitative measures for judging selected functional forms and further novel criteria. From limited information, a suitable explanatory model cannot be obtained. Prediction performance from all types of models is similar. With a medium amount of information, MFP performs better than splines on several criteria. MFP better recovers simpler functions, whereas splines better recover more complex functions. For a large amount of information and no local structure, MFP and the spline procedures often select similar explanatory models. Copyright © 2012 John Wiley & Sons, Ltd.

Rapid prototyping in orthopaedic surgery: a user's guide.

PubMed

Frame, Mark; Huntley, James S

2012-01-01

Rapid prototyping (RP) is applicable to orthopaedic problems involving three dimensions, particularly fractures, deformities, and reconstruction. In the past, RP has been hampered by cost and difficulties accessing the appropriate expertise. Here we outline the history of rapid prototyping and furthermore a process using open-source software to produce a high fidelity physical model from CT data. This greatly mitigates the expense associated with the technique, allowing surgeons to produce precise models for preoperative planning and procedure rehearsal. We describe the method with an illustrative case.

IDSE Version 1 User's Manual

NASA Technical Reports Server (NTRS)

Mayer, Richard

1988-01-01

The integrated development support environment (IDSE) is a suite of integrated software tools that provide intelligent support for information modelling. These tools assist in function, information, and process modeling. Additional tools exist to assist in gathering and analyzing information to be modeled. This is a user's guide to application of the IDSE. Sections covering the requirements and design of each of the tools are presented. There are currently three integrated computer aided manufacturing definition (IDEF) modeling methodologies: IDEF0, IDEF1, and IDEF2. Also, four appendices exist to describe hardware and software requirements, installation procedures, and basic hardware usage.

A thermal vacuum test optimization procedure

NASA Technical Reports Server (NTRS)

Kruger, R.; Norris, H. P.

1979-01-01

An analytical model was developed that can be used to establish certain parameters of a thermal vacuum environmental test program based on an optimization of program costs. This model is in the form of a computer program that interacts with a user insofar as the input of certain parameters. The program provides the user a list of pertinent information regarding an optimized test program and graphs of some of the parameters. The model is a first attempt in this area and includes numerous simplifications. The model appears useful as a general guide and provides a way for extrapolating past performance to future missions.

Guidelines for spaceborne microwave remote sensors

NASA Technical Reports Server (NTRS)

Litman, V.; Nicholas, J.

1982-01-01

A handbook was developed to provide information and support to the spaceborne remote sensing and frequency management communities: to guide sensor developers in the choice of frequencies; to advise regulators on sensor technology needs and sharing potential; to present sharing analysis models and, through example, methods for determining sensor sharing feasibility; to introduce developers to the regulatory process; to create awareness of proper assignment procedures; to present sensor allocations; and to provide guidelines on the use and limitations of allocated bands. Controlling physical factors and user requirements and the regulatory environment are discussed. Sensor frequency allocation achievable performance and usefulness are reviewed. Procedures for national and international registration, the use of non-allocated bands and steps for obtaining new frequency allocations, and procedures for reporting interference are also discussed.

Terrain Analysis Procedural Guide for Railroads (Report Number 10 in the ETL Series on Guides for Army Terrain Analysis).

DTIC Science & Technology

1982-12-01

study was conducted under DA Project 4A762707A855, Task C, Work 6 Unit 21, "Military Geographic Analysis Technology." This study was done under the...supplement to the Terrain Analysis Procedural Guide for Roads and Related Structures (ETL-0205, October 1979). In sparsely inhabited study areas, railroad data... study area. " W, In general, three major sources of information are available that will = be helpful in the production of factor overlays for railroads

Users guide: Steady-state aerodynamic-loads program for shuttle TPS tiles

NASA Technical Reports Server (NTRS)

Kerr, P. A.; Petley, D. H.

1984-01-01

A user's guide for the computer program that calculates the steady-state aerodynamic loads on the Shuttle thermal-protection tiles is presented. The main element in the program is the MITAS-II, Martin Marietta Interactive Thermal Analysis System. The MITAS-II is used to calculate the mass flow in a nine-tile model designed to simulate conditions duing a Shuttle flight. The procedures used to execute the program using the MITAS-II software are described. A list of the necessry software and data files along with a brief description of their functions is given. The format of the data file containing the surface pressure data is specified. The interpolation techniques used to calculate the pressure profile over the tile matrix are briefly described. In addition, the output from a sample run is explained. The actual output and the procedure file used to execute the program at NASA Langley Research Center on a CDC CYBER-175 are provided in the appendices.

Guide Catheter Extension Device Is Effective in Renal Angioplasty for Severely Calcified Lesions

PubMed Central

Sugimoto, Takeshi; Nomura, Tetsuya; Hori, Yusuke; Yoshioka, Kenichi; Kubota, Hiroshi; Miyawaki, Daisuke; Urata, Ryota; Kikai, Masakazu; Keira, Natsuya; Tatsumi, Tetsuya

2017-01-01

Patient: Male, 69 Final Diagnosis: Atherosclerotic renal artery stenosis Symptoms: None Medication: — Clinical Procedure: — Specialty: Radiology Objective: Unusual setting of medical care Background: The GuideLiner catheter extension device is a monorail-type “Child” support catheter that facilitates coaxial alignment with the guide catheter and provides an appropriate back-up force. This device has been developed in the field of coronary intervention, and now is becoming widely applied in the field of endovascular treatment. However, there has been no report on the effectiveness of the guide catheter extension device in percutaneous transluminal renal angioplasty (PTRA). Case Report: We encountered a case of atherosclerotic subtotal occlusion at the ostium of the left renal artery. Due to the severely calcified orifice and weaker back-up force provided by a JR4 guide catheter, we could not pass any guide-wires through the target lesion. Therefore, we introduced a guide catheter extension device, the GuideLiner catheter, through the guide catheter and achieved good guidewire maneuverability. We finally deployed 2 balloon-expandable stents and successfully performed all PTRA procedures. Conclusions: The guide catheter extension device can be effective in PTRA for severely calcified subtotal occlusion. PMID:28533503

Adjunctive intracardiac echocardiography imaging from the left ventricle to guide percutaneous mitral valve repair with the MitraClip in patients with failed prior surgical rings.

PubMed

Saji, Mike; Rossi, Ann M; Ailawadi, Gorav; Dent, John; Ragosta, Michael; Lim, D Scott

2016-02-01

We evaluated intracardiac echocardiography (ICE) for adjunctively guiding the MitraClip procedure in patients with prior surgical rings. Transesophageal echocardiography (TEE) is the standard imaging modality used to guide the MitraClip procedure (Abbott Vascular, CA). However, in patients with post-surgical anatomy, clear imaging of the mitral valve leaflets may be complex because of shadowing from the surgical ring. In these patients, TEE may be suboptimal for guiding the procedure, even using three-dimensional imaging. This retrospective analysis included data from 121 consecutive patients with mitral regurgitation who underwent MitraClip procedures at the University of Virginia. ICE was used adjunctively when there was difficulty with TEE, particularly for assessing the insertion of the posterior leaflet into the MitraClip's arms. The ICE catheter was introduced transarterially into the left ventricle and flexed to obtain the short-axis view. Six patients had prior surgical rings, and in five, we used adjunctive ICE. The etiology of the mitral regurgitation was prolapse of the posterior leaflet in one patient and restriction of the posterior leaflet due to ischemic tethering in the remainder. All images were obtained from the left ventricle, and were adequate for assessing posterior leaflet insertion and the perpendicularity of the MitraClip arms. The procedural success rate was 80%. There was no adverse event related to the ICE procedure. Mitral valve repair with the MitraClip system assisted by ICE is feasible in patients with prior surgical rings, achieving an excellent risk profile and satisfactory procedural success. © 2015 Wiley Periodicals, Inc.

Ultrasound-guided Interventions for Core and Hip Injuries in Athletes.

PubMed

McCarthy, Eoghan; Hegazi, Tarek M; Zoga, Adam C; Morrison, William B; Meyers, William C; Poor, Alex E; Nevalainen, Mika T; Roedl, Johannes B

2016-09-01

Trauma and the mechanical strain of high-energy activity predispose athletes to pelvic injuries. Magnetic resonance imaging remains the primary modality for diagnosing these conditions, but ultrasonography-guided interventions are important in the management of core muscle, hip, and other pelvic conditions. This article reviews ultrasonography-guided interventions for injuries at the core, including the pelvis and hips. It reviews common injuries, procedure optimization, medication preparation, clinical evidence behind injections, tenotomy, and platelet-rich plasma. These interventions are especially important in athletes, because ultrasonography-guided procedures are often undertaken early in the treatment process, paralleling conservative rehabilitation to facilitate a faster return to play. Copyright © 2016 Elsevier Inc. All rights reserved.

Usefulness and Safety of a Guide Catheter Extension System for the Percutaneous Treatment of Complex Coronary Lesions by a Transradial Approach

PubMed Central

García-Blas, Sergio; Núñez, Julio; Mainar, Luis; Miñana, Gema; Bonanad, Clara; Racugno, Paolo; Rodríguez, Juan Carlos; Moyano, Patricia; Sanchis, Juan

2015-01-01

Objective The aim of this study was to describe our initial experience with the GuideLiner® catheter (Vascular Solutions Inc.) in the transradial treatment of complex lesions. Materials and Methods The clinical, angiographic and procedural data of percutaneous coronary interventions where GuideLiner was used during 2013 were collected. The transradial approach was used in all cases. The indication for its use, efficacy and periprocedural complications were determined. Sixteen consecutive procedures (in 15 patients; 12 males and 3 females) were evaluated. The indication for the use of GuideLiner was a difficulty to advance and properly position a stent through a tortuous and/or calcified artery despite using high-support guide catheters or other useful techniques. Results Of the 16 angiographic procedures, 14 (87.5s%) were successful (stent deployment in 13 cases and a drug-eluting balloon in 1 case). Unsuccessful cases were a chronic total occlusion and a diffusely diseased left anterior descendant artery. A type B dissection of a proximal left circumflex artery was the only periprocedural complication. Conclusion Use of the GuideLiner was an effective and safe technique for the percutaneous treatment of complex coronary lesions in which the adequate progress of angioplasty devices had failed. GuideLiner was particularly helpful when using the transradial approach. Only one minor complication was recorded. PMID:25531292

Usefulness and safety of a guide catheter extension system for the percutaneous treatment of complex coronary lesions by a transradial approach.

PubMed

García-Blas, Sergio; Núñez, Julio; Mainar, Luis; Miñana, Gema; Bonanad, Clara; Racugno, Paolo; Rodríguez, Juan Carlos; Moyano, Patricia; Sanchis, Juan

2015-01-01

The aim of this study was to describe our initial experience with the GuideLiner® catheter (Vascular Solutions Inc.) in the transradial treatment of complex lesions. The clinical, angiographic and procedural data of percutaneous coronary interventions where GuideLiner was used during 2013 were collected. The transradial approach was used in all cases. The indication for its use, efficacy and periprocedural complications were determined. Sixteen consecutive procedures (in 15 patients; 12 males and 3 females) were evaluated. The indication for the use of GuideLiner was a difficulty to advance and properly position a stent through a tortuous and/or calcified artery despite using high-support guide catheters or other useful techniques. Of the 16 angiographic procedures, 14 (87.5%) were successful (stent deployment in 13 cases and a drug-eluting balloon in 1 case). Unsuccessful cases were a chronic total occlusion and a diffusely diseased left anterior descendant artery. A type B dissection of a proximal left circumflex artery was the only periprocedural complication. Use of the GuideLiner was an effective and safe technique for the percutaneous treatment of complex coronary lesions in which the adequate progress of angioplasty devices had failed. GuideLiner was particularly helpful when using the transradial approach. Only one minor complication was recorded. © 2014 S. Karger AG, Basel.

Wide-bore 1.5 T MRI-guided deep brain stimulation surgery: initial experience and technique comparison.

PubMed

Sillay, Karl A; Rusy, Deborah; Buyan-Dent, Laura; Ninman, Nancy L; Vigen, Karl K

2014-12-01

We report results of the initial experience with magnetic resonance image (MRI)-guided implantation of subthalamic nucleus (STN) deep brain stimulating (DBS) electrodes at the University of Wisconsin after having employed frame-based stereotaxy with previously available MR imaging techniques and microelectrode recording for STN DBS surgeries. Ten patients underwent MRI-guided DBS implantation of 20 electrodes between April 2011 and March 2013. The procedure was performed in a purpose-built intraoperative MRI suite configured specifically to allow MRI-guided DBS, using a wide-bore (70 cm) MRI system. Trajectory guidance was accomplished with commercially available system consisting of an MR-visible skull-mounted aiming device and a software guidance system processing intraoperatively acquired iterative MRI scans. A total of 10 patients (5 male, 5 female)-representative of the Parkinson Disease (PD) population-were operated on with standard technique and underwent 20 electrode placements under MRI-guided bilateral STN-targeted DBS placement. All patients completed the procedure with electrodes successfully placed in the STN. Procedure time improved with experience. Our initial experience confirms the safety of MRI-guided DBS, setting the stage for future investigations combining physiology and MRI guidance. Further follow-up is required to compare the efficacy of the MRI-guided surgery cohort to that of traditional frame-based stereotaxy. Copyright © 2014 Elsevier B.V. All rights reserved.

Virtual Simulation in Enhancing Procedural Training for Fluoroscopy-guided Lumbar Puncture: A Pilot Study.

PubMed

Ali, Saad; Qandeel, Monther; Ramakrishna, Rishi; Yang, Carina W

2018-02-01

Fluoroscopy-guided lumbar puncture (FGLP) is a basic procedural component of radiology residency and neuroradiology fellowship training. Performance of the procedure with limited experience is associated with increased patient discomfort as well as increased radiation dose, puncture attempts, and complication rate. Simulation in health care is a developing field that has potential for enhancing procedural training. We demonstrate the design and utility of a virtual reality simulator for performing FGLP. An FGLP module was developed on an ImmersiveTouch platform, which digitally reproduces the procedural environment with a hologram-like projection. From computed tomography datasets of healthy adult spines, we constructed a 3-D model of the lumbar spine and overlying soft tissues. We assigned different physical characteristics to each tissue type, which the user can experience through haptic feedback while advancing a virtual spinal needle. Virtual fluoroscopy as well as 3-D images can be obtained for procedural planning and guidance. The number of puncture attempts, the distance to the target, the number of fluoroscopic shots, and the approximate radiation dose can be calculated. Preliminary data from users who participated in the simulation were obtained in a postsimulation survey. All users found the simulation to be a realistic replication of the anatomy and procedure and would recommend to a colleague. On a scale of 1-5 (lowest to highest) rating the virtual simulator training overall, the mean score was 4.3 (range 3-5). We describe the design of a virtual reality simulator for performing FGLP and present the initial experience with this new technique. Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Patient-specific atrium models for training and pre-procedure surgical planning

NASA Astrophysics Data System (ADS)

Laing, Justin; Moore, John; Bainbridge, Daniel; Drangova, Maria; Peters, Terry

2017-03-01

Minimally invasive cardiac procedures requiring a trans-septal puncture such as atrial ablation and MitraClip® mitral valve repair are becoming increasingly common. These procedures are performed on the beating heart, and require clinicians to rely on image-guided techniques. For cases of complex or diseased anatomy, in which fluoroscopic and echocardiography images can be difficult to interpret, clinicians may benefit from patient-specific atrial models that can be used for training, surgical planning, and the validation of new devices and guidance techniques. Computed tomography (CT) images of a patient's heart were segmented and used to generate geometric models to create a patient-specific atrial phantom. Using rapid prototyping, the geometric models were converted into physical representations and used to build a mold. The atria were then molded using tissue-mimicking materials and imaged using CT. The resulting images were segmented and used to generate a point cloud data set that could be registered to the original patient data. The absolute distance of the two point clouds was compared and evaluated to determine the model's accuracy. The result when comparing the molded model point cloud to the original data set, resulted in a maximum Euclidean distance error of 4.5 mm, an average error of 0.5 mm and a standard deviation of 0.6 mm. Using our workflow for creating atrial models, potential complications, particularly for complex repairs, may be accounted for in pre-operative planning. The information gained by clinicians involved in planning and performing the procedure should lead to shorter procedural times and better outcomes for patients.

On a basic model of circulatory, fluid, and electrolyte regulation in the human system based upon the model of Guyton

NASA Technical Reports Server (NTRS)

White, R. J.

1973-01-01

A detailed description of Guyton's model and modifications are provided. Also included are descriptions of several typical experiments which the model can simulate to illustrate the model's general utility. A discussion of the problems associated with the interfacing of the model to other models such as respiratory and thermal regulation models which is prime importance since these stimuli are not present in the current model is also included. A user's guide for the operation of the model on the Xerox Sigma 3 computer is provided and two programs are described. A verification plan and procedure for performing experiments is also presented.

Ultrasound-guided synovial biopsy

PubMed Central

Sitt, Jacqueline C M; Wong, Priscilla

2016-01-01

Ultrasound-guided needle biopsy of synovium is an increasingly performed procedure with a high diagnostic yield. In this review, we discuss the normal synovium, as well as the indications, technique, tissue handling and clinical applications of ultrasound-guided synovial biopsy. PMID:26581578

Logistic regression model can reduce unnecessary artificial liver support in hepatitis B virus-associated acute-on-chronic liver failure: decision curve analysis.

PubMed

Qin, Gang; Bian, Zhao-Lian; Shen, Yi; Zhang, Lei; Zhu, Xiao-Hong; Liu, Yan-Mei; Shao, Jian-Guo

2016-06-04

Several models have been proposed to predict the short-term outcome of acute-on-chronic liver failure (ACLF) after treatment. We aimed to determine whether better decisions for artificial liver support system (ALSS) treatment could be made with a model than without, through decision curve analysis (DCA). The medical profiles of a cohort of 232 patients with hepatitis B virus (HBV)-associated ACLF were retrospectively analyzed to explore the role of plasma prothrombin activity (PTA), model for end-stage liver disease (MELD) and logistic regression model (LRM) in identifying patients who could benefit from ALSS. The accuracy and reliability of PTA, MELD and LRM were evaluated with previously reported cutoffs. DCA was performed to evaluate the clinical role of these models in predicting the treatment outcome. With the cut-off value of 0.2, LRM had sensitivity of 92.6 %, specificity of 42.3 % and an area under the receiving operating characteristic curve (AUC) of 0.68, which showed superior discrimination over PTA and MELD. DCA revealed that the LRM-guided ALSS treatment was superior over other strategies including "treating all" and MELD-guided therapy, for the midrange threshold probabilities of 16 to 64 %. The use of LRM-guided ALSS treatment could increase both the accuracy and efficiency of this procedure, allowing the avoidance of unnecessary ALSS.

An integrated orthognathic surgery system for virtual planning and image-guided transfer without intermediate splint.

PubMed

Kim, Dae-Seung; Woo, Sang-Yoon; Yang, Hoon Joo; Huh, Kyung-Hoe; Lee, Sam-Sun; Heo, Min-Suk; Choi, Soon-Chul; Hwang, Soon Jung; Yi, Won-Jin

2014-12-01

Accurate surgical planning and transfer of the planning in orthognathic surgery are very important in achieving a successful surgical outcome with appropriate improvement. Conventionally, the paper surgery is performed based on a 2D cephalometric radiograph, and the results are expressed using cast models and an articulator. We developed an integrated orthognathic surgery system with 3D virtual planning and image-guided transfer. The maxillary surgery of orthognathic patients was planned virtually, and the planning results were transferred to the cast model by image guidance. During virtual planning, the displacement of the reference points was confirmed by the displacement from conventional paper surgery at each procedure. The results of virtual surgery were transferred to the physical cast models directly through image guidance. The root mean square (RMS) difference between virtual surgery and conventional model surgery was 0.75 ± 0.51 mm for 12 patients. The RMS difference between virtual surgery and image-guidance results was 0.78 ± 0.52 mm, which showed no significant difference from the difference of conventional model surgery. The image-guided orthognathic surgery system integrated with virtual planning will replace physical model surgical planning and enable transfer of the virtual planning directly without the need for an intermediate splint. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Use of Low-Fidelity Simulation Laboratory Training for Teaching Radiology Residents CT-Guided Procedures.

PubMed

Picard, Melissa; Nelson, Rachel; Roebel, John; Collins, Heather; Anderson, M Bret

2016-11-01

To determine the benefit of the addition of low-fidelity simulation-based training to the standard didactic-based training in teaching radiology residents common CT-guided procedures. This was a prospective study involving 24 radiology residents across all years in a university program. All residents underwent standard didactic lecture followed by low-fidelity simulation-based training on three common CT-guided procedures: random liver biopsy, lung nodule biopsy, and drain placement. Baseline knowledge, confidence, and performance assessments were obtained after the didactic session and before the simulation training session. Approximately 2 months later, all residents participated in a simulation-based training session covering all three of these procedures. Knowledge, confidence, and performance data were obtained afterward. These assessments covered topics related to preprocedure workup, intraprocedure steps, and postprocedure management. Knowledge data were collected based on a 15-question assessment. Confidence data were obtained based on a 5-point Likert-like scale. Performance data were obtained based on successful completion of predefined critical steps. There was significant improvement in knowledge (P = .005), confidence (P < .008), and tested performance (P < .043) after the addition of simulation-based training to the standard didactic curriculum for all procedures. This study suggests that the addition of low-fidelity simulation-based training to a standard didactic-based curriculum is beneficial in improving resident knowledge, confidence, and tested performance of common CT-guided procedures. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Critical Viewing: Stimulant to Critical Thinking. Teacher's Guide.

ERIC Educational Resources Information Center

O'Reilly, Kevin; Splaine, John

The purpose of this guide is to implement the teaching of "Critical Viewing: Stimulant to Critical Thinking," a guide for students. Part one of the guide is an overview of the organization, methodologies, and evaluation procedures used in "Critical Viewing." Suggestions and activities for teaching the six chapters in "Critical Viewing" are given…

The Live Oak Curriculum: A Guide to Preschool Planning in the Heterogeneous Classroom.

ERIC Educational Resources Information Center

Meyers, Celeste, Ed.

Presented is a curriculum guide for preschool programs serving both handicapped and nonhandicapped children. It is explained that the guide is intended to suggest classroom activities which will strengthen existing skills and encourage development of new skills. The guide presents information on objectives, materials and procedures for the…

Interventional articular and para-articular knee procedures

PubMed Central

Lalam, Radhesh K; Winn, Naomi

2016-01-01

The knee is a common area of the body to undergo interventional procedures. This article discusses image-guided interventional issues specific to the knee area. The soft tissues in and around the knee are frequently affected by sport-related injuries and often need image-guided intervention. This article details the specific technical issues related to intervention in these soft tissues, including the iliotibial tract, fat pads, patellar tendon and other tendons, bursae and the meniscus. Most often, simple procedures such as injection and aspiration are performed without image guidance. Rarely image-guided diagnostic arthrography and therapeutic joint injections are necessary. The technique, indications and diagnostic considerations for arthrography are discussed in this article. Primary bone and soft-tissue tumours may involve the knee and adjacent soft tissues. Image-guided biopsies are frequently necessary for these lesions; this article details the technical issues related to image-guided biopsy around the knee. A number of newer ablation treatments are now available, including cryoablation, high-frequency ultrasound and microwave ablation. Radiofrequency ablation, however, still remains the most commonly employed ablation technique. The indications, technical and therapeutic considerations related to the application of this technique around the knee are discussed here. Finally, we briefly discuss some newer, but as of yet, unproven image-guided interventions for osteochondral lesions and Brodie's abscess. PMID:26682669

A Guide for Developing Standard Operating Job Procedures for the Activated Sludge - Aeration & Sedimentation Process Wastewater Treatment Facility. SOJP No. 5.

ERIC Educational Resources Information Center

Mason, George J.

This guide for developing standard operating job procedures for wastewater treatment facilities is devoted to the activated sludge aeration and sedimentation process. This process is for conversion of nonsettleable and nonfloatable materials in wastewater to settleable, floculated biological groups and separation of the settleable solids from the…

Selecting Students for Training in Health Care. A Practical Guide to Improving Selection Procedures. WHO Offset Publication No. 74.

ERIC Educational Resources Information Center

Bennett, Mick; Wakeford, Richard

This guide is intended to help those responsible for choosing health care trainees to develop and improve their selection procedures. Special reference is given to health workers in maternal and child health. Chapter 1 deals with health care policy implications for selection of trainees, the different functions of selection and conflicts that…

One-step endosonography-guided drainage of a pancreatic pseudocyst: a new technique of stent delivery through the echo endoscope.

PubMed

Vilmann, P; Hancke, S; Pless, T; Schell-Hincke, J D; Henriksen, F W

1998-10-01

We report here the first case of a one-step endosonography(EUS)-guided pseudocyst drainage. A prototype large channel curved array echo endoscope (Pentax FG-38 UX) and a prototype delivery system for placement of an endoprosthesis was used for the procedure. The delivery system (GIP MedicinTechnik GmbH/Medi-Globe Corporation) consists of a handle part with a piston, a metal ring sheath, a plastic catheter with a diathermy needle and a double pigtail endoprosthesis (8.5 Fr). When mounted on the endoscope the endoprosthesis can be advanced out of the distal end of the endoscope. The introduction of the stent as well as the stent release can be monitored entirely by ultrasound. The procedure was tested in a 76-year-old woman with a pseudocyst measuring 60 mm in diameter located in the tail of the pancreas. The procedure was well tolerated by the patient, and there were no procedural complications. The advantage of a large channel echo endoscope and our new prototype delivery system is that the endoprosthesis can be inserted in to a pancreatic cyst guided exclusively by EUS without exchange of endoscopes, catheters or guide wires. Further studies are warranted.

Concepts and Preliminary Data Toward the Realization of Image-guided Liver Surgery

PubMed Central

Cash, David M.; Miga, Michael I.; Glasgow, Sean C.; Dawant, Benoit M.; Clements, Logan W.; Cao, Zhujiang; Galloway, Robert L.; Chapman, William C.

2013-01-01

Image-guided surgery provides navigational assistance to the surgeon by displaying the surgical probe position on a set of preoperative tomograms in real time. In this study, the feasibility of implementing image-guided surgery concepts into liver surgery was examined during eight hepatic resection procedures. Preoperative tomographic image data were acquired and processed. Accompanying intraoperative data on liver shape and position were obtained through optically tracked probes and laser range scanning technology. The preoperative and intraoperative representations of the liver surface were aligned using the iterative closest point surface matching algorithm. Surface registrations resulted in mean residual errors from 2 to 6 mm, with errors of target surface regions being below a stated goal of 1 cm. Issues affecting registration accuracy include liver motion due to respiration, the quality of the intraoperative surface data, and intraoperative organ deformation. Respiratory motion was quantified during the procedures as cyclical, primarily along the cranial–caudal direction. The resulting registrations were more robust and accurate when using laser range scanning to rapidly acquire thousands of points on the liver surface and when capturing unique geometric regions on the liver surface, such as the inferior edge. Finally, finite element models recovered much of the observed intraoperative deformation, further decreasing errors in the registration. Image-guided liver surgery has shown the potential to provide surgeons with important navigation aids that could increase the accuracy of targeting lesions and the number of patients eligible for surgical resection. PMID:17458587

Dengue and Chikungunya Vector Control Pocket Guide

USDA-ARS?s Scientific Manuscript database

This technical guide consolidates information and procedures for surveillance and control of mosquitoes that transmit dengue and chikungunya viruses. The guide focuses on mosquitoes that transmit dengue but also makes reference to chikungunya and yellow fever because the pathogens that cause these ...

Teachers' Guide for Aviation Education for Use in Grades Two through Six.

ERIC Educational Resources Information Center

Aviation/Space, 1979

1979-01-01

This teacher's guide provides supplementary activities in aviation designed for students in grades 2-6. The activities stress communication arts, science, and social studies. The guide contains performance objectives, instructional procedures, student activities, and outcomes. (MA)

Factors influencing discomfort during anterior ultrasound-guided injection for hip arthrography.

PubMed

Hsu, Yi-Chih; Wu, Yu-Cheng; Kao, Hao-Lun; Pan, Ru-Yu; Lee, Meei-Shyuan; Huang, Guo-Shu

2013-09-01

Although ultrasound (US)-guided injection techniques for magnetic resonance arthrography of the hip have been used with increasing frequency to diagnose internal joint derangements, little is known about patient tolerance, which is relevant information for patients. The objective of this study was to evaluate prospectively the association between possible influencing factors and discomfort felt during the performance of anterior US-guided injection techniques targeting the femoral head-neck junction during hip arthrography. Forty-four consecutive patients (21 women and 23 men; mean age, 41 years) undergoing magnetic resonance hip arthrography were sequentially assigned to receive injection alternating between fixed and freehand US-guided injection. Discomfort was assessed using a visual analog scale and relative ratings. Patient body mass index, extra-articular contrast leakage, the duration of the procedure, the needle advancement distance, and the fixed trajectory of the needle were assessed. Pearson's correlation coefficients and multiple logistic regression analysis were used to determine the association. Puncture was successfully accomplished in all cases, and no relevant complications were reported. The only significant relationships were between discomfort and the time required for needle manipulation (r = 0.8) and fixed US-guided injection (r = 0.6; p < 0.001). Compared with the freehand technique, the fixed technique resulted in significantly less pain and took significantly less time to perform (p < 0.001). The procedure time during needle manipulation in the fixed US-guided injections (4.0 ± 0.9 seconds) was significantly less than that in the freehand US-guided injections (19.4 ± 17.6 seconds; p < 0.001). No significant relationships were found between discomfort and other parameters (r < 0.3, p > 0.05). The procedure time appears to be the most important factor influencing patient discomfort. Fixed US-guided injection is a time-saving technique that alleviates procedure-related discomfort. Copyright © 2013. Published by Elsevier B.V.

Symbolic Insight and Inhibitory Control: Two Problems Facing Young Children on Symbolic Retrieval Tasks

ERIC Educational Resources Information Center

Kuhlmeier, Valerie

2005-01-01

Many recent studies have explored young children's ability to use information from physical representations of space to guide search within the real world. In one commonly used procedure, children are asked to find a hidden toy in a room after observing a smaller toy being hidden in the analogous location in a scale model of the room.…

Material Selection Guide Derived from Material - Chemical Compatibility Database: Feasibility Based on Database and Predictive Model Evaluation

DTIC Science & Technology

1992-09-01

PI) 297 S S S S 15 Polyamideimide (PAI) 297 S S S S 14 Polyamide 6:6 (PA 6:6) 297 S S S S 35 Perfluoroakloxyethylene ( PFA ) 297 S S S S 42 Phenol...Procedures for the Measurement of Vapor Sorption Followed by Desorption and Comparisons with Polymer Cohesion Parameter and Polymer Coil Expansion Values

A Systematic Review and Summarization of the Recommendations and Research Surrounding Curriculum-Based Measurement of Oral Reading Fluency (CBM-R) Decision Rules

ERIC Educational Resources Information Center

Ardoin, Scott P.; Christ, Theodore J.; Morena, Laura S.; Cormier, Damien C.; Klingbeil, David A.

2013-01-01

Research and policy have established that data are necessary to guide decisions within education. Many of these decisions are made within problem solving and response to intervention frameworks for service delivery. Curriculum-Based Measurement in Reading (CBM-R) is a widely used data collection procedure within those models of service delivery.…

Recommendations for fluorescence instrument qualification: the new ASTM Standard Guide.

PubMed

DeRose, Paul C; Resch-Genger, Ute

2010-03-01

Aimed at improving quality assurance and quantitation for modern fluorescence techniques, ASTM International (ASTM) is about to release a Standard Guide for Fluorescence, reviewed here. The guide's main focus is on steady state fluorometry, for which available standards and instrument characterization procedures are discussed along with their purpose, suitability, and general instructions for use. These include the most relevant instrument properties needing qualification, such as linearity and spectral responsivity of the detection system, spectral irradiance reaching the sample, wavelength accuracy, sensitivity or limit of detection for an analyte, and day-to-day performance verification. With proper consideration of method-inherent requirements and limitations, many of these procedures and standards can be adapted to other fluorescence techniques. In addition, procedures for the determination of other relevant fluorometric quantities including fluorescence quantum yields and fluorescence lifetimes are briefly introduced. The guide is a clear and concise reference geared for users of fluorescence instrumentation at all levels of experience and is intended to aid in the ongoing standardization of fluorescence measurements.

Performance of magnetic field‐guided navigation system for interventional neurosurgical and cardiac procedures

PubMed Central

Chu, James C.H.; Hsi, Wen Chien; Hubbard, Lincoln; Zhang, Yunkai; Bernard, Damian; Reeder, Pamela; Lopes, Demetrius

2005-01-01

A hospital‐based magnetic guidance system (MGS) was installed to assist a physician in navigating catheters and guide wires during interventional cardiac and neurosurgical procedures. The objective of this study is to examine the performance of this magnetic field‐guided navigation system. Our results show that the system's radiological imaging components produce images with quality similar to that produced by other modern fluoroscopic devices. The system's magnetic navigation components also deflect the wire and catheter tips toward the intended direction. The physician, however, will have to oversteer the wire or catheter when defining the steering angle during the procedure. The MGS could be clinically useful in device navigation deflection and vessel access. PACS numbers: 07.55.Db, 07.85.‐m PMID:16143799

A comparison of multiprocessor scheduling methods for iterative data flow architectures

NASA Technical Reports Server (NTRS)

Storch, Matthew

1993-01-01

A comparative study is made between the Algorithm to Architecture Mapping Model (ATAMM) and three other related multiprocessing models from the published literature. The primary focus of all four models is the non-preemptive scheduling of large-grain iterative data flow graphs as required in real-time systems, control applications, signal processing, and pipelined computations. Important characteristics of the models such as injection control, dynamic assignment, multiple node instantiations, static optimum unfolding, range-chart guided scheduling, and mathematical optimization are identified. The models from the literature are compared with the ATAMM for performance, scheduling methods, memory requirements, and complexity of scheduling and design procedures.

Ultrasound imaging-guided intracardiac injection to develop a mouse model of breast cancer brain metastases followed by longitudinal MRI.

PubMed

Zhou, Heling; Zhao, Dawen

2014-03-06

Breast cancer brain metastasis, occurring in 30% of breast cancer patients at stage IV, is associated with high mortality. The median survival is only 6 months. It is critical to have suitable animal models to mimic the hemodynamic spread of the metastatic cells in the clinical scenario. Here, we are introducing the use of small animal ultrasound imaging to guide an accurate injection of brain tropical breast cancer cells into the left ventricle of athymic nude mice. Longitudinal MRI is used to assessing intracranial initiation and growth of brain metastases. Ultrasound-guided intracardiac injection ensures not only an accurate injection and hereby a higher successful rate but also significantly decreased mortality rate, as compared to our previous manual procedure. In vivo high resolution MRI allows the visualization of hyperintense multifocal lesions, as small as 310 µm in diameter on T2-weighted images at 3 weeks post injection. Follow-up MRI reveals intracranial tumor growth and increased number of metastases that distribute throughout the whole brain.

Rotator Cuff Calcific Tendinopathy: Randomized Comparison of US-guided Percutaneous Treatments by Using One or Two Needles.

PubMed

Orlandi, Davide; Mauri, Giovanni; Lacelli, Francesca; Corazza, Angelo; Messina, Carmelo; Silvestri, Enzo; Serafini, Giovanni; Sconfienza, Luca Maria

2017-11-01

Purpose To determine whether the use of one or two needles influences procedure performance and patient outcomes for ultrasonography (US)-guided percutaneous irrigation of calcific tendinopathy. Materials and Methods Institutional review board approval and written informed patient consent were obtained. From February 2012 to December 2014, 211 patients (77 men and 134 women; mean age, 41.6 years ± 11.6; range, 24-69 years) with painful calcific tendinopathy diagnosed at US were prospectively enrolled and randomized. Operators subjectively graded calcifications as hard, soft, or fluid according to their appearance at US. US-guided percutaneous irrigation of calcific tendinopathy (local anesthesia, needle lavage, intrabursal steroid injection) was performed in 100 patients by using the single-needle procedure and in 111 patients by using the double-needle procedure. Calcium dissolution was subjectively scored (easy = 1; intermediate = 2; difficult = 3). Procedure duration was recorded. Clinical evaluation was performed by using the Constant score up to 1 year after the procedure. The occurrence of postprocedural bursitis was recorded. Mann-Whitney U, χ 2 , and analysis of variance statistics were used. Results No difference in procedure duration was seen overall (P = .060). Procedure duration was shorter with the double-needle procedure in hard calcifications (P < .001) and with the single-needle procedure in fluid calcifications (P = .024). Ease of calcium dissolution was not different between single- and double-needle procedures, both overall and when considering calcification appearance (P > .089). No clinical differences were found (Constant scores for single-needle group: baseline, 55 ± 7; 1 month, 69 ± 7; 3 month, 90 ± 5; 1 year, 92 ± 4; double-needle group: 57 ± 6; 71 ± 9; 89 ± 7; 92 ± 4, respectively; P = .241). In the single-needle group, nine of 100 cases (9%) of postprocedural bursitis were seen, whereas four of 111 cases (3.6%) were seen in the double-needle group (P = .180). Conclusion The only difference between using the single- or double-needle procedure when performing US-guided percutaneous irrigation of calcific tendinopathy is procedure duration in hard and fluid calcifications. Clinical outcomes are similar up to 1 year. © RSNA, 2017.

[Gastro-entero anastomosis with flexible endoscope with the help of rare-earth magnets on biosynthetic model made of the gastrointestinal tract of slaughtered pigs].

PubMed

Lukovich, Péter; Jónás, Attila; Bata, Pál; Tari, Krisztina; Váradi, Gábor; Kádár, Balázs; Mehdi, Sadat Akhavi; Kupcsulik, Péter

2007-04-01

Gastro-entero anastomosis with flexible endoscope with the help of rare-earth magnets on biosynthetic model made of the gastrointestinal tract of slaughtered pigs Numerous malignant diseases may cause gastric outlet obstruction. The surgical gastrointestinal bypass, besides the fact that it requires narcosis, is also associated with high risks for patients with poor general condition. Endoscopic insertion of self-expandable metal stent is less invasive, but often causes complications. In the last years some studies examined a new minimal invasive technique, in which magnets are used to create gastroenteric anastomosis. A biosynthetic model was developed from combined synthetic materials with biogenic specimens taken from slaughtered domestic pigs. The procedure was performed with endoscopic and fluoroscopic guidance. To increase X-ray contrast differences the model was put into physiological saline solution. Two rare-earth magnets (Br: 2500 Gauss, D: 10 mm) with central hole were inserted with the help of a guiding wire and duodenal probe. The first magnet was placed in the first jejunal loop; the second one was placed in the stomach. The gastric magnet was maneuvered using the endoscope. When the magnets reached the right position, the guiding wires were removed to let the magnets stick together. The pressure between the magnets will result in a sterile inflammation on the living tissue which develops adhesion between the bowels, and 7-10 days later anastomosis will develop as a result of the necrosis. The biosynthetic model could be used for training endoscopy without sacrificing animals. In the end of the procedure the magnets stuck together across gastric and jejunal walls in all ten cases successfully. By practice the period necessary for the procedure could be decreased from 40 to 20 minutes. The technique could be made with standard upper endoscope and instruments, and after practice on living animals it could potentially be a useful solution for complaints of gastric outlet obstruction.

An ultra-high field strength MR image-guided robotic needle delivery system for in-bore small animal interventions.

PubMed

Gravett, Matthew; Cepek, Jeremy; Fenster, Aaron

2017-11-01

The purpose of this study was to develop and validate an image-guided robotic needle delivery system for accurate and repeatable needle targeting procedures in mouse brains inside the 12 cm inner diameter gradient coil insert of a 9.4 T MR scanner. Many preclinical research techniques require the use of accurate needle deliveries to soft tissues, including brain tissue. Soft tissues are optimally visualized in MR images, which offer high-soft tissue contrast, as well as a range of unique imaging techniques, including functional, spectroscopy and thermal imaging, however, there are currently no solutions for delivering needles to small animal brains inside the bore of an ultra-high field MR scanner. This paper describes the mechatronic design, evaluation of MR compatibility, registration technique, mechanical calibration, the quantitative validation of the in-bore image-guided needle targeting accuracy and repeatability, and demonstrated the system's ability to deliver needles in situ. Our six degree-of-freedom, MR compatible, mechatronic system was designed to fit inside the bore of a 9.4 T MR scanner and is actuated using a combination of piezoelectric and hydraulic mechanisms. The MR compatibility and targeting accuracy of the needle delivery system are evaluated to ensure that the system is precisely calibrated to perform the needle targeting procedures. A semi-automated image registration is performed to link the robot coordinates to the MR coordinate system. Soft tissue targets can be accurately localized in MR images, followed by automatic alignment of the needle trajectory to the target. Intra-procedure visualization of the needle target location and the needle were confirmed through MR images after needle insertion. The effects of geometric distortions and signal noise were found to be below threshold that would have an impact on the accuracy of the system. The system was found to have negligible effect on the MR image signal noise and geometric distortion. The system was mechanically calibrated and the mean image-guided needle targeting and needle trajectory accuracies were quantified in an image-guided tissue mimicking phantom experiment to be 178 ± 54 μm and 0.27 ± 0.65°, respectively. An MR image-guided system for in-bore needle deliveries to soft tissue targets in small animal models has been developed. The results of the needle targeting accuracy experiments in phantoms indicate that this system has the potential to deliver needles to the smallest soft tissue structures relevant in preclinical studies, at a wide variety of needle trajectories. Future work in the form of a fully-automated needle driver with precise depth control would benefit this system in terms of its applicability to a wider range of animal models and organ targets. © 2017 American Association of Physicists in Medicine.

An operating guide for the control of residential cut-through traffic.

DOT National Transportation Integrated Search

1990-01-01

The objective of this operating guide was to provide direction in conducting studies in accordance with the Policy and Procedures for Control of Residential Cut-Through Traffic" of the Virginia Department of Transportation. The guide is in eight part...

Image fusion and navigation platforms for percutaneous image-guided interventions.

PubMed

Rajagopal, Manoj; Venkatesan, Aradhana M

2016-04-01

Image-guided interventional procedures, particularly image guided biopsy and ablation, serve an important role in the care of the oncology patient. The need for tumor genomic and proteomic profiling, early tumor response assessment and confirmation of early recurrence are common scenarios that may necessitate successful biopsies of targets, including those that are small, anatomically unfavorable or inconspicuous. As image-guided ablation is increasingly incorporated into interventional oncology practice, similar obstacles are posed for the ablation of technically challenging tumor targets. Navigation tools, including image fusion and device tracking, can enable abdominal interventionalists to more accurately target challenging biopsy and ablation targets. Image fusion technologies enable multimodality fusion and real-time co-displays of US, CT, MRI, and PET/CT data, with navigational technologies including electromagnetic tracking, robotic, cone beam CT, optical, and laser guidance of interventional devices. Image fusion and navigational platform technology is reviewed in this article, including the results of studies implementing their use for interventional procedures. Pre-clinical and clinical experiences to date suggest these technologies have the potential to reduce procedure risk, time, and radiation dose to both the patient and the operator, with a valuable role to play for complex image-guided interventions.

Cone-beam computed tomography fusion and navigation for real-time positron emission tomography-guided biopsies and ablations: a feasibility study.

PubMed

Abi-Jaoudeh, Nadine; Mielekamp, Peter; Noordhoek, Niels; Venkatesan, Aradhana M; Millo, Corina; Radaelli, Alessandro; Carelsen, Bart; Wood, Bradford J

2012-06-01

To describe a novel technique for multimodality positron emission tomography (PET) fusion-guided interventions that combines cone-beam computed tomography (CT) with PET/CT before the procedure. Subjects were selected among patients scheduled for a biopsy or ablation procedure. The lesions were not visible with conventional imaging methods or did not have uniform uptake on PET. Clinical success was defined by adequate histopathologic specimens for molecular profiling or diagnosis and by lack of enhancement on follow-up imaging for ablation procedures. Time to target (time elapsed between the completion of the initial cone-beam CT scan and first tissue sample or treatment), total procedure time (time from the moment the patient was on the table until the patient was off the table), and number of times the needle was repositioned were recorded. Seven patients underwent eight procedures (two ablations and six biopsies). Registration and procedures were completed successfully in all cases. Clinical success was achieved in all biopsy procedures and in one of the two ablation procedures. The needle was repositioned once in one biopsy procedure only. On average, the time to target was 38 minutes (range 13-54 min). Total procedure time was 95 minutes (range 51-240 min, which includes composite ablation). On average, fluoroscopy time was 2.5 minutes (range 1.3-6.2 min). An integrated cone-beam CT software platform can enable PET-guided biopsies and ablation procedures without the need for additional specialized hardware. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

Evaluation of accuracy in implant site preparation performed in single- or multi-step drilling procedures.

PubMed

Marheineke, Nadine; Scherer, Uta; Rücker, Martin; von See, Constantin; Rahlf, Björn; Gellrich, Nils-Claudius; Stoetzer, Marcus

2018-06-01

Dental implant failure and insufficient osseointegration are proven results of mechanical and thermal damage during the surgery process. We herein performed a comparative study of a less invasive single-step drilling preparation protocol and a conventional multiple drilling sequence. Accuracy of drilling holes was precisely analyzed and the influence of different levels of expertise of the handlers and additional use of drill template guidance was evaluated. Six experimental groups, deployed in an osseous study model, were representing template-guided and freehanded drilling actions in a stepwise drilling procedure in comparison to a single-drill protocol. Each experimental condition was studied by the drilling actions of respectively three persons without surgical knowledge as well as three highly experienced oral surgeons. Drilling actions were performed and diameters were recorded with a precision measuring instrument. Less experienced operators were able to significantly increase the drilling accuracy using a guiding template, especially when multi-step preparations are performed. Improved accuracy without template guidance was observed when experienced operators were executing single-step versus multi-step technique. Single-step drilling protocols have shown to produce more accurate results than multi-step procedures. The outcome of any protocol can be further improved by use of guiding templates. Operator experience can be a contributing factor. Single-step preparations are less invasive and are promoting osseointegration. Even highly experienced surgeons are achieving higher levels of accuracy by combining this technique with template guidance. Hereby template guidance enables a reduction of hands-on time and side effects during surgery and lead to a more predictable clinical diameter.

75 FR 63434 - Availability of Compliance Guide for the Use of Video or Other Electronic Monitoring or Recording...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-15

...] Availability of Compliance Guide for the Use of Video or Other Electronic Monitoring or Recording Equipment in... the availability of a compliance guide on the use of video or other electronic monitoring or recording... Procedures video records. FSIS is soliciting comments on this compliance guide. Once FSIS receives OMB...

Improved method for roadside barrier length of need modeling using real-world trajectories.

PubMed

Johnson, Nicholas S; Thomson, Robert; Gabler, Hampton C

2015-07-01

The 2011 AASHTO Roadside Design Guide (RDG) contains perhaps the most widely used procedure for choosing an appropriate length of need (LON) for roadside barriers. However, this procedure has several limitations. The procedure uses a highly simplified model of vehicle departure, and the procedure does not allow designers to specify an explicit level of protection. A new procedure for choosing LON that addresses these limitations is presented in this paper. This new procedure is based on recent, real-world road departure trajectories and uses this departure data in a more realistic way. The new procedure also allows LON to be specified for a precisely known level of protection - a level which can be based on number of crashes, injury outcomes or even estimated crash cost - while still remaining straightforward and quick to use like the 2011 RDG procedure. In this analysis, the improved procedure was used to explore the effects of the RDG procedure's assumptions. LON recommendations given by the 2011 RDG procedure were compared with recommendations given by this improved procedure. For 55 mph roads, the 2011 RDG procedure appears to lead to a LON sufficient to intercept between 80% and 90% of right-side departures that would otherwise strike a hazard located 10 m from the roadway. For hazards closer than 10 m, the 2011 RDG procedure intercepts progressively higher percentages of real-world departures. This suggests the protection level provided by the 2011 RDG procedure varies with the hazard offset, becoming more conservative as the hazard moves closer to the roadway. The improved procedure, by comparison, gives a consistent protection level regardless of hazard location. Copyright © 2015. Published by Elsevier Ltd.

A Guide for Montana School Libraries; A Manual of Basic Library Procedures for Montana Schools, Developed by Montana Teachers and Librarians.

ERIC Educational Resources Information Center

Montana State Dept. of Public Instruction, Helena.

Basic procedures for setting up a new school library or for maintaining an established one are described to help economize the librarian's efforts and assist in establishing effective organization. Use of this guide to streamline library routine will give librarians more time to assist school personnel and to develop a better total library…

Remote magnetic navigation for circumferential pulmonary vein ablation: single-catheter technique or additional use of a circular mapping catheter?

PubMed

Vollmann, Dirk; Lüthje, Lars; Seegers, Joachim; Sohns, Christian; Sossalla, Samuel; Sohns, Jan; Röver, Christian; Hasenfuß, Gerd; Zabel, Markus

2014-10-01

Remote magnetic navigation (RMN) is utilized for catheter guidance during pulmonary vein ablation (PVA). We aimed to determine whether the additional use of a circular mapping catheter (CMC) influences efficacy and outcome of RMN-guided PVA. A total of 80 consecutive subjects (65 % male, age 62 ± 9 years) underwent circumferential PVA with a 3D mapping system and an RMN-guided irrigated catheter. Procedural endpoint was complete PV isolation (PVI), total radiofrequency (RF) time >60 min, or procedure duration >5 h. PVI was defined as an entrance and/or exit block, diagnosed with a CMC within the PV ostium or by pacing via the roving RMN-guided catheter (single-catheter technique). Prolonged Holter monitoring after 3 and 6 months was used to detect atrial tachyarrhythmia (AT/AF) recurrences. Complete PVI was achieved in 56 % (45/80) of all subjects (isolated PVs per patient, 3.1 ± 1.2; RF time, 56.3 ± 17.2 min; procedure duration, 3.8 ± 0.8 h). Prospective validation of the single-catheter technique for diagnosing PVI demonstrated high concordance (94 %) with blinded CMC results. CMC use in first-time PVA was associated with similar total RF and procedure times but higher PV isolation rate. Upon multivariate analysis, CMC use, female gender, left PV, smaller PV ostium and repeat PVA predicted PVI during RMN-guided ablation. Persistent AF and mitral regurgitation at baseline and the number of non-isolated PVs predicted AT/AF recurrence during follow-up. Concomitant CMC use for first-time, RMN-guided PVA is associated with similar procedure duration but higher PV isolation rates as compared to a single-catheter approach. Since the number of isolated PVs predicts freedom from AT/AF, CMC utilization appears advisable for first-time, RMN-guided PVA.

Infrared needle mapping to assist biopsy procedures and training.

PubMed

Shar, Bruce; Leis, John; Coucher, John

2018-04-01

A computed tomography (CT) biopsy is a radiological procedure which involves using a needle to withdraw tissue or a fluid specimen from a lesion of interest inside a patient's body. The needle is progressively advanced into the patient's body, guided by the most recent CT scan. CT guided biopsies invariably expose patients to high dosages of radiation, due to the number of scans required whilst the needle is advanced. This study details the design of a novel method to aid biopsy procedures using infrared cameras. Two cameras are used to image the biopsy needle area, from which the proposed algorithm computes an estimate of the needle endpoint, which is projected onto the CT image space. This estimated position may be used to guide the needle between scans, and results in a reduction in the number of CT scans that need to be performed during the biopsy procedure. The authors formulate a 2D augmentation system which compensates for camera pose, and show that multiple low-cost infrared imaging devices provide a promising approach.

ASHRAE's new Chiller Heat Recovery Application Guide

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

Dorgan, C.B.; Dorgan, C.E.

2000-07-01

The new Chiller Heat Recovery Application Guide, published by the American Society of Heating, Refrigerating and Air-conditioning Engineers (ASHRAE), provides a comprehensive reference manual on the options available for chiller heat recovery. The information in the guide will assist engineers, owners, and system operators in evaluating the potential of integrating chiller heat recovery into their cooling and heating systems. The primary focus is on new construction and applications where a chiller is being replaced due to inefficiency, high operating and maintenance (O and M) costs, or elimination of refrigerants containing ozone-depleting chemicals known as CFC/HCFCs. While chiller systems for commercialmore » buildings are the primary focus of the guide, the information and procedures also apply to industrial heat pumps. The function of this paper is to highlight key information contained in the guide, including the major benefits of chiller heat recovery, primary candidates, and application procedures. A description of the guide's general format and contents is also provided.« less

Fluid collection after partial pancreatectomy: EUS drainage and long-term follow-up.

PubMed

Caillol, Fabrice; Godat, Sebastien; Turrini, Olivier; Zemmour, Christophe; Bories, Erwan; Pesenti, Christian; Ratone, Jean Phillippe; Ewald, Jacques; Delpero, Jean Robert; Giovannini, Marc

2018-03-29

Postoperative fluid collection due to pancreatic leak is the most frequent complication after pancreatic surgery. Endoscopic ultrasound (EUS)-guided drainage of post-pancreatic surgery fluid collection is the gold standard procedure; however, data on outcomes of this procedure are limited. The primary endpoint of our study was relapse over longterm followup, and the secondary endpoint was the efficiency and safety of EUS-guided drainage of post-pancreatic surgery fluid collection. This retrospective study was conducted at a single center from December 2008 to April 2016. Global morbidity was defined as the occurrence of an event involving additional endoscopic procedures, hospitalization, or interventional radiologic or surgical procedures. EUS-guided drainage was considered a clinical failure if surgery was required to treat a relapse after stent removal. Fortyone patients were included. The technical success rate was 100%. Drainage was considered a clinical success in 93% (39/41) of cases. Additionally, 19 (46%) complications were identified as global morbidity. The duration between surgery and EUS-guided drainage was not a significantly related factor for morbidity rate (P = 0.8); however, bleeding due to arterial injuries (splenic artery and gastroduodenal artery) from salvage drainage procedures occurred within 25 days following the initial surgery. There was no difference in survival between patients with and without complications. No relapse was reported during the followup (median: 44.75 months; range: 29.24 to 65.74 months). EUSguided drainage for post-pancreatic surgery fluid collection was efficient with no relapse during longterm followup. Morbidity rate was independent of the duration between the initial surgery and EUS-guided drainage; however, bleeding risk was likely more important in cases of early drainage.

Training for percutaneous renal access on a virtual reality simulator.

PubMed

Zhang, Yi; Yu, Cheng-fan; Liu, Jin-shun; Wang, Gang; Zhu, He; Na, Yan-qun

2013-01-01

The need to develop new methods of surgical training combined with advances in computing has led to the development of virtual reality surgical simulators. The PERC Mentor(TM) is designed to train the user in percutaneous renal collecting system access puncture. This study aimed to validate the use of this kind of simulator, in percutaneous renal access training. Twenty-one urologists were enrolled as trainees to learn a fluoroscopy-guided percutaneous renal accessing technique. An assigned percutaneous renal access procedure was immediately performed on the PERC Mentor(TM) after watching instruction video and an analog operation. Objective parameters were recorded by the simulator and subjective global rating scale (GRS) score were determined. Simulation training followed and consisted of 2 hours daily training sessions for 2 consecutive days. Twenty-four hours after the training session, trainees were evaluated performing the same procedure. The post-training evaluation was compared to the evaluation of the initial attempt. During the initial attempt, none of the trainees could complete the appointed procedure due to the lack of experience in fluoroscopy-guided percutaneous renal access. After the short-term training, all trainees were able to independently complete the procedure. Of the 21 trainees, 10 had primitive experience in ultrasound-guided percutaneous nephrolithotomy. Trainees were thus categorized into the group of primitive experience and inexperience. The total operating time and amount of contrast material used were significantly lower in the group of primitive experience versus the inexperience group (P = 0.03 and 0.02, respectively). The training on the virtual reality simulator, PERC Mentor(TM), can help trainees with no previous experience of fluoroscopy-guided percutaneous renal access to complete the virtual manipulation of the procedure independently. This virtual reality simulator may become an important training and evaluation tool in teaching fluoroscopy-guided percutaneous renal access.

Radio-guided thoracoscopic surgery (RGTS) of small pulmonary nodules.

PubMed

Ambrogi, Marcello Carlo; Melfi, Franca; Zirafa, Carmelina; Lucchi, Marco; De Liperi, Annalisa; Mariani, Giuliano; Fanucchi, Olivia; Mussi, Alfredo

2012-04-01

The demand for adequate tissue sampling to determine individual tumor behavior is increasing the number of lung nodule resections, even when the diagnosis is already recognized. Video-assisted thoracic surgery (VATS) is the procedure of choice for diagnosis and treatment of small pulmonary nodules. Difficulties in localizing smaller and deeper nodules have been approached with different techniques. Herein we report our 13-years' experience with radio-guided thoracoscopic resection. Patients with pulmonary nodules smaller than 1 cm and/or deeper than 1 cm, below the visceral pleura, underwent computed tomography (CT)-guided injection of a solution, composed of 0.2 ml (99)Tc-labeled human serum albumin microspheres and 0.1 ml nonionic contrast, into the nodule. During the VATS procedure, an 11-mm-diameter collimated probe connected to a gamma ray detector was introduced to scan the lung surface. The area of major radioactivity, which matched with the area of the nodule, was resected. From 1997 to 2009, 573 patients underwent thoracoscopic resection of small pulmonary nodules, 211 with the radio-guided technique. There were 159 men and 52 women, with an average age of 60.6 years (range = 12-83). The mean duration of the surgical procedure was 41 min (range = 20-100). The procedure was successful in 208/211 cases. Three patients (0.5%) required conversion to a minithoracotomy. The mean length of pleural drainage and hospital stay was 2.3 and 3.7 days, respectively. Histological examination showed 98 benign lesions and 113 malignant lesions (61 metastases and 52 primary lung cancers). This study confirms that radio-guided localization of small pulmonary nodules is a feasible, safe, and quick procedure, with a high rate of success. The spread of the sentinel lymph node technique has increased the availability of technology required for RGTS.

Efficacy of ultrasound-guided thoracentesis catheter drainage for pleural effusion

PubMed Central

Cao, Weitian; Wang, Yi; Zhou, Ningming; Xu, Bing

2016-01-01

The factors influencing the efficacy of ultrasound-guided thoracentesis catheter drainage were investigated in the present study. A retrospective analysis of clinical data from 435 patients who presented with a pleural effusion was performed. Patients were divided into a control group and an intervention group. Thirty-seven patients in the control group were given standard care using pleural puncture to draw the excess fluid. The 398 patients in the intervention group were treated using ultrasound-guided thoracentesis catheter drainage. The rate of successful drainage of a pleural effusion was significantly higher (P<0.05), while the rate of complication was lower, in the ultrasound-guided thoracentesis cases compared to standard care treatment. In conclusion, ultrasound-guided thoracentesis catheter drainage is an efficient, safe and minimally invasive procedure to alleviate pleural effusion. The efficacy of the procedure is related to the separation of pleural effusion, drainage tube type and tube diameter. PMID:28105155

Review of telehealth stuttering management.

PubMed

Lowe, Robyn; O'Brian, Sue; Onslow, Mark

2013-01-01

Telehealth is the use of communication technology to provide health care services by means other than typical in-clinic attendance models. Telehealth is increasingly used for the management of speech, language and communication disorders. The aim of this article is to review telehealth applications to stuttering management. We conducted a search of peer-reviewed literature for the past 20 years using the Institute for Scientific Information Web of Science database, PubMed: The Bibliographic Database and a search for articles by hand. Outcomes for telehealth stuttering treatment were generally positive, but there may be a compromise of treatment efficiency with telehealth treatment of young children. Our search found no studies dealing with stuttering assessment procedures using telehealth models. No economic analyses of this delivery model have been reported. This review highlights the need for continued research about telehealth for stuttering management. Evidence from research is needed to inform the efficacy of assessment procedures using telehealth methods as well as guide the development of improved treatment procedures. Clinical and technical guidelines are urgently needed to ensure that the evolving and continued use of telehealth to manage stuttering does not compromise the standards of care afforded with standard in-clinic models.

Application of the QSDC procedure to the formulation of space shuttle design criteria. Volume 2: Applications guide

NASA Technical Reports Server (NTRS)

Bouton, I.; Martin, G. L.

1972-01-01

Criteria to determine the probability of aircraft structural failure were established according to the Quantitative Structural Design Criteria by Statistical Methods, the QSDC Procedure. This criteria method was applied to the design of the space shuttle during this contract. An Applications Guide was developed to demonstrate the utilization of the QSDC Procedure, with examples of the application to a hypothetical space shuttle illustrating the application to specific design problems. Discussions of the basic parameters of the QSDC Procedure: the Limit and Omega Conditions, and the strength scatter, have been included. Available data pertinent to the estimation of the strength scatter have also been included.

Shoulder-Mounted Robot for MRI-guided arthrography: Accuracy and mounting study.

PubMed

Monfaredi, R; Wilson, E; Sze, R; Sharma, K; Azizi, B; Iordachita, I; Cleary, K

2015-08-01

A new version of our compact and lightweight patient-mounted MRI-compatible 4 degree-of-freedom (DOF) robot for MRI-guided arthrography procedures is introduced. This robot could convert the traditional two-stage arthrography procedure (fluoroscopy-guided needle insertion followed by a diagnostic MRI scan) to a one-stage procedure, all in the MRI suite. The results of a recent accuracy study are reported. A new mounting technique is proposed and the mounting stability is investigated using optical and electromagnetic tracking on an anthropomorphic phantom. Five volunteer subjects including 2 radiologists were asked to conduct needle insertion in 4 different random positions and orientations within the robot's workspace and the displacement of the base of the robot was investigated during robot motion and needle insertion. Experimental results show that the proposed mounting method is stable and promising for clinical application.

Medical and biohazardous waste generator`s guide: Revision 1

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

Not Available

1994-09-01

This Guide describes the procedures required to comply with all federal and state laws and regulations and Lawrence Berkeley Laboratory (LBL) policy applicable to medical and biohazardous waste. The members of the LBL Biological Safety Subcommittee participated in writing these policies and procedures. The procedures and policies in this Guide apply to LBL personnel who work with infectious agents or potentially infectious agents, publicly perceived infectious items or materials (e.g., medical gloves, culture dishes), and sharps (e.g., needles, syringes, razor blades). If medical or biohazardous waste is contaminated or mixed with a hazardous chemical or material, with a radioactive material,more » or with both, the waste will be handled in accordance with the applicable federal and State of California laws and regulations for hazardous, radioactive, or mixed waste.« less

Value of MR contrast media in image-guided body interventions.

PubMed

Saeed, Maythem; Wilson, Mark

2012-01-28

In the past few years, there have been multiple advances in magnetic resonance (MR) instrumentation, in vivo devices, real-time imaging sequences and interventional procedures with new therapies. More recently, interventionists have started to use minimally invasive image-guided procedures and local therapies, which reduce the pain from conventional surgery and increase drug effectiveness, respectively. Local therapy also reduces the systemic dose and eliminates the toxic side effects of some drugs to other organs. The success of MR-guided procedures depends on visualization of the targets in 3D and precise deployment of ablation catheters, local therapies and devices. MR contrast media provide a wealth of tissue contrast and allows 3D and 4D image acquisitions. After the development of fast imaging sequences, the clinical applications of MR contrast media have been substantially expanded to include pre- during- and post-interventions. Prior to intervention, MR contrast media have the potential to localize and delineate pathologic tissues of vital organs, such as the brain, heart, breast, kidney, prostate, liver and uterus. They also offer other options such as labeling therapeutic agents or cells. During intervention, these agents have the capability to map blood vessels and enhance the contrast between the endovascular guidewire/catheters/devices, blood and tissues as well as direct therapies to the target. Furthermore, labeling therapeutic agents or cells aids in visualizing their delivery sites and tracking their tissue distribution. After intervention, MR contrast media have been used for assessing the efficacy of ablation and therapies. It should be noted that most image-guided procedures are under preclinical research and development. It can be concluded that MR contrast media have great value in preclinical and some clinical interventional procedures. Future applications of MR contrast media in image-guided procedures depend on their safety, tolerability, tissue specificity and effectiveness in demonstrating success of the interventions and therapies.

'X-ray'-free balloon dilation for totally ultrasound-guided percutaneous nephrolithotomy.

PubMed

Zhou, Tie; Chen, Guanghua; Gao, Xiaofeng; Zhang, Wei; Xu, Chuanliang; Li, Lei; Sun, Yinghao

2015-04-01

The objective of the study was to evaluate the feasibility and safety of balloon dilation for 'X-ray'-free ultrasound-guided percutaneous nephrolithotomy (PCNL). From January 2012 to December 2012, patients underwent 'X-ray'-free ultrasound-guided PCNL with Amplatz dilator (Group A). From January 2013 to April 2014, patients underwent 'X-ray'-free ultrasound-guided PCNL with balloon dilator (Group B). For balloon dilation, a 10 F fascial dilator was used to dilate the tract. Subsequently, the 6 F nephrostomy balloon (8 mm in diameter) was indwelled along the guidewire with a marked length equal to the dilation depth. Under the monitoring of ultrasound, the location of balloon was secured and disappearance of balloon waist was confirmed when the balloon was inflated at a pressure of 20 atm. A total of 163 patients were involved in this study. Of 81 procedures in Group A, 45 procedures were performed by a senior urologist while 36 procedures by a resident. Of 82 patients in Group B, 47 procedures were performed by the same senior urologist while 35 procedures by another resident. For the senior urologist, there was no statistically significant difference between two groups in calyx of entry, stone-free rate, decline of hemoglobin and hematocrit, operation time and hospitalization. But for the residents, there was less decline of hemoglobin and hematocrit, tract development time and hospitalization in Group B compared to Group A (0.6 vs. 1.7 g/dl, p = 0.001; 2.3% vs. 5.5%, p = 0.003; 10.1 vs. 11.0 min, p = 0.027; 7.8 vs. 13.9 days, p < 0.001). Balloon dilation method introduced in this study is compensable for tract development when 'X-ray'-free ultrasound-guided PCNL is performed. Modified techniques make totally ultrasound guidance for PCNL feasible, easy and safe. In addition, such a procedure is preferable for initial operators because of less hemorrhage complication.

A prospective comparison of procedural sedation and ultrasound-guided interscalene nerve block for shoulder reduction in the emergency department.

PubMed

Blaivas, Michael; Adhikari, Srikar; Lander, Lina

2011-09-01

Emergency physicians (EPs) are beginning to use ultrasound (US) guidance to perform regional nerve blocks. The primary objective of this study was to compare length of stay (LOS) in patients randomized to US-guided interscalene block or procedural sedation to facilitate reduction of shoulder dislocation in the emergency department (ED). The secondary objectives were to compare one-on-one health care provider time, pain experienced by the patient during reduction, and patient satisfaction between the two groups. This was a prospective, randomized study of patients presenting to the ED with shoulder dislocation. The study was conducted at an academic Level I trauma center ED with an annual census of approximately 80,000. Patients were eligible for the study if they were at least 18 years of age and required reduction of a shoulder dislocation. A convenience sample of patients was randomized to either traditional procedural sedation or US-guided interscalene nerve block. Procedural sedation was performed with etomidate as the sole agent. Interscalene blocks were performed by hospital-credentialed EPs using sterile technique and a SonoSite MicroMaxx US machine with a high-frequency linear array transducer. Categorical variables were evaluated using Fisher's exact test, and continuous variables were analyzed using the Wilcoxon rank sum test. Forty-two patients were enrolled, with 21 patients randomized to each group. The groups were not significantly different with respect to sex or age. The mean (±SD) LOS in the ED was significantly higher in the procedural sedation group (177.3 ± 37.9 min) than in the US-guided interscalene block group (100.3 ± 28.2 minutes; p < 0.0001). The mean (±SD) one-on-one health care provider time was 47.1 (±9.8) minutes for the sedation group and 5 (±0.7) minutes for the US-guided interscalene block group (p < 0.0001). There was no statistically significant difference between the two groups in patient satisfaction or pain experienced during the procedure. There were no significant differences between groups with respect to complications such as hypoxia or hypotension (p = 0.49). In this study, patients undergoing shoulder dislocation reduction using US-guided interscalene block spent less time in the ED and required less one-on-one health care provider time compared to those receiving procedural sedation. There was no difference in pain level or satisfaction when compared to procedural sedation patients. © 2011 by the Society for Academic Emergency Medicine.

Time Reversal Methods for Structural Health Monitoring of Metallic Structures Using Guided Waves

DTIC Science & Technology

2011-09-01

measure elastic properties of thin isotropic materials and laminated composite plates. Two types of waves propagate a symmetric wave and antisymmetric...compare it to the original signal. In this time reversal procedure wave propagation from point-A to point-B and can be modeled as a convolution ...where * is the convolution operator and transducer transmit and receive transfer function are neglected for simplification. In the frequency

Image-guided surgery and therapy: current status and future directions

NASA Astrophysics Data System (ADS)

Peters, Terence M.

2001-05-01

Image-guided surgery and therapy is assuming an increasingly important role, particularly considering the current emphasis on minimally-invasive surgical procedures. Volumetric CT and MR images have been used now for some time in conjunction with stereotactic frames, to guide many neurosurgical procedures. With the development of systems that permit surgical instruments to be tracked in space, image-guided surgery now includes the use of frame-less procedures, and the application of the technology has spread beyond neurosurgery to include orthopedic applications and therapy of various soft-tissue organs such as the breast, prostate and heart. Since tracking systems allow image- guided surgery to be undertaken without frames, a great deal of effort has been spent on image-to-image and image-to- patient registration techniques, and upon the means of combining real-time intra-operative images with images acquired pre-operatively. As image-guided surgery systems have become increasingly sophisticated, the greatest challenges to their successful adoption in the operating room of the future relate to the interface between the user and the system. To date, little effort has been expended to ensure that the human factors issues relating to the use of such equipment in the operating room have been adequately addressed. Such systems will only be employed routinely in the OR when they are designed to be intuitive, unobtrusive, and provide simple access to the source of the images.

Outcome of percutaneous continuous drainage of psoas abscess: A clinically guided technique.

PubMed

Dave, Bharat R; Kurupati, Ranganatha Babu; Shah, Dipak; Degulamadi, Devanand; Borgohain, Nitu; Krishnan, Ajay

2014-01-01

Percutaneous aspiration of abscesses under ultrasonography (USG) and computer tomography (CT) scan has been well described. With recurrence rate reported as high as 66%. The open drainage and percutaneous continuous drainage (PCD) has reduced the recurrence rate. The disadvantage of PCD under CT is radiation hazard and problems of asepsis. Hence a technique of clinically guided percutaneous continuous drainage of the psoas abscess without real-time imaging overcomes these problems. We describe clinically guided PCD of psoas abscess and its outcome. Twenty-nine patients with dorsolumbar spondylodiscitis without gross neural deficit with psoas abscess of size >5 cm were selected for PCD. It was done as a day care procedure under local anesthesia. Sequentially, aspiration followed by guide pin-guided trocar and catheter insertion was done without image guidance. Culture sensitivity was done and chemotherapy initiated and catheter kept till the drainage was <10 ml for 48 hours. Outcome assessment was done with relief of pain, successful abscess drainage and ODI (Oswestry Disability Index) score at 2 years. PCD was successful in all cases. Back and radicular pain improved in all cases. Average procedure time was 24.30 minutes, drain output was 234.40 ml, and the drainage duration was 7.90 days. One patient required surgical stabilisation due to progression of the spondylodiscitis resulting in instability inspite of successful drainage of abscess. Problems with the procedure were noticed in six patients. Multiple attempts (n = 2), persistent discharge (n = 1) for 2 weeks, blocked catheter (n = 2) and catheter pull out (n = 1) occurred with no effect on the outcome. The average ODI score improved from 62.47 to 5.51 at 2 years. Clinically guided PCD is an efficient, safe and easy procedure in drainage of psoas abscess.

Quality of life assessment in interventional radiology.

PubMed

Monsky, Wayne L; Khorsand, Derek; Nolan, Timothy; Douglas, David; Khanna, Pavan

2014-03-01

The aim of this review was to describe quality of life (QoL) questionnaires relevant to interventional radiology. Interventional radiologists perform a large number of palliative procedures. The effect of these therapies on QoL is important. This is particularly true for cancer therapies where procedures with marginal survival benefits may result in tremendous QoL benefits. Image-guided minimally invasive procedures should be compared to invasive procedures, with respect to QoL, as part of comparative effectiveness assessment. A large number of questionnaires have been validated for measurement of overall and disease-specific quality of life. Use of applicable QoL assessments can aid in evaluating clinical outcomes and help to further substantiate the need for minimally invasive image-guided procedures. Copyright © 2014 AUR. Published by Elsevier Inc. All rights reserved.

Proteus two-dimensional Navier-Stokes computer code, version 2.0. Volume 2: User's guide

NASA Technical Reports Server (NTRS)

Towne, Charles E.; Schwab, John R.; Bui, Trong T.

1993-01-01

A computer code called Proteus 2D was developed to solve the two-dimensional planar or axisymmetric, Reynolds-averaged, unsteady compressible Navier-Stokes equations in strong conservation law form. The objective in this effort was to develop a code for aerospace propulsion applications that is easy to use and easy to modify. Code readability, modularity, and documentation were emphasized. The governing equations are solved in generalized nonorthogonal body-fitted coordinates, by marching in time using a fully-coupled ADI solution procedure. The boundary conditions are treated implicitly. All terms, including the diffusion terms, are linearized using second-order Taylor series expansions. Turbulence is modeled using either an algebraic or two-equation eddy viscosity model. The thin-layer or Euler equations may also be solved. The energy equation may be eliminated by the assumption of constant total enthalpy. Explicit and implicit artificial viscosity may be used. Several time step options are available for convergence acceleration. The documentation is divided into three volumes. This is the User's Guide, and describes the program's features, the input and output, the procedure for setting up initial conditions, the computer resource requirements, the diagnostic messages that may be generated, the job control language used to run the program, and several test cases.

A 3D virtual reality simulator for training of minimally invasive surgery.

PubMed

Mi, Shao-Hua; Hou, Zeng-Gunag; Yang, Fan; Xie, Xiao-Liang; Bian, Gui-Bin

2014-01-01

For the last decade, remarkable progress has been made in the field of cardiovascular disease treatment. However, these complex medical procedures require a combination of rich experience and technical skills. In this paper, a 3D virtual reality simulator for core skills training in minimally invasive surgery is presented. The system can generate realistic 3D vascular models segmented from patient datasets, including a beating heart, and provide a real-time computation of force and force feedback module for surgical simulation. Instruments, such as a catheter or guide wire, are represented by a multi-body mass-spring model. In addition, a realistic user interface with multiple windows and real-time 3D views are developed. Moreover, the simulator is also provided with a human-machine interaction module that gives doctors the sense of touch during the surgery training, enables them to control the motion of a virtual catheter/guide wire inside a complex vascular model. Experimental results show that the simulator is suitable for minimally invasive surgery training.

Food Science & Technology. Instructor Guide. Student Reference.

ERIC Educational Resources Information Center

Martin, Phillip

This packet contains an instructor curriculum guide and a student reference book for a course in food science and technology. The 4-unit curriculum contains 23 lessons. The instructor's guide contains the following components of a unit of instruction: objectives, competencies, motivational techniques, teaching procedures, other activities,…

V-TECS Guide for Machine Shop (Machinist).

ERIC Educational Resources Information Center

Gregory, Margaret R.; Benson, Robert T.

This curriculum guide is intended to train trade and industrial education students in the hands-on aspects of the occupation of machinist. Included in the guide are course outlines that deal with the following topics: following safety procedures; performing mathematical calculations; designing and planning machine work; performing precision…

Using Gagne's theory to teach procedural skills.

PubMed

Buscombe, Charlotte

2013-10-01

Many key medical procedures are performed every day in clinical practice to yield important diagnostic information and to help determine the disease response to intensive treatments. Training clinicians to perform procedures competently and confidently thus carries considerable weight, helping to assure patient safety, the obtainment of adequate samples and minimising patient discomfort. This article considers how Robert Gagne's instructional design model may be effectively used to design lesson plans and teach procedural skills in small group settings. Gagne's model is based upon the information-processing model of mental events that occur when adults are presented with various stimuli. It highlights nine specific instructional events, which correlate with crucial conditions of learning, and are arranged to maximally enhance the learning process, improve session flow and, ultimately, ensure lesson objectives are comprehensively addressed. This article uses the nine points described by Gagne to outline a comprehensive lesson guide for teaching psychomotor skills, using a bone-marrow aspirate procedure as an example. Each of Gagne's instructional events is considered with specific activities for each, and with the variety of activities delineated to meet diverse learning styles. Gagne's instructional events can produce an effective and comprehensive lesson plan for teaching procedural skills, preparing learners with various preferred learning styles to perform psychomotor skills competently in clinical practice. This lesson plan can be of use for both teachers and students across clinical specialties, encouragingly outlining how Gagne's systematic and widely referenced theory can be creatively and practically used. © 2013 John Wiley & Sons Ltd.

Image-guided thoracic surgery in the hybrid operation room.

PubMed

Ujiie, Hideki; Effat, Andrew; Yasufuku, Kazuhiro

2017-01-01

There has been an increase in the use of image-guided technology to facilitate minimally invasive therapy. The next generation of minimally invasive therapy is focused on advancement and translation of novel image-guided technologies in therapeutic interventions, including surgery, interventional pulmonology, radiation therapy, and interventional laser therapy. To establish the efficacy of different minimally invasive therapies, we have developed a hybrid operating room, known as the guided therapeutics operating room (GTx OR) at the Toronto General Hospital. The GTx OR is equipped with multi-modality image-guidance systems, which features a dual source-dual energy computed tomography (CT) scanner, a robotic cone-beam CT (CBCT)/fluoroscopy, high-performance endobronchial ultrasound system, endoscopic surgery system, near-infrared (NIR) fluorescence imaging system, and navigation tracking systems. The novel multimodality image-guidance systems allow physicians to quickly, and accurately image patients while they are on the operating table. This yield improved outcomes since physicians are able to use image guidance during their procedures, and carry out innovative multi-modality therapeutics. Multiple preclinical translational studies pertaining to innovative minimally invasive technology is being developed in our guided therapeutics laboratory (GTx Lab). The GTx Lab is equipped with similar technology, and multimodality image-guidance systems as the GTx OR, and acts as an appropriate platform for translation of research into human clinical trials. Through the GTx Lab, we are able to perform basic research, such as the development of image-guided technologies, preclinical model testing, as well as preclinical imaging, and then translate that research into the GTx OR. This OR allows for the utilization of new technologies in cancer therapy, including molecular imaging, and other innovative imaging modalities, and therefore enables a better quality of life for patients, both during and after the procedure. In this article, we describe capabilities of the GTx systems, and discuss the first-in-human technologies used, and evaluated in GTx OR.

Utilizing collagen membranes for guided tissue regeneration-based root coverage.

PubMed

Wang, Hom-Lay; Modarressi, Marmar; Fu, Jia-Hui

2012-06-01

Gingival recession is a common clinical problem that can result in hypersensitivity, pain, root caries and esthetic concerns. Conventional soft tissue procedures for root coverage require an additional surgical site, thereby causing additional trauma and donor site morbidity. In addition, the grafted tissues heal by repair, with formation of long junctional epithelium with some connective tissue attachment. Guided tissue regeneration-based root coverage was thus developed in an attempt to overcome these limitations while providing comparable clinical results. This paper addresses the biologic foundation of guided tissue regeneration-based root coverage, and describes the indications and contraindications for this technique, as well as the factors that influence outcomes. The step-by-step clinical techniques utilizing collagen membranes are also described. In comparison with conventional soft tissue procedures, the benefits of guided tissue regeneration-based root coverage procedures include new attachment formation, elimination of donor site morbidity, less chair-time, and unlimited availability and uniform thickness of the product. Collagen membranes, in particular, benefit from product biocompatibility with the host, while promoting chemotaxis, hemostasis, and exchange of gas and nutrients. Such characteristics lead to better wound healing by promoting primary wound coverage, angiogenesis, space creation and maintenance, and clot stability. In conclusion, collagen membranes are a reliable alternative for use in root coverage procedures. © 2012 John Wiley & Sons A/S.

Fully Automated Prostate Magnetic Resonance Imaging and Transrectal Ultrasound Fusion via a Probabilistic Registration Metric.

PubMed

Sparks, Rachel; Bloch, B Nicolas; Feleppa, Ernest; Barratt, Dean; Madabhushi, Anant

2013-03-08

In this work, we present a novel, automated, registration method to fuse magnetic resonance imaging (MRI) and transrectal ultrasound (TRUS) images of the prostate. Our methodology consists of: (1) delineating the prostate on MRI, (2) building a probabilistic model of prostate location on TRUS, and (3) aligning the MRI prostate segmentation to the TRUS probabilistic model. TRUS-guided needle biopsy is the current gold standard for prostate cancer (CaP) diagnosis. Up to 40% of CaP lesions appear isoechoic on TRUS, hence TRUS-guided biopsy cannot reliably target CaP lesions and is associated with a high false negative rate. MRI is better able to distinguish CaP from benign prostatic tissue, but requires special equipment and training. MRI-TRUS fusion, whereby MRI is acquired pre-operatively and aligned to TRUS during the biopsy procedure, allows for information from both modalities to be used to help guide the biopsy. The use of MRI and TRUS in combination to guide biopsy at least doubles the yield of positive biopsies. Previous work on MRI-TRUS fusion has involved aligning manually determined fiducials or prostate surfaces to achieve image registration. The accuracy of these methods is dependent on the reader's ability to determine fiducials or prostate surfaces with minimal error, which is a difficult and time-consuming task. Our novel, fully automated MRI-TRUS fusion method represents a significant advance over the current state-of-the-art because it does not require manual intervention after TRUS acquisition. All necessary preprocessing steps (i.e. delineation of the prostate on MRI) can be performed offline prior to the biopsy procedure. We evaluated our method on seven patient studies, with B-mode TRUS and a 1.5 T surface coil MRI. Our method has a root mean square error (RMSE) for expertly selected fiducials (consisting of the urethra, calcifications, and the centroids of CaP nodules) of 3.39 ± 0.85 mm.

Rapid Prototyping in Orthopaedic Surgery: A User's Guide

PubMed Central

Frame, Mark; Huntley, James S.

2012-01-01

Rapid prototyping (RP) is applicable to orthopaedic problems involving three dimensions, particularly fractures, deformities, and reconstruction. In the past, RP has been hampered by cost and difficulties accessing the appropriate expertise. Here we outline the history of rapid prototyping and furthermore a process using open-source software to produce a high fidelity physical model from CT data. This greatly mitigates the expense associated with the technique, allowing surgeons to produce precise models for preoperative planning and procedure rehearsal. We describe the method with an illustrative case. PMID:22666160

Models to teach lung sonopathology and ultrasound-guided thoracentesis.

PubMed

Wojtczak, Jacek A

2014-12-01

Lung sonography allows rapid diagnosis of lung emergencies such as pulmonary edema, hemothorax or pneumothorax. The ability to timely diagnose an intraoperative pneumothorax is an important skill for the anesthesiologist. However, lung ultrasound exams require an interpretation of not only real images but also complex acoustic artifacts such as A-lines and B-lines. Therefore, appropriate training to gain proficiency is important. Simulated environment using ultrasound phantom models allows controlled, supervised learning. We have developed hybrid models that combine dry or wet polyurethane foams, porcine rib cages and human hand simulating a rib cage. These models simulate fairly accurately pulmonary sonopathology and allow supervised teaching of lung sonography with the immediate feedback. In-vitro models can also facilitate learning of procedural skills, improving transducer and needle positioning and movement, rapid recognition of thoracic anatomy and hand - eye coordination skills. We described a new model to teach an ultrasound guided thoracentesis. This model consists of the experimenter's hand placed on top of the water-filled container with a wet foam. Metacarpal bones of the human hand simulate a rib cage and a wet foam simulates a diseased lung immersed in the pleural fluid. Positive fluid flow offers users feedback when a simulated pleural effusion is accurately assessed.

Improved damage imaging in aerospace structures using a piezoceramic hybrid pin-force wave generation model

NASA Astrophysics Data System (ADS)

Ostiguy, Pierre-Claude; Quaegebeur, Nicolas; Masson, Patrice

2014-03-01

In this study, a correlation-based imaging technique called "Excitelet" is used to monitor an aerospace grade aluminum plate, representative of an aircraft component. The principle is based on ultrasonic guided wave generation and sensing using three piezoceramic (PZT) transducers, and measurement of reflections induced by potential defects. The method uses a propagation model to correlate measured signals with a bank of signals and imaging is performed using a roundrobin procedure (Full-Matrix Capture). The formulation compares two models for the complex transducer dynamics: one where the shear stress at the tip of the PZT is considered to vary as a function of the frequency generated, and one where the PZT is discretized in order to consider the shear distribution under the PZT. This method allows taking into account the transducer dynamics and finite dimensions, multi-modal and dispersive characteristics of the material and complex interactions between guided wave and damages. Experimental validation has been conducted on an aerospace grade aluminum joint instrumented with three circular PZTs of 10 mm diameter. A magnet, acting as a reflector, is used in order to simulate a local reflection in the structure. It is demonstrated that the defect can be accurately detected and localized. The two models proposed are compared to the classical pin-force model, using narrow and broad-band excitations. The results demonstrate the potential of the proposed imaging techniques for damage monitoring of aerospace structures considering improved models for guided wave generation and propagation.

Endoscopic ultrasound-guided biliary drainage

PubMed Central

Chavalitdhamrong, Disaya; Draganov, Peter V

2012-01-01

Endoscopic ultrasound (EUS)-guided biliary drainage has emerged as a minimally invasive alternative to percutaneous and surgical interventions for patients with biliary obstruction who had failed endoscopic retrograde cholangiopancreatography (ERCP). EUS-guided biliary drainage has become feasible due to the development of large channel curvilinear therapeutic echo-endoscopes and the use of real-time ultrasound and fluoroscopy imaging in addition to standard ERCP devices and techniques. EUS-guided biliary drainage is an attractive option because of its minimally invasive, single step procedure which provides internal biliary decompression. Multiple investigators have reported high success and low complication rates. Unfortunately, high quality prospective data are still lacking. We provide detailed review of the use of EUS for biliary drainage from the perspective of practicing endoscopists with specific focus on the technical aspects of the procedure. PMID:22363114

Preliminary study of ergonomic behavior during simulated ultrasound-guided regional anesthesia using a head-mounted display.

PubMed

Udani, Ankeet D; Harrison, T Kyle; Howard, Steven K; Kim, T Edward; Brock-Utne, John G; Gaba, David M; Mariano, Edward R

2012-08-01

A head-mounted display provides continuous real-time imaging within the practitioner's visual field. We evaluated the feasibility of using head-mounted display technology to improve ergonomics in ultrasound-guided regional anesthesia in a simulated environment. Two anesthesiologists performed an equal number of ultrasound-guided popliteal-sciatic nerve blocks using the head-mounted display on a porcine hindquarter, and an independent observer assessed each practitioner's ergonomics (eg, head turning, arching, eye movements, and needle manipulation) and the overall block quality based on the injectate spread around the target nerve for each procedure. Both practitioners performed their procedures without directly viewing the ultrasound monitor, and neither practitioner showed poor ergonomic behavior. Head-mounted display technology may offer potential advantages during ultrasound-guided regional anesthesia.

Endoscope-guided pneumatic dilation for treatment of esophageal achalasia

PubMed Central

Chuah, Seng-Kee; Wu, Keng-Liang; Hu, Tsung-Hui; Tai, Wei-Chen; Changchien, Chi-Sin

2010-01-01

Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force. The endoscope-guided procedure is done without fluoroscopic control. Clinicians usually use a low-compliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia. It has the advantage of determining mucosal injury during the dilation process, so that a repeat endoscopy is not needed to assess the mucosal tearing. Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities. Although the results may be promising, long-term follow-up is required in the near future. PMID:20101764

The PDB_REDO server for macromolecular structure model optimization.

PubMed

Joosten, Robbie P; Long, Fei; Murshudov, Garib N; Perrakis, Anastassis

2014-07-01

The refinement and validation of a crystallographic structure model is the last step before the coordinates and the associated data are submitted to the Protein Data Bank (PDB). The success of the refinement procedure is typically assessed by validating the models against geometrical criteria and the diffraction data, and is an important step in ensuring the quality of the PDB public archive [Read et al. (2011 ▶), Structure, 19, 1395-1412]. The PDB_REDO procedure aims for 'constructive validation', aspiring to consistent and optimal refinement parameterization and pro-active model rebuilding, not only correcting errors but striving for optimal interpretation of the electron density. A web server for PDB_REDO has been implemented, allowing thorough, consistent and fully automated optimization of the refinement procedure in REFMAC and partial model rebuilding. The goal of the web server is to help practicing crystallo-graphers to improve their model prior to submission to the PDB. For this, additional steps were implemented in the PDB_REDO pipeline, both in the refinement procedure, e.g. testing of resolution limits and k-fold cross-validation for small test sets, and as new validation criteria, e.g. the density-fit metrics implemented in EDSTATS and ligand validation as implemented in YASARA. Innovative ways to present the refinement and validation results to the user are also described, which together with auto-generated Coot scripts can guide users to subsequent model inspection and improvement. It is demonstrated that using the server can lead to substantial improvement of structure models before they are submitted to the PDB.

The PDB_REDO server for macromolecular structure model optimization

PubMed Central

Joosten, Robbie P.; Long, Fei; Murshudov, Garib N.; Perrakis, Anastassis

2014-01-01

The refinement and validation of a crystallographic structure model is the last step before the coordinates and the associated data are submitted to the Protein Data Bank (PDB). The success of the refinement procedure is typically assessed by validating the models against geometrical criteria and the diffraction data, and is an important step in ensuring the quality of the PDB public archive [Read et al. (2011 ▶), Structure, 19, 1395–1412]. The PDB_REDO procedure aims for ‘constructive validation’, aspiring to consistent and optimal refinement parameterization and pro-active model rebuilding, not only correcting errors but striving for optimal interpretation of the electron density. A web server for PDB_REDO has been implemented, allowing thorough, consistent and fully automated optimization of the refinement procedure in REFMAC and partial model rebuilding. The goal of the web server is to help practicing crystallo­graphers to improve their model prior to submission to the PDB. For this, additional steps were implemented in the PDB_REDO pipeline, both in the refinement procedure, e.g. testing of resolution limits and k-fold cross-validation for small test sets, and as new validation criteria, e.g. the density-fit metrics implemented in EDSTATS and ligand validation as implemented in YASARA. Innovative ways to present the refinement and validation results to the user are also described, which together with auto-generated Coot scripts can guide users to subsequent model inspection and improvement. It is demonstrated that using the server can lead to substantial improvement of structure models before they are submitted to the PDB. PMID:25075342

Contact force sensing for ablation of persistent atrial fibrillation: A randomized, multicenter trial.

PubMed

Conti, Sergio; Weerasooriya, Rukshen; Novak, Paul; Champagne, Jean; Lim, Hong Euy; Macle, Laurent; Khaykin, Yaariv; Pantano, Alfredo; Verma, Atul

2018-02-01

Impact of contact force sensing (CFS) on ablation of persistent atrial fibrillation (PeAF) is unknown. The purpose of the TOUCH AF (Therapeutic Outcomes Using Contact force Handling during Ablation of Persistent Atrial Fibrillation) randomized trial was to compare CFS-guided ablation to a CFS-blinded strategy. Patients (n = 128) undergoing first-time ablation for persistent AF were randomized to a CFS-guided vs CFS-blinded strategy. In the CFS-guided procedure, operators visualized real-time force data. In the blinded procedure, force data were hidden. Wide antral pulmonary vein isolation plus a roof line were performed. Patients were followed at 3, 6, 9, and 12 months with clinical visit, ECG, and 48-hour Holter monitoring. The primary endpoint was cumulative radiofrequency (RF) time for all procedures. Atrial arrhythmia >30 seconds after 3 months was a recurrence. PeAF was continuous for 26 weeks (interquartile range [IQR] 13-52), and left atrial size was 45 ± 5 mm. Force in the CFS-blinded and CFS-guided arms was 12 g [IQR 6-20] and 14 g [IQR 9-20] (P = .10), respectively. Total RF time did not differ between CFS-guided and CFS-blinded groups (49 ± 14 min vs 50 ± 20 min, respectively; P = .70). Single procedure freedom from atrial arrhythmia was 60% in the CFS-guided arm and 63% in the CFS-blinded arm off drugs. Lesions with gaps were associated with significantly less force (11.4 g [IQR 6-19] vs 13.2 g [IQR 8-20], respectively; P = .0007) and less force-time integral (174 gs [IQR 91-330] vs 210 gs [IQR 113-388], respectively; P <.001). CFS-guided ablation resulted in no difference to RF time or 12-month outcome. Lower force/force-time integral was associated with significantly more gaps. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Image-guided interventional procedures in the dog and cat.

PubMed

Vignoli, Massimo; Saunders, Jimmy H

2011-03-01

Medical imaging is essential for the diagnostic workup of many soft tissue and bone lesions in dogs and cats, but imaging modalities do not always allow the clinician to differentiate inflammatory or infectious conditions from neoplastic disorders. This review describes interventional procedures in dogs and cats for collection of samples for cytological or histopathological examinations under imaging guidance. It describes the indications and procedures for imaging-guided sampling, including ultrasound (US), computed tomography (CT), magnetic resonance imaging and fluoroscopy. US and CT are currently the modalities of choice in interventional imaging. Copyright © 2009 Elsevier Ltd. All rights reserved.

Fluoroscopic guide wire manipulation of malfunctioning peritoneal dialysis catheters initially placed by interventional radiologists.

PubMed

Kwon, Young Ho; Kwon, Se Hwan; Oh, Joo Hyeong; Jeong, Kyung Hwan; Lee, Tae Won

2014-06-01

To assess the efficacy of fluoroscopic guide wire manipulation in patients with malfunctioning peritoneal dialysis (PD) catheters that were initially placed by interventional radiologists under fluoroscopic guidance. From January 2002 to April 2012, 52 patients (mean age, 52.8 y ± 2.10s; range, 12-79 y) with malfunctioning PD catheters in whom fluoroscopic guide wire manipulation was performed were retrospectively reviewed. Technical success, clinical success, and complications were evaluated. Technical success was defined as fluoroscopically verified, successful catheter repositioning and adequate dialysate drainage after the procedure. Clinical success was defined as maintenance of PD catheter function for at least 30 days after the manipulation. During the study period, 72 manipulations (68 initial manipulations and 4 remanipulations) for malfunctioning PD catheters were done. The technical success rate was 74% (50 of 68) for initial manipulations and 75% (3 of 4) for remanipulations. The overall clinical success rate was 47% (32 of 68) for initial manipulations and 0% (0 of 4) for remanipulations. The primary causes of catheter malfunction were extraluminal obstruction by omental wrapping or adhesions in 43 of 68 cases (63.2%) and catheter malposition in 25 of 68 (36.8%) cases. There were no procedure-related major complications. Fluoroscopic guide wire manipulation in patients with malfunctioning PD catheters initially placed by interventional radiologists is a simple procedure, an effective way of prolonging PD catheter life, and a recommended procedure before invasive surgical procedures. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Ultrasound-guided central venous access using Google Glass.

PubMed

Wu, Teresa S; Dameff, Christian J; Tully, Jeffrey L

2014-12-01

The use of ultrasound during invasive bedside procedures is quickly becoming the standard of care. Ultrasound machine placement during procedures often requires the practitioner to turn their head during the procedure to view the screen. Such turning has been implicated in unintentional hand movements in novices. Google Glass is a head-mounted computer with a specialized screen capable of projecting images and video into the view of the wearer. Such technology may help decrease unintentional hand movements. Our aim was to evaluate whether or not medical practitioners at various levels of training could use Google Glass to perform an ultrasound-guided procedure, and to explore potential advantages of this technology. Forty participants of varying training levels were randomized into two groups. One group used Google Glass to perform an ultrasound-guided central line. The other group used traditional ultrasound during the procedure. Video recordings of eye and hand movements were analyzed. All participants from both groups were able to complete the procedure without difficulty. Google Glass wearers took longer to perform the procedure at all training levels (medical student year 1 [MS1]: 193 s vs. 77 s, p > 0.5; MS4: 197s vs. 91s, p ≤ 0.05; postgraduate year 1 [PGY1]: 288s vs. 125 s, p > 0.5; PGY3: 151 s vs. 52 s, p ≤ 0.05), and required more needle redirections (MS1: 4.4 vs. 2.0, p > 0.5; MS4: 4.8 vs. 2.8, p > 0.5; PGY1: 4.4 vs. 2.8, p > 0.5; PGY3: 2.0 vs. 1.0, p > 0.5). In this study, it was possible to perform ultrasound-guided procedures with Google Glass. Google Glass wearers, on average, took longer to gain access, and had more needle redirections, but less head movements were noted. Copyright © 2014 Elsevier Inc. All rights reserved.

Retrospective analysis of technical success rate and procedure-related complications of 867 percutaneous CT-guided needle biopsies of lung lesions.

PubMed

Mills, M; Choi, J; El-Haddad, G; Sweeney, J; Biebel, B; Robinson, L; Antonia, S; Kumar, A; Kis, B

2017-12-01

To investigate the technical success rate and procedure-related complications of computed tomography (CT)-guided needle biopsy of lung lesions and to identify the factors that are correlated with the occurrence of procedure-related complications. This was a single- institution retrospective study of 867 consecutive CT-guided needle biopsies of lung lesions performed on 772 patients in a tertiary cancer centre. The technical success rate and complications were correlated with patient, lung lesion, and procedure-related variables. The technical success rate was 87.2% and the mortality rate was 0.12%. Of the 867 total biopsies 25.7% were associated with pneumothorax, and 6.5% required chest tube drainage. The haemothorax rate was 1.8%. There was positive correlation between the development of pneumothorax and smaller lesion diameter (p<0.001), longer transparenchymal distance (p<0.001), and prone position (p=0.027). There was positive correlation between the need for chest tube placement and longer transparenchymal distance (p=0.007) and smaller lesion diameter (p=0.018). Lesions in the left lower lobe had the lowest rates of pneumothorax (p=0.008) and chest tube drainage (p=0.018). Patients whose pneumothoraces were diagnosed on the follow-up chest X-ray, but not on the immediate post-procedural CT scan had significantly higher requirement for chest tube drainage (p=0.039). CT-guided lung biopsy has a high rate of technical success and a low rate of major complications. The present study has revealed several variables that can be used to identify high-risk procedures. A post-procedural chest X-ray within hours after the procedure is highly recommended to identify high-risk patients who require chest tube placement. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma: specific technical aspects and clinical results.

PubMed

Sommer, C M; Lemm, G; Hohenstein, E; Bellemann, N; Stampfl, U; Goezen, A S; Rassweiler, J; Kauczor, H U; Radeleff, B A; Pereira, P L

2013-06-01

This study was designed to evaluate the clinical efficacy of CT-guided bipolar and multipolar radiofrequency ablation (RF ablation) of renal cell carcinoma (RCC) and to analyze specific technical aspects between both technologies. We included 22 consecutive patients (3 women; age 74.2 ± 8.6 years) after 28 CT-guided bipolar or multipolar RF ablations of 28 RCCs (diameter 2.5 ± 0.8 cm). Procedures were performed with a commercially available RF system (Celon AG Olympus, Berlin, Germany). Technical aspects of RF ablation procedures (ablation mode [bipolar or multipolar], number of applicators and ablation cycles, overall ablation time and deployed energy, and technical success rate) were analyzed. Clinical results (local recurrence-free survival and local tumor control rate, renal function [glomerular filtration rate (GFR)]) and complication rates were evaluated. Bipolar RF ablation was performed in 12 procedures and multipolar RF ablation in 16 procedures (2 applicators in 14 procedures and 3 applicators in 2 procedures). One ablation cycle was performed in 15 procedures and two ablation cycles in 13 procedures. Overall ablation time and deployed energy were 35.0 ± 13.6 min and 43.7 ± 17.9 kJ. Technical success rate was 100 %. Major and minor complication rates were 4 and 14 %. At an imaging follow-up of 15.2 ± 8.8 months, local recurrence-free survival was 14.4 ± 8.8 months and local tumor control rate was 93 %. GFR did not deteriorate after RF ablation (50.8 ± 16.6 ml/min/1.73 m(2) before RF ablation vs. 47.2 ± 11.9 ml/min/1.73 m(2) after RF ablation; not significant). CT-guided bipolar and multipolar RF ablation of RCC has a high rate of clinical success and low complication rates. At short-term follow-up, clinical efficacy is high without deterioration of the renal function.

Rail-Highway Crossing Resource Allocation Procedure - User's Guide. Third Edition

DOT National Transportation Integrated Search

1987-08-01

To assist states and railroads in determining effective allocations of Federal funds for rail-highway crossing improvements, the U.S. Department of Transportation has developed the DOT Rail-Highway Crossing Resource Allocation Procedure. The procedur...

Disinfection of a probe used in ultrasound-guided prostate biopsy.

PubMed

Rutala, William A; Gergen, Maria F; Weber, David J

2007-08-01

Transrectal ultrasound (TRUS)-guided prostate biopsies are among the most common outpatient diagnostic procedures in urology clinics and carry the risk of introducing pathogens that may lead to infection. To investigate the effectiveness of procedures for disinfecting a probe used in ultrasound-guided prostate biopsy. The effectiveness of disinfection was determined by inoculating 10(7) colony forming units (cfu) of Pseudomonas aeruginosa at the following 3 sites on the probe: the interior lumen of the biopsy needle guide, the outside surface of the biopsy needle guide, and the interior lumen of the ultrasound probe where the needle guide passes through the transducer. Each site was investigated separately. After inoculation, the probe was immersed in 2% glutaraldehyde for 20 minutes and then assessed for the level of microbial contamination. The results demonstrated that disinfection (ie, a reduction in bacterial load of greater than 7 log(10) cfu) could be achieved if the needle guide was removed from the probe. However, if the needle guide was left in the probe channel during immersion in 2% glutaraldehyde, disinfection was not achieved (ie, the reduction was approximately 1 log(10) cfu). Recommendations for probe disinfection are provided and include disassembling the device and immersing the probe and the needle guide separately in a high-level disinfectant.

In vitro model to evaluate reliability and accuracy of a dental shade-matching instrument.

PubMed

Kim-Pusateri, Seungyee; Brewer, Jane D; Dunford, Robert G; Wee, Alvin G

2007-11-01

There are several electronic shade-matching instruments available for clinical use; unfortunately, there are limited acceptable in vitro models to evaluate their reliability and accuracy. The purpose of this in vitro study was to evaluate the reliability and accuracy of a dental clinical shade-matching instrument. Using the shade-matching instrument (ShadeScan), color measurements were made of 3 commercial shade guides (VITA Classical, VITA 3D-Master, and Chromascop). Shade tabs were selected and placed in the middle of a gingival matrix (Shofu Gummy), with tabs of the same nominal shade from additional shade guides placed on both sides. Measurements were made of the central region of the shade tab inside a black box. For the reliability assessment, each shade tab from each of the 3 shade guide types was measured 10 times. For the accuracy assessment, each shade tab from 10 guides of each of the 3 types evaluated was measured once. Reliability, accuracy, and 95% confidence intervals were calculated for each shade tab. Differences were determined by 1-way ANOVA followed by the Bonferroni multiple comparison procedure. Reliability of ShadeScan was as follows: VITA Classical = 95.0%, VITA 3D-Master = 91.2%, and Chromascop = 76.5%. Accuracy of ShadeScan was as follows: VITA Classical = 65.0%, VITA 3D-Master = 54.2%, Chromascop = 84.5%. This in vitro study showed a varying degree of reliability and accuracy for ShadeScan, depending on the type of shade guide system used.

V-TECS Guide for Data Processing.

ERIC Educational Resources Information Center

Gregory, Margaret R.; Benson, Robert T.

This curriculum guide is intended to train trade and industrial education students in the hands-on aspects of the occupation of data processor. Included in the guide are course outlines that address the following topics: developing job descriptions; performing power-on and power-off procedures; loading the operating systems, programs, files, and…

Community Development Guide. "A Guide for Restructuring Community Development in Agricultural Education."

ERIC Educational Resources Information Center

Wagley, Leon A.; And Others

Information designed to acquaint teachers, teacher educators, and state supervisors of agricultural education with the concepts, roles, and procedures for developing a community development curriculum is presented in this guide. The first section is concerned with suggestions for restructuring materials relevant to teaching community development…

V-TECS Guide for Cosmetology (Cosmetologists).

ERIC Educational Resources Information Center

Gregory, Margaret R.; Benson, Robert T.

This curriculum guide is intended to train trade and industrial education students in the hands-on aspects of the occupation of cosmetologist. Included in the guide are course outlines that address the following topics: following safety and sanitation procedures in managing a salon; shampooing, conditioning, cutting, and styling hair; permanent…

The Food-Safe Schools Action Guide

ERIC Educational Resources Information Center

Centers for Disease Control and Prevention, 2007

2007-01-01

"The Food-Safe School Needs Assessment and Planning Guide" is a tool that can help schools assess their food safety policies, procedures, and programs and develop plans for improvement. This tool includes a simple, straightforward questionnaire, score card, and planning guide that give administrators, school staff, families, and students a chance…

Project Earth, A Curriculum Guide, Kindergarten-Primary-Intermediate.

ERIC Educational Resources Information Center

Rogers, Arnold R., Ed.

This conservation curriculum guide contains units on the air, water, soil, plants, and animals. The guide is organized by grade levels--kindergarten, primary, intermediate. Objectives and concepts are listed and suggested activities are complete with a statement of procedure and necessary materials. A resource appendix includes books, films, and…

Driver and Traffic Safety Education Curriculum Guide.

ERIC Educational Resources Information Center

Massachusetts State Dept. of Education, Boston. Bureau of Elementary and Secondary Education.

Materials contained in this Massachusetts curriculum guide are based on concepts and procedures developed by the Highway Users Federation for Safety and Mobility. The guide examines the philosophy of driver education, discusses such legal aspects as certification of students and teachers, presents a comprehensive classroom and behind-the-wheel…

Best Practice Guide: A Resource for Receiving Institutions

ERIC Educational Resources Information Center

British Columbia Council on Admissions and Transfer, 2008

2008-01-01

This guide has been developed primarily for institutions in the British Columbia (BC) Transfer System interested in seeking designation as receiving institutions. Institutions are encouraged to consult this guide and use those sections most relevant to their needs. Areas discussed include: (1) Policy, Procedure and Record-Keeping; (2) Transfer and…

Collegiate Drug Management Guide.

ERIC Educational Resources Information Center

Janosik, Steven M.; Anderson, David S.

A checklist to help colleges and universities reevaluate their policies and procedures regarding drug use among college students is presented. It is designed to supplement the "Collegiate Alcohol Risk Assessment Guide." In this guide drugs other than alcohol are of concern, although alcohol is viewed by many as the "drug of choice" among college…

21 CFR 886.4300 - Intraocular lens guide.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) MEDICAL DEVICES OPHTHALMIC DEVICES Surgical Devices § 886.4300 Intraocular lens guide. (a) Identification. An intraocular lens guide is a device intended to be inserted into the eye during surgery to direct... lenses, the device is exempt from the premarket notification procedures in subpart E of part 807 of this...

Anaesthetics, steroids and platelet-rich plasma (PRP) in ultrasound-guided musculoskeletal procedures

PubMed Central

La Marra, Alice; Arrigoni, Francesco; Mariani, Silvia; Zugaro, Luigi; Splendiani, Alessandra; Di Cesare, Ernesto; Reginelli, Alfonso; Zappia, Marcello; Brunese, Luca; Duka, Ejona; Carrafiello, Giampaolo; Masciocchi, Carlo

2016-01-01

This review aims to evaluate the role of anaesthetics, steroids and platelet-rich plasma (PRP) employed with ultrasound-guided injection in the management of musculoskeletal pathology of the extremities. Ultrasound-guided injection represents an interesting and minimally invasive solution for the treatment of tendon and joint inflammatory or degenerative diseases. The availability of a variety of new drugs such as hyaluronic acid and PRP provides expansion of the indications and therapeutic possibilities. The clinical results obtained in terms of pain reduction and functional recovery suggest that the use of infiltrative procedures can be a good therapeutic alternative in degenerative and inflammatory joint diseases. PMID:27302491

Anaesthetics, steroids and platelet-rich plasma (PRP) in ultrasound-guided musculoskeletal procedures.

PubMed

Barile, Antonio; La Marra, Alice; Arrigoni, Francesco; Mariani, Silvia; Zugaro, Luigi; Splendiani, Alessandra; Di Cesare, Ernesto; Reginelli, Alfonso; Zappia, Marcello; Brunese, Luca; Duka, Ejona; Carrafiello, Giampaolo; Masciocchi, Carlo

2016-09-01

This review aims to evaluate the role of anaesthetics, steroids and platelet-rich plasma (PRP) employed with ultrasound-guided injection in the management of musculoskeletal pathology of the extremities. Ultrasound-guided injection represents an interesting and minimally invasive solution for the treatment of tendon and joint inflammatory or degenerative diseases. The availability of a variety of new drugs such as hyaluronic acid and PRP provides expansion of the indications and therapeutic possibilities. The clinical results obtained in terms of pain reduction and functional recovery suggest that the use of infiltrative procedures can be a good therapeutic alternative in degenerative and inflammatory joint diseases.

Toward magnetic resonance-guided electroanatomical voltage mapping for catheter ablation of scar-related ventricular tachycardia: a comparison of registration methods.

PubMed

Tao, Qian; Milles, Julien; VAN Huls VAN Taxis, Carine; Lamb, Hildo J; Reiber, Johan H C; Zeppenfeld, Katja; VAN DER Geest, Rob J

2012-01-01

Integration of preprocedural delayed enhanced magnetic resonance imaging (DE-MRI) with electroanatomical voltage mapping (EAVM) may provide additional high-resolution substrate information for catheter ablation of scar-related ventricular tachycardias (VT). Accurate and fast image integration of DE-MRI with EAVM is desirable for MR-guided ablation. Twenty-six VT patients with large transmural scar underwent catheter ablation and preprocedural DE-MRI. With different registration models and EAVM input, 3 image integration methods were evaluated and compared to the commercial registration module CartoMerge. The performance was evaluated both in terms of distance measure that describes surface matching, and correlation measure that describes actual scar correspondence. Compared to CartoMerge, the method that uses the translation-and-rotation model and high-density EAVM input resulted in a registration error of 4.32±0.69 mm as compared to 4.84 ± 1.07 (P <0.05); the method that uses the translation model and high-density EAVM input resulted in a registration error of 4.60 ± 0.65 mm (P = NS); and the method that uses the translation model and a single anatomical landmark input resulted in a registration error of 6.58 ± 1.63 mm (P < 0.05). No significant difference in scar correlation was observed between all 3 methods and CartoMerge (P = NS). During VT ablation procedures, accurate integration of EAVM and DE-MRI can be achieved using a translation registration model and a single anatomical landmark. This model allows for image integration in minimal mapping time and is likely to reduce fluoroscopy time and increase procedure efficacy. © 2011 Wiley Periodicals, Inc.

Transcranial MRI-guided FUS-induced BBB opening in the rat brain

NASA Astrophysics Data System (ADS)

Treat, Lisa H.; McDannold, Nathan J.; Hynynen, Kullervo

2004-05-01

The blood-brain barrier (BBB) has been a major limitation in treating diseases of the brain because therapeutic agents are either unable to penetrate or have dose-limiting side effects in diffuse opening of the BBB. A previous study demonstrated that focused ultrasound (FUS) can locally open the BBB in a rabbit model when a piece of skull is removed and that magnetic resonance imaging (MRI) can be used to guide and monitor the procedure. This study examined whether the same desired effect of local BBB disruption can be achieved by applying FUS through an intact skull in a rat model. Twenty-eight Sprague-Dawley rats were anesthetized, shaved, and sonicated at four focal locations in the brain, using a 1.5-MHz focused transducer. Contrast-enhanced MR images were obtained before and after sonication. The images indicated contrast agent penetration at the focal coordinates following Optison-enhanced sonication. This study demonstrated that the distortion of the ultrasound beam by the rat skull was not significant enough to inhibit focal BBB opening. Subsequent experiments using MRI-guided FUS to aid in targeted drug delivery to brain tumors in a rodent model could thus be performed more efficiently without cranial surgery. [Research funded by NIH Grant No. CA76550.

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

Burge, S.W.

This report describes the theory and structure of the FORCE2 flow program. The manual describes the governing model equations, solution procedure and their implementation in the computer program. FORCE2 is an extension of an existing B&V multidimensional, two-phase flow program. FORCE2 was developed for application to fluid beds by flow implementing a gas-solids modeling technology derived, in part, during a joint government -- industry research program, ``Erosion of FBC Heat Transfer Tubes,`` coordinated by Argonne National Laboratory. The development of FORCE2 was sponsored by ASEA-Babcock, an industry participant in this program. This manual is the principal documentation for the programmore » theory and organization. Program usage and post-processing of code predictions with the FORCE2 post-processor are described in a companion report, FORCE2 -- A Multidimensional Flow Program for Fluid Beds, User`s Guide. This manual is segmented into sections to facilitate its usage. In section 2.0, the mass and momentum conservation principles, the basis for the code, are presented. In section 3.0, the constitutive relations used in modeling gas-solids hydrodynamics are given. The finite-difference model equations are derived in section 4.0 and the solution procedures described in sections 5.0 and 6.0. Finally, the implementation of the model equations and solution procedure in FORCE2 is described in section 7.0.« less

A procedure to evaluate environmental rehabilitation in limestone quarries.

PubMed

Neri, Ana Claudia; Sánchez, Luis Enrique

2010-11-01

A procedure to evaluate mine rehabilitation practices during the operational phase was developed and validated. It is based on a comparison of actually observed or documented practices with internationally recommended best practices (BP). A set of 150 BP statements was derived from international guides in order to establish the benchmark. The statements are arranged in six rehabilitation programs under three categories: (1) planning (2) operational and (3) management, corresponding to the adoption of the plan-do-check-act management systems model to mine rehabilitation. The procedure consists of (i) performing technical inspections guided by a series of field forms containing BP statements; (ii) classifying evidences in five categories; and (iii) calculating conformity indexes and levels. For testing and calibration purposes, the procedure was applied to nine limestone quarries and conformity indexes were calculated for the rehabilitation programs in each quarry. Most quarries featured poor planning practices, operational practices reached high conformity levels in 50% of the cases and management practices scored moderate conformity. Despite all quarries being ISO 14001 certified, their management systems pay low attention to issues pertaining to land rehabilitation and biodiversity. The best results were achieved by a quarry whose expansion was recently submitted to the environmental impact assessment process, suggesting that public scrutiny may play a positive role in enhancing rehabilitation practices. Conformity indexes and levels can be used to chart the evolution of rehabilitation practices at regular intervals, to establish corporate goals and for communication with stakeholders. Copyright 2010 Elsevier Ltd. All rights reserved.

NOTE: Development and preliminary evaluation of a prototype audiovisual biofeedback device incorporating a patient-specific guiding waveform

NASA Astrophysics Data System (ADS)

Venkat, Raghu B.; Sawant, Amit; Suh, Yelin; George, Rohini; Keall, Paul J.

2008-06-01

The aim of this research was to investigate the effectiveness of a novel audio-visual biofeedback respiratory training tool to reduce respiratory irregularity. The audiovisual biofeedback system acquires sample respiratory waveforms of a particular patient and computes a patient-specific waveform to guide the patient's subsequent breathing. Two visual feedback models with different displays and cognitive loads were investigated: a bar model and a wave model. The audio instructions were ascending/descending musical tones played at inhale and exhale respectively to assist in maintaining the breathing period. Free-breathing, bar model and wave model training was performed on ten volunteers for 5 min for three repeat sessions. A total of 90 respiratory waveforms were acquired. It was found that the bar model was superior to free breathing with overall rms displacement variations of 0.10 and 0.16 cm, respectively, and rms period variations of 0.77 and 0.33 s, respectively. The wave model was superior to the bar model and free breathing for all volunteers, with an overall rms displacement of 0.08 cm and rms periods of 0.2 s. The reduction in the displacement and period variations for the bar model compared with free breathing was statistically significant (p = 0.005 and 0.002, respectively); the wave model was significantly better than the bar model (p = 0.006 and 0.005, respectively). Audiovisual biofeedback with a patient-specific guiding waveform significantly reduces variations in breathing. The wave model approach reduces cycle-to-cycle variations in displacement by greater than 50% and variations in period by over 70% compared with free breathing. The planned application of this device is anatomic and functional imaging procedures and radiation therapy delivery.

Thermal fixation of swine liver tissue after magnetic resonance-guided high-intensity focused ultrasound ablation.

PubMed

Courivaud, Frédéric; Kazaryan, Airazat M; Lund, Alice; Orszagh, Vivian C; Svindland, Aud; Marangos, Irina Pavlik; Halvorsen, Per Steinar; Jebsen, Peter; Fosse, Erik; Hol, Per Kristian; Edwin, Bjørn

2014-07-01

The aim of this study was to investigate experimental conditions for efficient and controlled in vivo liver tissue ablation by magnetic resonance (MR)-guided high-intensity focused ultrasound (HIFU) in a swine model, with the ultimate goal of improving clinical treatment outcome. Histological changes were examined both acutely (four animals) and 1 wk after treatment (five animals). Effects of acoustic power and multiple sonication cycles were investigated. There was good correlation between target size and observed ablation size by thermal dose calculation, post-procedural MR imaging and histopathology, when temperature at the focal point was kept below 90°C. Structural histopathology investigations revealed tissue thermal fixation in ablated regions. In the presence of cavitation, mechanical tissue destruction occurred, resulting in an ablation larger than the target. Complete extra-corporeal MR-guided HIFU ablation in the liver is feasible using high acoustic power. Nearby large vessels were preserved, which makes MR-guided HIFU promising for the ablation of liver tumors adjacent to large veins. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Tensor-guided fitting of subduction slab depths

USGS Publications Warehouse

Bazargani, Farhad; Hayes, Gavin P.

2013-01-01

Geophysical measurements are often acquired at scattered locations in space. Therefore, interpolating or fitting the sparsely sampled data as a uniform function of space (a procedure commonly known as gridding) is a ubiquitous problem in geophysics. Most gridding methods require a model of spatial correlation for data. This spatial correlation model can often be inferred from some sort of secondary information, which may also be sparsely sampled in space. In this paper, we present a new method to model the geometry of a subducting slab in which we use a data‐fitting approach to address the problem. Earthquakes and active‐source seismic surveys provide estimates of depths of subducting slabs but only at scattered locations. In addition to estimates of depths from earthquake locations, focal mechanisms of subduction zone earthquakes also provide estimates of the strikes of the subducting slab on which they occur. We use these spatially sparse strike samples and the Earth’s curved surface geometry to infer a model for spatial correlation that guides a blended neighbor interpolation of slab depths. We then modify the interpolation method to account for the uncertainties associated with the depth estimates.

A methodology to guide the selection of composite materials in a wind turbine rotor blade design process

NASA Astrophysics Data System (ADS)

Bortolotti, P.; Adolphs, G.; Bottasso, C. L.

2016-09-01

This work is concerned with the development of an optimization methodology for the composite materials used in wind turbine blades. Goal of the approach is to guide designers in the selection of the different materials of the blade, while providing indications to composite manufacturers on optimal trade-offs between mechanical properties and material costs. The method works by using a parametric material model, and including its free parameters amongst the design variables of a multi-disciplinary wind turbine optimization procedure. The proposed method is tested on the structural redesign of a conceptual 10 MW wind turbine blade, its spar caps and shell skin laminates being subjected to optimization. The procedure identifies a blade optimum for a new spar cap laminate characterized by a higher longitudinal Young's modulus and higher cost than the initial one, which however in turn induce both cost and mass savings in the blade. In terms of shell skin, the adoption of a laminate with intermediate properties between a bi-axial one and a tri-axial one also leads to slight structural improvements.

Efficacy of a novel IGS system in atrial septal defect repair

NASA Astrophysics Data System (ADS)

Mefleh, Fuad N.; Baker, G. Hamilton; Kwartowitz, David M.

2013-03-01

Congenital heart disease occurs in 107.6 out of 10,000 live births, with Atrial Septal Defects (ASD) accounting for 10% of these conditions. Historically, ASDs were treated with open heart surgery using cardiopulmonary bypass, allowing a patch to be sewn over the defect. In 1976, King et al. demonstrated use of a transcatheter occlusion procedure, thus reducing the invasiveness of ASD repair. Localization during these catheter based procedures traditionally has relied on bi-plane fluoroscopy; more recently trans-esophageal echocardiography (TEE) and intra-cardiac echocardiography (ICE) have been used to navigate these procedures. Although there is a high success rate using the transcatheter occlusion procedure, fluoroscopy poses radiation dose risk to both patient and clinician. The impact of this dose to the patients is important as many of those undergoing this procedure are children, who have an increased risk associated with radiation exposure. Their longer life expectancy than adults provides a larger window of opportunity for expressing the damaging effects of ionizing radiation. In addition, epidemiologic studies of exposed populations have demonstrated that children are considerably more sensitive to the carcinogenic effects radiation. Image-guided surgery (IGS) uses pre-operative and intra-operative images to guide surgery or an interventional procedure. Central to every IGS system is a software application capable of processing and displaying patient images, registration between multiple coordinate systems, and interfacing with a tool tracking system. We have developed a novel image-guided surgery framework called Kit for Navigation by Image Focused Exploration (KNIFE). In this work we assess the efficacy of this image-guided navigation system for ASD repair using a series of mock clinical experiments designed to simulate ASD repair device deployment.

The Gemini-South MCAO operational model: insights on a new era of telescope operation

NASA Astrophysics Data System (ADS)

Trancho, Gelys; Bec, Matthieu; Artigau, Etienne; d'Orgeville, Celine; Gratadour, Damien; Rigaut, Francois J.; Walls, Brian

2008-07-01

The Gemini Observatory is implementing a Multi-Conjugate Adaptive Optics (MCAO) system as a facility instrument for the Gemini South telescope (GeMS). The system will include 5 Laser Guide Stars, 3 Natural Guide Stars, and 3 deformable mirrors, optically conjugated at different altitudes, to achieve near-uniform atmospheric compensation over a one arc minute square field of view. This setup implies some level of operational complexity. In this paper we describe how GeMS will be integrated into the flow of Gemini operations, from the observing procedures necessary to execute the programs in the queue (telescope control software, observing tools, sequence executor) to the safety implementation needed such as spotters/ASCAM, space command and laser traffic control software.

A practical guide to the Piccolo autopilot

NASA Astrophysics Data System (ADS)

Mornhinweg, Anton

In support of a UAV contract the Piccolo SL and Piccolo II autopilots were installed and operated on various aircraft. Numerous problems with the autopilot setup and analysis processes were found along with numerous problems with documentation and autopilot system information. Major areas of concern are identified along with objectives to eliminate the major areas of concern. Piccolo simulator vehicle gain calculations and Piccolo generation 2 version 2.1.4 control laws are reverse engineered. A complete modeling guide is created. Methods are developed to perform and analyze doublet maneuvers. A series of flight procedures are outlined that include methods for tuning gains. A series of MATLAB graphical user interfaces were created to analyze flight data and pertinent control loop data for gain tuning.

Transit Security Procedures Guide

DOT National Transportation Integrated Search

1994-12-01

To protect passenger, employees, revenue, and property, transit systems are encouraged to take a proactive, prevention-oriented systems approach to transit security. This guide is a compilation of materials for planning and improving transit security...

Simulation: Moving from Technology Challenge to Human Factors Success

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

Gould, Derek A., E-mail: dgould@liv.ac.uk; Chalmers, Nicholas; Johnson, Sheena J.

2012-06-15

Recognition of the many limitations of traditional apprenticeship training is driving new approaches to learning medical procedural skills. Among simulation technologies and methods available today, computer-based systems are topical and bring the benefits of automated, repeatable, and reliable performance assessments. Human factors research is central to simulator model development that is relevant to real-world imaging-guided interventional tasks and to the credentialing programs in which it would be used.

Hypertext: Improved Capability for Shipboard Naval Messages

DTIC Science & Technology

1989-09-01

message handling system; a complete working model of the system has not been developed . 3 D. ORGANIZATION OF STUDY 1. The "Paperless" Ship Initiative...work in tandem to improve afloat message handling procedures. The objective of the PCMT project is to develop a system that could be installed on...working group has identified a list of requirements to guide the DoD’s progress towards improving its message communication system. These

CT fluoroscopy-guided renal tumour cutting needle biopsy: retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure.

PubMed

Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Sakurai, Jun; Masaoka, Yoshihisa; Gobara, Hideo; Kanazawa, Susumu

2018-01-01

To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy. Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9-8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure. After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362-10.326; P = 0.011) to be a significant risk factor for diagnostic failure. CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure. • CT fluoroscopy-guided renal tumour biopsy has a high diagnostic yield. • CT fluoroscopy-guided renal tumour biopsy is safe. • Small tumour size (≤1.5 cm) is a risk factor for diagnostic failure.

Utility and Safety of Endoscopic Ultrasound With Bronchoscope-Guided Fine-Needle Aspiration in Mediastinal Lymph Node Sampling: Systematic Review and Meta-Analysis.

PubMed

Dhooria, Sahajal; Aggarwal, Ashutosh N; Gupta, Dheeraj; Behera, Digambar; Agarwal, Ritesh

2015-07-01

The use of endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) has been described in the evaluation of mediastinal lymphadenopathy. Herein, we conduct a meta-analysis to estimate the overall diagnostic yield and safety of EUS-B-FNA combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), in the diagnosis of mediastinal lymphadenopathy. The PubMed and EmBase databases were searched for studies reporting the outcomes of EUS-B-FNA in diagnosis of mediastinal lymphadenopathy. The study quality was assessed using the QualSyst tool. The yield of EBUS-TBNA alone and the combined procedure (EBUS-TBNA and EUS-B-FNA) were analyzed by calculating the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio for each study, and pooling the study results using a random effects model. Heterogeneity and publication bias were assessed for individual outcomes. The additional diagnostic gain of EUS-B-FNA over EBUS-TBNA was calculated using proportion meta-analysis. Our search yielded 10 studies (1,080 subjects with mediastinal lymphadenopathy). The sensitivity of the combined procedure was significantly higher than EBUS-TBNA alone (91% vs 80%, P = .004), in staging of lung cancer (4 studies, 465 subjects). The additional diagnostic gain of EUS-B-FNA over EBUS-TBNA was 7.6% in the diagnosis of mediastinal adenopathy. No serious complication of EUS-B-FNA procedure was reported. Clinical and statistical heterogeneity was present without any evidence of publication bias. Combining EBUS-TBNA and EUS-B-FNA is an effective and safe method, superior to EBUS-TBNA alone, in the diagnosis of mediastinal lymphadenopathy. Good quality randomized controlled trials are required to confirm the results of this systematic review. Copyright © 2015 by Daedalus Enterprises.

Feasibility of virtual 3-Fr percutaneous coronary intervention using standard guiding catheters

PubMed Central

Fujimoto, Kazuteru; Miyao, Yuji

2014-01-01

Introduction Recent studies have reported the efficacy of sheathless percutaneous coronary intervention (PCI) using hydrophilic-coated 5-Fr guiding catheters that are one to two Fr sizes smaller in diameter than the corresponding introducer sheath (virtual 3-Fr PCI). However, the limited number of shapes of hydrophilic-coated guiding catheters occasionally makes them difficult to engage and control. Aim To evaluate the efficacy and feasibility of virtual 3-Fr PCI using standard guiding catheters of various shapes. Material and methods We identified 35 consecutive patients with stable angina, who underwent virtual 3-Fr PCI using either hydrophilic-coated guiding catheters (Works™, Medikit, Japan) or standard guiding catheters (Heartrail™, Terumo, Japan). Results Thirty-five patients were identified (63% men; mean age 70 ±13 years). In 2 cases, hydrophilic-coated guiding catheters were exchanged to standard guiding catheters because of difficulty in engaging the target coronary arteries. Ultimately, standard guiding catheters were used in 20 patients (57%) and hydrophilic-coated catheters were used in 15 (43%). One of 20 patients treated with standard guiding catheters and 1 of 15 treated with hydrophilic-coated guiding catheters underwent the 4-in-3 “slender mother and child” PCI technique due to difficulty of stent deployment. There were no differences between the two groups in PCI procedural variables such as procedural time, fluoroscopy time, radiation dose, or contrast dye volume. There were no access site-related complications in this study. Conclusions These findings indicate that virtual 3-Fr PCI using standard guiding catheters is as efficient and safe as virtual 3-Fr PCI using hydrophilic-coated guiding catheters. PMID:25489315

When Is Rapid On-Site Evaluation Cost-Effective for Fine-Needle Aspiration Biopsy?

PubMed Central

Schmidt, Robert L.; Walker, Brandon S.; Cohen, Michael B.

2015-01-01

Background Rapid on-site evaluation (ROSE) can improve adequacy rates of fine-needle aspiration biopsy (FNAB) but increases operational costs. The performance of ROSE relative to fixed sampling depends on many factors. It is not clear when ROSE is less costly than sampling with a fixed number of needle passes. The objective of this study was to determine the conditions under which ROSE is less costly than fixed sampling. Methods Cost comparison of sampling with and without ROSE using mathematical modeling. Models were based on a societal perspective and used a mechanistic, micro-costing approach. Sampling policies (ROSE, fixed) were compared using the difference in total expected costs per case. Scenarios were based on procedure complexity (palpation-guided or image-guided), adequacy rates (low, high) and sampling protocols (stopping criteria for ROSE and fixed sampling). One-way, probabilistic, and scenario-based sensitivity analysis was performed to determine which variables had the greatest influence on the cost difference. Results ROSE is favored relative to fixed sampling under the following conditions: (1) the cytologist is accurate, (2) the total variable cost ($/hr) is low, (3) fixed costs ($/procedure) are high, (4) the setup time is long, (5) the time between needle passes for ROSE is low, (6) when the per-pass adequacy rate is low, and (7) ROSE stops after observing one adequate sample. The model is most sensitive to variation in the fixed cost, the per-pass adequacy rate, and the time per needle pass with ROSE. Conclusions Mathematical modeling can be used to predict the difference in cost between sampling with and without ROSE. PMID:26317785

Use of patient specific 3D printed (3DP) neurovascular phantoms for mechanical assessment of devices used in image guided minimally invasive procedures

NASA Astrophysics Data System (ADS)

Tabaczynski, Janelle R.; Stoll, Thomas; Shepard, Lauren; Siddiqui, Mohamed I. G.; Karkhanis, Nitant V.; Sommer, Kelsey; Siddiqui, Adnan H.; Ionita, Ciprian N.

2018-03-01

Patient-specific 3D printed phantoms (3DP) can reproduce accurate patient geometry and provide precise tools for Endovascular Image Guided Interventions (EIGI) simulations. We propose to build and test 3DP phantoms which mimic the arterial wall elasticity and surface properties and demonstrate their utility in comprehensive EIGI simulations. 3DP idealized and patient specific vascular phantoms were manufactured using Stratasys Objet 500 Connex 3. The idealized phantoms were created using a sine wave shape, patient specific phantoms were based on CT- angiography volumes. The phantoms were coated with a hydrophilic material to mimic vascular surface properties. We tested various endovascular procedures using an Interventional Device Testing Equipment (IDTE) 2000 and measured push/pull force used to actuate endovascular devices during EIGIs. The force needed to advance devices in neurovascular phantoms varied based on tortuosity, material and coating, ranging from -3 to 21 grams-force. Hydrophilic coating reduced maximum force from 21 to 4.8 grams-force in the same model. IDTE 2000 results of neurovascular models were compared to hand manipulation of guidewire access using a six-axis force sensor with forces ranging from -50 to 440 grams. The clot retriever tested in carotid models experienced most friction around tortuous bends ranging from -65 to -90 grams-force, with increasing rigidity of materials creating increased friction. Sine wave model forces varied from -2 to 105 grams. 3DP allows manufacturing of vascular phantoms with precise mechanical and surface properties which can be used for EIGI simulations for imaging protocol optimization and device behavior assessment.

Technical procedures for template-guided surgery for mandibular reconstruction based on digital design and manufacturing.

PubMed

Liu, Yun-feng; Xu, Liang-wei; Zhu, Hui-yong; Liu, Sean Shih-Yao

2014-05-23

The occurrence of mandibular defects caused by tumors has been continuously increasing in China in recent years. Conversely, results of the repair of mandibular defects affect the recovery of oral function and patient appearance, and the requirements for accuracy and high surgical quality must be more stringent. Digital techniques--including model reconstruction based on medical images, computer-aided design, and additive manufacturing--have been widely used in modern medicine to improve the accuracy and quality of diagnosis and surgery. However, some special software platforms and services from international companies are not always available for most of researchers and surgeons because they are expensive and time-consuming. Here, a new technical solution for guided surgery for the repair of mandibular defects is proposed, based on general popular tools in medical image processing, 3D (3 dimension) model reconstruction, digital design, and fabrication via 3D printing. First, CT (computerized tomography) images are processed to reconstruct the 3D model of the mandible and fibular bone. The defect area is then replaced by healthy contralateral bone to create the repair model. With the repair model as reference, the graft shape and cutline are designed on fibular bone, as is the guide for cutting and shaping. The physical model, fabricated via 3D printing, including surgical guide, the original model, and the repair model, can be used to preform a titanium locking plate, as well as to design and verify the surgical plan and guide. In clinics, surgeons can operate with the help of the surgical guide and preformed plate to realize the predesigned surgical plan. With sufficient communication between engineers and surgeons, an optimal surgical plan can be designed via some common software platforms but needs to be translated to the clinic. Based on customized models and tools, including three surgical guides, preformed titanium plate for fixation, and physical models of the mandible, grafts for defect repair can be cut from fibular bone, shaped with high accuracy during surgery, and fixed with a well-fitting preformed locking plate, so that the predesigned plan can be performed in the clinic and the oral function and appearance of the patient are recovered. This method requires 20% less operating time compared with conventional surgery, and the advantages in cost and convenience are significant compared with those of existing commercial services in China. This comparison between two groups of cases illustrates that, with the proposed method, the accuracy of mandibular defect repair surgery is increased significantly and is less time-consuming, and patients are satisfied with both the recovery of oral function and their appearance. Until now, more than 15 cases have been treated with the proposed methods, so their feasibility and validity have been verified.

Library Information Desk. An Organizational and Operating Guide.

ERIC Educational Resources Information Center

Souza, Mary Beth

Intended for those who manage, organize, and oversee the information desk of the State University of New York at Stony Brook Library, this guide contains practical information about staffing, acquiring materials, and operating procedures. The guide opens with a list of suggestions for recruiting and scheduling volunteers for the information desk.…

Oakland County Science Safety Series: Reference Guide for Elementary Science.

ERIC Educational Resources Information Center

Crowder, Betty Pogue; And Others

This reference guide is designed to organize and suggest acceptable practices and procedures for dealing with safety in elementary science instruction. It is intended as a reference for teachers, administrators, and other school staff in planning for science activities and in making daily safety decisions. Topics covered in the guide include: (1)…

Le Temps, des sucres [Sugaring-Off Time]. Teacher's Guide.

ERIC Educational Resources Information Center

Ullmann, Rebecca; And Others

A resource kit for the teaching of listening comprehension in French at the beginning elementary level is represented by a teacher's guide and a handbook entitled "The Maple Sugar Industry." The guide offers sample activities and lesson plans, as well as a complete procedure for conducting a listening comprehension test. Instructions are given for…

The Balancing Act: How Utility Rates Are Decided. Teacher/Facilitator's Guide.

ERIC Educational Resources Information Center

American Gas Association, Arlington, VA. Educational Services.

Designed for secondary level students, this guide describes the process of establishing utility rates for gas, electricity, telephone, or water services. Insights are presented into the parties and interests involved in rate changes, along with procedures and issues that influence decision-making. The goals of this teaching guide include: (1)…

Safety in the Science Laboratory, A Guide.

ERIC Educational Resources Information Center

Christian, Floyd T.

The bulletin was prepared as a general guide to encourage the use of safe practices in science laboratories in Florida schools. The guide begins with an outline of recommended emergency procedures. Chapter I discusses the importance of safety in the science program. Chapter II discusses handling and storage of equipment, and designing laboratory…

Drying Beds. Sludge Treatment and Disposal Course #166. Instructor's Guide [and] Student Workbook.

ERIC Educational Resources Information Center

Klopping, Paul H.

Provided in this lesson is introductory material on sand and surfaced sludge drying beds. Typical construction and operation, proper maintenance, and safety procedures are considered. The lesson includes an instructor's guide and student workbook. The instructor's guide contains a description of the lesson, estimated presentation time,…

Coding the Composing Process: A Guide for Teachers and Researchers.

ERIC Educational Resources Information Center

Perl, Sondra

Designed for teachers and researchers interested in the study of the composing process, this guide introduces a method of analysis that can be applied to data from a range of different cases. Specifically, the guide offers a simple, direct coding scheme for describing the movements occurring during composing that involves four procedures: teaching…

Guide for Improving NRS Data Quality: Procedures for Data Collection and Training.

ERIC Educational Resources Information Center

Condelli, Larry; Castillo, Laura; Seburn, Mary; Deveaux, Jon

This guide for improving the quality of National Reporting System for Adult Education (NRS) data through improved data collection and training is intended for local providers and state administrators. Chapter 1 explains the guide's purpose, contents, and use and defines the following components of data quality: objectivity; integrity;…

A Guide for Developing the Instructional Program in Agricultural Mechanics.

ERIC Educational Resources Information Center

Illinois State Board of Vocational Education and Rehabilitation, Springfield. Div. of Vocational and Technical Education.

This bulletin contains materials suggested for use by agricultural teachers in the improvement of their agricultural mechanics programs. In its function as a guide to planning a teaching program in agricultural mechanics the document outlines the principles and procedures in course planning, 12 guiding concepts in the teaching of agricultural…

Widening Horizons: A Guide to Organizing Field Trips for Adult Students. Final Report.

ERIC Educational Resources Information Center

Lutheran Social Mission Society, Philadelphia, PA. Lutheran Settlement House.

Based on a successful program for women conducted by Lutheran Settlement House in Philadelphia, this guide outlines step-by-step procedures for conducting educational field trips for students in adult basic education programs. The guide offers suggestions for identification of cultural, historical, and social resources that would provide valuable…

Joining the On-Line Community. An Introduction for Adult Literacy. Practice Guide.

ERIC Educational Resources Information Center

Rethemeyer, R. Karl

This technology guide is intended to introduce adult literacy providers to the concepts,hardware, and procedures of online communication. The six-part guide explains the following: (1) what electronic networks are; (2) why adult literacy practitioners may want to join the Internet; (3) how adult literacy practitioners are already using the…

Brakes. Auto Mechanics Curriculum Guide. Module 6. Instructor's Guide.

ERIC Educational Resources Information Center

Allain, Robert

This module is the sixth of nine modules in the competency-based Missouri Auto Mechanics Curriculum Guide. Eight units cover: introduction to automotive brake systems; disc and drum brake system components and how they operate; properties of brake fluid and procedures for bleeding the brake system; diagnosing and determining needed repairs on…

Guide for Teacher Preparation in Driver Education. Driving School Edition.

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This guide provides operators of driving schools with a body of information and procedures that will enable them to develop programs capable of meeting the particular needs of their students, and capable of being administered within the resources available to them. The guide does not attempt to prescribe one specific instructional program but…

SilMush: A procedure for modeling of the geochemical evolution of silicic magmas and granitic rocks

NASA Astrophysics Data System (ADS)

Hertogen, Jan; Mareels, Joyce

2016-07-01

A boundary layer crystallization modeling program is presented that specifically addresses the chemical fractionation in silicic magma systems and the solidification of plutonic bodies. The model is a Langmuir (1989) type approach and does not invoke crystal settling in high-viscosity silicic melts. The primary aim is to model a granitic rock as a congealed crystal-liquid mush, and to integrate major element and trace element modeling. The procedure allows for some exploratory investigation of the exsolution of H2O-fluids and of the fluid/melt partitioning of trace elements. The procedure is implemented as a collection of subroutines for the MS Excel spreadsheet environment and is coded in the Visual Basic for Applications (VBA) language. To increase the flexibility of the modeling, the procedure is based on discrete numeric process simulation rather than on solution of continuous differential equations. The program is applied to a study of the geochemical variation within and among three granitic units (Senones, Natzwiller, Kagenfels) from the Variscan Northern Vosges Massif, France. The three units cover the compositional range from monzogranite, over syenogranite to alkali-feldspar granite. An extensive set of new major element and trace element data is presented. Special attention is paid to the essential role of accessory minerals in the fractionation of the Rare Earth Elements. The crystallization model is able to reproduce the essential major and trace element variation trends in the data sets of the three separate granitic plutons. The Kagenfels alkali-feldspar leucogranite couples very limited variation in major element composition to a considerable and complex variation of trace elements. The modeling results can serve as a guide for the reconstruction of the emplacement sequence of petrographically distinct units. Although the modeling procedure essentially deals with geochemical fractionation within a single pluton, the modeling results bring up a number of questions about the petrogenetic relationships among parental magmas of nearly coeval granitic units emplaced in close proximity.

Recent Advances in Image Assisted Neurosurgical Procedures: Improved Navigational Accuracy and Patient Safety

ScienceCinema

Olivi, Alessandro, M.D.

2017-12-09

Neurosurgical procedures require precise planning and intraoperative support. Recent advances in image guided technology have provided neurosurgeons with improved navigational support for more effective and safer procedures. A number of exemplary cases will be presented.

Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial.

PubMed

Alam, Murad; Roongpisuthipong, Wanjarus; Kim, Natalie A; Goyal, Amita; Swary, Jillian H; Brindise, Renata T; Iyengar, Sanjana; Pace, Natalie; West, Dennis P; Polavarapu, Mahesh; Yoo, Simon

2016-09-01

Guided imagery and music can reportedly reduce pain and anxiety during surgery, but no comparative study has been performed for cutaneous surgery to our knowledge. We sought to determine whether short-contact recorded guided imagery or relaxing music could reduce patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures. Subjects were adults undergoing excisional surgery for basal and squamous cell carcinoma. Randomization was to guided imagery (n = 50), relaxing music (n = 54), or control group (n = 51). Primary outcomes were pain and anxiety measured using visual analog scale and 6-item short-form of the State-Trait Anxiety Inventory, respectively. Secondary outcomes were anxiety of surgeons measured by the 6-item short-form of the State-Trait Anxiety Inventory and physical stress of patients conveyed by vital signs, respectively. There were no significant differences in subjects' pain, anxiety, blood pressure, and pulse rate across groups. In the recorded guided imagery and the relaxing music group, surgeon anxiety was significantly lower than in the control group. Patients could not be blinded. Short-contact recorded guided imagery and relaxing music appear not to reduce patient pain and anxiety during excisional procedures under local anesthetic. However, surgeon anxiety may be reduced when patients are listening to such recordings. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

Endoscopic hyperspectral imaging: light guide optimization for spectral light source

NASA Astrophysics Data System (ADS)

Browning, Craig M.; Mayes, Samuel; Rich, Thomas C.; Leavesley, Silas J.

2018-02-01

Hyperspectral imaging (HSI) is a technology used in remote sensing, food processing and documentation recovery. Recently, this approach has been applied in the medical field to spectrally interrogate regions of interest within respective substrates. In spectral imaging, a two (spatial) dimensional image is collected, at many different (spectral) wavelengths, to sample spectral signatures from different regions and/or components within a sample. Here, we report on the use of hyperspectral imaging for endoscopic applications. Colorectal cancer is the 3rd leading cancer for incidences and deaths in the US. One factor of severity is the miss rate of precancerous/flat lesions ( 65% accuracy). Integrating HSI into colonoscopy procedures could minimize misdiagnosis and unnecessary resections. We have previously reported a working prototype light source with 16 high-powered light emitting diodes (LEDs) capable of high speed cycling and imaging. In recent testing, we have found our current prototype is limited by transmission loss ( 99%) through the multi-furcated solid light guide (lightpipe) and the desired framerate (20-30 fps) could not be achieved. Here, we report on a series of experimental and modeling studies to better optimize the lightpipe and the spectral endoscopy system as a whole. The lightpipe was experimentally evaluated using an integrating sphere and spectrometer (Ocean Optics). Modeling the lightpipe was performed using Monte Carlo optical ray tracing in TracePro (Lambda Research Corp.). Results of these optimization studies will aid in manufacturing a revised prototype with the newly designed light guide and increased sensitivity. Once the desired optical output (5-10 mW) is achieved then the HIS endoscope system will be able to be implemented without adding onto the procedure time.

Enhanced visualization of the bile duct via parallel white light and indocyanine green fluorescence laparoscopic imaging

NASA Astrophysics Data System (ADS)

Demos, Stavros G.; Urayama, Shiro

2014-03-01

Despite best efforts, bile duct injury during laparoscopic cholecystectomy is a major potential complication. Precise detection method of extrahepatic bile duct during laparoscopic procedures would minimize the risk of injury. Towards this goal, we have developed a compact imaging instrumentation designed to enable simultaneous acquisition of conventional white color and NIR fluorescence endoscopic/laparoscopic imaging using ICG as contrast agent. The capabilities of this system, which offers optimized sensitivity and functionality, are demonstrated for the detection of the bile duct in an animal model. This design could also provide a low-cost real-time surgical navigation capability to enhance the efficacy of a variety of other image-guided minimally invasive procedures.

Using an International Medical Advisory Board to guide clinical governance in a corporate refractive surgery model.

PubMed

Vukich, John A

2009-07-01

To describe the role played by the International Medical Advisory Board (IMAB) in clinical and corporate governance at Optical Express, a corporate provider of refractive surgery. A review of goals, objectives, and actions of the IMAB. The IMAB has contributed to study design, data analysis, and selection of instruments and procedures. Through interactions with Optical Express corporate and clinical staff, the IMAB has supported management's effort to craft a corporate culture focused on continuous improvement in the safety and visual outcomes of refractive surgery. The IMAB has fashioned significant changes in corporate policies and procedures and has had an impact on corporate culture at Optical Express.

On recent advances and future research directions for computational fluid dynamics

NASA Technical Reports Server (NTRS)

Baker, A. J.; Soliman, M. O.; Manhardt, P. D.

1986-01-01

This paper highlights some recent accomplishments regarding CFD numerical algorithm constructions for generation of discrete approximate solutions to classes of Reynolds-averaged Navier-Stokes equations. Following an overview of turbulent closure modeling, and development of appropriate conservation law systems, a Taylor weak-statement semi-discrete approximate solution algorithm is developed. Various forms for completion to the final linear algebra statement are cited, as are a range of candidate numerical linear algebra solution procedures. This development sequence emphasizes the key building blocks of a CFD RNS algorithm, including solution trial and test spaces, integration procedure and added numerical stability mechanisms. A range of numerical results are discussed focusing on key topics guiding future research directions.

Complex facial deformity reconstruction with a surgical guide incorporating a built-in occlusal stent as the positioning reference.

PubMed

Fang, Jing-Jing; Liu, Jia-Kuang; Wu, Tzu-Chieh; Lee, Jing-Wei; Kuo, Tai-Hong

2013-05-01

Computer-aided design has gained increasing popularity in clinical practice, and the advent of rapid prototyping technology has further enhanced the quality and predictability of surgical outcomes. It provides target guides for complex bony reconstruction during surgery. Therefore, surgeons can efficiently and precisely target fracture restorations. Based on three-dimensional models generated from a computed tomographic scan, precise preoperative planning simulation on a computer is possible. Combining the interdisciplinary knowledge of surgeons and engineers, this study proposes a novel surgical guidance method that incorporates a built-in occlusal wafer that serves as the positioning reference.Two patients with complex facial deformity suffering from severe facial asymmetry problems were recruited. In vitro facial reconstruction was first rehearsed on physical models, where a customized surgical guide incorporating a built-in occlusal stent as the positioning reference was designed to implement the surgery plan. This study is intended to present the authors' preliminary experience in a complex facial reconstruction procedure. It suggests that in regions with less information, where intraoperative computed tomographic scans or navigation systems are not available, our approach could be an effective, expedient, straightforward aid to enhance surgical outcome in a complex facial repair.

Terrain Analysis Procedural Guide for Drainage and Water Resources (Report Number 8 in the ETL Series on Guides for Army Terrain Analysts).

DTIC Science & Technology

1982-04-01

Geologist Director Oil and Gas Board Bldg., Moscow, Idaho University Campus Phone: TU2-6235 University, Alabama Phone: 8-2528 Illinois State Geological... UTh coordinates) of hydrologic structures not recorded in Data Table 4. d. Data Table 6. Tertiary Drainage Basins (1) Identification symbol (letter...such as oil companies, mining companies, and consulting firms should be contacted for additional geologic and hydrologic information. 3. PROCEDURAL

Duplex-guided percutaneous transluminal angioplasty in iliac arterial occlusive disease.

PubMed

Krasznai, A G; Sigterman, T A; Welten, R J; Heijboer, R; Sikkink, C J J M; van de Akker, L H J M; Bouwman, L H

2013-11-01

Chronic renal insufficiency (CRI) is a growing global problem. PTA can be performed without nephrotoxic contrast, utilizing Doppler-ultrasound (Duplex) guidance. Duplex-guided infra-inguinal interventions and access-related interventions have been reported. Duplex-guided iliac interventions have not been performed to any extent because of the anatomic location. In our study we evaluated the safety and efficacy of Duplex-guided percutaneous transluminal angioplasty (DuPTA) in iliac arteries. From June 2012 until February 2013, 31 patients (35 iliac lesions), underwent DuPTA. Indications ranged from Rutherford 3 to 5. Preoperative evaluation included Ankle Brachial Index (ABI), Duplex and MRA. Procedural success was defined as crossing the lesion with a guidewire and dilating or stenting the lesion. Clinical success was defined as 50% reduction in peak systolic velocity (PSV) or clinical improvement. PSV was evaluated after PTA, then at 2 weeks. Clinical results were assessed 2 weeks after the procedure. Procedural success was achieved in 94% of patients (33/35), all of whom also had clinical success. Post-procedural PSV reduction showed an average improvement of 63% (431 cm/s to 153 cm/s). Mean preoperative ABI was 0.72 and improved to 0.88 postoperatively. PTA using Duplex-guidance in significant iliac stenosis is a safe method with major advantages in patients at high risk for developing contrast-induced nephropathy. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Remote Magnetic versus Manual Navigation for Radiofrequency Ablation of Paroxysmal Atrial Fibrillation: Long-Term, Controlled Data in a Large Cohort.

PubMed

Kataria, Vikas; Berte, Benjamin; Vandekerckhove, Yves; Tavernier, Rene; Duytschaever, Mattias

2017-01-01

Purpose. We aimed to study long-term outcome after pulmonary vein isolation (PVI) guided by remote magnetic navigation (RMN) and provided comparative data to outcome after manual navigation (MAN). Methods. Three hundred thirty-six patients with symptomatic paroxysmal AF underwent PVI by irrigated point-by-point radiofrequency (RF) ablation (RMN, n = 114 versus MAN, n = 222). Patients were followed up with symptom guided rhythm monitoring for a period up to 43 months. The end point of the study was freedom from repeat ablation after a single procedure and without antiarrhythmic drug treatment (ADT). Results. At the end of follow-up (median 26.3 months), freedom from repeat ablation was comparable between RMN and MAN (70.9% versus 69.5%, p = 0.61). At repeat, mean number of reconnected veins was 2.4 ± 1.2 in RMN versus 2.6 ± 1.0 in MAN ( p = 0.08). The majority of repeat procedures occurred during the first year (82.1% in RMN versus 78.5% in MAN; p = 0.74). Conclusion. On the long term (up to 3 years) and in a large cohort of patients with paroxysmal AF, RMN-guided PVI is as effective as MAN guided PVI. In both strategies the majority of repeat procedures occurred during the first year after index procedure.

Remote Magnetic versus Manual Navigation for Radiofrequency Ablation of Paroxysmal Atrial Fibrillation: Long-Term, Controlled Data in a Large Cohort

PubMed Central

Berte, Benjamin; Vandekerckhove, Yves; Tavernier, Rene

2017-01-01

Purpose. We aimed to study long-term outcome after pulmonary vein isolation (PVI) guided by remote magnetic navigation (RMN) and provided comparative data to outcome after manual navigation (MAN). Methods. Three hundred thirty-six patients with symptomatic paroxysmal AF underwent PVI by irrigated point-by-point radiofrequency (RF) ablation (RMN, n = 114 versus MAN, n = 222). Patients were followed up with symptom guided rhythm monitoring for a period up to 43 months. The end point of the study was freedom from repeat ablation after a single procedure and without antiarrhythmic drug treatment (ADT). Results. At the end of follow-up (median 26.3 months), freedom from repeat ablation was comparable between RMN and MAN (70.9% versus 69.5%, p = 0.61). At repeat, mean number of reconnected veins was 2.4 ± 1.2 in RMN versus 2.6 ± 1.0 in MAN (p = 0.08). The majority of repeat procedures occurred during the first year (82.1% in RMN versus 78.5% in MAN; p = 0.74). Conclusion. On the long term (up to 3 years) and in a large cohort of patients with paroxysmal AF, RMN-guided PVI is as effective as MAN guided PVI. In both strategies the majority of repeat procedures occurred during the first year after index procedure. PMID:28386560

Toward computer-assisted image-guided congenital heart defect repair: an initial phantom analysis.

PubMed

Kwartowitz, David M; Mefleh, Fuad N; Baker, G Hamilton

2017-10-01

Radiation exposure in interventional cardiology is an important consideration, due to risk of cancer and other morbidity to the patient and clinical staff. Cardiac catheterizations rely heavily on fluoroscopic imaging exposing both patient and clinician to ionizing radiation. An image-guided surgery system capable of facilitating cardiac catheterizations was developed and tested to evaluate dose reduction. Several electromagnetically tracked tools were constructed specifically a 7-Fr catheter with five 5-degree-of-freedom magnetic seeds. Catheter guidance was accomplished using our image guidance system Kit for Navigation by Image-Focused Exploration and fluoroscopy alone. A cardiac phantom was designed and 3D printed to validate the image guidance procedure. In mock procedures, an expert clinician guided and deployed an occluder across the septal defect of the phantom heart. The image guidance method resulted in a dose of 1.26 mSv of radiation dose per procedure, while traditional guidance resulted in a dose of 3.33 mSv. Average overall dose savings for the image-guided method was nearly 2.07 mSv or 62 %. The work showed significant ([Formula: see text]) decrease in radiation dose with use of image guidance methods at the expense of a modest increase in procedure time. This study lays the groundwork for further exploration of image guidance applications in pediatric cardiology.

Characterization of optically actuated MRI-compatible active needles for medical interventions

NASA Astrophysics Data System (ADS)

Black, Richard J.; Ryu, Seokchang; Moslehi, Behzad; Costa, Joannes M.

2014-03-01

The development of a Magnetic Resonance Imaging (MRI) compatible optically-actuated active needle for guided percutaneous surgery and biopsy procedures is described. Electrically passive MRI-compatible actuation in the small diameter needle is provided by non-magnetic materials including a shape memory alloy (SMA) subject to precise fiber laser operation that can be from a remote (e.g., MRI control room) location. Characterization and optimization of the needle is facilitated using optical fiber Bragg grating (FBG) temperature sensors arrays. Active bending of the needle during insertion allows the needle to be accurately guided to even relatively small targets in an organ while avoiding obstacles and overcoming undesirable deviations away from the planned path due to unforeseen or unknowable tissue interactions. This feature makes the needle especially suitable for use in image-guided surgical procedures (ranging from MRI to CT and ultrasound) when accurate targeting is imperative for good treatment outcomes. Such interventions include reaching small tumors in biopsies, delineating freezing areas in, for example, cryosurgery and improving the accuracy of seed placement in brachytherapy. Particularly relevant are prostate procedures, which may be subject to pubic arch interference. Combining diagnostic imaging and actuation assisted biopsy into one treatment can obviate the need for a second exam for guided biopsy, shorten overall procedure times (thus increasing operating room efficiencies), address healthcare reimbursement constraints and, most importantly, improve patient comfort and clinical outcomes.

The American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies Joint Committee recommendations for education and training in ultrasound-guided interventional pain procedures.

PubMed

Narouze, Samer N; Provenzano, David; Peng, Philip; Eichenberger, Urs; Lee, Sang Chul; Nicholls, Barry; Moriggl, Bernhard

2012-01-01

The use of ultrasound in pain medicine for interventional axial, nonaxial, and musculoskeletal pain procedures is rapidly evolving and growing. Because of the lack of specialty-specific guidelines for ultrasonography in pain medicine, an international collaborative effort consisting of members of the Special Interest Group on Ultrasonography in Pain Medicine from the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, and the Asian Australasian Federation of Pain Societies developed the following recommendations for education and training in ultrasound-guided interventional pain procedures. The purpose of these recommendations is to define the required skills for performing ultrasound-guided pain procedures, the processes for appropriate education, and training and quality improvement. Training algorithms are outlined for practice- and fellowship-based pathways. The previously published American Society of Regional Anesthesia and Pain Medicine and European Society of Regional Anaesthesia and Pain Therapy education and teaching recommendations for ultrasound-guided regional anesthesia served as a foundation for the pain medicine recommendations. Although the decision to grant ultrasound privileges occurs at the institutional level, the committee recommends that the training guidelines outlined in this document serve as the foundation for educational training and the advancement of the practice of ultrasonography in pain medicine.

Patient-specific core decompression surgery for early-stage ischemic necrosis of the femoral head

PubMed Central

Wang, Wei; Hu, Wei; Yang, Pei; Dang, Xiao Qian; Li, Xiao Hui; Wang, Kun Zheng

2017-01-01

Introduction Core decompression is an efficient treatment for early stage ischemic necrosis of the femoral head. In conventional procedures, the pre-operative X-ray only shows one plane of the ischemic area, which often results in inaccurate drilling. This paper introduces a new method that uses computer-assisted technology and rapid prototyping to enhance drilling accuracy during core decompression surgeries and presents a validation study of cadaveric tests. Methods Twelve cadaveric human femurs were used to simulate early-stage ischemic necrosis. The core decompression target at the anterolateral femoral head was simulated using an embedded glass ball (target). Three positioning Kirschner wires were drilled into the top and bottom of the large rotor. The specimen was then subjected to computed tomography (CT). A CT image of the specimen was imported into the Mimics software to construct a three-dimensional model including the target. The best core decompression channel was then designed using the 3D model. A navigational template for the specimen was designed using the Pro/E software and manufactured by rapid prototyping technology to guide the drilling channel. The specimen-specific navigation template was installed on the specimen using positioning Kirschner wires. Drilling was performed using a guide needle through the guiding hole on the templates. The distance between the end point of the guide needle and the target was measured to validate the patient-specific surgical accuracy. Results The average distance between the tip of the guide needle drilled through the guiding template and the target was 1.92±0.071 mm. Conclusions Core decompression using a computer-rapid prototyping template is a reliable and accurate technique that could provide a new method of precision decompression for early-stage ischemic necrosis. PMID:28464029

Patient-specific core decompression surgery for early-stage ischemic necrosis of the femoral head.

PubMed

Wang, Wei; Hu, Wei; Yang, Pei; Dang, Xiao Qian; Li, Xiao Hui; Wang, Kun Zheng

2017-01-01

Core decompression is an efficient treatment for early stage ischemic necrosis of the femoral head. In conventional procedures, the pre-operative X-ray only shows one plane of the ischemic area, which often results in inaccurate drilling. This paper introduces a new method that uses computer-assisted technology and rapid prototyping to enhance drilling accuracy during core decompression surgeries and presents a validation study of cadaveric tests. Twelve cadaveric human femurs were used to simulate early-stage ischemic necrosis. The core decompression target at the anterolateral femoral head was simulated using an embedded glass ball (target). Three positioning Kirschner wires were drilled into the top and bottom of the large rotor. The specimen was then subjected to computed tomography (CT). A CT image of the specimen was imported into the Mimics software to construct a three-dimensional model including the target. The best core decompression channel was then designed using the 3D model. A navigational template for the specimen was designed using the Pro/E software and manufactured by rapid prototyping technology to guide the drilling channel. The specimen-specific navigation template was installed on the specimen using positioning Kirschner wires. Drilling was performed using a guide needle through the guiding hole on the templates. The distance between the end point of the guide needle and the target was measured to validate the patient-specific surgical accuracy. The average distance between the tip of the guide needle drilled through the guiding template and the target was 1.92±0.071 mm. Core decompression using a computer-rapid prototyping template is a reliable and accurate technique that could provide a new method of precision decompression for early-stage ischemic necrosis.

Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow: is a corticosteroid necessary?

PubMed

McShane, John M; Shah, Vinil N; Nazarian, Levon N

2008-08-01

Chronic refractory common extensor tendinosis of the lateral elbow has been shown to respond to sonographically guided percutaneous needle tenotomy (PNT) followed by corticosteroid injection. In this analysis, we attempted to determine whether the corticosteroid is a necessary component of the procedure. We performed PNT on 57 consecutive patients (age range, 34-61 years) with persistent pain and disability resulting from common extensor tendinosis. Under a local anesthetic and sonographic guidance, a needle was advanced into the tendon, and the tip of the needle was used to fenestrate the tendinotic tissue, break up any calcifications, and abrade the adjacent bone. After the procedure, patients underwent a specified physical therapy protocol. During a subsequent telephone interview, patients answered questions about their symptoms, the level of functioning, and perceptions of the procedure outcome. Of the 52 patients who agreed to participate in the study, 30 (57.7%) reported excellent outcomes, 18 (34.6%) good, 1 (1.9%) fair, and 3 (5.8%) poor. The average follow-up time from the date of the procedure to the telephone interview was 22 months (range, 7-38 months). No adverse events were reported, and 90% stated that they would refer a friend or close relative for the procedure. Sonographically guided PNT for refractory lateral elbow tendinosis is an effective procedure, and subsequent corticosteroid injection is not necessary.

Administrative Procedures for Small Institutions. Second Edition.

ERIC Educational Resources Information Center

Mathews, Keith W., Ed.

This guide offers sample administrative procedures and policies that can be used by small colleges and universities to prepare or revise administrative procedures manuals. The sample procedures and policies offered here have been compiled from a review of many manuals from many different institutions, and vary from the general to the specific.…

A novel stereotactic frame for real PET-guided biopsies: A preclinical proof-of-concept.

PubMed

Cortes-Rodicio, J; Sanchez-Merino, G; Garcia-Fidalgo, M A; Tobalina-Larrea, I

2017-09-01

To design, build and test a stereotactic device that allows PET image-guided biopsies to be performed. An initial prototype consisting of four main pieces, one of which contains radioactive markers to make it visible in the PET images, was built using a 3D printer. Once the device is mounted, a spherical coordinate system is built with the entrance needle point in the skin as the origin of coordinates. Two in-house software programs, namely getCoord.ijm, which obtains the spherical coordinates of the tumour tissue to be biopsied, and getNeedle.ijm, which virtualizes the inner needle tip once the puncture has taken place, were written. This prototype was tested on an FDG-doped phantom to characterize both the accuracy of the system and the procedure time. Up to 11 complete biopsy procedures were conducted. The mean total procedure time was less than 20min, which is less than the procedure time of conventional standard CT-guided biopsies. The overall accuracy of the system was found to be 5.0±1.3mm, which outperforms the criterion used in routine clinical practice when targeting tumours with a diameter of 10mm. A stereotactic frame to conduct real PET image-guided biopsies has been designed and built. A proof-of-concept was performed to characterize the system. The procedure time and accuracy of the system were found to meet the current needs of physicians performing biopsies. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Fiber optic photoacoustic probe with ultrasonic tracking for guiding minimally invasive procedures

NASA Astrophysics Data System (ADS)

Xia, Wenfeng; Mosse, Charles A.; Colchester, Richard J.; Mari, Jean Martial; Nikitichev, Daniil I.; West, Simeon J.; Ourselin, Sebastien; Beard, Paul C.; Desjardins, Adrien E.

2015-07-01

In a wide range of clinical procedures, accurate placement of medical devices such as needles and catheters is critical to optimize patient outcomes. Ultrasound imaging is often used to guide minimally invasive procedures, as it can provide real-time visualization of patient anatomy and medical devices. However, this modality can provide low image contrast for soft tissues, and poor visualization of medical devices that are steeply angled with respect to the incoming ultrasound beams. Photoacoustic sensors can provide information about the spatial distributions of tissue chromophores that could be valuable for guiding minimally invasive procedures. In this study, a system for guiding minimally invasive procedures using photoacoustic sensing was developed. This system included a miniature photoacoustic probe with three optical fibers: one with a bare end for photoacoustic excitation of tissue, a second for photoacoustic excitation of an optically absorbing coating at the distal end to transmit ultrasound, and a third with a Fabry-Perot cavity at the distal end for receiving ultrasound. The position of the photoacoustic probe was determined with ultrasonic tracking, which involved transmitting pulses from a linear-array ultrasound imaging probe at the tissue surface, and receiving them with the fiber-optic ultrasound receiver in the photoacoustic probe. The axial resolution of photoacoustic sensing was better than 70 μm, and the tracking accuracy was better than 1 mm in both axial and lateral dimensions. By translating the photoacoustic probe, depth scans were obtained from different spatial positions, and two-dimensional images were reconstructed using a frequency-domain algorithm.

Delphi Method Validation of a Procedural Performance Checklist for Insertion of an Ultrasound-Guided Internal Jugular Central Line.

PubMed

Hartman, Nicholas; Wittler, Mary; Askew, Kim; Manthey, David

2016-01-01

Placement of ultrasound-guided central lines is a critical skill for physicians in several specialties. Improving the quality of care delivered surrounding this procedure demands rigorous measurement of competency, and validated tools to assess performance are essential. Using the iterative, modified Delphi technique and experts in multiple disciplines across the United States, the study team created a 30-item checklist designed to assess competency in the placement of ultrasound-guided internal jugular central lines. Cronbach α was .94, indicating an excellent degree of internal consistency. Further validation of this checklist will require its implementation in simulated and clinical environments. © The Author(s) 2014.

Reflection and transmission coefficients for guided waves reflected by defects in viscoelastic material plates.

PubMed

Hosten, Bernard; Moreau, Ludovic; Castaings, Michel

2007-06-01

The paper presents a Fourier transform-based signal processing procedure for quantifying the reflection and transmission coefficients and mode conversion of guided waves diffracted by defects in plates made of viscoelastic materials. The case of the S(0) Lamb wave mode incident on a notch in a Perspex plate is considered. The procedure is applied to numerical data produced by a finite element code that simulates the propagation of attenuated guided modes and their diffraction by the notch, including mode conversion. Its validity and precision are checked by the way of the energy balance computation and by comparison with results obtained using an orthogonality relation-based processing method.

Summary of the white paper of DICOM WG24 'DICOM in Surgery'

NASA Astrophysics Data System (ADS)

Lemke, Heinz U.

2007-03-01

Standards for creating and integrating information about patients, equipment, and procedures are vitally needed when planning for an efficient Operating Room (OR). The DICOM Working Group 24 (WG24) has been established to develop DICOM objects and services related to Image Guided Surgery (IGS). To determine these standards, it is important to define day-to-day, step-by-step surgical workflow practices and create surgery workflow models per procedures or per variable cases. A well-defined workflow and a high fidelity patient model will be the base of activities for both, radiation therapy and surgery. Considering the present and future requirements for surgical planning and intervention, such a patient model must be n-dimensional, were n may include the spatial and temporal dimensions as well as a number of functional variables. As the boundaries between radiation therapy, surgery and interventional radiology are becoming less well-defined, precise patient models will become the greatest common denominator for all therapeutic disciplines. In addition to imaging, the focus of WG24 should, therefore, also be to serve the therapeutic disciplines by enabling modelling technology to be based on standards.

Teachers' Guide For Aviation Education.

ERIC Educational Resources Information Center

Aviation/Space, 1979

1979-01-01

This teacher's guide outlines the objectives, instructional procedures, student activities, and expected outcomes of an instructional unit on careers in aviation, designed for fifth and sixth grade students. It emphasizes aerospace activities and job opportunities in aviation. (GA)

Operator Certification Study Guide.

ERIC Educational Resources Information Center

American Water Works Association, Denver, CO.

This study guide contains typical questions and answers that all levels of water treatment plant operators might expect to find on a certification examination. The manual covers the basic sciences, treatment techniques, testing procedures, and federal legislation. (Author/SB)

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

PubMed

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

2015-03-01

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

Multifunctional nanoparticles as a tissue adhesive and an injectable marker for image-guided procedures

NASA Astrophysics Data System (ADS)

Shin, Kwangsoo; Choi, Jin Woo; Ko, Giho; Baik, Seungmin; Kim, Dokyoon; Park, Ok Kyu; Lee, Kyoungbun; Cho, Hye Rim; Han, Sang Ihn; Lee, Soo Hong; Lee, Dong Jun; Lee, Nohyun; Kim, Hyo-Cheol; Hyeon, Taeghwan

2017-07-01

Tissue adhesives have emerged as an alternative to sutures and staples for wound closure and reconnection of injured tissues after surgery or trauma. Owing to their convenience and effectiveness, these adhesives have received growing attention particularly in minimally invasive procedures. For safe and accurate applications, tissue adhesives should be detectable via clinical imaging modalities and be highly biocompatible for intracorporeal procedures. However, few adhesives meet all these requirements. Herein, we show that biocompatible tantalum oxide/silica core/shell nanoparticles (TSNs) exhibit not only high contrast effects for real-time imaging but also strong adhesive properties. Furthermore, the biocompatible TSNs cause much less cellular toxicity and less inflammation than a clinically used, imageable tissue adhesive (that is, a mixture of cyanoacrylate and Lipiodol). Because of their multifunctional imaging and adhesive property, the TSNs are successfully applied as a hemostatic adhesive for minimally invasive procedures and as an immobilized marker for image-guided procedures.

Analysis of multiple activity manual materials handling tasks using A Guide to Manual Materials Handling.

PubMed

Mital, A

1999-01-01

Manual handling of materials continues to be a hazardous activity, leading to a very significant number of severe overexertion injuries. Designing jobs that are within the physical capabilities of workers is one approach ergonomists have adopted to redress this problem. As a result, several job design procedures have been developed over the years. However, these procedures are limited to designing or evaluating only pure lifting jobs or only the lifting aspect of a materials handling job. This paper describes a general procedure that may be used to design or analyse materials handling jobs that involve several different kinds of activities (e.g. lifting, lowering, carrying, pushing, etc). The job design/analysis procedure utilizes an elemental approach (breaking the job into elements) and relies on databases provided in A Guide to Manual Materials Handling to compute associated risk factors. The use of the procedure is demonstrated with the help of two case studies.

Predicting bone strength with ultrasonic guided waves

PubMed Central

Bochud, Nicolas; Vallet, Quentin; Minonzio, Jean-Gabriel; Laugier, Pascal

2017-01-01

Recent bone quantitative ultrasound approaches exploit the multimode waveguide response of long bones for assessing properties such as cortical thickness and stiffness. Clinical applications remain, however, challenging, as the impact of soft tissue on guided waves characteristics is not fully understood yet. In particular, it must be clarified whether soft tissue must be incorporated in waveguide models needed to infer reliable cortical bone properties. We hypothesize that an inverse procedure using a free plate model can be applied to retrieve the thickness and stiffness of cortical bone from experimental data. This approach is first validated on a series of laboratory-controlled measurements performed on assemblies of bone- and soft tissue mimicking phantoms and then on in vivo measurements. The accuracy of the estimates is evaluated by comparison with reference values. To further support our hypothesis, these estimates are subsequently inserted into a bilayer model to test its accuracy. Our results show that the free plate model allows retrieving reliable waveguide properties, despite the presence of soft tissue. They also suggest that the more sophisticated bilayer model, although it is more precise to predict experimental data in the forward problem, could turn out to be hardly manageable for solving the inverse problem. PMID:28256568

Guidelines for Neurotoxicity Risk Assessment

EPA Pesticide Factsheets

These Guidelines set forth principles and procedures to guide EPA scientists in evaluating environmental contaminants that may pose neurotoxic risks, and inform Agency decision makers and the public about these procedures.

Real-time magnetic resonance-guided ablation of typical right atrial flutter using a combination of active catheter tracking and passive catheter visualization in man: initial results from a consecutive patient series.

PubMed

Hilbert, Sebastian; Sommer, Philipp; Gutberlet, Matthias; Gaspar, Thomas; Foldyna, Borek; Piorkowski, Christopher; Weiss, Steffen; Lloyd, Thomas; Schnackenburg, Bernhard; Krueger, Sascha; Fleiter, Christian; Paetsch, Ingo; Jahnke, Cosima; Hindricks, Gerhard; Grothoff, Matthias

2016-04-01

Recently cardiac magnetic resonance (CMR) imaging has been found feasible for the visualization of the underlying substrate for cardiac arrhythmias as well as for the visualization of cardiac catheters for diagnostic and ablation procedures. Real-time CMR-guided cavotricuspid isthmus ablation was performed in a series of six patients using a combination of active catheter tracking and catheter visualization using real-time MR imaging. Cardiac magnetic resonance utilizing a 1.5 T system was performed in patients under deep propofol sedation. A three-dimensional-whole-heart sequence with navigator technique and a fast automated segmentation algorithm was used for online segmentation of all cardiac chambers, which were thereafter displayed on a dedicated image guidance platform. In three out of six patients complete isthmus block could be achieved in the MR scanner, two of these patients did not need any additional fluoroscopy. In the first patient technical issues called for a completion of the procedure in a conventional laboratory, in another two patients the isthmus was partially blocked by magnetic resonance imaging (MRI)-guided ablation. The mean procedural time for the MR procedure was 109 ± 58 min. The intubation of the CS was performed within a mean time of 2.75 ± 2.21 min. Total fluoroscopy time for completion of the isthmus block ranged from 0 to 7.5 min. The combination of active catheter tracking and passive real-time visualization in CMR-guided electrophysiologic (EP) studies using advanced interventional hardware and software was safe and enabled efficient navigation, mapping, and ablation. These cases demonstrate significant progress in the development of MR-guided EP procedures. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Is Intra-Articular Steroid Injection to the Temporomandibular Joint for Juvenile Idiopathic Arthritis More Effective and Efficient When Performed With Image Guidance?

PubMed

Resnick, Cory M; Vakilian, Pouya M; Kaban, Leonard B; Peacock, Zachary S

2017-04-01

To compare short-term outcomes and procedure times for intra-articular steroid injection (IASI) to the temporomandibular joint (TMJ) with and without the use of intraoperative image guidance for patients with juvenile idiopathic arthritis (JIA). This is a retrospective study of children with JIA who underwent TMJ IASI at Boston Children's Hospital (Boston, MA). Patients were divided into groups according to IASI technique: 1) "landmark" group if performed by an oral and maxillofacial surgeon using an anatomic landmark technique with no intraoperative image guidance or 2) "image-guided" group if performed by an interventional radiologist using intraoperative ultrasound and computed tomography. Predictor variables included IASI technique (landmark vs image guided), age, gender, JIA subtype, category of medications for arthritis, and presence of family history of autoimmune disease. Outcome variables were changes in patient-reported pain, maximal incisal opening (MIO), synovial enhancement ratio (ER), and total procedure time. Forty-five patients with 71 injected TMJs were included. Twenty-two patients with 36 injected TMJs were in the landmark group and 23 patients with 35 injected joints were in the image-guided group. There were no relevant differences in age, gender, family history of rheumatologic disease, or disease subtype between groups. There were no differences in resolution of pain (P = 1.00), increase in MIO (P = .975), or decrease in ER (P = .492) between groups, but procedure times averaged 49 minutes longer for the image-guided group (P < .008). There were no statistical differences in short-term outcomes, but procedure times were longer for the image-guided group. Although specific indications for the use of image guidance might exist, routine use of this procedure cannot be justified. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Volumetric Trends Associated with MR-guided Stereotactic Laser Amygdalohippocampectomy in Mesial Temporal Lobe Epilepsy

PubMed Central

Patel, Nitesh V; Sundararajan, Sri; Keller, Irwin; Danish, Shabbar

2018-01-01

Objective: Magnetic resonance (MR)-guided stereotactic laser amygdalohippocampectomy is a minimally invasive procedure for the treatment of refractory epilepsy in patients with mesial temporal sclerosis. Limited data exist on post-ablation volumetric trends associated with the procedure. Methods: 10 patients with mesial temporal sclerosis underwent MR-guided stereotactic laser amygdalohippocampectomy. Three independent raters computed ablation volumes at the following time points: pre-ablation (PreA), immediate post-ablation (IPA), 24 hours post-ablation (24PA), first follow-up post-ablation (FPA), and greater than three months follow-up post-ablation (>3MPA), using OsiriX DICOM Viewer (Pixmeo, Bernex, Switzerland). Statistical trends in post-ablation volumes were determined for the time points. Results: MR-guided stereotactic laser amygdalohippocampectomy produces a rapid rise and distinct peak in post-ablation volume immediately following the procedure. IPA volumes are significantly higher than all other time points. Comparing individual time points within each raters dataset (intra-rater), a significant difference was seen between the IPA time point and all others. There was no statistical difference between the 24PA, FPA, and >3MPA time points. A correlation analysis demonstrated the strongest correlations at the 24PA (r=0.97), FPA (r=0.95), and 3MPA time points (r=0.99), with a weaker correlation at IPA (r=0.92). Conclusion: MR-guided stereotactic laser amygdalohippocampectomy produces a maximal increase in post-ablation volume immediately following the procedure, which decreases and stabilizes at 24 hours post-procedure and beyond three months follow-up. Based on the correlation analysis, the lower inter-rater reliability at the IPA time point suggests it may be less accurate to assess volume at this time point. We recommend post-ablation volume assessments be made at least 24 hours post-selective ablation of the amygdalohippocampal complex (SLAH).

A Method for Developing Standard Patient Education Program.

PubMed

Lura, Carolina Bryne; Hauch, Sophie Misser Pallesgaard; Gøeg, Kirstine Rosenbeck; Pape-Haugaard, Louise

2018-01-01

In Denmark, patients being treated on Haematology Outpatients Departments get instructed to self-manage their blood sample collection from Central Venous Catheter (CVC). However, this is a complex and risky procedure, which can jeopardize patient safety. The aim of the study was to suggest a method for developing standard digital patient education programs for patients in self-administration of blood samples drawn from CVC. The Design Science Research Paradigm was used to develop a digital patient education program, called PAVIOSY, to increase patient safety during execution of the blood sample collection procedure by using videos for teaching as well as procedural support. A step-by-step guide was developed and used as basis for making the videos. Quality assurance through evaluation with a nurse was conducted on both the step-by-step guide and the videos. The quality assurance evaluation of the videos showed; 1) Errors due to the order of the procedure can be determined by reviewing the videos despite that the guide was followed. 2) Videos can be used to identify errors - important for patient safety - in the procedure, which are not identifiable in a written script. To ensure correct clinical content of the educational patient system, health professionals must be engaged early in the development of content and design phase.

The cost-effectiveness of CT-guided sacroiliac joint injections: a measure of QALY gained.

PubMed

Bydon, Mohamad; Macki, Mohamed; De la Garza-Ramos, Rafael; Youssef, Mina; Gokaslan, Ziya L; Meleka, Sherif; Bydon, Ali

2014-10-01

The purpose of this study is to estimate the total cost and the quality of life years (QALY) gained for computer tomography (CT)-guided sacroiliac joint (SIJ) injections. The cost per QALY gained for the procedure is the primary end-point of this study. In our 1-year prospective institutional study, we gathered 30 patients undergoing CT-guided SIJ injections for degenerative changes at the SIJ space. Patient-reported outcomes included both the US population-based EQ-5D (EuroQol) index score and the EQ-visual analog scale (VAS). The EQ-5D is based on mobility, self-care, usual activities, pain/discomfort, and anxiety depression. Utility expenditures were based on hospital charges at our institution. All 30 patients had one pre-injection physician visit followed by 43 initial injections (13 bilateral). Each patient underwent one CT scan, and three patients required additional plain films. In the 1 year following the injections, 26 physician visits were documented. Five patients required repeat CT-guided injections. Total 1-year cost for all 30 patients was $34 874·00. Mean decrease in EQ-VAS was 0·60 (P  =  0·187). The mean 1-year gain of 0·58 EQ-5D QALY reached statistical significance (P < 0·001). The cost per QALY gained by CT-guided sacroiliac injections was $2004·29. In one of the first cost analyses of CT-guided sacroiliac injections, we found that the procedure improves pain and activities of daily living. The cost per QALY gained by CT-guided sacroiliac injections falls well below the threshold cost of 1 QALY, suggesting that the procedure is strongly cost-effective.

Comparison of Moderate- to High-Astigmatism Corrections Using WaveFront-Guided Laser In Situ Keratomileusis and Small-Incision Lenticule Extraction.

PubMed

Zhang, Jiamei; Wang, Yan; Chen, Xiaoqin

2016-04-01

To evaluate and compare refractive outcomes of moderate- and high-astigmatism correction after wavefront-guided laser in situ keratomileusis (LASIK) and small-incision lenticule extraction (SMILE). This comparative study enrolled a total of 64 eyes that had undergone SMILE (42 eyes) and wavefront-guided LASIK (22 eyes). Preoperative cylindrical diopters were ≤-2.25 D in moderate- and >-2.25 D in high-astigmatism subgroups. The refractive results were analyzed based on the Alpins vector method that included target-induced astigmatism, surgically induced astigmatism, difference vector, correction index, index of success, magnitude of error, angle of error, and flattening index. All subjects completed the 3-month follow-up. No significant differences were found in the target-induced astigmatism, surgically induced astigmatism, and difference vector between SMILE and wavefront-guided LASIK. However, the average angle of error value was -1.00 ± 3.16 after wavefront-guided LASIK and 1.22 ± 3.85 after SMILE with statistical significance (P < 0.05). The absolute angle of error value was statistically correlated with difference vector and index of success after both procedures. In the moderate-astigmatism group, correction index was 1.04 ± 0.15 after wavefront-guided LASIK and 0.88 ± 0.15 after SMILE (P < 0.05). However, in the high-astigmatism group, correction index was 0.87 ± 0.13 after wavefront-guided LASIK and 0.88 ± 0.12 after SMILE (P = 0.889). Both procedures showed preferable outcomes in the correction of moderate and high astigmatism. However, high astigmatism was undercorrected after both procedures. Axial error of astigmatic correction may be one of the potential factors for the undercorrection.

Jobs and Engines, Teacher's Guide: Political Issues. Comparing Political Experiences, Experimental Edition.

ERIC Educational Resources Information Center

Gillespie, Judith A.; Lazarus, Stuart

This teacher's guide to unit 5 of the 12th-grade second-semester "Comparing Political Experiences" course provides specific objectives and instructional procedures for each of the five activities that focus on the case study of the Cummins Engine Company. In addition, the guide provides instructions for coordinating the use of the…

Justice. Law in a Free Society Series. Level VI. Teacher's Guide. Second Edition.

ERIC Educational Resources Information Center

Center for Civic Education, Calabasas, CA.

This teacher's curriculum guide is designed to help high school teachers guide students to develop a better understanding of difficult issues raised by questions of justice. It is hoped that the ideas, observations, questions, and procedures students learn in the curriculum will help them to make informed decisions about how to promote justice and…

Agricultural Mechanics Unit for Plant Science Core Curriculum. Volume 15, Number 4. Instructor's Guide.

ERIC Educational Resources Information Center

Linhardt, Richard E.; Hunter, Bill

This instructor's guide is intended for use in teaching the agricultural mechanics unit of a plant science core curriculum. Covered in the individual units of the guide are the following topics: arc welding (following safety procedures, controlling distortion, selecting and caring for electrodes, identifying the material to be welded, and welding…

Cook's Helper. DOT No. 317.687-010. Restaurant Occupations. Coordinator's Guide. First Edition.

ERIC Educational Resources Information Center

Hohhertz, Durwin

This coordinator's guide for a module on cook's helpers, one of seven individualized units about restaurant occupations, has been developed for students enrolled in cooperative part-time training and employed in a commercial restaurant. Included in the first part of the guide are a progress chart, suggested teaching procedures, answers to the…

Kitchen Helper. DOT No. 318.687-010. Restaurant Occupations. Coordinator's Guide. First Edition.

ERIC Educational Resources Information Center

Hohhertz, Durwin

This coordinator's guide for a module on kitchen helpers, one of seven individualized units about restaurant occupations, has been developed for students enrolled in cooperative part-time training and employed in a commercial restaurant. Included in the first part of the guide are a progress chart, suggested teaching procedures, answers to the…

A-110: Do We Need Another Audit Guide?

ERIC Educational Resources Information Center

Spruill, Warren H.

1982-01-01

Implications for colleges and universities of a proposed new audit guide for Office of Management and the Budget (OMB) Circular A-110 are considered. The Department of Health and Human Services (HHS) is considering issuance of an audit guide that will outline procedures to be followed to comply with the audit requirement in Circular A-110. With…

Learner's Guide: Water Quality Monitoring. An Instructional Guide for the Two-Year Water Quality Monitoring Curriculum.

ERIC Educational Resources Information Center

Glazer, Richard B.; And Others

This learner's guide is designed to meet the training needs for technicians involved in monitoring activities related to the Federal Water Pollution Act and the Safe Drinking Water Act. In addition it will assist technicians in learning how to perform process control laboratory procedures for drinking water and wastewater treatment plant…

A Guide to Cost Allocation Procedures: Implementing Strategies for Universal Pre-Kindergarten.

ERIC Educational Resources Information Center

Russell-Browne, Acquenetta; Lederman, Nancy

This guide is intended to assist community-based providers in New York City who intend to blend universal pre-kindergarten funds with public child care funds, Head Start, preschool special education, or other funds to provide full or extended day early education programs for children. The guide provides information on how to allocate a programs…

[An experimental model of transgastric ooforectomy using a porcine model].

PubMed

Tomulescu, V; Gheorghe, C; Piţigoi, D; Kosa, A; Ciocarlan, M; Pietrăreanu, D; Turcu, F; Copăescu, C; Droc, G; Popescu, H; Grigorescu, B; Stănciulea, O; Herlea, V; Popescu, I

2010-01-01

Transabdominal routes for surgery entail general anaesthesia with its inherent risks and complications (prolonged hospital stay, abdominal incisions that may be difficult in obese patients). Minimally invasive procedures require shorter hospitalization, have shorter recovery periods, less postoperative discomfort, and lower morbidity and complications. The purpose of this study was to use a porcine model to determine the feasibility and the safety of organ resection (oophorectomy and tubectomy). 10 Big White pigs between 25-30 kg underwent transgastric ooforectomy. The first 5 cases were performed in a hybrid procedure (laparoscopic-NOTES) in order to have a better control and supervise the maneuvers done by the mobile endoscope and to guide in the abdominal cavity. Adnexectomy was possible in all ten experiments. Full operative time (from starting endoscopy to complete gastrectomy closing) was 180 min to 270 min. The gastric defect closing was the most difficult manoever lasting from 10 min with OTSC clips to 100 using endoloops and clips. The animals have tolerated well the experiments and there have been no remarkable incidents during our 10 experments. In only one case a bleeding from gastotomy required electric coagulation. Transgastric ooforectomy in an experimental model is a procedure that requires advanced laparoscopical and endoscopical skills. Our early results are promissing. Its application in humans needs further confirmation of the method.

Cybernetic modeling based on pathway analysis for Penicillium chrysogenum fed-batch fermentation.

PubMed

Geng, Jun; Yuan, Jingqi

2010-08-01

A macrokinetic model employing cybernetic methodology is proposed to describe mycelium growth and penicillin production. Based on the primordial and complete metabolic network of Penicillium chrysogenum found in the literature, the modeling procedure is guided by metabolic flux analysis and cybernetic modeling framework. The abstracted cybernetic model describes the transients of the consumption rates of the substrates, the assimilation rates of intermediates, the biomass growth rate, as well as the penicillin formation rate. Combined with the bioreactor model, these reaction rates are linked with the most important state variables, i.e., mycelium, substrate and product concentrations. Simplex method is used to estimate the sensitive parameters of the model. Finally, validation of the model is carried out with 20 batches of industrial-scale penicillin cultivation.

The role of ultrasound guidance in pediatric caudal block

PubMed Central

Erbüyün, Koray; Açıkgöz, Barış; Ok, Gülay; Yılmaz, Ömer; Temeltaş, Gökhan; Tekin, İdil; Tok, Demet

2016-01-01

Objectives: To compare the time interval of the procedure, possible complications, post-operative pain levels, additional analgesics, and nurse satisfaction in ultrasonography-guided and standard caudal block applications. Methods: This retrospective study was conducted in Celal Bayar University Hospital, Manisa, Turkey, between January and December 2014, included 78 pediatric patients. Caudal block was applied to 2 different groups; one with ultrasound guide, and the other using the standard method. Results: The time interval of the procedure was significantly shorter in the standard application group compared with ultrasound-guided group (p=0.020). Wong-Baker FACES Pain Rating Scale values obtained at the 90th minute was statistically lower in the standard application group compared with ultrasound-guided group (p=0.035). No statistically significant difference was found on the other parameters between the 2 groups. The shorter time interval of the procedure at standard application group should not be considered as a distinctive mark by the pediatric anesthesiologists, because this time difference was as short as seconds. Conclusion: Ultrasound guidance for caudal block applications would neither increase nor decrease the success of the treatment. However, ultrasound guidance should be needed in cases where the detection of sacral anatomy is difficult, especially by palpations. PMID:26837396

Propagation of flexural and membrane waves with fluid loaded NASTRAN plate and shell elements

NASA Technical Reports Server (NTRS)

Kalinowski, A. J.; Wagner, C. A.

1983-01-01

Modeling of flexural and membrane type waves existing in various submerged (or in vacuo) plate and/or shell finite element models that are excited with steady state type harmonic loadings proportioned to e(i omega t) is discussed. Only thin walled plates and shells are treated wherein rotary inertia and shear correction factors are not included. More specifically, the issue of determining the shell or plate mesh size needed to represent the spatial distribution of the plate or shell response is of prime importance towards successfully representing the solution to the problem at hand. To this end, a procedure is presented for establishing guide lines for determining the mesh size based on a simple test model that can be used for a variety of plate and shell configurations such as, cylindrical shells with water loading, cylindrical shells in vacuo, plates with water loading, and plates in vacuo. The procedure for doing these four cases is given, with specific numerical examples present only for the cylindrical shell case.

Thermoablation of Malignant Kidney Tumors Using Magnetic Nanoparticles: An In Vivo Feasibility Study in a Rabbit Model

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

Bruners, Philipp, E-mail: bruners@hia.rwth-aachen.d; Braunschweig, Till; Hodenius, Michael

2010-02-15

The objective of this study was to assess the technical feasibility of CT-guided magnetic thermoablation for the treatment of malignant kidney tumors in a VX2 tumor rabbit model. VX2 tumors were implanted into the kidneys of five rabbits and allowed to grow for 2 weeks. After preinterventional CT perfusion imaging, CT-guided injection of superparamagnetic iron oxide particles (300 {mu}l) was performed, followed by exposure of the animals to an alternating electromagnetic field for 15 min ({approx}0.32 kA/m). Then animals underwent CT perfusion imaging again. Afterward, animals were sacrificed and kidneys were dissected for macroscopic and histological evaluation. Changes in perfusionmore » before and after exposure to the alternating magnetic field were analyzed. In one animal no tumor growth could be detected so the animal was used for optimization of the ablation procedure including injection technique and peri-interventional cross-sectional imaging (CT, MRI). After image-guided intratumoral injection of ferrofluids, the depiction of nanoparticle distribution by CT correlated well with macroscopic evaluation of the dissected kidneys. MRI was limited due to severe susceptibility artefacts. Postinterventional CT perfusion imaging revealed a perfusion deficiency around the ferrofluid deposits. Histological workup showed different zones of thermal damage adjacent to the ferrofluid deposits. In conclusion, CT-guided magnetic thermoablation of malignant kidney tumors is technically feasible in an animal model and results in a perfusion deficiency indicating tumor necrosis as depicted by CT perfusion imaging and shown in histological evaluation.« less

Surgical Procedures. Second Edition. Teacher Edition.

ERIC Educational Resources Information Center

Baker, Beverly; And Others

This teacher's guide contains 13 units of instruction for a course that will prepare students with the entry-level competencies needed by a surgical technologist. The course covers the following topics: introduction to surgical procedures; diagnostic procedures; general surgery; gastrointestinal surgery; obstetrics and gynecological surgery;…

Percutaneous coronary angioplasty of a left anterior descending artery implanted on a Dacron coronary prosthesis on an aortic conduit.

PubMed

Drobinski, G; Thomas, D; Funck, F; Metzger, J P; Canny, M; Grosgogeat, Y

1986-08-01

Certain surgical techniques may make it difficult to catheterize the coronary ostia and perform percutaneous coronary angioplasty. We report the case of a 48 year old patient who developed unstable angina four years after a Bentall's procedure with reimplantation of the coronary arteries on a Dacron coronary prosthesis. The anginal pain was related to very severe stenosis of the proximal segment of the left anterior descending artery. The difficulties encountered during the dilatation procedure were due to: (a) the ectopic position of the ostium of the prosthesis on the anterior aortic wall; (b) the forces exerted on the aortic prosthesis wall and on the valvular prosthesis during positioning of the guiding catheter which were poorly tolerated and induced a vagal reaction; (c) the direction taken by the distal tip of the guiding catheter, perpendicular to the wall of the aortic prosthesis; (d) the sinuosity of the arterial trajectory: the left coronary segment of the coronary prosthesis was directed towards the left circumflex artery rather than towards the left anterior descending artery. Coronary angioplasty succeeded after relatively complex technical procedures: special guiding catheter, unusual intra-aortic manoeuvres for positioning the guiding catheter, dilatation catheter change on a 3-metre long guide wire in order to cross the stenotic segment; this was performed with a super low-profiled dilatation catheter. There were no complications and anginal pain disappeared.

Neuronavigation-guided focused ultrasound-induced blood-brain barrier opening: A preliminary study in swine

NASA Astrophysics Data System (ADS)

Liu, Hao-Li; Tsai, Hong-Chieh; Lu, Yu-Jen; Wei, Kuo-Chen

2012-11-01

FUS-induced BBB opening is a promising technique for noninvasive and local delivery of drugs into the brain. Here we propose the novel use of a neuronavigation system to guide the FUS-induced BBB opening procedure, and investigate its feasibility in vivo in large animals. We developed an interface between the neuronavigator and FUS to allow guidance of the focal energy produced by the FUS transducer. The system was tested in 29 pigs by more than 40 sonication procedures and evaluated by MRI. Gd-DTPA concentration was quantitated in vivo by MRI R1 relaxometry and compared by ICP-OES assay. Brain histology after FUS exposure was investigated by HE and TUNEL staining. Neuronavigation could successfully guide the focal beam with comparable precision to neurosurgical stereotactic procedures (2.3 ± 0.9 mm). FUS pressure of 0.43 MPa resulted in consistent BBB-opening. Neuronavigation-guided BBB-opening increased Gd-DTPA deposition by up to 1.83 mM (140% increase). MR relaxometry demonstrated high correlation to ICP-OES measurements (r2 = 0.822), suggesting that Gd-DTPA deposition can be directly measured by imaging. Neuronavigation could provide sufficient precision for guiding FUS to temporally and locally open the BBB. Gd-DTPA deposition in the brain could be quantified by MR relaxometry, providing a potential tool for the in vivo quantification of therapeutic agents in CNS disease treatment.

Gold nanoshelled liquid perfluorocarbon nanocapsules for combined dual modal ultrasound/CT imaging and photothermal therapy of cancer.

PubMed

Ke, Hengte; Yue, Xiuli; Wang, Jinrui; Xing, Sen; Zhang, Qian; Dai, Zhifei; Tian, Jie; Wang, Shumin; Jin, Yushen

2014-03-26

The integration of multimodal contrast-enhanced diagnostic imaging and therapeutic capabilities could utilize imaging guided therapy to plan the treatment strategy based on the diagnostic results and to guide/monitor the therapeutic procedures. Herein, gold nanoshelled perfluorooctylbromide (PFOB) nanocapsules with PEGylation (PGsP NCs) are constructed by oil-in-water emulsion method to form polymeric PFOB nanocapsules, followed by the formation of PEGylated gold nanoshell on the surface. PGsP NCs could not only provide excellent contrast enhancement for dual modal ultrasound and CT imaging in vitro and in vivo, but also serve as efficient photoabsorbers for photothermal ablation of tumors on xenografted nude mouse model. To our best knowledge, this is the first report of gold nanoshell serving as both CT contrast agents and photoabsorbers for photothermal therapy. The novel multifunctional nanomedicine would be of great value to offer more comprehensive diagnostic information to guide more accurate and effective cancer therapy. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Guide for Regional Integrated Assessments: Handbook of Methods and Procedures, Version 5.1. Appendix 1

NASA Technical Reports Server (NTRS)

Rosenzweig, Cynthia E.; Jones, James W.; Hatfield, Jerry; Antle, John; Ruane, Alex; Boote, Ken; Thorburn, Peter; Valdivia, Roberto; Porter, Cheryl; Janssen, Sander;

Clinical application of fully digital Cerec surgical guides made in-house.

PubMed

Bindl, A

2015-01-01

It is now possible to produce full-digital drilling templates with Cerec Guide 2 (Sirona) in the dental practice relatively quickly, efficiently, and economically. Here, a patient case example is used to present an exemplary description of the procedure and method to do this. The solution described herein shows the advantageous efficiency, compared with other systems presently on the market, of a procedure that does not require the external production of the drilling template in the laboratory or a manufacturing center.

A Modular Set of Mixed Reality Simulators for blind and Guided Procedures

DTIC Science & Technology

2015-08-01

W81XWH-14-1-0113 – Year 1 Report University of Florida Page 1 of 12 AWARD NUMBER: W81XWH-14-1-0113 TITLE: A Modular Set of Mixed Reality...Simulators for “blind” and Guided Procedures PRINCIPAL INVESTIGATOR: Samsun Lampotang CONTRACTING ORGANIZATION: University of Florida Gainesville, FL...designated by other documentation. W81XWH-14-1-0113 – Year 1 Report University of Florida Page 2 of 12 REPORT DOCUMENTATION PAGE Form Approved OMB No

M60A3 Tank Procedure Guides

DTIC Science & Technology

1985-02-01

no longer needed. Pleai do not return it to the U.S. Army Research Institute for the Behavioral and Social Sciencis . NOTE, This Research Product Is not...B. L., Vaughan, J. J., Jr., and Schaefer, R. H. Development of M1 Abrams Tank Sustainment Training Material . ARI Research Report 1334, June 1982. .5...place of the M60A3 Operator’s Manual or M60A3 training materials . The guides will aid you in remembering long or difficult sets of procedures. In

Computer & manual accident typing for bicyclist accidents : administrator's guide

DOT National Transportation Integrated Search

1983-01-01

This guide provides guidelines and procedures for classifying and analyzing bicyclist-motor vehicle accidents. The approach described herein is part of a systematic effort by the National Highway Traffic Safety Administration (NHTSA) to assist states...

High-Altitude Electromagnetic Pulse (HEMP) Testing

DTIC Science & Technology

2011-11-10

Security Classification Guide ( SCG ). b. The HEMP simulation facility shall have a measured map of the peak amplitude waveform of the...Quadripartite Standardization Agreement s, sec second SCG security classification guide SN serial number SOP Standard Operating Procedure

Step-by-Step Guide to Producing a Comprehensive Academic Advising Handbook.

ERIC Educational Resources Information Center

Ford, Jerry; Ford, Sheila Stoma

1993-01-01

Procedures for creating a guide to academic advising are outlined, including obtaining administrative commitment; clarifying responsibilities and chain of command; identifying general and specific objectives; developing content; organizing content; entering production; and revising. (MSE)

Hybrid Self-Adaptive Evolution Strategies Guided by Neighborhood Structures for Combinatorial Optimization Problems.

PubMed

Coelho, V N; Coelho, I M; Souza, M J F; Oliveira, T A; Cota, L P; Haddad, M N; Mladenovic, N; Silva, R C P; Guimarães, F G

2016-01-01

This article presents an Evolution Strategy (ES)--based algorithm, designed to self-adapt its mutation operators, guiding the search into the solution space using a Self-Adaptive Reduced Variable Neighborhood Search procedure. In view of the specific local search operators for each individual, the proposed population-based approach also fits into the context of the Memetic Algorithms. The proposed variant uses the Greedy Randomized Adaptive Search Procedure with different greedy parameters for generating its initial population, providing an interesting exploration-exploitation balance. To validate the proposal, this framework is applied to solve three different [Formula: see text]-Hard combinatorial optimization problems: an Open-Pit-Mining Operational Planning Problem with dynamic allocation of trucks, an Unrelated Parallel Machine Scheduling Problem with Setup Times, and the calibration of a hybrid fuzzy model for Short-Term Load Forecasting. Computational results point out the convergence of the proposed model and highlight its ability in combining the application of move operations from distinct neighborhood structures along the optimization. The results gathered and reported in this article represent a collective evidence of the performance of the method in challenging combinatorial optimization problems from different application domains. The proposed evolution strategy demonstrates an ability of adapting the strength of the mutation disturbance during the generations of its evolution process. The effectiveness of the proposal motivates the application of this novel evolutionary framework for solving other combinatorial optimization problems.

Scale-space for empty catheter segmentation in PCI fluoroscopic images.

PubMed

Bacchuwar, Ketan; Cousty, Jean; Vaillant, Régis; Najman, Laurent

2017-07-01

In this article, we present a method for empty guiding catheter segmentation in fluoroscopic X-ray images. The guiding catheter, being a commonly visible landmark, its segmentation is an important and a difficult brick for Percutaneous Coronary Intervention (PCI) procedure modeling. In number of clinical situations, the catheter is empty and appears as a low contrasted structure with two parallel and partially disconnected edges. To segment it, we work on the level-set scale-space of image, the min tree, to extract curve blobs. We then propose a novel structural scale-space, a hierarchy built on these curve blobs. The deep connected component, i.e. the cluster of curve blobs on this hierarchy, that maximizes the likelihood to be an empty catheter is retained as final segmentation. We evaluate the performance of the algorithm on a database of 1250 fluoroscopic images from 6 patients. As a result, we obtain very good qualitative and quantitative segmentation performance, with mean precision and recall of 80.48 and 63.04% respectively. We develop a novel structural scale-space to segment a structured object, the empty catheter, in challenging situations where the information content is very sparse in the images. Fully-automatic empty catheter segmentation in X-ray fluoroscopic images is an important and preliminary step in PCI procedure modeling, as it aids in tagging the arrival and removal location of other interventional tools.

Using SAS PROC MCMC for Item Response Theory Models

PubMed Central

Samonte, Kelli

2014-01-01

Interest in using Bayesian methods for estimating item response theory models has grown at a remarkable rate in recent years. This attentiveness to Bayesian estimation has also inspired a growth in available software such as WinBUGS, R packages, BMIRT, MPLUS, and SAS PROC MCMC. This article intends to provide an accessible overview of Bayesian methods in the context of item response theory to serve as a useful guide for practitioners in estimating and interpreting item response theory (IRT) models. Included is a description of the estimation procedure used by SAS PROC MCMC. Syntax is provided for estimation of both dichotomous and polytomous IRT models, as well as a discussion on how to extend the syntax to accommodate more complex IRT models. PMID:29795834

Computer Simulation and Digital Resources for Plastic Surgery Psychomotor Education.

PubMed

Diaz-Siso, J Rodrigo; Plana, Natalie M; Stranix, John T; Cutting, Court B; McCarthy, Joseph G; Flores, Roberto L

2016-10-01

Contemporary plastic surgery residents are increasingly challenged to learn a greater number of complex surgical techniques within a limited period. Surgical simulation and digital education resources have the potential to address some limitations of the traditional training model, and have been shown to accelerate knowledge and skills acquisition. Although animal, cadaver, and bench models are widely used for skills and procedure-specific training, digital simulation has not been fully embraced within plastic surgery. Digital educational resources may play a future role in a multistage strategy for skills and procedures training. The authors present two virtual surgical simulators addressing procedural cognition for cleft repair and craniofacial surgery. Furthermore, the authors describe how partnerships among surgical educators, industry, and philanthropy can be a successful strategy for the development and maintenance of digital simulators and educational resources relevant to plastic surgery training. It is our responsibility as surgical educators not only to create these resources, but to demonstrate their utility for enhanced trainee knowledge and technical skills development. Currently available digital resources should be evaluated in partnership with plastic surgery educational societies to guide trainees and practitioners toward effective digital content.

MRI-Guided Percutaneous Biopsy of Mediastinal Masses Using a Large Bore Magnet: Technical Feasibility

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

Garnon, J., E-mail: juliengarnon@gmail.com; Ramamurthy, N., E-mail: nitin-ramamurthy@hotmail.com; Caudrelier J, J., E-mail: caudjean@yahoo.fr

2016-05-15

ObjectiveTo evaluate the diagnostic accuracy and safety of magnetic resonance imaging (MRI)-guided percutaneous biopsy of mediastinal masses performed using a wide-bore high-field scanner.Materials and MethodsThis is a retrospective study of 16 consecutive patients (8 male, 8 female; mean age 74 years) who underwent MRI-guided core needle biopsy of a mediastinal mass between February 2010 and January 2014. Size and location of lesion, approach taken, time for needle placement, overall duration of procedure, and post-procedural complications were evaluated. Technical success rates and correlation with surgical pathology (where available) were assessed.ResultsTarget lesions were located in the anterior (n = 13), middle (n = 2), and posterior mediastinummore » (n = 1), respectively. Mean size was 7.2 cm (range 3.6–11 cm). Average time for needle placement was 9.4 min (range 3–18 min); average duration of entire procedure was 42 min (range 27–62 min). 2–5 core samples were obtained from each lesion (mean 2.6). Technical success rate was 100 %, with specimens successfully obtained in all 16 patients. There were no immediate complications. Histopathology revealed malignancy in 12 cases (4 of which were surgically confirmed), benign lesions in 3 cases (1 of which was false negative following surgical resection), and one inconclusive specimen (treated as inaccurate since repeat CT-guided biopsy demonstrated thymic hyperplasia). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy in our study were 92.3, 100, 100, 66.7, and 87.5 %, respectively.ConclusionMRI-guided mediastinal biopsy is a safe procedure with high diagnostic accuracy, which may offer a non-ionizing alternative to CT guidance.« less

Personalized Feedback on Staff Dose in Fluoroscopy-Guided Interventions: A New Era in Radiation Dose Monitoring.

PubMed

Sailer, Anna M; Vergoossen, Laura; Paulis, Leonie; van Zwam, Willem H; Das, Marco; Wildberger, Joachim E; Jeukens, Cécile R L P N

2017-11-01

Radiation safety and protection are a key component of fluoroscopy-guided interventions. We hypothesize that providing weekly personal dose feedback will increase radiation awareness and ultimately will lead to optimized behavior. Therefore, we designed and implemented a personalized feedback of procedure and personal doses for medical staff involved in fluoroscopy-guided interventions. Medical staff (physicians and technicians, n = 27) involved in fluoroscopy-guided interventions were equipped with electronic personal dose meters (PDMs). Procedure dose data including the dose area product and effective doses from PDMs were prospectively monitored for each consecutive procedure over an 8-month period (n = 1082). A personalized feedback form was designed displaying for each staff individually the personal dose per procedure, as well as relative and cumulative doses. This study consisted of two phases: (1) 1-5th months: Staff did not receive feedback (n = 701) and (2) 6-8th months: Staff received weekly individual dose feedback (n = 381). An anonymous evaluation was performed on the feedback and occupational dose. Personalized feedback was scored valuable by 76% of the staff and increased radiation dose awareness for 71%. 57 and 52% reported an increased feeling of occupational safety and changing their behavior because of personalized feedback, respectively. For technicians, the normalized dose was significantly lower in the feedback phase compared to the prefeedback phase: [median (IQR) normalized dose (phase 1) 0.12 (0.04-0.50) µSv/Gy cm 2 versus (phase 2) 0.08 (0.02-0.24) µSv/Gy cm 2 , p = 0.002]. Personalized dose feedback increases radiation awareness and safety and can be provided to staff involved in fluoroscopy-guided interventions.

Robotic System for MRI-Guided Stereotactic Neurosurgery

PubMed Central

Li, Gang; Cole, Gregory A.; Shang, Weijian; Harrington, Kevin; Camilo, Alex; Pilitsis, Julie G.; Fischer, Gregory S.

2015-01-01

Stereotaxy is a neurosurgical technique that can take several hours to reach a specific target, typically utilizing a mechanical frame and guided by preoperative imaging. An error in any one of the numerous steps or deviations of the target anatomy from the preoperative plan such as brain shift (up to 20 mm), may affect the targeting accuracy and thus the treatment effectiveness. Moreover, because the procedure is typically performed through a small burr hole opening in the skull that prevents tissue visualization, the intervention is basically “blind” for the operator with limited means of intraoperative confirmation that may result in reduced accuracy and safety. The presented system is intended to address the clinical needs for enhanced efficiency, accuracy, and safety of image-guided stereotactic neurosurgery for Deep Brain Stimulation (DBS) lead placement. The work describes a magnetic resonance imaging (MRI)-guided, robotically actuated stereotactic neural intervention system for deep brain stimulation procedure, which offers the potential of reducing procedure duration while improving targeting accuracy and enhancing safety. This is achieved through simultaneous robotic manipulation of the instrument and interactively updated in situ MRI guidance that enables visualization of the anatomy and interventional instrument. During simultaneous actuation and imaging, the system has demonstrated less than 15% signal-to-noise ratio (SNR) variation and less than 0.20% geometric distortion artifact without affecting the imaging usability to visualize and guide the procedure. Optical tracking and MRI phantom experiments streamline the clinical workflow of the prototype system, corroborating targeting accuracy with 3-axis root mean square error 1.38 ± 0.45 mm in tip position and 2.03 ± 0.58° in insertion angle. PMID:25376035

A Generalized Approach for the Interpretation of Geophysical Well Logs in Ground-Water Studies - Theory and Application

USGS Publications Warehouse

Paillet, Frederick L.; Crowder, R.E.

1996-01-01

Quantitative analysis of geophysical logs in ground-water studies often involves at least as broad a range of applications and variation in lithology as is typically encountered in petroleum exploration, making such logs difficult to calibrate and complicating inversion problem formulation. At the same time, data inversion and analysis depend on inversion model formulation and refinement, so that log interpretation cannot be deferred to a geophysical log specialist unless active involvement with interpretation can be maintained by such an expert over the lifetime of the project. We propose a generalized log-interpretation procedure designed to guide hydrogeologists in the interpretation of geophysical logs, and in the integration of log data into ground-water models that may be systematically refined and improved in an iterative way. The procedure is designed to maximize the effective use of three primary contributions from geophysical logs: (1) The continuous depth scale of the measurements along the well bore; (2) The in situ measurement of lithologic properties and the correlation with hydraulic properties of the formations over a finite sample volume; and (3) Multiple independent measurements that can potentially be inverted for multiple physical or hydraulic properties of interest. The approach is formulated in the context of geophysical inversion theory, and is designed to be interfaced with surface geophysical soundings and conventional hydraulic testing. The step-by-step procedures given in our generalized interpretation and inversion technique are based on both qualitative analysis designed to assist formulation of the interpretation model, and quantitative analysis used to assign numerical values to model parameters. The approach bases a decision as to whether quantitative inversion is statistically warranted by formulating an over-determined inversion. If no such inversion is consistent with the inversion model, quantitative inversion is judged not possible with the given data set. Additional statistical criteria such as the statistical significance of regressions are used to guide the subsequent calibration of geophysical data in terms of hydraulic variables in those situations where quantitative data inversion is considered appropriate.

Technical communication: new teaching model for practicing ultrasound-guided regional anesthesia techniques: no perishable food products!

PubMed

Liu, Yang; Glass, Nancy L; Power, Robert W

2010-04-01

There is a pronounced learning curve for the technique of ultrasound-guided regional anesthesia. Practicing with a simulator model has been shown to speed the acquisition of these skills for various ultrasound-guided procedures. However, commercial models for ultrasound-guided regional anesthesia may be too costly or not readily available. Models using turkey breasts or tofu blocks have the disadvantage of containing perishable food products that can be a source for infection. We describe an alternative inexpensive model that is made from nonperishable components readily available in the operating room. The materials required include 1 clean used 500-mL bag of IV fluids, a bottle of Premisorb (TYCO Healthcare Group, Mansfield, MA), and a piece of foam material approximately 0.3 cm in diameter and 5 cm in length trimmed from operating room foam pads. After filling the IV bag with tap water and inserting the foam into the IV bag from the outlet port of the IV bag, one-third of a bottle of Premisorb (approximately 15 g) is poured into the IV bag. The outlet port of the bag is then sealed by taping the rubber stopper that originally came with the bag. Premisorb, a solidifying agent frequently used to absorb irrigating fluids or blood in operating room suction canisters, produces a gel-like material in the IV bag. The foam inserted into the bag creates a relatively hyperechoic target. This gel-like substance in the bag will seal the holes created after multiple practice needle insertions, resulting in minimal leakage. The semitransparent nature of the gel allows the trainee to visualize the target directly and on the ultrasound screen. The model we describe is inexpensive and easy to make from materials readily available in the operating room with the advantages of being nonperishable, easy to carry, and reusable.

Cable median barrier maintenance manual.

DOT National Transportation Integrated Search

2008-08-01

This implementation guide describes the conceptual framework, data requirements, and computational procedures for determining the safety and mobility impacts of work zones in Texas. Researchers designed the framework and procedures to assist district...

Alternative Refractive Surgery Procedures

MedlinePlus

... alternative refractive surgery procedures to LASIK . Wavefront-Guided LASIK Before surgery, the excimer laser is programmed with ... precise "sculpting" of each unique cornea. In conventional LASIK , this programming is based on the patient's vision ...

Evaluation of a Standardized Program for Training Practicing Anesthesiologists in Ultrasound-Guided Regional Anesthesia Skills.

PubMed

Mariano, Edward R; Harrison, T Kyle; Kim, T Edward; Kan, Jack; Shum, Cynthia; Gaba, David M; Ganaway, Toni; Kou, Alex; Udani, Ankeet D; Howard, Steven K

2015-10-01

Practicing anesthesiologists have generally not received formal training in ultrasound-guided perineural catheter insertion. We designed this study to determine the efficacy of a standardized teaching program in this population. Anesthesiologists in practice for 10 years or more were recruited and enrolled to participate in a 1-day program: lectures and live-model ultrasound scanning (morning) and faculty-led iterative practice and mannequin-based simulation (afternoon). Participants were assessed and recorded while performing ultrasound-guided perineural catheter insertion at baseline, at midday (interval), and after the program (final). Videos were scored by 2 blinded reviewers using a composite tool and global rating scale. Participants were surveyed every 3 months for 1 year to report the number of procedures, efficacy of teaching methods, and implementation obstacles. Thirty-two participants were enrolled and completed the program; 31 of 32 (97%) completed the 1-year follow-up. Final scores [median (10th-90th percentiles)] were 21.5 (14.5-28.0) of 30 points compared to 14.0 (9.0-20.0) at interval (P < .001 versus final) and 12.0 (8.5-17.5) at baseline (P < .001 versus final), with no difference between interval and baseline. The global rating scale showed an identical pattern. Twelve of 26 participants without previous experience performed at least 1 perineural catheter insertion after training (P < .001). However, there were no differences in the monthly average number of procedures or complications after the course when compared to baseline. Practicing anesthesiologists without previous training in ultrasound-guided regional anesthesia can acquire perineural catheter insertion skills after a 1-day standardized course, but changing clinical practice remains a challenge. © 2015 by the American Institute of Ultrasound in Medicine.

Application of a topical vapocoolant spray decreases pain at the site of initial intradermal anaesthetic injection during ultrasound-guided breast needle biopsy.

PubMed

Collado-Mesa, F; Net, J M; Arheart, K; Klevos, G A; Yepes, M M

2015-09-01

To assess whether the application of a topical vapocoolant spray immediately prior to initial intradermal anaesthetic injection during ultrasound-guided breast biopsy decreases pain at the site of the initial injection. In this institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study, 50 women aged 49.1 ± 1.6 years (mean ± standard error) were recruited and provided written informed consent. Participants served as their own controls and were blinded as to whether a topical vapocoolant spray or a placebo was used immediately prior to the initial local anaesthetic injection at two separate biopsy sites. With the exception of the application of vapocoolant or placebo, the entire ultrasound-guided procedure was performed according to a routine protocol. Participants recorded pain at initial injection site on a visual analogue scale. General linear mixed models for repeated measures analysis of variance and a 0.05 significance level were used. Application of topical vapocoolant spray was shown to significantly decrease pain at the site of initial intradermal anaesthetic injection as compared to placebo (p<0.001). Treatment effect was independent of age of the subject, race/ethnicity, operator, type of biopsy device, and histopathology result. No complications from vapocoolant spray use were reported. Application of a topical vapocoolant spray immediately prior to initial intradermal anaesthetic injection during ultrasound-guided breast biopsy significantly decreases pain at the site of the initial injection and could contribute to improve the patient's overall procedural experience. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Assessing the fit of site-occupancy models

USGS Publications Warehouse

MacKenzie, D.I.; Bailey, L.L.

2004-01-01

Few species are likely to be so evident that they will always be detected at a site when present. Recently a model has been developed that enables estimation of the proportion of area occupied, when the target species is not detected with certainty. Here we apply this modeling approach to data collected on terrestrial salamanders in the Plethodon glutinosus complex in the Great Smoky Mountains National Park, USA, and wish to address the question 'how accurately does the fitted model represent the data?' The goodness-of-fit of the model needs to be assessed in order to make accurate inferences. This article presents a method where a simple Pearson chi-square statistic is calculated and a parametric bootstrap procedure is used to determine whether the observed statistic is unusually large. We found evidence that the most global model considered provides a poor fit to the data, hence estimated an overdispersion factor to adjust model selection procedures and inflate standard errors. Two hypothetical datasets with known assumption violations are also analyzed, illustrating that the method may be used to guide researchers to making appropriate inferences. The results of a simulation study are presented to provide a broader view of the methods properties.

Clinical application of stereolithographic surgical guide with a handpiece guidance apparatus: a case report.

PubMed

Ozan, Oguz; Seker, Emre; Kurtulmus-Yilmaz, Sevcan; Ersoy, Ahmet Ersan

2012-10-01

The success of implant-supported restorations depends on the treatment planning and the transfer of planning through the surgical field. Recently, new computer-aided design and manufacturing (CAD/CAM) techniques, such as stereolithographic (SLA) rapid prototyping, have been developed to fabricate surgical guides to improve the precision of implant placement. The objective of the present case is to introduce a recently developed SLA surgical guide system into the rehabilitation of a 62-year-old male patient with mandibular edentulism. After obtaining a cone-beam computerized tomography (CBCT) scan of the mandible with a radiographic template, the images were transferred into a 3-dimensional (3D) image-based software for implant planning. The StentCad Beyond SLA surgical guide system, which is a combination of a currently used surgical template with pilot hollows and a surgical handpiece guidance apparatus, was designed to transfer a preoperatively defined implant position onto the surgical site without any drill-surgical guide contact. For the fabrication of this system, a surgical handpiece was scanned by a laser optical scanner and a mucosa-supported surgical guide was designed according to the patient's 3D model, which was attained from the CBCT images. Four dental implants were inserted through the SLA surgical guide system by a torque-controlled surgical handpiece to the interforaminal region via a flapless surgical procedure. Implants were assessed 3 months after surgery, and an implant-retained mandibular overdenture was fabricated. The present case emphasizes that CAD/CAM SLA surgical guides, along with CBCT images and scanning data, may help clinicians plan and place dental implants.

Ethnicity influences pain after ultrasound-guided percutaneous liver biopsy.

PubMed

Mahadeva, Sanjiv; Mahfudz, Anis S; Vijayananthan, Anushya

2015-12-01

The influence of ethnicity on pain complicating ultrasound-guided percutaneous liver biopsy (US-guided PLB) and its clinical impact has not been reported to date. Consecutive adults from a multiethnic background, undergoing an US-guided PLB, were independently assessed for pain up to 6 h after the procedure. Clinical and demographic parameters were analysed to determine independent predictors of significant pain after PLB. Willingness to undergo a repeat procedure was assessed 1 week after PLB. Data from 203 patients (median age 50 years; 43.9% female; ethnicity: Malay 41.5%, Chinese 40%, Indian 18%; median BMI 27.7 kg/m; median waist circumference 92.0 cm) were analysed. Pain after US-guided PLB was experienced in 133 (61.1%) patients, with severity grades as follows: none, n=81 (39.9%); mild, n=56 (27.6%); moderate, n=51 (25.1%); and severe, n=15 (7.4%). Analgesia requirements correlated well with severity of pain. Independent predictors of significant pain after PLB (moderate and severe categories) in patients included age less than 50 years [odds ratio (OR) 3.0], female sex (OR 3.7), Indian ethnicity (OR 2.9) and Malay ethnicity (OR 2.7), but not number of needle passes, BMI and educational levels. Patients who experienced moderate/severe pain were less willing to undergo a repeat PLB compared with those who experienced mild/no pain (60.9 vs. 82.8%, P=0.001). Ethnicity has an important role in the development of pain after US-guided PLB. This has a significant impact on willingness to repeat the procedure.

A new procedure to analyze the effect of air changes in building energy consumption

PubMed Central

2014-01-01

Background Today, the International Energy Agency is working under good practice guides that integrate appropriate and cost effective technologies. In this paper a new procedure to define building energy consumption in accordance with the ISO 13790 standard was performed and tested based on real data from a Spanish region. Results Results showed that the effect of air changes on building energy consumption can be defined using the Weibull peak function model. Furthermore, the effect of climate change on building energy consumption under several different air changes was nearly nil during the summer season. Conclusions The procedure obtained could be the much sought-after solution to the problem stated by researchers in the past and future research works relating to this new methodology could help us define the optimal improvement in real buildings to reduce energy consumption, and its related carbon dioxide emissions, at minimal economical cost. PMID:24456655

16 CFR 1.88 - Implementing procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... efforts to improve environmental quality. He will provide assistance to the staff in determining when an... Competition will supplement these procedures for their Bureaus to assure that every proposed rule and guide is...

The 'green whistle': a novel method of analgesia for transrectal prostate biopsy.

PubMed

Grummet, Jeremy; Huang, Sean; Konstantatos, Alex; Frydenberg, Mark

2012-12-01

• Patients undergoing TRUS-guided biopsies were each given a Penthrox inhaler to self-administer during the procedure and instructed in its use. • Immediately after the procedure, patients were asked to rate their pain using a verbal rating scale from 0 to 10. • In all, 42 consecutive men underwent a TRUS-guided biopsy. • The median pain score was 3. • All 42 patients stated they would be happy to undergo the same procedure again. The only adverse effects reported by patients were brief light-headedness and a sickly sweet taste. • This study of our initial experience using Penthrox suggests that it may have a role in analgesia for TRUS-guided biopsy. • It may provide safe, adequate analgesia that is easy for urologists to use and avoids excessive use of resources. • Planning for a randomised control trial comparing Penthrox to the current 'gold standard' of prostatic infiltration of local anaesthetic is presently underway. © 2012 THE AUTHORS. BJU INTERNATIONAL © 2012 BJU INTERNATIONAL.

Ultrasound-Guided Percutaneous Tenotomy of Biceps Tendon: Technical Feasibility on Cadavers.

PubMed

Sconfienza, Luca Maria; Mauri, Giovanni; Messina, Carmelo; Aliprandi, Alberto; Secchi, Francesco; Sardanelli, Francesco; Randelli, Pietro Simone

2016-10-01

We tested the technical feasibility of ultrasound-guided percutaneous tenotomy of the long head of the biceps tendon (LHBT) in cadavers. Both shoulders of two fresh cadavers were scanned anteriorly to evaluate the extra-articular portion of the LHBT. Under ultrasound monitoring, a scalpel was advanced obliquely up to touch the superficial medial side of the LHBT, cutting it until the tendon was not visible anymore. Ultrasound evaluation was repeated after the procedure, and anatomic dissection was performed. The procedure was 100% feasible: four cuts were made to completely sever the tendon; the duration was less than 1 min. Skin incision measured 5 mm in two cases and 6 mm in two cases. Anatomic dissection confirmed complete tendon cut in all cases with proximal and distal tendon stumps very close to each other. Ultrasound-guided percutaneous LHBT tenotomy was 100% technically feasible in cadavers with a quick procedure and minimal cutaneous incision. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Thyroid Nodules

MedlinePlus

... the thyroid and see if the nodule is solid or filled with fluid (cystic). Although this test cannot tell if the nodule is cancerous, it is very useful to guide the needle to remove (aspirate) cells from nodules. This procedure is called “ultrasound-guided ...

Guide to Documenting and Managing Cost and Performance Information for Remediation Projects - Revised Version

EPA Pesticide Factsheets

This Guide to Documenting and Managing Cost and Performance Information for Remediation Projects provides the recommended procedures for documenting the results of completed and on-going full-scale and demonstration-scale remediation projects.

Culvert rating guide : August 2009.

DOT National Transportation Integrated Search

2009-08-01

The purpose of this Culvert Rating Guide is to present a clear, repeatable and valid procedure for Texas : Department of Transportation (TxDOT) engineers and their consultants to use for load rating culverts in the TxDOT : roadway system. : The Ameri...

CDS - Database Administrator's Guide

NASA Astrophysics Data System (ADS)

Day, J. P.

This guide aims to instruct the CDS database administrator in: o The CDS file system. o The CDS index files. o The procedure for assimilating a new CDS tape into the database. It is assumed that the administrator has read SUN/79.

Guide to Black Politics 1976, Part II: The Republican National Convention, Kansas City, Missouri, August 16-19, 1976.

ERIC Educational Resources Information Center

Joint Center for Political Studies, Washington, DC.

This guide was designed to assist black delegates attending the 1976 Republican National Convention. The guide is divided into four main parts. The first part contains information on convention procedures, convention committees, and various aspects of black participation in politics. The second and third parts include the names of delegates to the…

First Aid: Helping Yourself, Helping Others. Teacher's Guide. Health Promotion for Adult Literacy Students: An Empowering Approach.

ERIC Educational Resources Information Center

Hudson River Center for Program Development, Glenmont, NY.

This teaching guide is part of a series of materials developed, with input from adult learners, to aid adult literacy teachers in incorporating health education into the curriculum. This guide aims to help teachers to provide adult students with information about first-aid procedures that will substantially reduce the severity of accidents and…

Zone Nationale D'Etude de L'Environnment: Un Guide (National Environmental Study Area: A Guide).

ERIC Educational Resources Information Center

National Park Service (Dept. of Interior), Washington, DC.

This booklet, the French version of SE 014 817, is a guide for teachers and resource managers who are interested in establishing National Environmental Study Areas (NESA) or interested in receiving NESA recognition for their on-going environmental study area programs. It outlines the characteristics and procedures of the program; the nature,…

Guide to the TANDEM System for the Modern Languages Department Tape Library: A Non-Technical Guide for Teachers.

ERIC Educational Resources Information Center

Hounsell, D.; And Others

This guide for teachers to the tape indexing system (TANDEM) in use at the Modern Languages Department at Portsmouth Polytechnic focuses on tape classification, numbering, labeling, and shelving system procedures. The appendixes contain information on: (1) the classification system and related codes, (2) color and letter codes, (3) marking of tape…

Treatment of proximal hamstring tendinopathy-related sciatic nerve entrapment: presentation of an ultrasound-guided "Intratissue Percutaneous Electrolysis" application.

PubMed

Mattiussi, Gabriele; Moreno, Carlos

2016-01-01

Proximal Hamstring Tendinopathy-related Sciatic Nerve Entrapment (PHTrSNE) is a neuropathy caused by fibrosis interposed between the semimembranosus tendon and the sciatic nerve, at the level of the ischial tuberosity. Ultrasound-guided Intratissue Percutaneous Electrolysis (US-guided EPI) involves galvanic current transfer within the treatment target tissue (fibrosis) via a needle 0.30 to 0.33 mm in diameter. The galvanic current in a saline solution instantly develops the chemical process of electrolysis, which in turn induces electrochemical ablation of fibrosis. In this article, the interventional procedure is presented in detail, and both the strengths and limits of the technique are discussed. US-guided EPI eliminates the fibrotic accumulation that causes PHTrSNE, without the semimembranosus tendon or the sciatic nerve being directly involved during the procedure. The technique is however of limited use in cases of compression neuropathy. US-guided EPI is a technique that is quick to perform, minimally invasive and does not force the patient to suspend their activities (work or sports) to make the treatment effective. This, coupled to the fact that the technique is generally well-tolerated by patients, supports use of US-guided EPI in the treatment of PHTrSNE.

Glenohumeral joint injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography.

PubMed

Rutten, Matthieu J C M; Collins, James M P; Maresch, Bas J; Smeets, Jacques H J M; Janssen, Caroline M M; Kiemeney, Lambertus A L M; Jager, Gerrit J

2009-03-01

To assess the variability in accuracy of contrast media introduction, leakage, required time and patient discomfort in four different centres, each using a different image-guided glenohumeral injection technique. Each centre included 25 consecutive patients. The ultrasound-guided anterior (USa) and posterior approach (USp), fluoroscopic-guided anterior (FLa) and posterior (FLp) approach were used. Number of injection attempts, effect of contrast leakage on diagnostic quality, and total room, radiologist and procedure times were measured. Pain was documented with a visual analogue scale (VAS) pain score. Access to the joint was achieved in all patients. A successful first attempt significantly occurred more often with US (94%) than with fluoroscopic guidance (72%). Leakage of contrast medium did not cause interpretative difficulties. With US guidance mean room, procedure and radiologist times were significantly shorter (p < 0.001). The USa approach was rated with the lowest pre- and post-injection VAS scores. The four image-guided injection techniques are successful in injection of contrast material into the glenohumeral joint. US-guided injections and especially the anterior approach are significantly less time consuming, more successful on the first attempt, cause less patient discomfort and obviate the need for radiation and iodine contrast.

Preoperative computed tomography-guided percutaneous hookwire localization of metallic marker clips in the breast with a radial approach: initial experience.

PubMed

Uematsu, T; Kasami, M; Uchida, Y; Sanuki, J; Kimura, K; Tanaka, K; Takahashi, K

2007-06-01

Hookwire localization is the current standard technique for radiological marking of nonpalpable breast lesions. Stereotactic directional vacuum-assisted breast biopsy (SVAB) is of sufficient sensitivity and specificity to replace surgical biopsy. Wire localization for metallic marker clips placed after SVAB is needed. To describe a method for performing computed tomography (CT)-guided hookwire localization using a radial approach for metallic marker clips placed percutaneously after SVAB. Nineteen women scheduled for SVAB with marker-clip placement, CT-guided wire localization of marker clips, and, eventually, surgical excision were prospectively entered into the study. CT-guided wire localization was performed with a radial approach, followed by placement of a localizing marker-clip surgical excision. Feasibility and reliability of the procedure and the incidence of complications were examined. CT-guided wire localization surgical excision was successfully performed in all 19 women without any complications. The mean total procedure time was 15 min. The median distance on CT image from marker clip to hookwire was 2 mm (range 0-3 mm). CT-guided preoperative hookwire localization with a radial approach for marker clips after SVAB is technically feasible.

Endoscopic trans-nasal approach for biopsy of orbital tumours using image-guided neuro-navigation system.

PubMed

Sieskiewicz, A; Lyson, T; Mariak, Z; Rogowski, M

2008-05-01

Histopathological diagnosis of intraorbital tumours is of crucial value for planning further therapy. The aim of the study was to explore clinical utility of image-guided endoscopy for biopsy of orbital tumours. Trans-nasal endoscopic biopsy of intraorbital mass lesions was performed in 6 patients using a neuro-navigation system (Medtronic Stealth Station Treon plus). The CT and MRI 1 mm slice images were fused by the system in order to visualise both bony and soft tissue structures. The anatomic fiducial registration protocol was used during the procedure. All lesions were precisely localised and the biopsies could be taken from the representative part of the pathological mass. None of the patients developed aggravation of ocular symptoms after the procedure. The operative corridor as well as the size of orbital wall fenestration could be limited to a minimum. The accuracy of neuro-navigation remained high and stable during the entire procedure. The image-guided neuro-navigation system facilitated endoscopic localisation and biopsy of intraorbital tumours and contributed to the reduction of surgical trauma during the procedure. The technique was particularly useful in small, medially located, retrobulbar tumours and in unclear situations when the structure of the lesion resembled surrounding intraorbital tissue.

Comparison between ultrasound-guided compression and para-aneurysmal saline injection in the treatment of postcatheterization femoral artery pseudoaneurysms.

PubMed

ElMahdy, Mahmoud Farouk; Kassem, Hussien Heshmat; Ewis, Essam Baligh; Mahdy, Soliman Gharieb

2014-03-01

Management of postcatheterization femoral artery pseudoaneurysm (FAP) is problematic. Ultrasound-guided compression (UGC) is painful and cumbersome. Thrombin injection is costly and may cause thromboembolism. Ultrasound-guided para-aneurysmal saline injection (PASI) has been described but was never compared against other treatment methods of FAP. We aimed at comparing the success rate and complications of PASI versus UGC. We randomly assigned 80 patients with postcatheterization FAPs to either UGC (40 patients) or PASI (40 patients). We compared the 2 procedures regarding successful obliteration of the FAP, incidence of vasovagal attacks, procedure time, discontinuation of antiplatelet and/or anticoagulants, and the Doppler waveform in the ipsilateral pedal arteries at the end of the procedure. There was no significant difference between patients in both groups regarding clinical and vascular duplex data. The mean durations of UGC and PASI procedures were 58.14 ± 28.45 and 30.33 ± 8.56 minutes, respectively (p = 0.045). Vasovagal attacks were reported in 10 (25%) and 2 patients (5%) treated with UGC and PASI, respectively (p = 0.05). All patients in both groups had triphasic Doppler waveform in the infrapopliteal arteries before and after the procedure. The primary and final success rates were 75%, 92.5%, 87.5%, and 95% for UGC and PASI, respectively (p = 0.43). In successfully treated patients, there was no reperfusion of the FAP in the follow-up studies (days 1 and 7) in both groups. In conclusion, ultrasound-guided PASI is an effective method for the treatment of FAP. Compared with UGC, PASI is faster, less likely to cause vasovagal reactions, and can be more convenient to patients and physicians. Copyright © 2014 Elsevier Inc. All rights reserved.

Test and evaluation procedures for Sandia's Teraflops Operating System (TOS) on Janus.

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

Barnette, Daniel Wayne

This report describes the test and evaluation methods by which the Teraflops Operating System, or TOS, that resides on Sandia's massively-parallel computer Janus is verified for production release. Also discussed are methods used to build TOS before testing and evaluating, miscellaneous utility scripts, a sample test plan, and a proposed post-test method for quickly examining the large number of test results. The purpose of the report is threefold: (1) to provide a guide to T&E procedures, (2) to aid and guide others who will run T&E procedures on the new ASCI Red Storm machine, and (3) to document some ofmore » the history of evaluation and testing of TOS. This report is not intended to serve as an exhaustive manual for testers to conduct T&E procedures.« less

Assessment in Counseling: A Guide to the Use of Psychological Assessment Procedures. Third Edition.

ERIC Educational Resources Information Center

Hood, Albert B.; Johnson, Richard W.

This book presents information about various psychological assessment procedures that are specifically relevant for practicing counselors. It deals with the use of assessment procedures in the counseling process and emphasizes the selection, interpretation, and communication of psychological test results. The importance of integrating test results…

Policy and Procedures, University of Rhode Island Foundation.

ERIC Educational Resources Information Center

Leslie, James W.

A guide to policies and procedures of the University of Rhode Island Foundation is presented. Attention is directed to the following concerns: fund-raising policies, the act incorporating the University of Rhode Island Foundation, by-laws, dual signature system, nominating committee responsibilities and procedures, policy and guidelines for the…

Aviation Pilot Training II. Task Analyses: [Year II.] Field Review Copy.

ERIC Educational Resources Information Center

Upchurch, Richard

This guide for aviation pilot II training begins with a course description, resource information, and a course outline. Tasks/competencies are categorized into 10 concept/duty areas: understanding aircraft staffs and procedures for safe recovery; understanding procedures for constant altitude turns; understanding procedures for traffic pattern…

Methods for Calibration of Prout-Tompkins Kinetics Parameters Using EZM Iteration and GLO

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

Wemhoff, A P; Burnham, A K; de Supinski, B

2006-11-07

This document contains information regarding the standard procedures used to calibrate chemical kinetics parameters for the extended Prout-Tompkins model to match experimental data. Two methods for calibration are mentioned: EZM calibration and GLO calibration. EZM calibration matches kinetics parameters to three data points, while GLO calibration slightly adjusts kinetic parameters to match multiple points. Information is provided regarding the theoretical approach and application procedure for both of these calibration algorithms. It is recommended that for the calibration process, the user begin with EZM calibration to provide a good estimate, and then fine-tune the parameters using GLO. Two examples have beenmore » provided to guide the reader through a general calibrating process.« less

Parameter learning for performance adaptation

NASA Technical Reports Server (NTRS)

Peek, Mark D.; Antsaklis, Panos J.

1990-01-01

A parameter learning method is introduced and used to broaden the region of operability of the adaptive control system of a flexible space antenna. The learning system guides the selection of control parameters in a process leading to optimal system performance. A grid search procedure is used to estimate an initial set of parameter values. The optimization search procedure uses a variation of the Hooke and Jeeves multidimensional search algorithm. The method is applicable to any system where performance depends on a number of adjustable parameters. A mathematical model is not necessary, as the learning system can be used whenever the performance can be measured via simulation or experiment. The results of two experiments, the transient regulation and the command following experiment, are presented.

Novel ex vivo model for hands-on teaching of and training in EUS-guided biliary drainage: creation of "Mumbai EUS" stereolithography/3D printing bile duct prototype (with videos).

PubMed

Dhir, Vinay; Itoi, Takao; Fockens, Paul; Perez-Miranda, Manuel; Khashab, Mouen A; Seo, Dong Wan; Yang, Ai Ming; Lawrence, Khek Yu; Maydeo, Amit

2015-02-01

EUS-guided biliary drainage (EUS-BD) has emerged as an alternative rescue method in patients with failed ERCP. Opportunities for teaching and training are limited because of a low case volume at most centers. To evaluate a stereolithography/3-dimensional (3D) printing bile duct prototype for teaching and training in EUS-BD. Prospective observational feasibility study. Tertiary referral center. Twenty endosonographers attending an interventional EUS workshop. A prototype of a dilated biliary system was prepared by computer-aided design and 3D printing. The study participants performed guidewire manipulation and EUS-BD procedures (antegrade procedure and/or choledochoduodenostomy) on the prototype. Participants were scored with the device on a scale of 1 to 5 via a questionnaire. Participants' success rate for various steps of the EUS-BD procedure was noted. Subjective and objective evaluation of the prototype regarding its overall applicability, quality of radiographic and EUS images, and 4 steps of EUS-BD procedure (needle puncture, guidewire manipulation, tract dilation, stent placement). Fifteen participants returned the questionnaire, and 10 completed all 4 steps of EUS-BD. The median score for overall utility was 4, whereas that for EUS and US views was 5. Participants with experience in performing more than 20 EUS-BD procedures scored the prototype significantly lower for stent placement (P = .013) and equivalent for needle puncture, tract dilation, and wire manipulation. The success rate of various steps was 100% for needle puncture and tract dilation, 82.35% for wire manipulation, and 80% for stent placement. The mean overall procedure time was 18 minutes. Small number of participants. The 3D printing bile duct prototype appears suitable for teaching of and training in the various steps of EUS-BD. Further studies are required to elucidate its role. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Evaluation of methods to produce an image library for automatic patient model localization for dose mapping during fluoroscopically guided procedures

NASA Astrophysics Data System (ADS)

Kilian-Meneghin, Josh; Xiong, Z.; Rudin, S.; Oines, A.; Bednarek, D. R.

2017-03-01

The purpose of this work is to evaluate methods for producing a library of 2D-radiographic images to be correlated to clinical images obtained during a fluoroscopically-guided procedure for automated patient-model localization. The localization algorithm will be used to improve the accuracy of the skin-dose map superimposed on the 3D patient- model of the real-time Dose-Tracking-System (DTS). For the library, 2D images were generated from CT datasets of the SK-150 anthropomorphic phantom using two methods: Schmid's 3D-visualization tool and Plastimatch's digitally-reconstructed-radiograph (DRR) code. Those images, as well as a standard 2D-radiographic image, were correlated to a 2D-fluoroscopic image of a phantom, which represented the clinical-fluoroscopic image, using the Corr2 function in Matlab. The Corr2 function takes two images and outputs the relative correlation between them, which is fed into the localization algorithm. Higher correlation means better alignment of the 3D patient-model with the patient image. In this instance, it was determined that the localization algorithm will succeed when Corr2 returns a correlation of at least 50%. The 3D-visualization tool images returned 55-80% correlation relative to the fluoroscopic-image, which was comparable to the correlation for the radiograph. The DRR images returned 61-90% correlation, again comparable to the radiograph. Both methods prove to be sufficient for the localization algorithm and can be produced quickly; however, the DRR method produces more accurate grey-levels. Using the DRR code, a library at varying angles can be produced for the localization algorithm.

HEALTH CARE GUIDE TO POLLUTION PREVENTION IMPLEMENTATION THROUGH ENVIRONMENTAL MANAGEMENT SYSTEMS

EPA Science Inventory

The Health Care Guide to Pollution Prevention Implementation through Environmental Management Systems provides example EMS procedures and forms used in four ISO 14001 EMS certified hospitals. The latest revisions include more EMS hospital case studies, more compliance resources, ...

Gravel roads management : volume 2, gravel roads management : implementation guide.

DOT National Transportation Integrated Search

2011-10-01

This report establishes procedures for managing dirt and gravel roads, with a primary focus on smaller agencies, such as Wyoming counties, that must manage their roads with very limited resources. The report strives, first, to guide and assist smalle...

Gravel roads management : volume 3, gravel roads management : programming guide.

DOT National Transportation Integrated Search

2010-10-01

This report establishes procedures for managing dirt and gravel roads, with a primary focus on smaller agencies, such as Wyoming counties, that must manage their roads with very limited resources. The report strives, first, to guide and assist smalle...

Design procedures for heat-straightening repair : an engineering guide.

DOT National Transportation Integrated Search

1992-12-01

This report summarizes over four years of research on heat-straightening repairs and provides a prototype engineering guide for the application of heat-straightening to bridge structures. It is based on the research results detailed in a companion re...

Effectiveness of electrocardiographic guidance in CVAD tip placement.

PubMed

Walker, Graham; Chan, Raymond J; Alexandrou, Evan; Webster, Joan; Rickard, Claire

International standard practice for the correct confirmation of the central venous access device is the chest X-ray. The intracavitary electrocardiogram-based insertion method is radiation-free, and allows real-time placement verification, providing immediate treatment and reduced requirement for post-procedural repositioning. Relevant databases were searched for prospective randomised controlled trials (RCTs) or quasi RCTs that compared the effectiveness of electrocardiogram-guided catheter tip positioning with placement using surface-anatomy-guided insertion plus chest X-ray confirmation. The primary outcome was accurate catheter tip placement. Secondary outcomes included complications, patient satisfaction and costs. Five studies involving 729 participants were included. Electrocardiogram-guided insertion was more accurate than surface anatomy guided insertion (odds ratio: 8.3; 95% confidence interval (CI) 1.38; 50.07; p=0.02). There was a lack of reporting on complications, patient satisfaction and costs. The evidence suggests that intracavitary electrocardiogram-based positioning is superior to surface-anatomy-guided positioning of central venous access devices, leading to significantly more successful placements. This technique could potentially remove the requirement for post-procedural chest X-ray, especially during peripherally inserted central catheter (PICC) line insertion.

Sphincterotomy by triple lumen needle knife using guide wire in patients with Billroth II gastrectomy

PubMed Central

Park, Su Bum; Kim, Hyung Wook; Kang, Dae Hwan; Choi, Cheol Woong; Yoon, Ki Tae; Cho, Mong; Song, Byeong Jun

2013-01-01

AIM: To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in Billroth II (B-II) gastrectomy patients. METHODS: Endoscopic sphincterotomy in patients with B-II gastrectomy is challenging. We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy. This technique was performed in nine patients between August 2010 and June 2012. Sphincterotomy as described above was performed. Adequate sphincterotomy, successful stone removal, and complications were investigated prospectively. RESULTS: Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients. Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof. Complete stone removal in one session was achieved in all patients. There were no procedure related complications, such as bleeding, pancreatitis, or perforation. CONCLUSION: In patients with B-II gastrectomy, guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones. PMID:24409069

Building the atomic model of a boreal lake virus of unknown fold in a 3.9 Å cryo-EM map.

PubMed

De Colibus, Luigi; Stuart, David I

2018-04-01

We report here the protocol adopted to build the atomic model of the newly discovered virus FLiP (Flavobacterium infecting, lipid-containing phage) into 3.9 Å cryo-electron microscopy (cryo-EM) maps. In particular, this report discusses the combination of density modification procedures, automatic model building and bioinformatics tools applied to guide the tracing of the major capsid protein (MCP) of this virus. The protocol outlined here may serve as a reference for future structural determination by cryo-EM of viruses lacking detectable structural homologues. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Adaptive segmentation of cerebrovascular tree in time-of-flight magnetic resonance angiography.

PubMed

Hao, J T; Li, M L; Tang, F L

2008-01-01

Accurate segmentation of the human vasculature is an important prerequisite for a number of clinical procedures, such as diagnosis, image-guided neurosurgery and pre-surgical planning. In this paper, an improved statistical approach to extracting whole cerebrovascular tree in time-of-flight magnetic resonance angiography is proposed. Firstly, in order to get a more accurate segmentation result, a localized observation model is proposed instead of defining the observation model over the entire dataset. Secondly, for the binary segmentation, an improved Iterative Conditional Model (ICM) algorithm is presented to accelerate the segmentation process. The experimental results showed that the proposed algorithm can obtain more satisfactory segmentation results and save more processing time than conventional approaches, simultaneously.

Changing attitudes toward needle biopsies of breast cancer in Shanghai: experience and current status over the past 8 years

PubMed Central

Hao, Shuang; Liu, Zhe-Bin; Ling, Hong; Chen, Jia-Jian; Shen, Ju-Ping; Yang, Wen-Tao; Shao, Zhi-Min

2015-01-01

Diagnostic patterns in breast cancer have greatly changed over the past few decades, and core needle biopsy (CNB) has become a reliable procedure for detecting breast cancer without invasive surgery. To estimate the changing diagnostic patterns of breast cancer in urban Shanghai, 11,947 women with breast lesions detected by preoperative needle biopsy between January 1995 and December 2012 were selected from the Shanghai Cancer Data base, which integrates information from approximately 50% of breast cancer patients in Shanghai. The CNB procedure uses an automated prone unit, biopsy gun, and 14-gauge needles under freehand or ultrasound guidance and was performed by experienced radiologists and surgeons specializing in needle biopsies. Diagnosis and classification for each patient were independently evaluated by pathologists. Over the indicated 8-year period, biopsy type consisted of 11,947 ultrasound-guided core needle biopsies (UCNBs), 2,015 ultrasound-guided vacuum-assisted biopsies (UVABs), and 654 stereotactic X-ray-guided vacuum-assisted biopsies (XVABs). For all the 11,947 women included in this study, image-guided needle biopsy was the initial diagnostic procedure. Approximately 81.0% of biopsied samples were histopathologically determined to be malignant lesions, 5.5% were determined to be high-risk lesions, and 13.5% were determined to be benign lesions. The number of patients choosing UCNB increased at the greatest rate, and UCNB has become a standard procedure for histodiagnosis because it is inexpensive, convenient, and accurate. The overall false-negative rate of CNB was 1.7%, and the specific false-negative rates for UCNB, UVAB, and XVAB, were 1.7%, 0%, and 0%, respectively. This study suggests that the use of preoperative needle biopsy as the initial breast cancer diagnostic procedure is acceptable in urban Shanghai. Preoperative needle biopsy is now a standard procedure in the Shanghai Cancer Center because it may reduce the number of surgeries needed to treat breast cancer. PMID:26491359

Real-time fluoroscopic needle guidance in the interventional radiology suite using navigational software for percutaneous bone biopsies in children.

PubMed

Shellikeri, Sphoorti; Setser, Randolph M; Hwang, Tiffany J; Srinivasan, Abhay; Krishnamurthy, Ganesh; Vatsky, Seth; Girard, Erin; Zhu, Xiaowei; Keller, Marc S; Cahill, Anne Marie

2017-07-01

Navigational software provides real-time fluoroscopic needle guidance for percutaneous procedures in the Interventional Radiology (IR) suite. We describe our experience with navigational software for pediatric percutaneous bone biopsies in the IR suite and compare technical success, diagnostic accuracy, radiation dose and procedure time with that of CT-guided biopsies. Pediatric bone biopsies performed using navigational software (Syngo iGuide, Siemens Healthcare) from 2011 to 2016 were prospectively included and anatomically matched CT-guided bone biopsies from 2008 to 2016 were retrospectively reviewed with institutional review board approval. C-arm CT protocols used for navigational software-assisted cases included institution-developed low-dose (0.1/0.17 μGy/projection), regular-dose (0.36 μGy/projection), or a combination of low-dose/regular-dose protocols. Estimated effective radiation dose and procedure times were compared between software-assisted and CT-guided biopsies. Twenty-six patients (15 male; mean age: 10 years) underwent software-assisted biopsies (15 pelvic, 7 lumbar and 4 lower extremity) and 33 patients (13 male; mean age: 9 years) underwent CT-guided biopsies (22 pelvic, 7 lumbar and 4 lower extremity). Both modality biopsies resulted in a 100% technical success rate. Twenty-five of 26 (96%) software-assisted and 29/33 (88%) CT-guided biopsies were diagnostic. Overall, the effective radiation dose was significantly lower in software-assisted than CT-guided cases (3.0±3.4 vs. 6.6±7.7 mSv, P=0.02). The effective dose difference was most dramatic in software-assisted cases using low-dose C-arm CT (1.2±1.8 vs. 6.6±7.7 mSv, P=0.001) or combined low-dose/regular-dose C-arm CT (1.9±2.4 vs. 6.6±7.7 mSv, P=0.04), whereas effective dose was comparable in software-assisted cases using regular-dose C-arm CT (6.0±3.5 vs. 6.6±7.7 mSv, P=0.7). Mean procedure time was significantly lower for software-assisted cases (91±54 vs. 141±68 min, P=0.005). In our experience, navigational software technology in the IR suite is a promising alternative to CT guidance for pediatric bone biopsies providing comparable technical success and diagnostic accuracy with lower radiation dose and procedure time, in addition to providing real-time fluoroscopic needle guidance.

Structured Analysis of the Logistic Support Analysis (LSA) Task, ’Integrated Logistic Support (ILS) Assessment Maintenance Planning E-1 Element’ (APJ 966-204)

DTIC Science & Technology

1988-10-01

Structured Analysis involves building a logical (non-physical) model of a system, using graphic techniques which enable users, analysts, and designers to... Design uses tools, especially graphic ones, to render systems readily understandable. 8 Ř. Structured Design offers a set of strategies for...in the overall systems design process, and an overview of the assessment procedures, as well as a guide to the overall assessment. 20. DISTRIBUTION

An evaluation of three statistical estimation methods for assessing health policy effects on prescription drug claims.

PubMed

Mittal, Manish; Harrison, Donald L; Thompson, David M; Miller, Michael J; Farmer, Kevin C; Ng, Yu-Tze

2016-01-01

While the choice of analytical approach affects study results and their interpretation, there is no consensus to guide the choice of statistical approaches to evaluate public health policy change. This study compared and contrasted three statistical estimation procedures in the assessment of a U.S. Food and Drug Administration (FDA) suicidality warning, communicated in January 2008 and implemented in May 2009, on antiepileptic drug (AED) prescription claims. Longitudinal designs were utilized to evaluate Oklahoma (U.S. State) Medicaid claim data from January 2006 through December 2009. The study included 9289 continuously eligible individuals with prevalent diagnoses of epilepsy and/or psychiatric disorder. Segmented regression models using three estimation procedures [i.e., generalized linear models (GLM), generalized estimation equations (GEE), and generalized linear mixed models (GLMM)] were used to estimate trends of AED prescription claims across three time periods: before (January 2006-January 2008); during (February 2008-May 2009); and after (June 2009-December 2009) the FDA warning. All three statistical procedures estimated an increasing trend (P < 0.0001) in AED prescription claims before the FDA warning period. No procedures detected a significant change in trend during (GLM: -30.0%, 99% CI: -60.0% to 10.0%; GEE: -20.0%, 99% CI: -70.0% to 30.0%; GLMM: -23.5%, 99% CI: -58.8% to 1.2%) and after (GLM: 50.0%, 99% CI: -70.0% to 160.0%; GEE: 80.0%, 99% CI: -20.0% to 200.0%; GLMM: 47.1%, 99% CI: -41.2% to 135.3%) the FDA warning when compared to pre-warning period. Although the three procedures provided consistent inferences, the GEE and GLMM approaches accounted appropriately for correlation. Further, marginal models estimated using GEE produced more robust and valid population-level estimations. Copyright © 2016 Elsevier Inc. All rights reserved.

Geologic Carbon Sequestration Leakage Detection: A Physics-Guided Machine Learning Approach

NASA Astrophysics Data System (ADS)

Lin, Y.; Harp, D. R.; Chen, B.; Pawar, R.

2017-12-01

One of the risks of large-scale geologic carbon sequestration is the potential migration of fluids out of the storage formations. Accurate and fast detection of this fluids migration is not only important but also challenging, due to the large subsurface uncertainty and complex governing physics. Traditional leakage detection and monitoring techniques rely on geophysical observations including pressure. However, the resulting accuracy of these methods is limited because of indirect information they provide requiring expert interpretation, therefore yielding in-accurate estimates of leakage rates and locations. In this work, we develop a novel machine-learning technique based on support vector regression to effectively and efficiently predict the leakage locations and leakage rates based on limited number of pressure observations. Compared to the conventional data-driven approaches, which can be usually seem as a "black box" procedure, we develop a physics-guided machine learning method to incorporate the governing physics into the learning procedure. To validate the performance of our proposed leakage detection method, we employ our method to both 2D and 3D synthetic subsurface models. Our novel CO2 leakage detection method has shown high detection accuracy in the example problems.

Image-guided laparoscopic surgery in an open MRI operating theater.

PubMed

Tsutsumi, Norifumi; Tomikawa, Morimasa; Uemura, Munenori; Akahoshi, Tomohiko; Nagao, Yoshihiro; Konishi, Kozo; Ieiri, Satoshi; Hong, Jaesung; Maehara, Yoshihiko; Hashizume, Makoto

2013-06-01

The recent development of open magnetic resonance imaging (MRI) has provided an opportunity for the next stage of image-guided surgical and interventional procedures. The purpose of this study was to evaluate the feasibility of laparoscopic surgery under the pneumoperitoneum with the system of an open MRI operating theater. Five patients underwent laparoscopic surgery with a real-time augmented reality navigation system that we previously developed in a horizontal-type 0.4-T open MRI operating theater. All procedures were performed in an open MRI operating theater. During the operations, the laparoscopic monitor clearly showed the augmented reality models of the intraperitoneal structures, such as the common bile ducts and the urinary bladder, as well as the proper positions of the prosthesis. The navigation frame rate was 8 frames per min. The mean fiducial registration error was 6.88 ± 6.18 mm in navigated cases. We were able to use magnetic resonance-incompatible surgical instruments out of the 5-Gs restriction area, as well as conventional laparoscopic surgery, and we developed a real-time augmented reality navigation system using open MRI. Laparoscopic surgery with our real-time augmented reality navigation system in the open MRI operating theater is a feasible option.

Adolescent test or procedure preparation

MedlinePlus

... someone else) during the procedure Playing hand-held video games Using guided imagery Trying other distractions, such as listening to music through headphones, if allowed When possible, let ... from videos that show adolescents of the same age explaining ...

Guide to Black Politics 1976, Part I: The Democratic National Convention, Madison Square Garden, New York, July 12-15, 1976.

ERIC Educational Resources Information Center

Joint Center for Political Studies, Washington, DC.

This guide was designed to assist black delegates attending the 1976 Democratic National Convention. The guide is divided into four main parts. The first part contains information on convention procedures, standing committees, and various aspects of black participation in politics. The second and third parts lists the names of alternates as well…

Building a Better You: Volume 2. A Guide for Health Education in Georgia Schools...Grade Seven Through Eleven.

ERIC Educational Resources Information Center

Georgia State Dept. of Education, Atlanta. Office of Instructional Services.

Developing a secondary level health education program is the main focus of this guide, and concepts and supporting data pertaining to some of the major health problems facing children and youth are presented as well. The guide is divided into three sections. The first section, "Policies and Procedures," is concerned with school health policies and…

Virginia State Adult Basic Education Administrative Guide for Local Programs and Projects under the Adult Education Act, P.L. 91-230 and Amendments.

ERIC Educational Resources Information Center

Virginia State Dept. of Education, Richmond. Adult Education Service.

This administrative guide was developed to provide local school divisions and other agencies operating federally funded Adult Basic Education (ABE) programs in Virginia with the purpose, requirements, and procedures for conducting these programs. The guide is divided into eleven sections. The introduction covers the purpose and scope of ABE…

Cost comparison between ultrasound-guided 14-g large core breast biopsy and open surgical biopsy: an analysis for Austria.

PubMed

Gruber, R; Walter, E; Helbich, T H

2010-06-01

To examine the budget impact of ultrasound-guided 14-g large core breast biopsy (US-guided LCBB) by comparing the costs of US-guided LCBB and open surgical biopsy (OSB); to calculate the cost savings attributable to US-guided LCBB; and to assess the frequency with which US-guided LCBB obviates the need for an OSB. In a retrospective study, we reviewed 399 suspicious breast lesions on which US-guided LCBB and OSB or, in cases of benign histology, clinical follow-up, were performed. Cost savings were calculated using nationally allowed flat rates (A-drg) and patient charges. Costs were measured from both, a hospital and a socioeconomic perspective. Deterministic sensitivity analyses were simulated to assess the extent of achievable cost savings. Overall cost savings for US-guided LCBB over OSB were euro 977 (euro 2,337/euro 3,314) per case from a hospital perspective, resulting in a total cost decrease of 30% for the diagnosis of suspicious breast lesions. From a socioeconomic perspective, cost savings were euro 1,542 (euro 2,600/euro 4,142) per case, resulting in a 37% reduction in biopsy cost. US-guided LCBB obviated the need for a surgical procedure in 240 (60%) of 399 women. In all four sensitivity analyses, costs of US-guided LCBB remained lower than that of OSB. From an economic perspective, US-guided LCBB is highly recommended for the diagnosis of suspicious breast lesions, as this procedure reduces the cost of diagnosis substantially. In Austria, annual cost savings would be euro 18.5 million. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

A New Classification of Three-Dimensional Printing Technologies: Systematic Review of Three-Dimensional Printing for Patient-Specific Craniomaxillofacial Surgery.

PubMed

Jacobs, Carly A; Lin, Alexander Y

2017-05-01

Three-dimensional printing technology has been advancing in surgical applications. This systematic review examines its patient-specific applications in craniomaxillofacial surgery. Terms related to "three-dimensional printing" and "surgery" were searched on PubMed on May 4, 2015; 313 unique articles were returned. Inclusion and exclusion criteria concentrated on patient-specific surgical applications, yielding 141 full-text articles, of which 33 craniomaxillofacial articles were analyzed. Thirty-three articles included 315 patients who underwent three-dimensional printing-assisted operations. The most common modeling software was Mimics, the most common printing software was 3D Systems, the average time to create a printed object was 18.9 hours (range, 1.5 to 96 hours), and the average cost of a printed object was $1353.31 (range, $69.75 to $5500). Surgical procedures were divided among 203 craniofacial patients (205 three-dimensional printing objects) and 112 maxillofacial patients (137 objects). Printing technologies could be classified as contour models, guides, splints, and implants. For craniofacial patients, 173 contour models (84 percent), 13 guides (6 percent), two splints (1 percent), and 17 implants (8 percent) were made. For maxillofacial patients, 41 contour models (30 percent), 48 guides (35 percent), 40 splints (29 percent), and eight implants (6 percent) were made. These distributions were significantly different (p < 0.0001). Four studies compared three-dimensional printing techniques to conventional techniques; two of them found that three-dimensional printing produced improved outcomes. Three-dimensional printing technology in craniomaxillofacial surgery can be classified into contour models (type I), guides (type II), splints (type III), and implants (type IV). These four methods vary in their use between craniofacial and maxillofacial surgery, reflecting their different goals. This understanding may help advance and predict three-dimensional printing applications for other types of plastic surgery and beyond.

A randomised crossover study to compare the cross-sectional and longitudinal approaches to ultrasound-guided peripheral venepuncture in a model.

PubMed

Griffiths, James; Carnegie, Amadeus; Kendall, Richard; Madan, Rajeev

2017-12-01

Ultrasound-guided peripheral intravenous access may present an alternative to central or intraosseous access in patients with difficult peripheral veins. Using venepuncture of a phantom model as a proxy, we investigated whether novice ultrasound users should adopt a cross-sectional or longitudinal approach when learning to access peripheral veins under ultrasound guidance. This result would inform the development of a structured training method for this procedure. We conducted a randomised controlled trial of 30 medical students. Subjects received 35 min of training, then attempted to aspirate 1 ml of synthetic blood from a deep vein in a training model under ultrasound guidance. Subjects attempted both the cross-sectional and longitudinal approaches. Group 1 used cross-sectional first, followed by longitudinal. Group 2 used longitudinal first, then cross-sectional. We measured the time from first puncture of the model's skin to aspiration of fluid, and the number of attempts required. Subjects also reported difficulty ratings for each approach. Paired sample t-tests were used for statistical analysis. The mean number of attempts was 1.13 using the cross-sectional approach, compared with 1.30 using the longitudinal approach (p = 0.17). Mean time to aspiration of fluid was 45.1 s using the cross-sectional approach and 52.8 s using the longitudinal approach (p = 0.43). The mean difficulty score out of 10 was 3.97 for the cross-sectional approach and 3.93 for the longitudinal approach (p = 0.95). We found no significant difference in effectiveness between the cross-sectional and longitudinal approaches to ultrasound-guided venepuncture when performed on a model. We believe that both approaches should be included when teaching ultrasound-guided peripheral vascular access. To confirm which approach would be best in clinical practice, we advocate future testing of both approaches on patients.

Image-guided scapulothoracic arthroscopy for removing firearm projectiles

PubMed Central

Ejnisman, Benno; Andreoli, Carlos Vicente; Carvalho, Cassiano Diniz; Pochini, Alberto De Castro

2014-01-01

Scapulothoracic arthroscopy is gaining recognition among arthroscopic procedures as it is considered a relatively low morbidity procedure; also, continuing studies of this technique are making it safer. Scapulothoracic arthroscopy can be used for removal of a foreign body. This case report describes the removal of a firearm projectile using image-guided arthroscopy, highlighting the anatomical aspects and characteristics of the surgical technique. In this case, the patient recovered uneventfully, with complete remission of symptoms in 30 days, returning to his usual activities within 2 months after surgery. PMID:25480137

Diagnosis and treatment of haemorrhoids.

PubMed

Buntzen, Steen; Christensen, Peter; Khalid, Ali; Ljungmann, Ken; Lindholt, Jan; Lundby, Lilli; Walker, Line Rossell; Raahave, Dennis; Qvist, Niels

2013-12-01

These guidelines provide a review of diagnosis, conservative and surgical treatment of haemorrhoids with primary focus on the surgical treatment. In symptomatic hemorrhoids it is recommended, that conservative treatment is used as basic treatment regardless of grading. The vast majority of grade II haemorrhoids are treated conservatively, but surgery may be considered in a few cases with pronounced symptoms. In these cases chirurgia minor, Doppler guided dearterilization procedures or stapled haemorrhoidopexy are recommended. In grade III and IV Doppler guided dearterilization procedures, stapled haemorrhoidopexy (Grade III) or conventional Milligan Morgan haemorrhoidectomy are recommended.

Reconstruction Of The Permittivity Profile Of A Stratified Dielectric Layer

NASA Astrophysics Data System (ADS)

Vogelzang, E.; Ferwerda, H. A.; Yevick, D.

1985-03-01

A numerical procedure is given for the reconstruction of the permittivity profile of a dielectric slab on a perfect conductor. Profiles not supporting guided modes are reconstructed from the complex reflection amplitude for TE-polarized, monochromatic plane waves incident from different directions using the Marchenko theory. The contribution of guided modes is incorporated in the reconstruction procedure through the Gelfand-Levitan equations. An advantage of our approach is that a unique solution for the permittivity profile is obtained without the use of complicated regularization techniques. Some illustrative numerical examples are presented.

Liquid Pipeline Operator's Control Room Human Factors Risk Assessment and Management Guide

DOT National Transportation Integrated Search

2008-11-26

The purpose of this guide is to document methodologies, tools, procedures, guidance, and instructions that have been developed to provide liquid pipeline operators with an efficient and effective means of managing the human factors risks in their con...

Aviation Maintenance Technology. Course Content Guides. FAA Approved Curriculum.

ERIC Educational Resources Information Center

Shrawder, Jack; And Others

Course content guides are provided for the 30 courses in this aviation maintenance technology curriculum approved by the Federal Aviation Administration. Course titles are physics for technicians; aircraft information, regulations, and procedures; aircraft assembly; fundamentals of aircraft electronics; aircraft electrical components; aircraft…

HAL/S programmer's guide. [space shuttle flight software language

NASA Technical Reports Server (NTRS)

Newbold, P. M.; Hotz, R. L.

1974-01-01

HAL/S is a programming language developed to satisfy the flight software requirements for the space shuttle program. The user's guide explains pertinent language operating procedures and described the various HAL/S facilities for manipulating integer, scalar, vector, and matrix data types.

North Dakota implementation of mechanistic-empirical pavement design guide (MEPDG).

DOT National Transportation Integrated Search

2014-12-01

North Dakota currently designs roads based on the AASHTO Design Guide procedure, which is based on : the empirical findings of the AASHTO Road Test of the late 1950s. However, limitations of the current : empirical approach have prompted AASHTO to mo...

Elements of a Research Report.

ERIC Educational Resources Information Center

Schurter, William J.

This guide for writing research or technical reports discusses eleven basic elements of such reports and provides examples of "good" and "bad" wordings. These elements are the title, problem statement, purpose statement, need statement, hypothesis, assumptions, procedures, limitations, terminology, conclusion and recommendations. This guide is…

Curriculum Guide for Adult Education Teachers.

ERIC Educational Resources Information Center

Hammett, Earl Lee

This curriculum guide for teachers of adult education is divided into three parts. The first offers an overview of adult basic education, the teacher as counselor, testing and evaluation, instructional procedures--physical environment and classroom management, techniques providing variety in instruction--discussions, demonstrations, projects,…

Guidelines and Standards for Proprietary Schools.

ERIC Educational Resources Information Center

Georgia State Board of Education, Atlanta.

This guide contains information pertaining to Georgia law, rules, regulations, and standards of practice for regulating proprietary schools in Georgia. Section 1 of the guide presents operation guidelines, including definitions, exemptions, general provisions, certificates of approval of schools, and appeals procedures. Section 2 presents minimum…

Guide for Science Laboratory Safety.

ERIC Educational Resources Information Center

McDermott, John J.

General and specific safety procedures and recommendations for secondary school science laboratories are provided in this guide. Areas of concern include: (1) chemicals (storage, disposal, toxicity, unstable and incompatible chemicals); (2) microorganisms; (3) plants; (4) animals; (5) electricity; (6) lasers; (7) rockets; (8) eye safety and…

In-Plane Ultrasound-Guided Knee Injection Through a Lateral Suprapatellar Approach: A Safe Technique.

PubMed

Chagas-Neto, Francisco A; Taneja, Atul K; Gregio-Junior, Everaldo; Nogueira-Barbosa, Marcello H

2017-06-01

This study aims to describe a technique for in-plane ultrasound-guided knee arthrography through a lateral suprapatellar approach, reporting its accuracy and related complications. A retrospective search was performed for computed tomography and magnetic resonance reports from June 2013 through June 2015. Imaging studies, puncture descriptions, and guided-procedure images were reviewed along with clinical and surgical history. A fellowship-trained musculoskeletal radiologist performed all procedures under sterile technique and ultrasound guidance with the probe in oblique position on the lateral suprapatellar recess after local anesthesia with the patient on dorsal decubitus, hip in neutral rotation, and 30 to 45 degrees of knee flexion. A total of 86 consecutive subjects were evaluated (mean, 55 years). All subjects underwent intra-articular injection of contrast, which was successfully reached in the first attempt in 94.2% of the procedures (81/86), and in the second attempt in 5.8% (5/86) after needle repositioning without a second puncture. There were no postprocedural reports of regional complications at the puncture site, such as significant pain, bleeding, or vascular lesions. Our study demonstrates that in-plane ultrasound-guided injection of the knee in semiflexion approaching the lateral suprapatellar recess is a safe and useful technique to administer intra-articular contrast solution, as an alternative method without radiation exposure.

Time Projection Compton Spectrometer (TPCS). User`s guide

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

Landron, C.O.; Baldwin, G.T.

1994-04-01

The Time Projection Compton Spectrometer (TPCS) is a radiation diagnostic designed to determine the time-integrated energy spectrum between 100 keV -- 2 MeV of flash x-ray sources. This guide is intended as a reference for the routine operator of the TPCS. Contents include a brief overview of the principle of operation, detailed component descriptions, detailed assembly and disassembly procedures, guide to routine operations, and troubleshooting flowcharts. Detailed principle of operation, signal analysis and spectrum unfold algorithms are beyond the scope of this guide; however, the guide makes reference to sources containing this information.

A sampling procedure to guide the collection of narrow-band, high-resolution spatially and spectrally representative reflectance data. [satellite imagery of earth resources

NASA Technical Reports Server (NTRS)

Brand, R. R.; Barker, J. L.

1983-01-01

A multistage sampling procedure using image processing, geographical information systems, and analytical photogrammetry is presented which can be used to guide the collection of representative, high-resolution spectra and discrete reflectance targets for future satellite sensors. The procedure is general and can be adapted to characterize areas as small as minor watersheds and as large as multistate regions. Beginning with a user-determined study area, successive reductions in size and spectral variation are performed using image analysis techniques on data from the Multispectral Scanner, orbital and simulated Thematic Mapper, low altitude photography synchronized with the simulator, and associated digital data. An integrated image-based geographical information system supports processing requirements.

Sheathless guide catheter in transradial percutaneous coronary intervention for ST-segment elevation myocardial infarction.

PubMed

Miyasaka, Masaki; Tada, Norio; Kato, Shigeaki; Kami, Masahiro; Horie, Kazunori; Honda, Taku; Takizawa, Kaname; Otomo, Tatsushi; Inoue, Naoto

2016-05-01

The aim of this study was to assess the safety and efficacy of sheathless guide catheters in transradial percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Transradial PCI for STEMI offers significant clinical benefits, including a reduced incidence of vascular complications. As the size of the radial artery is small, the radial artery is frequently damaged in this procedure using large-bore catheters. A sheathless guide catheter offers a solution to this problem as it does not require an introducer sheath. However, the efficacy and safety of sheathless guide catheters remain to be fully determined in emergent transradial PCI for STEMI. Data on consecutive STEMI patients undergoing primary PCI at the Sendai Kousei Hospital between September 2010 and May 2013 were analyzed. The primary endpoint was the rate of acute procedural success without access site crossover. Secondary endpoints included door-to-balloon time, fluoroscopy time, volume of contrast, and radial artery stenosis or occlusion rate. We conducted transradial PCI for 478 patients with STEMI using a sheathless guide catheter. Acute procedural success was achieved in 466 patients (97.5%). The median door-to-balloon time was 45 min (range, 15-317 min). The median fluoroscopy time was 16.4 min (range, 10-90 min). The median volume of contrast was 134 mL (range, 31-431 mL). Radial stenosis or occlusion developed in 14 (3.8%) of the 370 evaluable patients. This study showed that use of a sheathless guide catheter taking a transradial approach was effective and safe in primary PCI for STEMI. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Data Input for Publishers. State-of-the-Art Report.

ERIC Educational Resources Information Center

Buckland, Lawrence F.

Intended to serve as a guide for selecting the most suitable automated method for preparing and sending papers for publication, this report briefly describes data entry and editing procedures available from one publisher (Inforonics) and provides an estimate of processing costs for each procedure. The procedures, arranged in order of increasing…

Driving Procedures. A Resource Guide for Driver Education Teachers.

ERIC Educational Resources Information Center

Texas State Dept. of Public Safety, Austin.

Designed to provide instructors with resource materials for driver education, this book contains mainly materials on established safe driving procedures. An introduction defines a procedure as describing ways in which a driver can comply with the law to do something extra that will increase his/her safety and prevent congestion and collision.…

Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of liver tumours.

PubMed

Wijlemans, J W; Bartels, L W; Deckers, R; Ries, M; Mali, W P Th M; Moonen, C T W; van den Bosch, M A A J

2012-09-28

Recent decades have seen a paradigm shift in the treatment of liver tumours from invasive surgical procedures to minimally invasive image-guided ablation techniques. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a novel, completely non-invasive ablation technique that has the potential to change the field of liver tumour ablation. The image guidance, using MR imaging and MR temperature mapping, provides excellent planning images and real-time temperature information during the ablation procedure. However, before clinical implementation of MR-HIFU for liver tumour ablation is feasible, several organ-specific challenges have to be addressed. In this review we discuss the MR-HIFU ablation technique, the liver-specific challenges for MR-HIFU tumour ablation, and the proposed solutions for clinical translation.

Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablation of liver tumours

PubMed Central

Bartels, L.W.; Deckers, R.; Ries, M.; Mali, W.P.Th.M.; Moonen, C.T.W.; van den Bosch, M.A.A.J.

2012-01-01

Abstract Recent decades have seen a paradigm shift in the treatment of liver tumours from invasive surgical procedures to minimally invasive image-guided ablation techniques. Magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) is a novel, completely non-invasive ablation technique that has the potential to change the field of liver tumour ablation. The image guidance, using MR imaging and MR temperature mapping, provides excellent planning images and real-time temperature information during the ablation procedure. However, before clinical implementation of MR-HIFU for liver tumour ablation is feasible, several organ-specific challenges have to be addressed. In this review we discuss the MR-HIFU ablation technique, the liver-specific challenges for MR-HIFU tumour ablation, and the proposed solutions for clinical translation. PMID:23022541

Psychopathy-related traits and the use of reward and social information: a computational approach

PubMed Central

Brazil, Inti A.; Hunt, Laurence T.; Bulten, Berend H.; Kessels, Roy P. C.; de Bruijn, Ellen R. A.; Mars, Rogier B.

2013-01-01

Psychopathy is often linked to disturbed reinforcement-guided adaptation of behavior in both clinical and non-clinical populations. Recent work suggests that these disturbances might be due to a deficit in actively using information to guide changes in behavior. However, how much information is actually used to guide behavior is difficult to observe directly. Therefore, we used a computational model to estimate the use of information during learning. Thirty-six female subjects were recruited based on their total scores on the Psychopathic Personality Inventory (PPI), a self-report psychopathy list, and performed a task involving simultaneous learning of reward-based and social information. A Bayesian reinforcement-learning model was used to parameterize the use of each source of information during learning. Subsequently, we used the subscales of the PPI to assess psychopathy-related traits, and the traits that were strongly related to the model's parameters were isolated through a formal variable selection procedure. Finally, we assessed how these covaried with model parameters. We succeeded in isolating key personality traits believed to be relevant for psychopathy that can be related to model-based descriptions of subject behavior. Use of reward-history information was negatively related to levels of trait anxiety and fearlessness, whereas use of social advice decreased as the perceived ability to manipulate others and lack of anxiety increased. These results corroborate previous findings suggesting that sub-optimal use of different types of information might be implicated in psychopathy. They also further highlight the importance of considering the potential of computational modeling to understand the role of latent variables, such as the weight people give to various sources of information during goal-directed behavior, when conducting research on psychopathy-related traits and in the field of forensic psychiatry. PMID:24391615

Endodontic Treatment of an Anomalous Anterior Tooth with the Aid of a 3-dimensional Printed Physical Tooth Model.

PubMed

Byun, Chanhee; Kim, Changhwan; Cho, Seungryong; Baek, Seung Hoon; Kim, Gyutae; Kim, Sahng G; Kim, Sun-Young

2015-06-01

Endodontic treatment of tooth formation anomalies is a challenge to clinicians and as such requires a complete understanding of the aberrant root canal anatomy followed by careful root canal disinfection and obturation. Here, we report the use of a 3-dimensional (3D) printed physical tooth model including internal root canal structures for the endodontic treatment of a challenging tooth anomaly. A 12-year-old boy was referred for endodontic treatment of tooth #8. The tooth showed class II mobility with swelling and a sinus tract in the buccal mucosa and periapical radiolucency. The tooth presented a very narrow structure between the crown and root by distal concavity and a severely dilacerated root. Moreover, a perforation site with bleeding and another ditching site were identified around the cervical area in the access cavity. A translucent physical tooth model carrying the information on internal root canal structures was built through a 3-step process: data acquisition by cone-beam computed tomographic scanning, virtual modeling by image processing, and manufacturing by 3D printing. A custom-made guide jig was then fabricated to achieve a safe and precise working path to the root canal. Endodontic procedures including access cavity preparation were performed using the physical tooth model and the guide jig. At the 7-month follow-up, the endodontically treated tooth showed complete periapical healing with no clinical signs and symptoms. This case report describes a novel method of endodontic treatment of an anomalous maxillary central incisor with the aid of a physical tooth model and a custom-made guide jig via 3D printing technique. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Image-Guided Cryoablation of the Spine in a Swine Model: Clinical, Radiological, and Pathological Findings with Light and Electron Microscopy.

PubMed

de Freitas, Ricardo Miguel Costa; Andrade, Celi Santos; Caldas, José Guilherme Mendes Pereira; Tsunemi, Miriam Harumi; Ferreira, Lorraine Braga; Arana-Chavez, Victor Elias; Cury, Patrícia Maluf

2015-10-01

This study was designed to present the feasibility of an in vivo image-guided percutaneous cryoablation of the porcine vertebral body. The institutional animal care committee approved this study. Cone-beam computed tomography (CBCT)-guided vertebral cryoablations (n = 22) were performed in eight pigs with short, 2-min, single or double-freezing protocols. Protective measures to nerves included dioxide carbon (CO2) epidural injections and spinal canal temperature monitoring. Clinical, radiological, and pathological data with light (n = 20) or transmission electron (n = 2) microscopic analyses were evaluated after 6 days of clinical follow-up and euthanasia. CBCT/fluoroscopic-guided transpedicular vertebral body cryoprobe positioning and CO2 epidural injection were successful in all procedures. No major complications were observed in seven animals (87.5 %, n = 8). A minor complication was observed in one pig (12.5 %, n = 1). Logistic regression model analysis showed the cryoprobe-spinal canal (Cp-Sc) distance as the most efficient parameter to categorize spinal canal temperatures lower than 19 °C (p < 0.004), with a significant Pearson's correlation test (p < 0.041) between the Cp-Sc distance and the lowest spinal canal temperatures. Ablation zones encompassed pedicles and the posterior wall of the vertebral bodies with an inflammatory rim, although no inflammatory infiltrate was depicted in the surrounding neural structures at light microscopy. Ultrastructural analyses evidenced myelin sheath disruption in some large nerve fibers, although neurological deficits were not observed. CBCT-guided vertebral cryoablation of the porcine spine is feasible under a combination of a short freezing protocol and protective measures to the surrounding nerves. Ultrastructural analyses may be helpful assess the early modifications of the nerve fibers.

An integrated model-based software for FUS in moving abdominal organs.

PubMed

Schwenke, Michael; Strehlow, Jan; Haase, Sabrina; Jenne, Juergen; Tanner, Christine; Langø, Thomas; Loeve, Arjo J; Karakitsios, Ioannis; Xiao, Xu; Levy, Yoav; Sat, Giora; Bezzi, Mario; Braunewell, Stefan; Guenther, Matthias; Melzer, Andreas; Preusser, Tobias

2015-05-01

Focused ultrasound surgery (FUS) is a non-invasive method for tissue ablation that has the potential for complete and controlled local tumour destruction with minimal side effects. The treatment of abdominal organs such as the liver, however, requires particular technological support in order to enable a safe, efficient and effective treatment. As FUS is applied from outside the patient's body, suitable imaging methods, such as magnetic resonance imaging or diagnostic ultrasound, are needed to guide and track the procedure. To facilitate an efficient FUS procedure in the liver, the organ motion during breathing and the partial occlusion by the rib cage need to be taken into account in real time, demanding a continuous patient-specific adaptation of the treatment configuration. Modelling the patient's respiratory motion and combining this with tracking data improves the accuracy of motion predictions. Modelling and simulation of the FUS effects within the body allows the use of treatment planning and has the potential to be used within therapy to increase knowledge about the patient status. This article describes integrated model-based software for patient-specific modelling and prediction for FUS treatments of moving abdominal organs.

REACH. Teacher's Guide, Volume I. Secondary Program Management.

ERIC Educational Resources Information Center

Morris, James Lee; And Others

Designed for use with individualized instructional units (CE 026 345 and CE 026 348-350) in the REACH (Refrigeration, Electro-Mechanical, Air-Conditioning, Heating) electromechanical cluster, this secondary teacher's guide is devoted to the establishment of standard instructional procedures. Following an introductory section, sections provide…

Identifying Gifted Students: A Practical Guide

ERIC Educational Resources Information Center

Johnsen, S., Ed.

2004-01-01

This user-friendly guide offers advice and insight on developing defensible identification procedures and services for gifted and talented students. Special attention is given to the use of multiple methods including qualitative and quantitative assessments such as standardized measures (e.g. intelligence, aptitude, and achievement tests),…

What Is Career English?

ERIC Educational Resources Information Center

Brevard County School Board, Cocoa, FL.

English courses which involve the language arts skills and which should be incorporated into major career areas are described in this guide. The guide also describes the units, procedures, activities, supplementary materials, and evaluation tools and is keyed--by number--to the State Accreditation Standards and assessment objectives. Teaching…

School Emergency Planning Guide.

ERIC Educational Resources Information Center

Benedetto, Harry J.

This guide was prepared to assist Pennsylvania schools and communities in the development of comprehensive emergency plans. Procedures for identifying and responding to potential community and school emergency situations are presented. A plan for developing and organizing mass care centers utilizing school and community facilities and resources is…

Improved guidance for users of the 1993 AASHTO flexible pavement design procedures : LTPP TechBrief

DOT National Transportation Integrated Search

1997-08-01

A key design challenge faced by engineers using the 1993 AASHTO Guide for Design of Pavement Structures (AASHTO Guide) is the determination of appropriate design parameters for the subgrade and pavement materials. The Long-Term Pavement Performance (...