40 CFR 265.310 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Closure and post-closure care. 265.310... DISPOSAL FACILITIES Landfills § 265.310 Closure and post-closure care. (a) At final closure of the landfill... subsoils present. (b) After final closure, the owner or operator must comply with all post-closure...

40 CFR 265.310 - Closure and post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 26 2014-07-01 2014-07-01 false Closure and post-closure care. 265.310... DISPOSAL FACILITIES Landfills § 265.310 Closure and post-closure care. (a) At final closure of the landfill... subsoils present. (b) After final closure, the owner or operator must comply with all post-closure...

Pericardium closure after heart operations: a safety option?

PubMed

Dantas, Carlos Eduardo Pereira; Sá, Mauro Paes Leme de; Bastos, Eduardo Sergio; Magnanini, Monica M F

2010-01-01

Primary pericardium closure may reduce the risk of cardiac injury during chest re opening, especially the right ventricle, aorta and coronary bypass grafts. Nevertheless, concern about adverse hemodynamic effects prevents most heart surgeons of closuring the pericardium. We evaluated 48 patients undergoing open heart surgery consecutively which the pericardium was closed in 30 patients (group A) and 18 patients, as a control group (group B) in which the pericardium was left open. All patients underwent posteroanterior and lateral chest roentgenograms before surgery and one week postoperatively. Postoperative evaluation also included echocardiograms, ECG and postoperative enzyme analysis. There were no deaths or any complications in both groups (acute myocardial infarction, stroke, bleeding or cardiac tamponate). It was observed statistically differences between both groups especially in echocardiogram parameters and cardiothoracic ratio without clinical impact. Pericardium closure is a simple method to facilitate resternotomy during subsequent re operative procedures. However, cardiac surgeons should be aware of the transient deterioration in hemodynamics associated with it, even thought there was no clinical significance in this study.

Clinical target volume delineation in glioblastomas: pre-operative versus post-operative/pre-radiotherapy MRI

PubMed Central

Farace, P; Giri, M G; Meliadò, G; Amelio, D; Widesott, L; Ricciardi, G K; Dall'Oglio, S; Rizzotti, A; Sbarbati, A; Beltramello, A; Maluta, S; Amichetti, M

2011-01-01

Objectives Delineation of clinical target volume (CTV) is still controversial in glioblastomas. In order to assess the differences in volume and shape of the radiotherapy target, the use of pre-operative vs post-operative/pre-radiotherapy T1 and T2 weighted MRI was compared. Methods 4 CTVs were delineated in 24 patients pre-operatively and post-operatively using T1 contrast-enhanced (T1PRECTV and T1POSTCTV) and T2 weighted images (T2PRECTV and T2POSTCTV). Pre-operative MRI examinations were performed the day before surgery, whereas post-operative examinations were acquired 1 month after surgery and before chemoradiation. A concordance index (CI) was defined as the ratio between the overlapping and composite volumes. Results The volumes of T1PRECTV and T1POSTCTV were not statistically different (248 ± 88 vs 254 ± 101), although volume differences >100 cm3 were observed in 6 out of 24 patients. A marked increase due to tumour progression was shown in three patients. Three patients showed a decrease because of a reduced mass effect. A significant reduction occurred between pre-operative and post-operative T2 volumes (139 ± 68 vs 78 ± 59). Lack of concordance was observed between T1PRECTV and T1POSTCTV (CI = 0.67 ± 0.09), T2PRECTV and T2POSTCTV (CI = 0.39 ± 0.20) and comparing the portion of the T1PRECTV and T1POSTCTV not covered by that defined on T2PRECTV images (CI = 0.45 ± 0.16 and 0.44 ± 0.17, respectively). Conclusion Using T2 MRI, huge variations can be observed in peritumoural oedema, which are probably due to steroid treatment. Using T1 MRI, brain shifts after surgery and possible progressive enhancing lesions produce substantial differences in CTVs. Our data support the use of post-operative/pre-radiotherapy T1 weighted MRI for planning purposes. PMID:21045069

40 CFR 264.280 - Closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 264.280 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Land Treatment § 264.280 Closure and post-closure care. (a) During the closure period the owner or...

40 CFR 264.280 - Closure and post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Section 264.280 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Land Treatment § 264.280 Closure and post-closure care. (a) During the closure period the owner or...

40 CFR 264.280 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... Section 264.280 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Land Treatment § 264.280 Closure and post-closure care. (a) During the closure period the owner or...

40 CFR 264.280 - Closure and post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Section 264.280 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Land Treatment § 264.280 Closure and post-closure care. (a) During the closure period the owner or...

The pre-operative electrocardiogram: an assessment.

PubMed

Paterson, K R; Caskie, J P; Galloway, D J; McArthur, K; McWhinnie, D L

1983-04-01

Electrocardiography is of limited value in pre-operative screening for cardiac disease. A short questionnaire has been shown to be helpful in assessing cardiac status and could permit a 30% reduction in the number of pre-operative ECGs performed.

40 CFR 146.93 - Post-injection site care and site closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

...) The pressure differential between pre-injection and predicted post-injection pressures in the... 40 Protection of Environment 23 2011-07-01 2011-07-01 false Post-injection site care and site... Applicable to Class VI Wells § 146.93 Post-injection site care and site closure. (a) The owner or operator of...

40 CFR 146.93 - Post-injection site care and site closure.

Code of Federal Regulations, 2013 CFR

2013-07-01

...) The pressure differential between pre-injection and predicted post-injection pressures in the... 40 Protection of Environment 24 2013-07-01 2013-07-01 false Post-injection site care and site... Applicable to Class VI Wells § 146.93 Post-injection site care and site closure. (a) The owner or operator of...

40 CFR 146.93 - Post-injection site care and site closure.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) The pressure differential between pre-injection and predicted post-injection pressures in the... 40 Protection of Environment 24 2012-07-01 2012-07-01 false Post-injection site care and site... Applicable to Class VI Wells § 146.93 Post-injection site care and site closure. (a) The owner or operator of...

Pre-operative anaemia.

PubMed

Clevenger, B; Richards, T

2015-01-01

Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated. © 2014 The Association of Anaesthetists of Great Britain and Ireland.

10 CFR 60.111 - Performance of the geologic repository operations area through permanent closure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Performance of the geologic repository operations area... OF HIGH-LEVEL RADIOACTIVE WASTES IN GEOLOGIC REPOSITORIES Technical Criteria Performance Objectives § 60.111 Performance of the geologic repository operations area through permanent closure. (a...

Pre-operative biliary drainage for obstructive jaundice

PubMed Central

Fang, Yuan; Gurusamy, Kurinchi Selvan; Wang, Qin; Davidson, Brian R; Lin, He; Xie, Xiaodong; Wang, Chaohua

2014-01-01

Background Patients with obstructive jaundice have various pathophysiological changes that affect the liver, kidney, heart, and the immune system. There is considerable controversy as to whether temporary relief of biliary obstruction prior to major definitive surgery (pre-operative biliary drainage) is of any benefit to the patient. Objectives To assess the benefits and harms of pre-operative biliary drainage versus no pre-operative biliary drainage (direct surgery) in patients with obstructive jaundice (irrespective of a benign or malignant cause). Search methods We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Clinical Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2012. Selection criteria We included all randomised clinical trials comparing biliary drainage followed by surgery versus direct surgery, performed for obstructive jaundice, irrespective of the sample size, language, and publication status. Data collection and analysis Two authors independently assessed trials for inclusion and extracted data. We calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on the available patient analyses. We assessed the risk of bias (systematic overestimation of benefit or systematic underestimation of harm) with components of the Cochrane risk of bias tool. We assessed the risk of play of chance (random errors) with trial sequential analysis. Main results We included six trials with 520 patients comparing pre-operative biliary drainage (265 patients) versus no pre-operative biliary drainage (255 patients). Four trials used percutaneous transhepatic biliary drainage and two trials used endoscopic sphincterotomy and stenting as the method of pre-operative biliary drainage. The risk of bias was high in all trials. The proportion of patients with malignant obstruction varied between 60

40 CFR 264.197 - Closure and post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Section 264.197 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... as hazardous waste, unless § 261.3(d) of this chapter applies. The closure plan, closure activities...

Whole body vibration in mountain-rescue operations

NASA Astrophysics Data System (ADS)

Alberti, E.; Chiappa, D.; Moschioni, G.; Saggin, B.; Tarabini, M.

2006-12-01

In mountain-rescue operations injured people are generally exposed to vibrations and shocks that can be potential causes of physical conditions worsening. Such vibrations can derive both from patient's body manipulations (e.g. when it is being loaded and immobilized on a stretcher) and from forces coming from the transport devices and vehicles. Despite the general feeling that during this kind of operations the levels of transmitted vibrations to the injured can be quite large and potentially dangerous, there is practically no study in literature providing reliable parameters (i.e. measurements) to support or dismiss these beliefs. This paper reports the results of a measurement campaign carried-out in order to outline, identify and quantify the excitations a human body is exposed to, during typical transportation phases related to mountain-rescue operations. The work mainly presents and discusses the experimental setup with the aim of focusing on the problems related to this kind of measurements; the results of the experimental campaign carried-out for the measurement of the vibrations undergone by a human body during a simulated rescue operation are presented and discussed as well. Such simulation includes three phases of transportation: on a hand-held stretcher, on an ambulance and on a helicopter. The work is not intended to supply a complete characterization and analysis of vibrations transmission during any rescue operation but just to provide a preliminary overview and to define a measurement method that can be applied for a more comprehensive characterization. With such aims measurements were carried out in on-field situations stated as "typical" by rescue experts and data then analyzed both with standard procedures and algorithms (e.g. ISO 2631s weighting curves) and with the commonly used statistical indexes; in the analysis it is important to be aware that standardized measurement procedures and indexes, created to verify comfort or health-risks of

Iron therapy for pre-operative anaemia.

PubMed

Ng, Oliver; Keeler, Barrie D; Mishra, Amitabh; Simpson, Alastair; Neal, Keith; Brookes, Matthew J; Acheson, Austin G

2015-12-22

Pre-operative anaemia is common and occurs in up to 76% of patients. It is associated with increased peri-operative allogeneic blood transfusions, longer hospital lengths of stay and increased morbidity and mortality. Iron deficiency is one of the most common causes of this anaemia. Oral iron therapy has traditionally been used to treat anaemia but newer, safer parenteral iron preparations have been shown to be more effective in other conditions such as inflammatory bowel disease, chronic heart failure and post-partum haemorrhage. A limited number of studies look at iron therapy for the treatment of pre-operative anaemia. The aim of this Cochrane review is to summarise the evidence for use of iron supplementation, both enteral and parenteral, for the management of pre-operative anaemia. The objective of this review is to evaluate the effects of pre-operative iron therapy (enteral or parenteral) in reducing the need for allogeneic blood transfusions in anaemic patients undergoing surgery. We ran the search on 25 March 2015. We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic and EMBASE (Ovid), CINAHL Plus (EBSCO), PubMed, clinical trials registries, conference abstracts, and we screened reference lists. We included all randomised controlled trials (RCTs) which compared pre-operative iron monotherapy to placebo, no treatment, standard of care or another form of iron therapy for anaemic adults undergoing surgery. Anaemia was defined by haemoglobin values less than 13 g/dL for males and 12 g/dL for non-pregnant females. Data were collected by two authors on the proportion of patients who receive a blood transfusion, amount of blood transfused per patient (units) and haemoglobin measured as continuous variables at pre-determined time-points: pre

Time-to-Surgery and Pre-operative Cerebral Hemodynamics Predict Post-operative White Matter Injury in Neonates with Hypoplastic Left Heart Syndrome

PubMed Central

Lynch, Jennifer M.; Buckley, Erin M.; Schwab, Peter J.; McCarthy, Ann L.; Winters, Madeline E.; Busch, David R.; Xiao, Rui; Goff, Donna A.; Nicolson, Susan C.; Montenegro, Lisa M.; Fuller, Stephanie; Gaynor, J. William; Spray, Thomas L.; Yodh, Arjun G.; Naim, Maryam Y.; Licht, Daniel J.

2014-01-01

Objective Hypoxic-ischemic white mater brain injury commonly occurs in neonates with hypoplastic left heart syndrome (HLHS). Approximately half of the HLHS survivors exhibit neurobehavioral symptoms believed to be associated with this injury, though the exact timing of the injury is not known. Methods Neonates with HLHS were recruited for pre- and post-operative monitoring of cerebral oxygen saturation (ScO2), cerebral oxygen extraction fraction (OEF), and cerebral blood flow (CBF) using two non-invasive optical-based techniques, namely diffuse optical spectroscopy and diffuse correlation spectroscopy. Anatomical magnetic resonance imaging (MRI) scans were performed prior to and approximately one week after surgery in order to quantify the extent and timing of the acquired white matter injury. Risk factors for developing new or worsened white matter injury were assessed using uni- and multi-variate logistic regression. Results Thirty-seven neonates with HLHS were studied. In a univariate analysis, neonates who developed a large volume of new, or worsened, postoperative white matter injury had a significantly longer time-to-surgery (p=0.0003). In a multivariate model, longer time between birth and surgery (i.e., time-to-surgery), delayed sternal closure, and higher pre-operative CBF were predictors of post-operative white matter injury. Additionally, longer time-to-surgery and higher pre-operative CBF on morning of surgery were correlated with lower ScO2 (p=0.03 and p=0.05) and higher OEF (p=0.05 and p=0.05). Conclusions Longer time-to-surgery is associated with new post-operative white matter injury in otherwise healthy neonates with HLHS. The results suggest that earlier Norwood palliation may decrease the likelihood of acquiring postoperative white matter injury. PMID:25109755

40 CFR 264.146 - Use of a mechanism for financial assurance of both closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... assurance of both closure and post-closure care. 264.146 Section 264.146 Protection of Environment... mechanism for financial assurance of both closure and post-closure care. An owner or operator may satisfy the requirements for financial assurance for both closure and post-closure care for one or more...

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

PubMed

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

2012-01-01

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

Closure of colostomy.

PubMed Central

Beck, P H; Conklin, H B

1975-01-01

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

40 CFR 265.146 - Use of a mechanism for financial assurance of both closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... assurance of both closure and post-closure care. 265.146 Section 265.146 Protection of Environment... Use of a mechanism for financial assurance of both closure and post-closure care. An owner or operator may satisfy the requirements for financial assurance for both closure and post-closure care for one or...

75 FR 60740 - Record of Decision for the Base Closure and Realignment Beddown and Flight Operations of Remotely...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-01

... DEPARTMENT OF DEFENSE Department of the Air Force Record of Decision for the Base Closure and Realignment Beddown and Flight Operations of Remotely Piloted Aircraft at Grand Forks Air Force Base (AFB), ND... United States Air Force signed the ROD for the 2005 Base Closure and Realignment (BRAC 2005) directed...

[Pre-operation evaluation and intra-operation management of cochlear implantation].

PubMed

Zhang, Dao-xing; Hu, Bao-hua; Xiao, Yu-li; Shi, Bo-ning

2004-10-01

To summarize pre-operation evaluation experiences in cochlear implantation. Performing auditory evaluation and image analysis seriously in 158 severe hearing loss or total deaf cases before cochlear implantation, comparing their performance with the findings during and post operation. Among the total 158 cases, 116 cases with normal structure, 42 cases with the abnormal findings of the inner or middle ear. Stapedial gusher happened in 6 cases, 1 case was not predicted before operation. Except 1 case with serious malformation, the findings of other 157 cases in operation were consistent with the pre-operation evaluation. We helped all patients reconstruct auditory conduction with cochlear implantation, and the average hearing level up to 37.6 dB SPL. Performing image analysis seriously before operation and planning for operation according to HRCT can do great help to cochlear implantation. The operation under the HRCT instruction has less complications.

Flow Characterization of Severe Carotid Artery Stenosis in Pre- and Post-operative Phantoms by Using Magnetic Resonance Velocimetry

NASA Astrophysics Data System (ADS)

Ko, Seungbin; Song, Simon; Kim, Doosang

2016-11-01

It is remained unknown that the flow characteristics changes between pre- and post-operative severe carotid artery stenosis could affect the long-term patency or failure. However, in-vivo clinical experiments to uncover the flow details are far from bed-side due to limited measurement resolutions, blurring artifact, etc. We studied detailed flow characteristics of more than 75% severe carotid artery stenosis before and after surgical treatments. Real-size flow phantoms for 10 patients, who underwent carotid endarterectomy with patch/no patch closure, were prepared by using a 3D rapid-prototype machine from CT scanned images. The working fluid is a glycerin aqueous solution, and patient-specific pulsatile flows were applied to the phantoms, based on ultrasonic flow rate measurements. The flows were visualized with magnetic resonance velocimetry (MRV). The detailed flow characteristics are presented for both pre- and post-operative carotid arteries along with visualization data of 3 dimensional, 3 component velocity fields. This work was supported by the National Research Foundation of Korea (NRF) Grant funded by the Korea government (MSIP) (No. 2016R1A2B3009541).

40 CFR 280.74 - Closure records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... following ways: (a) By the owners and operators who took the UST system out of service; (b) By the current... STANDARDS AND CORRECTIVE ACTION REQUIREMENTS FOR OWNERS AND OPERATORS OF UNDERGROUND STORAGE TANKS (UST) Out-of-Service UST Systems and Closure § 280.74 Closure records. Owners and operators must maintain...

40 CFR 280.74 - Closure records.

Code of Federal Regulations, 2014 CFR

2014-07-01

... following ways: (a) By the owners and operators who took the UST system out of service; (b) By the current... STANDARDS AND CORRECTIVE ACTION REQUIREMENTS FOR OWNERS AND OPERATORS OF UNDERGROUND STORAGE TANKS (UST) Out-of-Service UST Systems and Closure § 280.74 Closure records. Owners and operators must maintain...

40 CFR 280.74 - Closure records.

Code of Federal Regulations, 2012 CFR

2012-07-01

... following ways: (a) By the owners and operators who took the UST system out of service; (b) By the current... STANDARDS AND CORRECTIVE ACTION REQUIREMENTS FOR OWNERS AND OPERATORS OF UNDERGROUND STORAGE TANKS (UST) Out-of-Service UST Systems and Closure § 280.74 Closure records. Owners and operators must maintain...

40 CFR 280.74 - Closure records.

Code of Federal Regulations, 2013 CFR

2013-07-01

... following ways: (a) By the owners and operators who took the UST system out of service; (b) By the current... STANDARDS AND CORRECTIVE ACTION REQUIREMENTS FOR OWNERS AND OPERATORS OF UNDERGROUND STORAGE TANKS (UST) Out-of-Service UST Systems and Closure § 280.74 Closure records. Owners and operators must maintain...

40 CFR 280.74 - Closure records.

Code of Federal Regulations, 2011 CFR

2011-07-01

... following ways: (a) By the owners and operators who took the UST system out of service; (b) By the current... STANDARDS AND CORRECTIVE ACTION REQUIREMENTS FOR OWNERS AND OPERATORS OF UNDERGROUND STORAGE TANKS (UST) Out-of-Service UST Systems and Closure § 280.74 Closure records. Owners and operators must maintain...

New Mexico's 1998 drive-up liquor window closure. Study II: economic impact on owners.

PubMed

Lapham, Sandra C; Skipper, Betty J

2004-05-01

This study examined the economic impact of the New Mexico legislative action closing drive-up liquor windows on the retail establishments that operated them. A telephone survey was conducted 20 months after the closure seeking information and owners' opinions about how their outlets had changed since the closure and how this affected their business. In addition, 2 years of aggregated pre- and post-closure total gross receipts revenues were obtained from the New Mexico Taxation and Revenue Department, with convenience stores as a comparison group. Interviews were completed for 149 of 220 establishments. Over one-quarter of former drive-up liquor windows (28%) had been converted to 'step-in' sales, defined as an outside door where customers can stop and enter the premises while their car is running. Almost two-thirds (61%) of owners reported decreased annual gross revenues following closure, with a reported average 15% reduction in alcohol sales. This is consistent with findings of decreased gross receipts for operators of non-urban, but not urban, drive-up liquor windows compared to convenience store gross receipts. Almost three-quarters (72%) of those surveyed would re-open the drive-up window if the law were rescinded. Over one-quarter of the drive-up owners converted to step-in alcohol sales that still allow a form of drive-up liquor sales. Despite this, the forced closure of New Mexico's drive-up liquor windows negatively impacted total sales and liquor sales revenues of establishments that operated them.

Automated Road Closure Gate

DOT National Transportation Integrated Search

2000-05-01

This report presents the procedures involved in the research, design, construction, and testing of an Automated Road Closure Gate. The current road closure gates used in South Dakota are often unsafe and difficult to operate. This report will assist ...

Linearly exact parallel closures for slab geometry

NASA Astrophysics Data System (ADS)

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

2013-08-01

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

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

PubMed

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

2016-01-01

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

Post-Closure Monitoring Report for Corrective Action Unit 339: Area 12 Fleet Operations Steam Cleaning Effluent Nevada Test Site, Nevada

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

K. B. Campbell

2002-09-01

The Area 12 Fleet Operations Steam Cleaning Effluent site is located in the southeastern portion of the Area 12 Camp at the Nevada Test Site. This site is identified in the Federal Facility Agreement and Consent Order (1996) as Corrective Action Site (CAS) 12-19-01 and is the only CAS assigned to Corrective Action Unit (CAU) 339. Post-closure sampling and inspection of the site were completed on March 27, 2002. Post-closure monitoring activities were scheduled biennially (every two years) in the Post-Closure Monitoring Plan provided in the Closure Report for CAU 339: Area 12 Fleet Operations Steam Cleaning Effluent, Nevada Testmore » Site (U.S. Department of Energy, Nevada Operations Office [DOEN], 1997). A baseline for the site was established by sampling in 1997. Based on the recommendations from the 1999 post-closure monitoring report (DOE/NV, 1999), samples were collected in 2000, earlier than originally proposed, because the 1999 sample results did not provide the expected decrease in total petroleum hydrocarbon (TPH) concentrations at the site. Sampling results from 2000 (DOE/NV, 2000) and 2001 (DOE/NV, 2001) revealed favorable conditions for natural degradation at the CAU 339 site, but because of differing sample methods and heterogeneity of the soil, data results from 2000 and later were not directly correlated with previous results. Post-closure monitoring activities for 2002 consisted of the following: (1) Soil sample collection from three undisturbed plots (Plots A, B, and C, Figure 2). (2) Sample analysis for TPH as oil and bio-characterization parameters (Comparative Enumeration Assay [CEA] and Standard Nutrient Panel [SNP]). (3) Site inspection to evaluate the condition of the fencing and signs. (4) Preparation and submittal of the Post-Closure Monitoring Report.« less

Pre-operative assessment and post-operative care in elective shoulder surgery.

PubMed

Akhtar, Ahsan; Macfarlane, Robert J; Waseem, Mohammad

2013-01-01

Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery.

40 CFR 146.71 - Closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Waste Injection Wells § 146.71 Closure. (a) Closure Plan. The owner or operator of a Class I hazardous waste injection well shall prepare, maintain, and comply with a plan for closure of the well that meets... of material to be used in plugging; (iv) The method of placement of the plugs; (v) Any proposed test...

40 CFR 267.143 - Financial assurance for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Financial assurance for closure. 267... PERMIT Financial Requirements § 267.143 Financial assurance for closure. The owner or operator must establish financial assurance for closure of each storage or treatment unit that he owns or operates. In...

Pre-Operative Pelvic Floor Muscle Training--A Review.

PubMed

Nahon, Irmina; Martin, Melissa; Adams, Roger

2014-01-01

The use of pelvic floor muscle training has been well established for the management of post-prostatectomy incontinence. In recent years, it has been hypothesized that because the severity and period of incontinence are not predictable pre-operatively, it makes sense to teach all men the new motor skill of correct pelvic floor muscle activation before surgery. This review is based on literature found through computerized and manual searches on available databases. Included were any studies that looked at the effect of adding pelvic floor muscle training pre-operatively and comparing them to the effect of not having pre-operative pelvic floor muscle exercises. Pre-operative pelvic floor muscle training was found to be effective in reducing the time to continence as well as the severity of incontinence in only four studies. Adding biofeedback or electrical stimulation was not found to change the outcomes.

Silicone absorption of elastomeric closures--an accelerated study.

PubMed

Degrazio, F L; Hlobik, T; Vaughan, S

1998-01-01

There is a trend in the parenteral industry to move from the use of elastomeric closures which are washed, siliconized, dried and sterilized in-house at the pharmaceutical manufacturers' site to pre-prepared closures purchased from the closure supplier. This preparation can consist of washing to reduce particle-load and bioburden, siliconization, placement in ready-to-sterilize bags and may eventually extend to sterilization by steam autoclave or gamma irradiation. Since silicone oil lubrication is critical to the processability/machinability of closures, research was designed to investigate this phenomenon in closures prepared using the Westar RS (Ready-to-Sterilize) process. This paper presents the data gathered in a study of the characteristic of silicone absorption into elastomeric closures under accelerated conditions. Variables such as silicone viscosity, rubber formulation, effect of sterilization and others are considered.

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

PubMed

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

2017-04-01

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

Temporary closure of the abdominal wall by use of silicone rubber sheets after operative repair of ruptured abdominal aortic aneurysms.

PubMed

Akers, D L; Fowl, R J; Kempczinski, R F; Davis, K; Hurst, J M; Uhl, S

1991-07-01

Management of patients after operative repair of abdominal aortic aneurysms can be further complicated if primary closure of the abdominal wall cannot be technically accomplished or is associated with profound increases in intraabdominal and peak inspiratory pressures. We recently treated five patients with ruptured abdominal aortic aneurysms and one patient with a ruptured thoracoabdominal aneurysm whose abdominal incisions had to be closed with a Dacron reinforced, silicone sheet. All patients were hemodynamically unstable either at admission to the hospital or became so during operation. Four patients required the insertion of a silicone rubber sheet at the primary operation because of massive retroperitoneal hematoma or edema of the bowel wall or both. Incisions in two patients were closed primarily, but the patients required reexploration and secondary closure with silicone rubber sheets because of the development of marked increases in peak inspiratory pressures, intraabdominal pressures, and decreased urinary output. Four of the six patients subsequently underwent successful removal of the silicone rubber sheets with delayed primary closure of the abdominal wall, and two others died before removal. The patient with the ruptured thoracoabdominal aneurysm died on postoperative day 20 because of pulmonary sepsis but had a healed abdominal incision. The three surviving patients have been discharged. A silicone rubber sheet may be necessary for closure of the abdominal wall after repair of ruptured abdominal aortic aneurysm in patients where primary abdominal wall closure is impossible or where it results in compromise in respiratory or renal function.

10 CFR 63.161 - Emergency plan for the geologic repository operations area through permanent closure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 10 Energy 2 2010-01-01 2010-01-01 false Emergency plan for the geologic repository operations area... OF HIGH-LEVEL RADIOACTIVE WASTES IN A GEOLOGIC REPOSITORY AT YUCCA MOUNTAIN, NEVADA Emergency Planning Criteria § 63.161 Emergency plan for the geologic repository operations area through permanent...

Sampling and monitoring for closure

USGS Publications Warehouse

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

2007-01-01

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

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

PubMed

Sowerby, Leigh J; Wright, Erin D

2013-11-01

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

Physician staffed helicopter emergency medical systems can provide advanced trauma life support in mountainous and remote areas.

PubMed

Ausserer, Julia; Moritz, Elizabeth; Stroehle, Matthias; Brugger, Hermann; Strapazzon, Giacomo; Rauch, Simon; Mair, Peter

2017-01-01

In remote and mountainous areas, helicopter emergency medical systems (HEMS) are used to expedite evacuation and provide pre-hospital advanced trauma life support (ATLS) in major trauma victims. Aim of the study was to investigate feasibility of ATLS in HEMS mountain rescue missions and its influence on patient condition at hospital admission. 58 major trauma victims (Injury Severity Score ≥16), evacuated by physician staffed HEMS from remote and mountainous areas in the State of Tyrol, Austria between 1.1.2011 and 31.12.2013. Pre-hospital time exceeded 90min in 24 (44%) cases. 31 (53%) patients suffered critical impairment of at least one vital function (systolic blood pressure <90mmHg, GCS <10, or respiratory rate <10 or >30). 4 (6.9%) of 58 patients died prior to hospital admission. Volume resuscitation was restrictive: 18 (72%) of 25 hypotensive patients received ≤500ml fluids and blood pressure was increased >90mmHg at hospital admission in only 9 (36%) of these 25 patients. 8 (50%) of 16 brain trauma patients with a blood pressure <90mmHg remained hypotensive at hospital admission. Endotracheal intubation was accomplished without major complications in 15 (79%) of 19 patients with a Glasgow Coma Scale score <10. Rope operations were necessary in 40 (69%) of 58 cases and ATLS was started before hoist evacuation in 30 (75%) of them. The frequent combination of prolonged pre-hospital times, with critical impairment of vital functions, supports the need for early ATLS in HEMS mountain rescue missions. Pre-hospital endotracheal intubation is possible with a high success and low complication rate also in a mountain rescue scenario. Pre-hospital volume resuscitation is restrictive and hypotension is reversed at hospital admission in only one third of patients. Prolonged pre-hospital hypotension remains an unresolved problem in half of all brain trauma patients and indicates the difficulties to increase blood pressure to a desired level in a mountain rescue

40 CFR 265.146 - Use of a mechanism for financial assurance of both closure and post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Use of a mechanism for financial... OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.146 Use of a mechanism for financial assurance of both closure and post-closure care. An owner or operator...

Stump closure of a thick pancreas using stapler closure increases pancreatic fistula after distal pancreatectomy.

PubMed

Kawai, Manabu; Tani, Masaji; Okada, Ken-ichi; Hirono, Seiko; Miyazawa, Motoki; Shimizu, Astusi; Kitahata, Yuji; Yamaue, Hiroki

2013-09-01

The appropriate surgical stump closure after distal pancreatectomy (DP) is still controversial. This study investigated the benefits and risks of stapler closure during DP. The risk factors of pancreatic fistulas were investigated in 122 DPs among 3 types of stump closure: hand-sewn suture (n = 32), bipolar scissors (n = 45), and stapler closure (n = 45). There was no significant difference in the incidence of pancreatic fistula between the 3 types of stump closure (hand-sewn suture [44%] vs bipolar scissors [37.7%] vs stapler closure [35.5%]). By using receiver operating characteristics curves, 12 mm was the best cutoff value of the thickness of the pancreas for pancreatic fistulas after DP using stapler closure. Three factors (ie, male sex, body mass index >25 kg/m(2), and stapler closure) were independent risk factors of pancreatic fistulas after DP with a pancreas thicker than 12 mm. A pancreas thicker than 12 mm significantly increased the incidence of pancreatic fistulas after DP using stapler closure. Copyright © 2013 Elsevier Inc. All rights reserved.

Site productivity and diversity of the Middle Mountain long-term soil productivity study, West Virginia: Pre-experimental site characterization

Treesearch

Mary Beth Adams

2018-01-01

To better understand the impacts of a changing environment and interactions with forest management options for forest resources, including soil, large long-term experiments are required. Such experiments require careful documentation of reference or pre-experimental conditions. This publication describes the Middle Mountain Long-term Soil Productivity (LTSP) Study,...

100-D Ponds closure plan. Revision 1

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

Petersen, S.W.

1997-09-01

The 100-D Ponds is a Treatment, Storage, and Disposal (TSD) unit on the Hanford Facility that received both dangerous and nonregulated waste. This Closure Plan (Rev. 1) for the 100-D Ponds TSD unit consists of a RCRA Part A Dangerous Waste Permit Application (Rev. 3), a RCRA Closure Plan, and supporting information contained in the appendices to the plan. The closure plan consists of eight chapters containing facility description, process information, waste characteristics, and groundwater monitoring data. There are also chapters containing the closure strategy and performance standards. The strategy for the closure of the 100-D Ponds TSD unit ismore » clean closure. Appendices A and B of the closure plan demonstrate that soil and groundwater beneath 100-D Ponds are below cleanup limits. All dangerous wastes or dangerous waste constituents or residues associated with the operation of the ponds have been removed, therefore, human health and the environment are protected. Discharges to the 100-D Ponds, which are located in the 100-DR-1 operable unit, were discontinued in June 1994. Contaminated sediment was removed from the ponds in August 1996. Subsequent sampling and analysis demonstrated that there is no contamination remaining in the ponds, therefore, this closure plan is a demonstration of clean closure.« less

The etiology and determinants of hospital closure.

PubMed

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

1996-01-01

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

40 CFR 267.142 - Cost estimate for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

40 CFR 267.142 - Cost estimate for closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

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

14 CFR 437.27 - Pre-flight and post-flight operations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 4 2012-01-01 2012-01-01 false Pre-flight and post-flight operations. 437.27 Section 437.27 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION... Experimental Permit Operational Safety Documentation § 437.27 Pre-flight and post-flight operations. An...

14 CFR 437.27 - Pre-flight and post-flight operations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 4 2011-01-01 2011-01-01 false Pre-flight and post-flight operations. 437.27 Section 437.27 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION... Experimental Permit Operational Safety Documentation § 437.27 Pre-flight and post-flight operations. An...

14 CFR 437.27 - Pre-flight and post-flight operations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 4 2014-01-01 2014-01-01 false Pre-flight and post-flight operations. 437.27 Section 437.27 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION... Experimental Permit Operational Safety Documentation § 437.27 Pre-flight and post-flight operations. An...

14 CFR 437.27 - Pre-flight and post-flight operations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 4 2013-01-01 2013-01-01 false Pre-flight and post-flight operations. 437.27 Section 437.27 Aeronautics and Space COMMERCIAL SPACE TRANSPORTATION, FEDERAL AVIATION... Experimental Permit Operational Safety Documentation § 437.27 Pre-flight and post-flight operations. An...

Pre-operative serum alkaline phosphatase as a predictive indicator of post-operative hypocalcaemia in patients undergoing total thyroidectomy.

PubMed

Miah, M S; Mahendran, S; Mak, C; Leese, G; Smith, D

2015-11-01

This study aimed to evaluate whether a pre-operative elevated serum alkaline phosphatase level is a potential predictor of post-operative hypocalcaemia after total thyroidectomy. Data was retrospectively collected from the case notes of patients who had undergone total thyroidectomy. Patients were divided into Graves' disease and non-Graves' groups. Pre-operative and post-operative biochemical markers, including serum calcium, alkaline phosphatase and parathyroid hormone levels, were reviewed. A total of 225 patients met the inclusion criteria. Graves' disease was the most common indication (n = 134; 59.5 per cent) for thyroidectomy. Post-operative hypocalcaemia developed in 48 patients (21.3 per cent) and raised pre-operative serum alkaline phosphatase was noted in 94 patients (41.8 per cent). Raised pre-operative serum alkaline phosphatase was significantly associated with post-operative hypocalcaemia, particularly in Graves' disease patients (p < 0.05). Pre-operative serum alkaline phosphatase measurements help to predict post-thyroidectomy hypocalcaemia, especially in patients who do not develop hypoparathyroidism. Ascertaining the pre-operative serum alkaline phosphatase level in patients undergoing total thyroidectomy may help surgeons to identify at-risk patients.

Avoiding Accountability: How Charter Operators Evade Ohio's Automatic Closure Law. K-12 Education

ERIC Educational Resources Information Center

DePaoli, Jennifer; van Lier, Piet

2013-01-01

Ohio's charter-closure law is touted as one of the toughest in the nation because it requires the automatic closure of charter schools that consistently fail to meet academic standards. Ohio's charter-closure law, which became effective in 2008 and was revised in 2011, calls for automatic closure of schools rated in Academic Emergency for at least…

Sampling and monitoring for closure

USGS Publications Warehouse

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

2004-01-01

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

40 CFR 264.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... § 264.145. For owners or operators using the financial test or corporate guarantee, the post-closure... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Cost estimate for post-closure care... FACILITIES Financial Requirements § 264.144 Cost estimate for post-closure care. (a) The owner or operator of...

40 CFR 264.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... § 264.145. For owners or operators using the financial test or corporate guarantee, the post-closure... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Cost estimate for post-closure care... FACILITIES Financial Requirements § 264.144 Cost estimate for post-closure care. (a) The owner or operator of...

40 CFR 264.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... § 264.145. For owners or operators using the financial test or corporate guarantee, the post-closure... 40 Protection of Environment 27 2013-07-01 2013-07-01 false Cost estimate for post-closure care... FACILITIES Financial Requirements § 264.144 Cost estimate for post-closure care. (a) The owner or operator of...

40 CFR 264.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... § 264.145. For owners or operators using the financial test or corporate guarantee, the post-closure... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Cost estimate for post-closure care... FACILITIES Financial Requirements § 264.144 Cost estimate for post-closure care. (a) The owner or operator of...

Improving the Safety of Moving Lane Closures

DOT National Transportation Integrated Search

2009-06-01

Moving lane closures are an increasingly utilized and inherently hazardous traffic control procedure for highway : maintenance and operations activities. To improve the safety of moving lane closures for workers and motorists, : this research studied...

Pressure-tight closure for thermoelements

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

Not Available

1937-06-14

The thermoelements were arranged in a pressure-tight housing for measuring temperatures on the inside of high-pressure hydrogenation equipment. Should the housing ever leak due to failure of the material or the grinding action of the high sand content of the coal paste, the stall was liable to be set on fire. If, in an installation protected in this manner, an element housing should leak, the pressure tight closure at one end of the housing prevented an escape of the gas and product and the stall could continue to run without danger. The final form of this closure was discussed inmore » detail in this report. In the development of this closure, particular value was attached to a compact construction. In the sealing for a 30-mm high pressure tube, four steel and four constantan wires were insulated and arranged pressure-tight. Each of the three fillers had a different purpose. The hard-rubber insert took the surface pressure, the rubber stopper provided a seal and the cast gypsum provided protection against heat should hot gas or product reach the closure in case of a leaky housing. Two drawings were given showing the thermoelement-closure, and the final form of the closure. The report discussed methods of evacuating from the thermohousings any accumulations of condensed water, which could damage insulation, or hydrogen, which continually diffused in small amounts during operation and which could attack the iron elements of the thermocouples. The pressure-tight closures for thermoelements had been successful at preventing fires due to leakage for more than nine months of operation. 2 sketches.« less

Transcatheter umbrella closure of valvular and paravalvular leaks.

PubMed

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

1992-11-15

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

Scalp Wound Closure with K wires: An alternative easier method to scalp wound closure.

PubMed

Ramesh, S; Ajik, S

2012-12-01

Scalp defects and lacerations present a reconstructive challenge to plastic surgeons. Many methods have been described from the use of skin grafting to rotation flaps. Here we present a method of closure of a contaminated scalp wound with the use of Kirschner wires. In our case, closure of scalp laceration was made possible with the use of 1.4 Kirschner wires and cable tie/ zip tie fasteners. The duration to closure of wound was 10 days. In reconstructing the scalp defect, this method was found to adhere to principles of scalp reconstruction. There were no post operative complications found from the procedure. On initial application on the edge of the wound, tension applied caused the K wires to cut through the wound edge. On replacement of K wires 1cm away from wound edge the procedure was not plagued by any further complication. In conclusion we find scalp closure with Kirschner wires are a simple and effective method for scalp wound closure.

3718-F Alkali Metal Treatment and Storage Facility Closure Plan

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

None

Since 1987, Westinghouse Hanford Company has been a major contractor to the U.S. Department of Energy-Richland Operations Office and has served as co-operator of the 3718-F Alkali Metal Treatment and Storage Facility, the waste management unit addressed in this closure plan. The closure plan consists of a Part A Dangerous waste Permit Application and a RCRA Closure Plan. An explanation of the Part A Revision (Revision 1) submitted with this document is provided at the beginning of the Part A section. The closure plan consists of 9 chapters and 5 appendices. The chapters cover: introduction; facility description; process information; wastemore » characteristics; groundwater; closure strategy and performance standards; closure activities; postclosure; and references.« less

14 CFR 136.35 - Prohibition of commercial air tour operations over the Rocky Mountain National Park.

Code of Federal Regulations, 2013 CFR

2013-01-01

... operations over the Rocky Mountain National Park. 136.35 Section 136.35 Aeronautics and Space FEDERAL... COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS COMMERCIAL AIR TOURS AND NATIONAL PARKS AIR TOUR MANAGEMENT National Parks Air Tour Management § 136.35 Prohibition of commercial air tour operations over the Rocky...

14 CFR 136.35 - Prohibition of commercial air tour operations over the Rocky Mountain National Park.

Code of Federal Regulations, 2012 CFR

2012-01-01

... operations over the Rocky Mountain National Park. 136.35 Section 136.35 Aeronautics and Space FEDERAL... COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS COMMERCIAL AIR TOURS AND NATIONAL PARKS AIR TOUR MANAGEMENT National Parks Air Tour Management § 136.35 Prohibition of commercial air tour operations over the Rocky...

14 CFR 136.35 - Prohibition of commercial air tour operations over the Rocky Mountain National Park.

Code of Federal Regulations, 2014 CFR

2014-01-01

... operations over the Rocky Mountain National Park. 136.35 Section 136.35 Aeronautics and Space FEDERAL... COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS COMMERCIAL AIR TOURS AND NATIONAL PARKS AIR TOUR MANAGEMENT National Parks Air Tour Management § 136.35 Prohibition of commercial air tour operations over the Rocky...

14 CFR 136.35 - Prohibition of commercial air tour operations over the Rocky Mountain National Park.

Code of Federal Regulations, 2010 CFR

2010-01-01

... operations over the Rocky Mountain National Park. 136.35 Section 136.35 Aeronautics and Space FEDERAL... COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS COMMERCIAL AIR TOURS AND NATIONAL PARKS AIR TOUR MANAGEMENT National Parks Air Tour Management § 136.35 Prohibition of commercial air tour operations over the Rocky...

14 CFR 136.35 - Prohibition of commercial air tour operations over the Rocky Mountain National Park.

Code of Federal Regulations, 2011 CFR

2011-01-01

... operations over the Rocky Mountain National Park. 136.35 Section 136.35 Aeronautics and Space FEDERAL... COMPENSATION OR HIRE: CERTIFICATION AND OPERATIONS COMMERCIAL AIR TOURS AND NATIONAL PARKS AIR TOUR MANAGEMENT National Parks Air Tour Management § 136.35 Prohibition of commercial air tour operations over the Rocky...

Pre-operative skin preparation practices: results of the 2007 French national assessment.

PubMed

Borgey, F; Thibon, P; Ertzscheid, M-A; Bernet, C; Gautier, C; Mourens, C; Bettinger, A; Aggoune, M; Galy, E; Lejeune, B; Kadi, Z

2012-05-01

Pre-operative skin preparation, aimed at reducing the endogenous microbial flora, is one of the main preventive measures employed to decrease the likelihood of surgical site infection. National recommendations on pre-operative management of infection risks were issued in France in 2004. To assess compliance with the French national guidelines for pre-operative skin preparation in 2007. A prospective audit was undertaken in French hospitals through interviews with patients and staff, and observation of professional practice. Compliance with five major criteria selected from the guidelines was studied: patient information, pre-operative showering, pre-operative hair removal, surgical site disinfection and documentation of these procedures. Data for 41,188 patients from all specialties at 609 facilities were analysed. Patients were issued with information about pre-operative showering in 88.2% of cases [95% confidence interval (CI) 87.9-88.5]. The recommended procedure for pre-operative showering, including hairwashing, with an antiseptic skin wash solution was followed by 70.3% of patients (95% CI 69.9-70.8); this percentage was higher when patients had received appropriate information (P < 0.001). Compliance with hair removal procedures was observed in 91.5% of cases (95% CI 91.2-91.8), and compliance with surgical site disinfection recommendations was observed in 25,529 cases (62.0%, 95% CI 61.5-62.5). The following documentary evidence was found: information given to patient, 35.6% of cases; pre-operative surgical hygiene, 82.3% of cases; and pre-operative site disinfection, 71.7% of cases. The essential content of the French guidelines seems to be understood, but reminders need to be issued. Some recommendations may need to be adapted for certain specialties. Copyright © 2012 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Humid site stabilization and closure

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

Cutshall, N.H.

1981-01-01

The purpose of the work described here is to identify and evaluate the importance of factors that are expected to dictate the nature of site stabilization and closure requirements. Subsequent efforts will plan for implementation of such requirements. Two principal areas of site stabilization and closure effort will be pursued initially - geological management and vegetation management. The geological effort will focus on chemical weathering and surficial erosion. Such catastrophic geologic events as landslides, flooding, earthquakes, volcanos, etc. are already considered in site selection and operation and these factors will not be emphasized initially. Vegetation management will be designed tomore » control erosion, to minimize nuclide mobilization by roots and to be compatible with natural successional pressures. It is anticipated that the results of this work will be important both to site selection and operation as well as the actual stabilization and closure procedure.« less

Bar code-based pre-transfusion check in pre-operative autologous blood donation.

PubMed

Ohsaka, Akimichi; Furuta, Yoshiaki; Ohsawa, Toshiya; Kobayashi, Mitsue; Abe, Katsumi; Inada, Eiichi

2010-10-01

The objective of this study was to demonstrate the feasibility of a bar code-based identification system for the pre-transfusion check at the bedside in the setting of pre-operative autologous blood donation (PABD). Between July 2003 and December 2008 we determined the compliance rate and causes of failure of electronic bedside checking for PABD transfusion. A total of 5627 (9% of all transfusions) PABD units were administered without a single mistransfusion. The overall rate of compliance with electronic checking was 99%. The bar code-based identification system was applicable to the pre-transfusion check for PABD transfusion. Copyright © 2010 Elsevier Ltd. All rights reserved.

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

PubMed Central

2013-01-01

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

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

PubMed

Tilahun, Birkneh; Tefera, Endale

2013-05-31

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

Closedure - Mine Closure Technologies Resource

NASA Astrophysics Data System (ADS)

Kauppila, Päivi; Kauppila, Tommi; Pasanen, Antti; Backnäs, Soile; Liisa Räisänen, Marja; Turunen, Kaisa; Karlsson, Teemu; Solismaa, Lauri; Hentinen, Kimmo

2015-04-01

Closure of mining operations is an essential part of the development of eco-efficient mining and the Green Mining concept in Finland to reduce the environmental footprint of mining. Closedure is a 2-year joint research project between Geological Survey of Finland and Technical Research Centre of Finland that aims at developing accessible tools and resources for planning, executing and monitoring mine closure. The main outcome of the Closedure project is an updatable wiki technology-based internet platform (http://mineclosure.gtk.fi) in which comprehensive guidance on the mine closure is provided and main methods and technologies related to mine closure are evaluated. Closedure also provides new data on the key issues of mine closure, such as performance of passive water treatment in Finland, applicability of test methods for evaluating cover structures for mining wastes, prediction of water effluents from mine wastes, and isotopic and geophysical methods to recognize contaminant transport paths in crystalline bedrock.

40 CFR 265.142 - Cost estimate for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

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

40 CFR 265.142 - Cost estimate for closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

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

Tectonic and neotectonic framework of the Yucca Mountain Region

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

Schweickert, R.A.

1992-09-30

Highlights of major research accomplishments concerned with the tectonics and neotectonics of the Yucca Mountain Region include: structural studies in Grapevine Mountains, Bullfrog Hills, and Bare Mountain; recognition of significance of pre-Middle Miocene normal and strike-slip faulting at Bare Mountain; compilation of map of quaternary faulting in Southern Amargosa Valley; and preliminary paleomagnetic analysis of Paleozoic and Cenozoic units at Bare Mountain.

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

PubMed

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

2015-01-01

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

Pre-operative optimisation of lung function

PubMed Central

Azhar, Naheed

2015-01-01

The anaesthetic management of patients with pre-existing pulmonary disease is a challenging task. It is associated with increased morbidity in the form of post-operative pulmonary complications. Pre-operative optimisation of lung function helps in reducing these complications. Patients are advised to stop smoking for a period of 4–6 weeks. This reduces airway reactivity, improves mucociliary function and decreases carboxy-haemoglobin. The widely used incentive spirometry may be useful only when combined with other respiratory muscle exercises. Volume-based inspiratory devices have the best results. Pharmacotherapy of asthma and chronic obstructive pulmonary disease must be optimised before considering the patient for elective surgery. Beta 2 agonists, inhaled corticosteroids and systemic corticosteroids, are the main drugs used for this and several drugs play an adjunctive role in medical therapy. A graded approach has been suggested to manage these patients for elective surgery with an aim to achieve optimal pulmonary function. PMID:26556913

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... closure of a magazine or unit which stored hazardous waste under this subpart, the owner or operator must..., and financial responsibility for magazines or units must meet all of the requirements specified in... it remains in service as a munitions or explosives magazine or storage unit. (b) If, after removing...

Cache Scheme Based on Pre-Fetch Operation in ICN

PubMed Central

Duan, Jie; Wang, Xiong; Xu, Shizhong; Liu, Yuanni; Xu, Chuan; Zhao, Guofeng

2016-01-01

Many recent researches focus on ICN (Information-Centric Network), in which named content becomes the first citizen instead of end-host. In ICN, Named content can be further divided into many small sized chunks, and chunk-based communication has merits over content-based communication. The universal in-network cache is one of the fundamental infrastructures for ICN. In this work, a chunk-level cache mechanism based on pre-fetch operation is proposed. The main idea is that, routers with cache store should pre-fetch and cache the next chunks which may be accessed in the near future according to received requests and cache policy for reducing the users’ perceived latency. Two pre-fetch driven modes are present to answer when and how to pre-fetch. The LRU (Least Recently Used) is employed for the cache replacement. Simulation results show that the average user perceived latency and hops can be decreased by employed this cache mechanism based on pre-fetch operation. Furthermore, we also demonstrate that the results are influenced by many factors, such as the cache capacity, Zipf parameters and pre-fetch window size. PMID:27362478

Numerical simulation of the nocturnal turbulence characteristics over Rattlesnake Mountain

Treesearch

W.E. Heilman; E.S. Takle

1991-01-01

A two-dimensional second-order turbulence-closure model based on Mellor-Yamada level 3 is used to examine the nocturnal turbulence characteristics over Rattlesnake Mountain in Washington. Simulations of mean horizontal velocities and potential temperatures agree well with data. The equations for the components of the turbulent kinetic energy (TKE) show that anisotropy...

Closure Time of the Junggar-Balkhash Ocean: Constraints From Late Paleozoic Volcano-Sedimentary Sequences in the Barleik Mountains, West Junggar, NW China

NASA Astrophysics Data System (ADS)

Liu, Bo; Han, Bao-Fu; Chen, Jia-Fu; Ren, Rong; Zheng, Bo; Wang, Zeng-Zhen; Feng, Li-Xia

2017-12-01

The Junggar-Balkhash Ocean was a major branch of the southern Paleo-Asian Ocean. The timing of its closure is important for understanding the history of the Central Asian Orogenic Belt. New sedimentological and geochronological data from the Late Paleozoic volcano-sedimentary sequences in the Barleik Mountains of West Junggar, NW China, help to constrain the closure time of the Junggar-Balkhash Ocean. Tielieketi Formation (Fm) is dominated by littoral sediments, but its upper glauconite-bearing sandstone is interpreted to deposit rapidly in a shallow-water shelf setting. By contrast, Heishantou Fm consists chiefly of volcanic rocks, conformably overlying or in fault contact with Tielieketi Fm. Molaoba Fm is composed of parallel-stratified fine sandstone and sandy conglomerate with graded bedding, typical of nonmarine, fluvial deposition. This formation unconformably overlies the Tielieketi and Heishantou formations and is conformably covered by Kalagang Fm characterized by a continental bimodal volcanic association. The youngest U-Pb ages of detrital zircons from sandstones and zircon U-Pb ages from volcanic rocks suggest that the Tielieketi, Heishantou, Molaoba, and Kalagang formations were deposited during the Famennian-Tournaisian, Tournaisian-early Bashkirian, Gzhelian, and Asselian-Sakmarian, respectively. The absence of upper Bashkirian to Kasimovian was likely caused by tectonic uplifting of the West Junggar terrane. This is compatible with the occurrence of coeval stitching plutons in the West Junggar and adjacent areas. The Junggar-Balkhash Ocean should be finally closed before the Gzhelian, slightly later or concurrent with that of other ocean domains of the southern Paleo-Asian Ocean.

Non-native plant invasion along elevation and canopy closure gradients in a Middle Rocky Mountain ecosystem

Treesearch

Joshua P. Averett; Bruce McCune; Catherine G. Parks; Bridgett J. Naylor; Tim DelCurto; Ricardo Mata-Gonz??lez; RunGuo Zang

2016-01-01

Mountain environments are currently among the ecosystems least invaded by non-native species; however, mountains are increasingly under threat of non-native plant invasion. The slow pace of exotic plant invasions in mountain ecosystems is likely due to a combination of low anthropogenic disturbances, low propagule supply, and extreme/steep environmental gradients. The...

Avoiding Accountability: How Charter Operators Evade Ohio's Automatic Closure Law. K-12 Education. Executive Summary

ERIC Educational Resources Information Center

DePaoli, Jennifer; van Lier, Piet

2013-01-01

Ohio's charter-closure law is touted as one of the toughest in the nation because it requires the automatic closure of charter schools that consistently fail to meet academic standards. Ohio's charter-closure law, which became effective in 2008 and was revised in 2011, calls for automatic closure of schools rated in Academic Emergency for at least…

Meta-analysis: pre-operative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis.

PubMed

Yang, Z; Wu, Q; Wu, K; Fan, D

2010-02-15

Infliximab was approved for use in ulcerative colitis in recent years. It has been debated if infliximab increases the risk of post-operative complications in patients with ulcerative colitis. To perform a meta-analysis that examines the relationship between preoperative infliximab treatment and short-term post-operative complications in patients with ulcerative colitis. We searched the PubMed and MEDLINE databases to identify observational studies on the impact of pre-operative infliximab use on short-term post-operative complications in ulcerative colitis. Infectious complications mainly included wound infection, sepsis and abscess, whereas non-infectious complications included intestinal obstruction, thromboembolism and gastrointestinal haemorrhage. Pooled odds ratios (ORs) were calculated for each relationship. A total of 5 studies and 706 patients were included in our meta-analysis. Overall, we did not find a strong association between pre-operative treatment of infliximab and short-term infectious [OR 2.24, 95% confidence interval (CI) 0.63-7.95] or non-infectious (OR 0.85, 95% CI 0.50-1.45) post-operative complications in ulcerative colitis patients. On the contrary, we discovered that pre-operative infliximab use increased short-term total post-operative complications (OR 1.80, 95% CI 1.12-2.87). Pre-operative infliximab use increased the risk of short-term post-operative complications. Subgroup analysis is underpowered to assess the nature of these complications but shows a trend towards increased post-operative infection.

Pre-operative patient teaching in an acute care ward in Hong Kong: a case study.

PubMed

Lee, David S; Chien, W T

2002-10-01

Many nurses have acknowledged that adequate pre-operative teaching can alleviate patients' anxiety, increase patient participation in their own care, and minimize post-operative complications. However, the organization and degree to which pre-operative patient teachingfeatured in nurses' practice varies in different acute care settings. A case study design was used to explore the practice of pre-operative teaching in a surgical ward of an acute general hospital in Hong Kong. Seventeen registered nurses working on the ward were interviewed and observed in order to explore how they conduct a pre-operative teaching program and the difficulties encountered by them in carrying out pre-operative teaching on this acute care setting. Thefindings of this study indicate that pre-operative teaching workshops are organized and conducted by nursesfrom the operating theatre, in the day surgery center. Ward nurses were not actively involved in this pre-operative teaching. The results of this study present some similarities to a study with the similar design in Australia. There are also issues unique to the Hong Kong context. This case study was to review Hong Kong nurses' current practices of pre-operative teaching and to understand the cultural, conceptual and managementfactors influencing the practice in pre-operative teaching.

Influence of a Pre-Exercise Glycerol Hydration Beverage on Performance and Physiologic Function During Mountain-Bike Races in the Heat

PubMed Central

Wingo, Jonathan E.; Berger, Erik M.; Dellis, William O.; Knight, J. Chad; McClung, Joseph M.

2004-01-01

Objective: To determine if pre-exercise hydration with and without glycerol differentially affects physiologic and performance responses during mountain-bike races in the heat. Design and Setting: Testing (random, crossover, double-blind design) included the following 3 treatments administered in conjunction with a 30-mile mountain-bike race consisting of three 10-mile (16-km) loops: (1) no water during exercise (NE): water consumed before the race and no water consumed during the race, (2) glycerol (G): mixture of water and glycerol consumed before the race and water via 2 water bottles consumed during the race, and (3) water (W): water consumed before the race and water via 2 water bottles consumed during the race. Subjects stopped for 8 minutes after each 10-mile loop for collection of data. Subjects: Twelve heat-acclimated male mountain bikers with age = 24.5 ± 1.1 years, percentage of body fat = 14.3 ± 1.0%, mass = 76.9 ± 1.9 kg, height = 179 ± 2 cm. Measurements: We measured body weight, percentage of body fat, rectal temperature, blood lactate, blood glucose, urine volume, urine color, urine specific gravity, thirst sensation, thermal sensation, rating of perceived exertion, fluid consumption, heart rate, and sweat rate. Each subject completed the Environmental Symptoms Questionnaire. Results: The G trial was less dehydrated than the NE and W trials postexercise. Pre-exercise urine volume was less in the G trial than in the NE and W trials, and postexercise thirst was less in the G trial than the NE and W trials. Postexercise Environmental Symptoms Questionnaire scores were lower in the G trial than the NE or W trials. It is noteworthy that, although not significant, the G trial performed 5 minutes faster on loop 3 than the NE and W trials. Conclusions: Lower Environmental Symptoms Questionnaire scores and percentage of dehydration may indicate decreased signs and symptoms of heat strain in the G trial. Based on the NE trial performance, adequate pre

Percutaneous closure of atrial septal defects leads to normalisation of atrial and ventricular volumes

PubMed Central

Teo, Karen SL; Dundon, Benjamin K; Molaee, Payman; Williams, Kerry F; Carbone, Angelo; Brown, Michael A; Worthley, Matthew I; Disney, Patrick J; Sanders, Prashanthan; Worthley, Stephen G

2008-01-01

Background Percutaneous closure of atrial septal defects (ASDs) should potentially reduce right heart volumes by removing left-to-right shunting. Due to ventricular interdependence, this may be associated with impaired left ventricular filling and potentially function. Furthermore, atrial changes post-ASD closure have been poorly understood and may be important for understanding risk of atrial arrhythmia post-ASD closure. Cardiovascular magnetic resonance (CMR) is an accurate and reproducible imaging modality for the assessment of cardiac function and volumes. We assessed cardiac volumes pre- and post-percutaneous ASD closure using CMR. Methods Consecutive patients (n = 23) underwent CMR pre- and 6 months post-ASD closure. Steady state free precession cine CMR was performed using contiguous slices in both short and long axis views through the ASD. Data was collected for assessment of left and right atrial, ventricular end diastolic volumes (EDV) and end systolic volumes (ESV). Data is presented as mean ± SD, volumes as mL, and paired t-testing performed between groups. Statistical significance was taken as p < 0.05. Results There was a significant reduction in right ventricular volumes at 6 months post-ASD closure (RVEDV: 208.7 ± 76.7 vs. 140.6 ± 60.4 mL, p < 0.0001) and RVEF was significantly increased (RVEF 35.5 ± 15.5 vs. 42.0 ± 15.2%, p = 0.025). There was a significant increase in the left ventricular volumes (LVEDV 84.8 ± 32.3 vs. 106.3 ± 38.1 mL, p = 0.003 and LVESV 37.4 ± 20.9 vs. 46.8 ± 18.5 mL, p = 0.016). However, there was no significant difference in LVEF and LV mass post-ASD closure. There was a significant reduction in right atrial volumes at 6 months post-ASD closure (pre-closure 110.5 ± 55.7 vs. post-closure 90.7 ± 69.3 mL, p = 0.019). Although there was a trend to a decrease in left atrial volumes post-ASD closure, this was not statistically significant (84.5 ± 34.8 mL to 81.8 ± 44.2 mL, p = NS). Conclusion ASD closure leads to

46 CFR 64.41 - Stop valve closure.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Stop valve closure. 64.41 Section 64.41 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE ENGINEERING MARINE PORTABLE TANKS AND CARGO HANDLING SYSTEMS Standards for an MPT § 64.41 Stop valve closure. A stop valve that operates by a screwed...

Paleomagnetism and tectonics of the Jura arcuate mountain belt in France and Switzerland

NASA Astrophysics Data System (ADS)

Gehring, Andreas U.; Keller, Peter; Heller, Friedrich

1991-02-01

Goethite and hematite in ferriferous oolitic beds of Callovian age from the Jura mountains (Switzerland, France) carry either pre- and/or post-tectonic magnetization. The frequent pre-tectonic origin of goethite magnetization indicates a temperature range during formation of the arcuate Jura mountain belt below the goethite Néel temperature of about 100°C. The scatter of the pre-tectonic paleomagnetic directions ( D = 11.5° E, I = 55.5°; α95 = 4.7) which reside both in goethite and hematite, provides strong evidence that the arcuate mountain belt was shaped without significant rotation. The paleomagnetic results support tectonic thin-skinned models for the formation of the Jura mountain belt.

45 CFR 303.11 - Case closure criteria.

Code of Federal Regulations, 2011 CFR

2011-10-01

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

Pre-Operative Diet Impacts the Adipose Tissue Response to Surgical Trauma

PubMed Central

Nguyen, Binh; Tao, Ming; Yu, Peng; Mauro, Christine; Seidman, Michael A.; Wang, Yaoyu E.; Mitchell, James; Ozaki, C. Keith

2012-01-01

Background Short-term changes in pre-operative nutrition can have profound effects on surgery related outcomes such as ischemia reperfusions injury in pre-clinical models. Dietary interventions that lend protection against stress in animal models (e.g. fasting, dietary restriction [DR]) impact adipose tissue quality/quantity. Adipose tissue holds high surgical relevance due to its anatomic location and high tissue volume, and it is ubiquitously traumatized during surgery. Yet the response of adipose tissue to trauma under clinically relevant circumstances including dietary status remains poorly defined. We hypothesized that pre-operative diet alters the adipose tissue response to surgical trauma. Methods A novel mouse model of adipose tissue surgical trauma was employed. Dietary conditions (diet induced obesity [DIO], pre-operative DR) were modulated prior to application of surgical adipose tissue trauma in the context of clinically common scenarios (different ages, simulated bacterial wound contamination). Local/distant adipose tissue phenotypic responses were measured as represented by gene expression of inflammatory, tissue remodeling/growth, and metabolic markers. Results Surgical trauma had a profound effect on adipose tissue phenotype at the site of trauma. Milder but significant distal effects on non-traumatized adipose tissue were also observed. DIO exacerbated the inflammatory aspects of this response, and pre-operative DR tended to reverse these changes. Age and LPS-simulated bacterial contamination also impacted the adipose tissue response to trauma, with young adult animals and LPS treatment exacerbating the proinflammatory response. Conclusions Surgical trauma dramatically impacts both local and distal adipose tissue biology. Short-term pre-operative DR may offer a strategy to attenuate this response. PMID:23274098

Linear stapler closure of the pharynx during total laryngectomy: a 15-year experience (from closed technique to semi-closed technique)

PubMed Central

Altissimi, G; Frenguelli, A

2007-01-01

Summary Personal experience in performing linear stapler closure of the pharynx during 70 total laryngectomies is reported. Laryngeal staplers (55 and 60 cm) with an angled handle were used, permitting vertical closure with 19 or 20 metal staples in a double row. A closed technique was initially used, but, over the years, this has gradually been replaced by the semi-closed technique to avoid trapping the suprahyoid part of the epiglottis between the jaws of the stapler. The stapler is inserted below the larynx after having separated it from all muscular and neurovascular connections, and after performing a mini-pharyngotomy at the vallecula epiglottica in order to extract the epiglottis, evert it ventrally and suture it to the hyothyroepiglottic space. The jaws of the stapler are closed and the staples are fired while the flaps of the mini-pharyngotomy are raised above the jaws. The scalpel is inserted above the stapler to remove the larynx. When the stapler is opened, the vertical linear suture of the pharynx is evident and can be examined. This procedure takes only a few minutes to perform. It guarantees a long-term stable watertight closure, dramatically reduces contamination of the operating field by pharyngeal secretions, and permits rapid healing time, greatly lowering patient management costs. In the cases presented here, there was a 1.8% rate of pharyngocutaneous fistulae in patients who were not radiated, whereas the rate was 13.1% in pre-radiated patients. In agreement with the international literature, this procedure does not increase the rate of fistulae and, in fact, it seems to reduce it. Moreover, it is particularly indicated for pre-radiated patients. Nevertheless, the Authors recommend reserving this type of procedure to cases in which, based on meticulous pre-operative assessment by means of endoscopy and imaging, the endolaryngeal site of the tumour has been assessed and there is no need for peri-operative exploration of the pharynx or tongue

40 CFR 265.228 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Closure and post-closure care. 265.228... DISPOSAL FACILITIES Surface Impoundments § 265.228 Closure and post-closure care. (a) At closure, the owner... impoundment and provide post-closure care for a landfill under subpart G and § 265.310, including the...

40 CFR 265.228 - Closure and post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Closure and post-closure care. 265.228... DISPOSAL FACILITIES Surface Impoundments § 265.228 Closure and post-closure care. (a) At closure, the owner... impoundment and provide post-closure care for a landfill under subpart G and § 265.310, including the...

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

NASA Technical Reports Server (NTRS)

Hohwiesner, Bill; Claudinon, Bernard

1991-01-01

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

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

PubMed

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

2014-11-01

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

Pre-operative labs: Wasted dollars or predictors of post-operative cardiac and septic events in orthopaedic trauma patients?

PubMed

Lakomkin, Nikita; Sathiyakumar, Vasanth; Dodd, Ashley C; Jahangir, A Alex; Whiting, Paul S; Obremskey, William T; Sethi, Manish K

2016-06-01

As US healthcare expenditures continue to rise, there is significant pressure to reduce the cost of inpatient medical services. Studies have estimated that over 70% of routine labs may not yield clinical benefits while adding over $300 in costs per day for every inpatient. Although orthopaedic trauma patients tend to have longer inpatient stays and hip fractures have been associated with significant morbidity, there is a dearth of data examining pre-operative labs in predicting post-operative adverse events in these populations. The purpose of this study was to assess whether pre-operative labs significantly predict post-operative cardiac and septic complications in orthopaedic trauma and hip fracture patients. Between 2006 and 2013, 56,336 (15.6%) orthopaedic trauma patients were identified and 27,441 patients (7.6%) were diagnosed with hip fractures. Pre-operative labs included sodium, BUN, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase, white count, hematocrit, platelet count, prothrombin time, INR, and partial thromboplastin time. For each of these labs, patients were deemed to have normal or abnormal values. Patients were noted to have developed cardiac or septic complications if they sustained (1) myocardial infarction (MI), (2) cardiac arrest, or (3) septic shock within 30 days after surgery. Separate regressions incorporating over 40 patient characteristics including age, gender, pre-operative comorbidities, and labs were performed for orthopaedic trauma patients in order to determine whether pre-operative labs predicted adverse cardiac or septic outcomes. 749 (1.3%) orthopaedic trauma patients developed cardiac complications and 311 (0.6%) developed septic shock. Multivariate regression demonstrated that abnormal pre-operative platelet values were significantly predictive of post-operative cardiac arrest (OR: 11.107, p=0.036), and abnormal bilirubin levels were predictive (OR: 8.487, p=0.008) of the development of septic shock in trauma

40 CFR 265.143 - Financial assurance for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., except as provided in § 265.143(f), divided by the number of years in the pay-in period. (ii) Subsequent... bills for partial or final closure activities, the Regional Administrator will instruct the trustee to... facility over its remaining operating life. Within 60 days after receiving bills for closure activities...

40 CFR 264.143 - Financial assurance for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

... in § 264.143(g), divided by the number of years in the pay-in period. Subsequent payments must be... for partial or final closure activities, the Regional Administrator will instruct the trustee to make... operating life. Within 60 days after receiving bills for closure activities, the Regional Administrator will...

Stapler Esophageal Closure During Total Laryngectomy.

PubMed

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

2017-01-01

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

Planning for the closure of uncontrolled landfills in Turkey to reduce environmental impacts.

PubMed

Ergene Şentürk, Didar; Alp, Emre

2016-11-01

Landfilling is the most preferred solid waste disposal method in Turkey owing to both economic and technical reasons. However, beside the sanitary landfills there are also hundreds of uncontrolled waste sites located throughout Turkey, which are often left either abandoned or burning. Because there is a lack of legislative guidelines governing the closure and rehabilitation of these dumpsites, the municipalities that are responsible for waste management do not initiate the proactive strategies required for the closure of these sites. In this study, a method based on a multi-criteria analysis is conducted for different dumpsites in Turkey to evaluate the level of negative impacts on the environment. This method is based on the use of environmental indices for a quantitative assessment of the landfills, such as environmental interaction between the source and the receptors, environmental values of the receptors, and operational conditions. It was possible to assess the robustness of the proposed methodology since the pre- and post-groundwater quality monitoring data was available from the study sites that were closed and rehabilitated in 2014. The results of this study show that the method based on a multi-criteria analysis is an effective tool while in the preliminary planning stages of closure and rehabilitation activities of uncontrolled waste landfills. © The Author(s) 2016.

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

PubMed Central

Bamigboye, Anthony A; Hofmeyr, G Justus

2014-01-01

Background Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal layers at caesarean section may or may not confer benefit, hence the need to evaluate whether this step should be omitted or routinely performed. Objectives The objective of this review was to assess the effects of non-closure as an alternative to closure of the peritoneum at caesarean section on intraoperative and immediate- and long-term postoperative outcomes. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (1 November 2013). Selection criteria Randomised controlled trials comparing leaving the visceral or parietal peritoneum, or both, unsutured at caesarean section with a technique which involves suturing the peritoneum in women undergoing elective or emergency caesarean section. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked it for accuracy. Main results A total of 29 trials were included in this review and 21 trials (17,276 women) provided data that could be included in an analysis. The quality of the trials was variable. 1. Non-closure of visceral and parietal peritoneum versus closure of both parietal layers Sixteen trials involving 15,480 women, were included and analysed, when both parietal peritoneum was left unclosed versus when both peritoneal surfaces were closed. Postoperative adhesion formation was assessed in only four trials with 282 women, and no difference was found between groups (risk ratio (RR) 0.99, 95% confidence interval (CI) 0.76 to 1.29). There was significant reduction in the operative time (mean difference (MD) -5.81 minutes, 95% CI -7.68 to -3.93). The duration of hospital stay in a total of 13 trials involving 14,906 women, was also reduced (MD -0.26, 95% CI -0.47 to -0.05) days. In a trial involving 112 women, reduced chronic pelvic pain was found in the peritoneal non-closure group. 2. Non-closure of

Real time remote monitoring and pre-warning system for Highway landslide in mountain area.

PubMed

Zhang, Yonghui; Li, Hongxu; Sheng, Qian; Wu, Kai; Chen, Guoliang

2011-06-01

The wire-pulling trigger displacement meter with precision of 1 mm and the grid pluviometer with precision of 0.1 mm are used to monitor the surface displacement and rainfall for Highway slope, and the measured data are transferred to the remote computer in real time by general packet radio service (GPRS) net of China telecom. The wire-pulling trigger displacement meter, grid pluviometer, data acquisition and transmission unit, and solar power supply device are integrated to form a comprehensive monitoring hardware system for Highway landslide in mountain area, which proven to be economical, energy-saving, automatic and high efficient. Meantime, based on the map and geographic information system (MAPGIS) platform, the software system is also developed for three dimensional (3D) geology modeling and visualization, data inquiring and drawing, stability calculation, displacement forecasting, and real time pre-warning. Moreover, the pre-warning methods based on monitoring displacement and rainfall are discussed. The monitoring and forecasting system for Highway landslide has been successfully applied in engineering practice to provide security for Highway transportation and construction and reduce environment disruption. Copyright © 2011 The Research Centre for Eco-Environmental Sciences, Chinese Academy of Sciences. Published by Elsevier B.V. All rights reserved.

Digital mountains: toward development and environment protection in mountain regions

NASA Astrophysics Data System (ADS)

Jiang, Xiaobo

2007-06-01

Former studies on mountain system are focused on the department or subject characters, i.e. different department and branches of learning carry out researches only for their individual purposes and with individual characters of the subject of interests. As a whole, their investigation is lacking of comprehensive study in combination with global environment. Ecological environment in mountain regions is vulnerable to the disturbance of human activities. Therefore, it is a key issue to coordinate economic development and environment protection in mountain regions. On the other hand, a lot of work is ongoing on mountain sciences, especially depending on the application of RS and GIS. Moreover, the development of the Digital Earth (DE) provides a clue to re-understand mountains. These are the background of the emergence of the Digital Mountains (DM). One of the purposes of the DM is integrating spatial related data and information about mountains. Moreover, the DM is a viewpoint and methodology of understanding and quantifying mountains holistically. The concept of the DM is that, the spatial and temporal data related to mountain regions are stored and managed in computers; moreover, manipulating, analyzing, modeling, simulating and sharing of the mountain information are implemented by utilizing technologies of RS, GIS, GPS, Geo-informatic Tupu, computer, virtual reality (VR), 3D simulation, massive storage, mutual operation and network communication. The DM aims at advancing mountain sciences and sustainable mountain development. The DM is used to providing information and method for coordinating the mountain regions development and environment protection. The fundamental work of the DM is the design of the scientific architecture. Furthermore, construct and develop massive databases of mountains are the important steps these days.

Umbilical hernia following gastroschisis closure: a common event?

PubMed

Tullie, L G C; Bough, G M; Shalaby, A; Kiely, E M; Curry, J I; Pierro, A; De Coppi, P; Cross, K M K

2016-08-01

To assess incidence and natural history of umbilical hernia following sutured and sutureless gastroschisis closure. With audit approval, we undertook a retrospective clinical record review of all gastroschisis closures in our institution (2007-2013). Patient demographics, gastroschisis closure method and umbilical hernia occurrence were recorded. Data, presented as median (range), underwent appropriate statistical analysis. Fifty-three patients were identified, gestation 36 weeks (31-38), birth weight 2.39 kg (1-3.52) and 23 (43 %) were male. Fourteen patients (26 %) underwent sutureless closure: 12 primary, 2 staged; and 39 (74 %) sutured closure: 19 primary, 20 staged. Sutured closure was interrupted sutures in 24 patients, 11 pursestring and 4 not specified. Fifty patients were followed-up over 53 months (10-101) and 22 (44 %) developed umbilical hernias. There was a significantly greater hernia incidence following sutureless closure (p = 0.0002). In sutured closure, pursestring technique had the highest hernia rate (64 %). Seven patients underwent operative hernia closure; three secondary to another procedure. Seven patients had their hernias resolve. One patient was lost to follow-up and seven remain under observation with no reported complications. There is a significant umbilical hernia incidence following sutureless and pursestring sutured gastroschisis closure. This has not led to complications and the majority have not undergone repair.

Does patent foramen ovale closure have an anti-arrhythmic effect? A meta-analysis.

PubMed

Jarral, Omar A; Saso, Srdjan; Vecht, Joshua A; Harling, Leanne; Rao, Christopher; Ahmed, Kamran; Gatzoulis, Michael A; Malik, Iqbal S; Athanasiou, Thanos

2011-11-17

Atrial tachyarrhythmias are associated with patent foramen ovale. The objective was to determine the anti-arrhythmic effect of patent foramen ovale closure on pre-existing atrial tachyarrhythmias. Medline, EMBASE, Cochrane Library, and Google Scholar databases were searched between 1967 and 2010. The search was expanded using the 'related articles' function and reference lists of key studies. All studies reporting pre- and post-closure incidence (or prevalence) of atrial tachyarrhythmia in the same patient population were included. Random and fixed effect meta-analyses were used to aggregate the data. Six studies were identified including 2570 patients who underwent percutaneous closure. Atrial fibrillation was in fact the only AT reported in all studies. Meta-analysis using a fixed effects model demonstrated a significant reduction in the prevalence of atrial fibrillation with an OR of 0.43 (95% CI 0.26-0.71). When using the random-effects model, OR was 0.44 (95% CI 0.18-1.04) with a statistically significant trend demonstrated (test for overall effect: Z=1.87, p=0.06). Closure of a patent foramen ovale may be associated with reduction in the prevalence of atrial fibrillation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Echocardiographic predictors of coil vs device closure in patients undergoing percutaneous patent ductus arteriosus closure.

PubMed

Roushdy, Alaa; Abd El Razek, Yasmeen; Mamdouh Tawfik, Ahmed

2018-01-01

To determine anatomic and hemodynamic echocardiographic predictors for patent ductus arteriosus (PDA) device vs coil closure. Seventy-six patients who were referred for elective transcatheter PDA closure were enrolled in the study. All patients underwent full echocardiogram including measurement of the PDA pulmonary end diameter, color flow width and extent, peak and end-diastolic Doppler gradients across the duct, diastolic flow reversal, left atrial dimensions and volume, left ventricular sphericity index, and volumes. The study group was subdivided into 2 subgroups based on the mode of PDA closure whether by coil (n = 42) or device (n = 34). Using univariate analysis there was a highly significant difference between the 2 groups as regard the pulmonary end diameter measured in both the suprasternal and parasternal short-axis views as well as the color flow width and color flow extent (P < .0001). The device closure group had statistically significant higher end-systolic and end-diastolic volumes indexed, left atrial volume, and diastolic flow reversal. Receiver operating characteristic curve analysis showed a pulmonary end diameter cutoff point from the suprasternal view > 2.5 mm and from parasternal short-axis view > 2.61 mm to have the highest balanced sensitivity and specificity to predict the likelihood for device closure (AUC 0.971 and 0.979 respectively). The pulmonary end diameter measured from the suprasternal view was the most independent predictor of device closure. The selection between PDA coil or device closure can be done on the basis of multiple anatomic and hemodynamic echocardiographic variables. © 2017 Wiley Periodicals, Inc.

Colostomy closure: how to avoid complications

PubMed Central

Levitt, Marc A.; Lawal, Taiwo A.; Peña, Alberto

2010-01-01

Purpose Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. Methods The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48–72 h after the operation. Results The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung’s disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic

Colostomy closure: how to avoid complications.

PubMed

Bischoff, Andrea; Levitt, Marc A; Lawal, Taiwo A; Peña, Alberto

2010-11-01

Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48-72 h after the operation. The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung's disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic stricture and no mortality. Based on

Permanent Closure of MFC Biodiesel Underground Storage Tank 99ANL00013

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

Kerry L. Nisson

2012-10-01

This closure package documents the site assessment and permanent closure of the Materials and Fuels Complex biodiesel underground storage tank 99ANL00013 in accordance with the regulatory requirements established in 40 CFR 280.71, “Technical Standards and Corrective Action Requirements for Owners and Operators of Underground Storage Tanks: Out-of-Service UST Systems and Closure.”

Association of aortic stiffness to brain natriuretic peptide in children before and after device closure of patent ductus arteriosus

PubMed Central

Mahfouz, Ragab A.; Alzaiat, Ahmad; Gad, Marwa

2014-01-01

Objectives We evaluated the influence of device closure for patent ductus arteriosus (PDA) on the aortic stiffness index (ASI) and brain natriuretic peptide (BNP) and their association with cardiac function. Patients and methods ASI and echocardiography assessment before and after treatment (16 ± 9 months) in 48 children with PDA (mean age 10 ± 4.5) and 52 control children (mean age 9.7 ± 4.6). BNP level was measured pre-closure for all children, and was measured six months after closure only for children with PDA. Results ASI was higher in PDA patients than in controls (P < 0.001). ASI correlated with age (P < 0.05), LVEF% (P < 0.01), E/E′ (<0.03), pulmonary artery pressure (P < 0.001), and BNP (P < 0.001). ASI and BNP significantly decreased after closure (P < 0.001). ASI and BNP were independent predictors for post-closure systolic dysfunction (P < 0.001and <0.005, respectively). Receiver operating curve (ROC) analysis showed that ASI ⩾ 13.5, BNP level ⩾75 pg/ml and basal mean pulmonary artery pressure (PAP) ⩾ 23 were powerful predictors for post-closure systolic function. Conclusion ASI is significantly associated with BNP and basal PAP in children with PDA. After device closure, aortic distensibility improved significantly and was associated with significant improvement in both systolic and diastolic functions. ASI can be used for monitoring the course of patients with PDA, and may give opportunities for early intervention. PMID:25544819

The Effects of Pre-Operative Enteral Nutrition from Nasal Feeding Tubes on Gastric Outlet Obstruction.

PubMed

Chen, Zhi-Hua; Lin, Su-Yong; Dai, Qi-Bao; Hua, Jin; Chen, Shao-Qin

2017-04-10

We examined gastric outlet obstruction (GOO) patients who received two weeks of strengthening pre-operative enteral nutrition therapy (pre-EN) through a nasal-jejenal feeding tube placed under a gastroscope to evaluate the feasibility and potential benefit of pre-EN compared to parenteral nutrition (PN). In this study, 68 patients confirmed to have GOO with upper-gastrointestinal contrast and who accepted the operation were randomized into an EN group and a PN group. The differences in nutritional status, immune function, post-operative complications, weight of patients, first bowel sound and first flatus time, pull tube time, length of hospital stay (LOH), and cost of hospitalization between pre-operation and post-operation were all recorded. Statistical analyses were performed using the chi square test and t -test; statistical significance was defined as p < 0.05. The success rate of the placement was 91.18% (three out of 31 cases). After pre-EN, the levels of weight, albumin (ALB), prealbumin (PA), and transferrin (TNF) in the EN group were significantly increased by pre-operation day compared to admission day, but were not significantly increased in the PN group; the weights in the EN group were significantly increased compared to the PN group by pre-operation day and day of discharge; total protein (TP), ALB, PA, and TNF of the EN group were significantly increased compared to the PN group on pre-operation and post-operative days one and three. The levels of CD3+, CD4+/CD8+, IgA, and IgM in the EN group were higher than those of the PN group at pre-operation and post-operation; the EN group had a significantly lower incidence of poor wound healing, peritoneal cavity infection, pneumonia, and a shorter first bowel sound time, first flatus time, and post-operation hospital stay than the PN group. Pre-EN through a nasal-jejunum feeding tube and placed under a gastroscope in GOO patients was safe, feasible, and beneficial to the nutrition status, immune function

Does the Timing of Pre-Operative Medical Evaluation Influence Perioperative Total Hip Arthroplasty Outcomes?

PubMed

Lan, Roy H; Kamath, Atul F

2017-01-01

Medical evaluation pre-operatively is an important component of risk stratification and potential risk optimization. However, the effect of timing prior to surgical intervention is not well-understood. We hypothesized that total hip arthroplasty (THA) patients seen in pre-operative evaluation closer to the date of surgery would experience better perioperative outcomes. We retrospectively reviewed 167 elective THA patients to study the relationship between the number of days between pre-operative evaluation (range, 0-80 days) and surgical intervention. Patients' demographics, length of stay (LOS), ICU admission frequency, and rate of major complications were recorded. When pre-operative evaluation carried out 4 days or less before the procedure date, there was a significant reduction in LOS (3.91 vs. 4.49; p=0.03). When pre-operative evaluation carried out 11 days or less prior to the procedure date, there was a four-fold decrease in rate of intensive care admission (p=0.04). Furthermore, the major complication rate also significantly reduced (p<0.05). However, when pre-operative evaluation took place 30 days or less before the procedure date compared to more than 30 days prior, there were no significant changes in the outcomes. From this study, pre-operative medical evaluation closer to the procedure date was correlated with improved selected peri-operative outcomes. However, further study on larger patient groups must be done to confirm this finding. More study is needed to define the effect on rare events like infection, and to analyze the subsets of THA patients with modifiable risk factors that may be time-dependent and need further time to optimization.

Criticality assessment of LLRWDF closure

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

Sarrack, A.G.; Weber, J.H.; Woody, N.D.

1992-10-06

During the operation of the Low Level Radioactive Waste Disposal Facility (LLRWDF), large amounts (greater than 100 kg) of enriched uranium (EU) were buried. This EU came primarily from the closing and decontamination of the Naval Fuels Facility in the time period from 1987--1989. Waste Management Operations (WMO) procedures were used to keep the EU boxes separated to prevent possible criticality during normal operation. Closure of the LLRWDF is currently being planned, and waste stabilization by Dynamic Compaction (DC) is proposed. Dynamic compaction will crush the containers in the LLRWDF and result in changes in their geometry. Research of themore » LLRWDF operations and record keeping practices have shown that the EU contents of trenches are known, but details of the arrangement of the contents cannot be proven. Reviews of the trench contents, combined with analysis of potential critical configurations, revealed that some portions of the LLRWDF can be expected to be free of criticality concerns while other sections have credible probabilities for the assembly of a critical mass, even in the uncompacted configuration. This will have an impact on the closure options and which trenches can be compacted.« less

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

PubMed

Gerlach, Undine A; Pascher, Andreas

2012-06-01

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

Venous thromboembolism: patient awareness and education in the pre-operative assessment clinic.

PubMed

Haymes, Adam

2016-04-01

Each year venous thromboembolism (VTE) causes up to 60,000 deaths in the UK, many resulting from hospital-acquired thromboses following elective surgery. National Institute for Health and Clinical Excellence (NICE) guidelines state that all elective surgical patients should receive verbal and written information pre-operatively regarding the risks of developing VTE. This audit assessed elective surgical patient's prior awareness of VTE and examined how effective targeted patient education during the pre-operative assessment is in increasing this awareness. A 13 point questionnaire designed to assess a pre-operative patient's understanding of topics relating to VTE was provided to consecutive patients identified as being at risk of developing VTE at the end of their pre-operative assessment over a two-week period. A total of 68 questionnaires were completed. Provision of verbal and written information was poor (47 %, n = 32 and 47 %, n = 32 respectively). Despite this, 71 % (n = 48) of patients were aware of the consequences of developing VTE. Many patients correctly identified surgery (71 %, n = 48), immobility (71 %, n = 48) and being overweight (68 %, n = 46) as risk factors, but not dehydration (47 %, n = 32). Lack of awareness regarding personal methods to reduce the risk of developing a VTE post-operatively (24 %, n = 16) and potential side-effects of medical prophylaxis (32 %, n = 22) were also identified. Many patients already possess an awareness of VTE, however, specific knowledge regarding its risk factors and methods of prevention is lacking. Provision of targeted written and verbal educational information during the pre-operative assessment is an effective method of increasing a patient's awareness of these topics. Increased patient awareness may empower patients in their post-operative recovery and enable them to make more informed decisions regarding VTE prophylaxis options.

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

PubMed

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

2017-12-01

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

Oral Paracetamol for Patent Ductus Arteriosus Rescue Closure.

PubMed

Pharande, Pramod; Watson, Hadley; Tan, Kenneth; Sehgal, Arvind

2018-01-01

The objective of this study was to ascertain the efficacy of oral paracetamol in closing a symptomatic patent ductus arteriosus (PDA) when used as 'rescue' option. After obtaining ethics approval, a retrospective appraisal of the data from April 2014 to July 2015 was performed. Infants who were administered oral paracetamol either after unsuccessful therapy with ibuprofen or where it was considered contraindicated were included. A previously published echocardiographic scoring schema to stratify for ductal disease severity was used. Using univariate analysis, characteristics of infants with successful closure were compared with partial (a priori reduction in composite score by ≥ 50% of pretreatment) or no closure. Twenty infants with gestation age and birthweight of 25.7 ± 1.5 weeks and 724.1 ± 143 g, respectively, were studied. Complete closure was noted in 10 (50%) infants with additional four infants showing a significant reduction in haemodynamic shunting. Gestational age at birth and at therapy, chronological age at therapy, birthweight and total fluid intake were comparable between the two groups. The pre-therapy composite score had a significant association with successful closure (the higher the echocardiographic score, the lesser the closure). Concomitant furosemide therapy and late-onset sepsis had a high likelihood ratio of unsuccessful closure (11.01 [2-tailed, p = 0.005] and 5.3 [2-tailed, p = 0.07]), respectively. Oral paracetamol may be a possible therapeutic option in premature infants where therapy with first-line agents is unsuccessful or contraindicated. Concomitant sepsis and furosemide administration may affect successful therapy.

The Rising Rate of Rural Hospital Closures.

PubMed

Kaufman, Brystana G; Thomas, Sharita R; Randolph, Randy K; Perry, Julie R; Thompson, Kristie W; Holmes, George M; Pink, George H

2016-01-01

Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. The 2009 financial performance and market characteristics of rural hospitals that closed from 2010 through 2014 were compared to rural hospitals that remained open during the same period, stratified by critical access hospitals (CAHs) and other rural hospitals (ORHs). Differences were tested using Pearson's chi-square (categorical variables) and Wilcoxon rank test of medians. The relationships between negative operating margin and (1) market factors and (2) utilization/staffing factors were explored using logistic regression. In 2009, CAHs that subsequently closed from 2010 through 2014 had, in general, lower levels of profitability, liquidity, equity, patient volume, and staffing. In addition, ORHs that closed had smaller market shares and operated in markets with smaller populations compared to ORHs that remained open. Odds of unprofitability were associated with both market and utilization factors. Although half of the closed hospitals ceased providing health services altogether, the remainder have since converted to an alternative health care delivery model. Financial and market characteristics appear to be associated with closure of rural hospitals from 2010 through 2014, suggesting that it is possible to identify hospitals at risk of closure. As closure rates show no sign of abating, it is important to study the drivers of distress in rural hospitals, as well as the potential for alternative health care delivery models. © 2015 National Rural Health Association.

Standard operating procedure changed pre-hospital critical care anaesthesiologists’ behaviour: a quality control study

PubMed Central

2013-01-01

Introduction The ability of standard operating procedures to improve pre-hospital critical care by changing pre-hospital physician behaviour is uncertain. We report data from a prospective quality control study of the effect on pre-hospital critical care anaesthesiologists’ behaviour of implementing a standard operating procedure for pre-hospital controlled ventilation. Materials and methods Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region prospectively registered pre-hospital advanced airway-management data according to the Utstein-style template. We collected pre-intervention data from February 1st 2011 to January 31st 2012, implemented the standard operating procedure on February 1st 2012 and collected post intervention data from February 1st 2012 until October 31st 2012. We included transported patients of all ages in need of controlled ventilation treated with pre-hospital endotracheal intubation or the insertion of a supraglottic airways device. The objective was to evaluate whether the development and implementation of a standard operating procedure for controlled ventilation during transport could change pre-hospital critical care anaesthesiologists’ behaviour and thereby increase the use of automated ventilators in these patients. Results The implementation of a standard operating procedure increased the overall prevalence of automated ventilator use in transported patients in need of controlled ventilation from 0.40 (0.34-0.47) to 0.74 (0.69-0.80) with a prevalence ratio of 1.85 (1.57-2.19) (p = 0.00). The prevalence of automated ventilator use in transported traumatic brain injury patients in need of controlled ventilation increased from 0.44 (0.26-0.62) to 0.85 (0.62-0.97) with a prevalence ratio of 1.94 (1.26-3.0) (p = 0.0039). The prevalence of automated ventilator use in patients transported after return of spontaneous circulation following pre-hospital cardiac arrest increased from 0.39 (0

Geology of drill hole UE25p No. 1: A test hole into pre-Tertiary rocks near Yucca Mountain, southern Nevada

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

Carr, M.D.; Waddell, S.J.; Vick, G.S.

1986-12-31

Yucca Mountain in southern Nye County, Nevada, has been proposed as a potential site for the underground disposal of high-level nuclear waste. An exploratory drill hole designated UE25p No. 1 was drilled 3 km east of the proposed repository site to investigate the geology and hydrology of the rocks that underlie the Tertiary volcanic and sedimentary rock sequence forming Yucca Mountain. Silurian dolomite assigned to the Roberts Mountain and Lone Mountain Formations was intersected below the Tertiary section between a depth of approximately 1244 m (4080 ft) and the bottom of the drill hole at 1807 m (5923 ft). Thesemore » formations are part of an important regional carbonate aquifer in the deep ground-water system. Tertiary units deeper than 1139 m (3733 ft) in drill hole UE25p No. 1 are stratigraphically older than any units previously penetrated by drill holes at Yucca Mountain. These units are, in ascending order, the tuff of Yucca Flat, an unnamed calcified ash-flow tuff, and a sequence of clastic deposits. The upper part of the Tertiary sequence in drill hole UE25p No. 1 is similar to that found in other drill holes at Yucca Mountain. The Tertiary sequence is in fault contact with the Silurian rocks. This fault between Tertiary and Paleozoic rocks may correlate with the Fran Ridge fault, a steeply westward-dipping fault exposed approximately 0.5 km east of the drill hole. Another fault intersects UE25p No. 1 at 873 m (2863 ft), but its surface trace is concealed beneath the valley west of the Fran Ridge fault. The Paintbrush Canyon fault, the trace of which passes less than 100 m (330 ft) east of the drilling site, intersects drill hole UE25p No. 1 at a depth of approximately 78 m (255 ft). The drill hole apparently intersected the west flank of a structural high of pre-Tertiary rocks, near the eastern edge of the Crater Flat structural depression.« less

Gopherus Agassizii (Desert Tortoise). Predation/Mountain Lions (Pre-Print)

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

Paul D. Greger and Philip A. Medica

2009-01-01

adult sized Mountain Lion. By comparison, a 2 year old male Mountain Lion salvaged on NTS had an upper intercanine bite width of 45 mm, and a 6 month old kitten measured 35mm respectively. The Mountain Lion (Puma concolor) is the only predator that exists in southern Nevada that could possibly have a bite with a gap between its upper canine teeth that large (Murmann et al. 2006. J. Forensic Sci. 51:846-860). The appearance of the shell remains in Figure 1A is similar to that depicting Jaguar (Panthera onca) predation, on the Amazonian Tortoise (Geochelone denticulata) as illustrated by Emmons (1989. J. Herpetol. 23:311-314) with the majority of the carapace broken open and the plastron still intact. Predation of Desert Tortoises by Mountain Lions was also documented in 1993 in southern Arizona (Little Shipp Wash Plot), where 7 of 8 carcasses found were attributed to Mountain Lion predation (Averill-Murray et al. 2002. In. T.R.Van Devender [ed.], The Sonoran Desert Tortoise: Natural History, Biology, and Conservation, pp.109-134. University of Arizona Press and Arizona-Sonora Desert Museum, Tucson, Arizona). Similarly, predation by a Mountain Lion has been reported on the Argentine Tortoise (Chelonoidis chilensis) in Argentina (Acosta et al. 2004. Herpetol. Review 35:53-54), and a Mountain Lion kitten was observed to kill and consume a portion of the carapace of a Texas Tortoise (Gopherus berlandieri) in west Texas (Adams et al. 2006. Southwestern Nat. 51:581-581). Over the past 45 years this Desert Tortoise population has been monitored yearly, with no prior evidence of predation to tortoises within the fenced enclosures. On several occasions other predators such as Bobcats (Lynx rufus) have been observed within the study enclosures for as long as a week. Evidence of Kit Fox (Vulpes macrotus) sign has been observed on numerous occasions, and a Spotted Skunk (Spilogale putorius) and Longtail Weasels (Mustela frenata) have been captured and released (B.G. Maza, pers. comm

Can the pre-operative Western Ontario and McMaster score predict patient satisfaction following total hip arthroplasty?

PubMed

Rogers, B A; Alolabi, B; Carrothers, A D; Kreder, H J; Jenkinson, R J

2015-02-01

In this study we evaluated whether pre-operative Western Ontario and McMaster Universities (WOMAC) osteoarthritis scores can predict satisfaction following total hip arthroplasty (THA). Prospective data for a cohort of patients undergoing THA from two large academic centres were collected, and pre-operative and one-year post-operative WOMAC scores and a 25-point satisfaction questionnaire were obtained for 446 patients. Satisfaction scores were dichotomised into either improvement or deterioration. Scatter plots and Spearman's rank correlation coefficient were used to describe the association between pre-operative WOMAC and one-year post-operative WOMAC scores and patient satisfaction. Satisfaction was compared using receiver operating characteristic (ROC) analysis against pre-operative, post-operative and δ WOMAC scores. We found no relationship between pre-operative WOMAC scores and one-year post-operative WOMAC or satisfaction scores, with Spearman's rank correlation coefficients of 0.16 and -0.05, respectively. The ROC analysis showed areas under the curve (AUC) of 0.54 (pre-operative WOMAC), 0.67 (post-operative WOMAC) and 0.43 (δ WOMAC), respectively, for an improvement in satisfaction. We conclude that the pre-operative WOMAC score does not predict the post-operative WOMAC score or patient satisfaction after THA, and that WOMAC scores can therefore not be used to prioritise patient care. ©2015 The British Editorial Society of Bone & Joint Surgery.

Risk Management and Physical Modelling for Mountainous Natural Hazards

NASA Astrophysics Data System (ADS)

Lehning, Michael; Wilhelm, Christian

Population growth and climate change cause rapid changes in mountainous regions resulting in increased risks of floods, avalanches, debris flows and other natural hazards. Xevents are of particular concern, since attempts to protect against them result in exponentially growing costs. In this contribution, we suggest an integral risk management approach to dealing with natural hazards that occur in mountainous areas. Using the example of a mountain pass road, which can be protected from the danger of an avalanche by engineering (galleries) and/or organisational (road closure) measures, we show the advantage of an optimal combination of both versus the traditional approach, which is to rely solely on engineering structures. Organisational measures become especially important for Xevents because engineering structures cannot be designed for those events. However, organisational measures need a reliable and objective forecast of the hazard. Therefore, we further suggest that such forecasts should be developed using physical numerical modelling. We present the status of current approaches to using physical modelling to predict snow cover stability for avalanche warnings and peak runoff from mountain catchments for flood warnings. While detailed physical models can already predict peak runoff reliably, they are only used to support avalanche warnings. With increased process knowledge and computer power, current developments should lead to a enhanced role for detailed physical models in natural mountain hazard prediction.

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

PubMed

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

2016-05-27

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

Relict basin closure accommodates continental convergence with minimal crustal shortening or deceleration of plate motion as inferred from detrital zircon provenance in the Caucasus

NASA Astrophysics Data System (ADS)

Cowgill, E.; Forte, A. M.; Niemi, N. A.; Avdeev, B.; Tye, A. R.; Trexler, C. C.; Javakhishvili, Z.; Elashvili, M.; Godoladze, T.

2016-12-01

Comparison of plate convergence with the timing and magnitude of upper-crustal shortening in collisional orogens indicates both shortening deficits (200-1700 km) and significant (30-40%) plate deceleration during collision, the cause(s) for which remain debated. The Greater Caucasus Mountains, which result from post-collisional Cenozoic closure of a relict Mesozoic back-arc basin on the northern margin of the Arabia-Eurasia collision zone, help reconcile these debates. Here we use U-Pb detrital zircon provenance data and the regional geology of the Caucasus to investigate the width of the now-consumed Mesozoic back-arc basin and its closure history. The provenance data record distinct southern and northern provenance domains that persisted until at least the Miocene; maximum basin width was likely 350-400 km. We propose that closure of the back-arc basin initiated at 35 Ma, coincident with initial (soft) Arabia-Eurasia collision along the Bitlis suture, eventually leading to 5 Ma (hard) collision between the Lesser Caucasus arc and the Scythian platform to form the Greater Caucasus Mountains. Final basin closure triggered deceleration of plate convergence and tectonic reorganization throughout the collision. Post-collisional subduction of such small (500-1000 km wide) relict ocean basins can account for both shortening deficits and delays in plate deceleration by accommodating convergence via subduction/underthrusting, although such shortening is easily missed if it occurs along structures hidden within flysch/slate belts. Relict-basin closure is likely typical early in continental collision at the end of a Wilson cycle due to the irregularity of colliding margins and extensive back-arc basin development during closure of long-lived ocean basins.

Comparison of surgical techniques for stoma closure: A retrospective study of purse-string skin closure versus conventional skin closure following ileostomy and colostomy reversal

PubMed Central

WADA, YUMA; MIYOSHI, NORIKATSU; OHUE, MASAYUKI; NOURA, SHINGO; FUJINO, SHIKI; SUGIMURA, KEIJIROU; AKITA, HIROFUMI; MOTOORI, MASAAKI; GOTOH, KUNIHITO; TAKAHASHI, HIDENORI; KOBAYASHI, SHOGO; OHMORI, TAKESHI; FUJIWARA, YOSHIYUKI; YANO, MASAHIKO

2015-01-01

The aim of this study was to compare the incidence of postoperative complications, including superficial incisional surgical site infection (SSI) following purse-string skin closure (PS) and conventional skin closure with a drainage tube (CD) following stoma closure. A total of 55 consecutive patients who underwent loop colostomy and loop ileostomy closures in our hospital between October, 2011 and September, 2014 were retrospectively assessed. The patients were divided into two groups, namely the PS group (26 patients) and the CD group (29 patients). There were no significant differences in the characteristics of the patients between the two groups. The baseline and operative characteristics also did not differ significantly between the two groups. However the incidence of superficial incisional SSI was lower in the PS group compared to that in the CD group (0 vs. 13.8%, respectively; P=0.049). The overall incidence of complications did not differ significantly between the two groups (P=0.313). The duration of postoperative hospital stay in the PS group was shorter compared to that in the CD group. In conclusion, the results of this study suggest that PS may an effective technique to reduce the incidence of superficial incisional SSI. This technique appears to be superior to the conventional technique, allowing for better cosmesis. PMID:26137277

The urethral closure function in continent and stress urinary incontinent women assessed by urethral pressure reflectometry.

PubMed

Saaby, Marie-Louise

2014-02-01

a more detailed description of the efficiency of the closure function and the extent and nature of a possible dysfunction in the individual woman. The urethral closure equation (UCE) and urethral opening pressure at an abdominal pressure of 50 cm H2O (Po-Abd 50), respectively, which combine the permanent and the adjunctive closure forces, could separate continent and SUI women and thus appear to be excellent diagnostic tests. Moreover, the parameters showed highly significant negative correlation with ICIQ-SF, pad test and the number of incontinence episodes per week and are therefore valid as urodynamic severity measures. UPR in SUI women before and after TVT demonstrated a more efficient urethral closure function after the operation. The Po-rest was unchanged suggesting that the sphincteric unit was virtually unaltered and hence the permanent closure forces unchanged. However, the resting opening elastance increased by 18% indicating that at the resting state the TVT somewhat improves the closure function by providing increased resistance against the dilation of the urethra, which probably explains the decreased maximum urine flow rate found after TVT in this and previous studies. The APIR increased in all patients after TVT suggesting that the support system was re-established and thus the adjunctive closure forces improved, regardless of the type of pre-operative dysfunction. The new UPR parameters may be used as outcome measures after treatment.

Tissue adhesives for closure of surgical incisions.

PubMed

Coulthard, Paul; Esposito, Marco; Worthington, Helen V; van der Elst, Maarten; van Waes, Oscar J F; Darcey, James

2010-05-12

Sutures, staples and adhesive tapes are the traditional methods of wound closure, whilst tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables meticulous closure, but they may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of no risk of needlestick injury and no requirement to remove sutures later. Tissue adhesives have been used primarily in emergency rooms but this review looks at the use of tissue adhesives in the operating room where surgeons are increasingly using these for the closure of surgical skin incisions. To determine the relative effects of various tissue adhesives and conventional skin closure techniques on the healing of surgical wounds. For this update we searched the Cochrane Wounds Group Specialised Register (Searched 17/11/09); The Cochrane Central Register of Controlled Trials (CENTRAL) - The Cochrane Library Issue 4 2009; Ovid MEDLINE - 1950 to November Week 1 2009; Ovid EMBASE - 1980 to 2009 Week 46; EBSCO CINAHL - 1982 to 17 November 20098. No date or language restrictions were applied. Only randomised controlled clinical trials were eligible for inclusion. Screening of eligible studies and data extraction were conducted independently and in triplicate whilst assessment of the methodological quality of the trials was conducted independently and in duplicate. Results were expressed as random effects models using mean difference for continuous outcomes and relative risks with 95% confidence intervals for dichotomous outcomes. Heterogeneity was investigated including both clinical and methodological factors. This update identified an additional six trials resulting in a total of fourteen RCTs (1152 patients) which met the inclusion criteria. Sutures were significantly better than tissue adhesives for minimising dehiscence (10 trials). Sutures were also found to be significantly faster to use. For all other analyses of infection, patient and operator

Pre-operative assessment of patients undergoing endoscopic, transnasal, transsphenoidal pituitary surgery.

PubMed

Lubbe, D; Semple, P

2008-06-01

To demonstrate the importance of pre-operative ear, nose and throat assessment in patients undergoing endoscopic, transsphenoidal surgery for pituitary tumours. Literature pertaining to the pre-operative otorhinolaryngological assessment and management of patients undergoing endoscopic anterior skull base surgery is sparse. We describe two cases from our series of 59 patients undergoing endoscopic pituitary surgery. The first case involved a young male patient with a large pituitary macroadenoma. His main complaint was visual impairment. He had no previous history of sinonasal pathology and did not complain of any nasal symptoms during the pre-operative neurosurgical assessment. At the time of surgery, a purulent nasal discharge was seen emanating from both middle meati. Surgery was abandoned due to the risk of post-operative meningitis, and postponed until the patient's chronic rhinosinusitis was optimally managed. The second patient was a 47-year-old woman with a large pituitary macroadenoma, who presented to the neurosurgical department with a main complaint of diplopia. She too gave no history of previous nasal problems, and she underwent uneventful surgery using the endoscopic, transnasal approach. Two weeks after surgery, she presented to the emergency unit with severe epistaxis. A previous diagnosis of hereditary haemorrhagic telangiectasia was discovered, and further surgical and medical intervention was required before the epistaxis was finally controlled. Pre-operative otorhinolaryngological assessment is essential prior to endoscopic pituitary or anterior skull base surgery. A thorough otorhinolaryngological history will determine whether any co-morbid diseases exist which could affect the surgical field. Nasal anatomy can be assessed via nasal endoscopy and sinusitis excluded. Computed tomography imaging is a valuable aid to decisions regarding additional procedures needed to optimise access to the pituitary fossa.

Taking Closure to the Next Level - 13030

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

Feist, E.T.

2013-07-01

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

Percutaneous device closure of atrial septal defect results in very early and sustained changes of right and left heart function.

PubMed

Monfredi, Oliver; Luckie, Matthew; Mirjafari, Hoda; Willard, Terence; Buckley, Helen; Griffiths, Linda; Clarke, Bernard; Mahadevan, Vaikom S

2013-08-20

To investigate the echocardiographic effects of percutaneous closure of secundum atrial septal defect (ASD) in adults and assess which pre-closure parameters predict good response to closure. ASD is a common congenital heart disease often undiscovered until adulthood. ASD closure has been revolutionized by the use of percutaneous devices. The effects of these procedures on echocardiographic parameters are not well characterized. Patients undergoing percutaneous device closure of ASD between June 2007 and June 2009 had 3 sequential echocardiograms reviewed: pre-procedure, immediate post-procedure (24 hours) and 6-8 weeks post-procedure. Significant changes from baseline were investigated using paired t-test/1-way ANOVA. Pearson correlation (2-tailed) tests were used to categorize patients as 'good responders' to closure in terms of selected parameters. 129 echocardiograms in 43 consecutive patients were included. Remodeling of both ventricles occurred immediately following ASD closure and was sustained. Right ventricular (RV) diameter in diastole decreased by 13.5% and 19.3% compared to baseline at 24 hours and 6-8 weeks post-closure, respectively (p<0.05); Left ventricular (LV) diameter in diastole increased by 8.5% and 15.6%, respectively (p<0.05). Functional parameters of the RV also demonstrated early and sustained decreases (TAPSE decreased by 8.3% and 17% compared to baseline at 24 hours and 6-8 weeks post-closure, respectively (p<0.05)). Smaller RV baseline diameter appeared to predict good response to closure. Percutaneous ASD closure has immediate, sustained benefits on multiple echocardiographic parameters. Good responders have smaller RV at baseline, suggesting early closure is preferable. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Resident-performed laser peripheral iridotomy in primary angle closure, primary angle closure suspects, and primary angle closure glaucoma.

PubMed

Kam, Jason P; Zepeda, Emily M; Ding, Leona; Wen, Joanne C

2017-01-01

To investigate the power use and complication frequency of resident-performed laser peripheral iridotomy (LPI). A retrospective analysis of 196 eyes from 103 patients who underwent neodymium: yttrium-aluminum-garnet laser iridotomy performed by resident physicians from January 1, 2010 through April 30, 2015 at a university-based county hospital was done. All patients were treated for primary angle closure, primary angle closure suspects, and primary angle closure glaucoma. Data were collected on pre- and post-laser intraocular pressure (IOP), ethnicity, laser parameters and complications. Mean power use and frequency of complications were evaluated. Complications included elevated post-laser IOP at 30-45 minutes (≥8 mmHg), hyphema, aborted procedures, and lasering non-iris structures. The number of repeated LPI procedures, was also recorded. Mean total power used for all residents was 78.2±68.7 mJ per eye. Power use by first-year trainees was significantly higher than second- and third-year trainees (103.5±75.5 mJ versus 73.7±73.8 mJ and 67.2±56.4 mJ, respectively, p =0.011). Complications included hyphema or microhyphema in 17.9% (35/196), IOP spikes in 5.1% (10/196), aborted procedures in 1.1% (3/196) and lasering non-iris structures in 0.5% (1/196). LPI was repeated in 22.4% of cases (44/196) with higher incidence of repeat LPI among non-Caucasian compared to the Caucasian subjects ( p =0.02). Complication rates did not differ with increased training ( p =0.16). Total power used for LPI decreased with increased resident training, while the complication rate did not differ significantly among resident classes. Complication rates were comparable to rates reported in the literature for attending-performed LPIs.

Airflows and turbulent flux measurements in mountainous terrain: Part 2: Mesoscale effects

USGS Publications Warehouse

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

2004-01-01

The location of the Niwot Ridge Ameriflux site within the rocky mountains subjects it to airflows which are common in mountainous terrain. In this study, we examine the effects of some of these mesoscale features on local turbulent flux measurements; most notably, the formation of valley/mountain flows and mountain lee-side waves. The valley/mountain flows created local non-stationarities in the wind flow caused by the passage of a lee-side convergence zone (LCZ) in which upslope and downslope flows met in the vicinity of the measurement tower. During June-August, 2001, possible lee-side convergences were flagged for ???26% of all half-hour daytime flux measurement periods. However, there was no apparent loss of flux during these periods. On some relatively stable, summer nights, turbulence (designated via ??w), and scalar fluctuations (temperature and CO2, for example) exhibited periodicities that appeared congruent with passage of low frequency gravity waves (?? ??? 20 min). Spectral peaks at 0.0008 Hz (20 min) in both vertical velocity and scalar spectra were observed and indicated that 25-50% of the total scalar covariances were accounted for by the low frequency waves. During some periods of strong westerly winds (predominantly in winter), large mountain gravity waves were observed to form. Typically, the flux tower resided within a region of downslope "shooting flow", which created high turbulence, but had no detrimental effect on local flux measurements based on valid turbulence statistics and nearly complete energy budget closure. Periodically, we found evidence for re-circulating, rotor winds in the simultaneous time series of wind data from the Ameriflux tower site and a second meteorological site situated 8 km upslope and to the West. Only 14% of the half-hour time periods that we examined for a 4 month period in the winter of 2000-2001 indicated the possible existence of rotor winds. On average, energy budget closure was ???20% less during periods with

40 CFR 265.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... comply with § 265.145. For owners or operators using the financial test or corporate guarantee, the post... 40 Protection of Environment 27 2012-07-01 2012-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a...

40 CFR 265.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... comply with § 265.145. For owners or operators using the financial test or corporate guarantee, the post... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a...

40 CFR 265.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... comply with § 265.145. For owners or operators using the financial test or corporate guarantee, the post... 40 Protection of Environment 27 2013-07-01 2013-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a...

40 CFR 265.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... comply with § 265.145. For owners or operators using the financial test or corporate guarantee, the post... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a...

40 CFR 265.144 - Cost estimate for post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... comply with § 265.145. For owners or operators using the financial test or corporate guarantee, the post... 40 Protection of Environment 26 2014-07-01 2014-07-01 false Cost estimate for post-closure care..., STORAGE, AND DISPOSAL FACILITIES Financial Requirements § 265.144 Cost estimate for post-closure care. (a...

40 CFR 258.72 - Financial assurance for post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... care. 258.72 Section 258.72 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID... assurance for post-closure care. (a) The owner or operator must have a detailed written estimate, in current dollars, of the cost of hiring a third party to conduct post-closure care for the MSWLF unit in compliance...

Post-operative course of coronary artery bypass surgery patients who pre-donate autologous blood.

PubMed

Jovin, Ion S; Stelzig, Georg; Strelitz, Joachim C; Taborski, Uwe; Jovin, Angelika; Heidinger, Kathrin; Klövekorn, Wolf-Peter; Müller-Berghaus, Gert

2003-12-01

Pre-operative autologous blood donation is used to reduce the need of allogeneic blood in patients undergoing coronary bypass surgery operations, but it is not clear what impact the blood donation has on the post-operative course of these patients. We studied the post-operative course of 210 patients who pre-donated autologous blood before their coronary bypass operation (donors) and of 67 patients who were eligible to pre-donate but did not (controls). The clinical variables and the technical operative parameters of the patients in the two groups were similar. There was no significant difference between the duration of assisted ventilation post-operatively (756 +/- 197 vs. 802 +/- 395 min; P=0.54) or length of stay in the intensive care unit (1.8 +/- 1.1 vs. 1.7 +/- 0.9 days; P=0.52) of the two groups. The number of autologous units of packed red cells and of fresh frozen plasma (FFP) received by the donors was significantly higher than the number of units of allogeneic packed red cells (1.5 +/- 0.9 vs. 0.3 +/- 0.9; P=0.001) and the units of homologous FFP received by the controls (2.3 +/- 0.8 vs. 0.6 +/- 1; P=0.001). We found no evidence that autologous blood donation exerted a negative influence on the post-operative course of patients undergoing coronary bypass surgery. Patients who pre-donated blood received no allogeneic blood products, but the number of autologous blood products received by donors was higher than the number of blood products received by patients who did not pre-donate.

Closure properties of Watson-Crick grammars

NASA Astrophysics Data System (ADS)

Zulkufli, Nurul Liyana binti Mohamad; Turaev, Sherzod; Tamrin, Mohd Izzuddin Mohd; Azeddine, Messikh

2015-12-01

In this paper, we define Watson-Crick context-free grammars, as an extension of Watson-Crick regular grammars and Watson-Crick linear grammars with context-free grammar rules. We show the relation of Watson-Crick (regular and linear) grammars to the sticker systems, and study some of the important closure properties of the Watson-Crick grammars. We establish that the Watson-Crick regular grammars are closed under almost all of the main closure operations, while the differences between other Watson-Crick grammars with their corresponding Chomsky grammars depend on the computational power of the Watson-Crick grammars which still need to be studied.

Pre- and post-operative dizziness, tinnitus, and taste disturbances among cochlear implant recipients.

PubMed

Mikkelsen, K S; Ovesen, T; Swan, C Z

2017-04-01

To determine the pre- and post-operative prevalence of dizziness, tinnitus and taste disturbances in adult cochlear implant recipients. A questionnaire regarding pre- and post-operative dizziness, tinnitus and taste disturbances was sent to 170 cochlear implant recipients implanted between January 2003 and March 2009. Seventy-seven patients (41 per cent) responded. Pre-operatively, 20 per cent of the participants experienced dizziness, 52 per cent experienced tinnitus and 3 per cent experienced taste disturbances. Post-operative dizziness developed in 46 per cent of patients and resolved in the majority of these; however, 15 per cent reported dizziness more than six months after implantation. Tinnitus worsened in 25 per cent of patients, whereas 73 per cent reported attenuation or termination of tinnitus. Post-operatively, tinnitus developed in 12 per cent and taste disturbances developed in 17 per cent of the patients. The high prevalence of dizziness, tinnitus and taste disturbances reported by cochlear implant recipients necessitates that assessment of symptoms related to inner ear and chorda tympani damage are included when evaluating operative results.

Mountain-Plains Handbook: The Design and Operation of a Residential Family Based Education Program. Appendix. Supplement II to Volume 5. Operational Support: Administrative Services Division.

ERIC Educational Resources Information Center

Anderson, Newell B.; And Others

One of two supplements which accompany chapter 5 of "Mountain-Plains Handbook: The Design and Operation of a Residential, Family Oriented Career Education Model" (CE 014 630), this document contains specific information concerning the following components of the administrative services division: purchasing, property control, and…

Does the pre-operative serum phosphate level predict early hypocalcaemia following parathyroidectomy for primary hyperparathyroidism?

PubMed

Ellul, David; Townsley, Richard Brendan; Clark, Louise Jane

2013-06-01

Hypocalcaemia is a significant post-operative complication following parathyroidectomy. Early identification of risk factors can help pre-empt hypocalcaemia and avoid serious sequelae. It can also help identify those patients that are not suitable for day-case surgery. The aim of this study was to analyse the predictive value of the pre-operative serum phosphate level as an indicator for developing hypocalcaemia post-operatively in patients undergoing parathyroidectomy for primary hyperparathyroidism. We performed a retrospective review of all patients who underwent parathyroidectomy between 2008 and 2010 at the Southern General Hospital in Glasgow. Data collected included the number of parathyroid glands excised and their histology, pre-operative adjusted calcium (aCa) and phosphate levels, post-operative aCa at 6 and 24 h following surgery, and the fall in aCa levels in the first 6 h and 24 h following surgery. Minitab Statistical Analysis (Version 15) was used for data analysis. Fifty-six patients underwent parathyroidectomy in the study period. Twelve patients were excluded for various reasons including incomplete records and secondary hyperparathyroidism. Patients given calcium or Vitamin D supplements immediately post-operatively were also excluded. Statistical analysis showed no significant correlation between the pre-operative phosphate level and the post-operative decline in aCa level 6 h or 24 h following surgery. Patients with a lower phosphate level pre-operatively were not at risk of a more drastic fall in calcium levels following parathyroidectomy. The pre-operative phosphate level was not found to be predictive of post-operative hypocalcaemia in our study. Copyright © 2012 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Tissue adhesives for closure of surgical incisions.

PubMed

Coulthard, P; Worthington, H; Esposito, M; Elst, M; Waes, O J F

2004-01-01

Sutures, staples and adhesive tapes are the traditional methods of wound closure, whilst tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables meticulous closure, but sutures may induce tissue reactivity and they usually require removal. Tissue adhesives offer the advantages there are no sutures to remove later for the patient and no risk of needlestick injury to the surgeon. Tissue adhesives have been used primarily in emergency rooms but this review looks at the use of tissue adhesives in the operating room where surgeons are increasingly using these for the closure of surgical skin incisions. To determine the relative effects of various tissue adhesives and conventional skin closure techniques on the healing of surgical wounds. The Cochrane Wounds Group Specialised Trials Register, The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. Bibliographies of review articles were checked for studies outside the handsearched journals and wound care product manufacturers were contacted. Randomised controlled clinical trials only. Screening of eligible studies and data extraction was conducted independently and in triplicate whilst assessment of the methodological quality of the trials was conducted independently and in duplicate. Results were expressed as random effect models using weighted mean differences for continuous outcomes and relative risk with 95% confidence intervals for dichotomous outcomes. Heterogeneity was investigated including both clinical and methodological factors. Eight RCTs were included (630 patients). No statistically significant differences were found between various tissue adhesives and sutures (8 trials) for dehiscence, infection, satisfaction with cosmetic appearance when assessed by patients' or surgeons' general satisfaction. Nor were differences found between a tissue adhesive and tapes (2 trials) for infection, patients' assessment of cosmetic

Colour coding for blood collection tube closures - a call for harmonisation.

PubMed

Simundic, Ana-Maria; Cornes, Michael P; Grankvist, Kjell; Lippi, Giuseppe; Nybo, Mads; Ceriotti, Ferruccio; Theodorsson, Elvar; Panteghini, Mauro

2015-02-01

At least one in 10 patients experience adverse events while receiving hospital care. Many of the errors are related to laboratory diagnostics. Efforts to reduce laboratory errors over recent decades have primarily focused on the measurement process while pre- and post-analytical errors including errors in sampling, reporting and decision-making have received much less attention. Proper sampling and additives to the samples are essential. Tubes and additives are identified not only in writing on the tubes but also by the colour of the tube closures. Unfortunately these colours have not been standardised, running the risk of error when tubes from one manufacturer are replaced by the tubes from another manufacturer that use different colour coding. EFLM therefore supports the worldwide harmonisation of the colour coding for blood collection tube closures and labels in order to reduce the risk of pre-analytical errors and improve the patient safety.

76 FR 51053 - Notice of Change of Hours of Operation and Closure of P.O. Box for the Nevada State Office

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-17

... DEPARTMENT OF THE INTERIOR Bureau of Land Management [LLNV956000.L142000000.XH0000.241E0; 11-08807; MO 4500022720; TAS: 14X1109] Notice of Change of Hours of Operation and Closure of P.O. Box for the Nevada State Office AGENCY: Bureau of Land Management, Interior. ACTION: Notice SUMMARY: The Bureau of...

Reynolds Stress Closure for Inertial Frames and Rotating Frames

NASA Astrophysics Data System (ADS)

Petty, Charles; Benard, Andre

2017-11-01

In a rotating frame-of-reference, the Coriolis acceleration and the mean vorticity field have a profound impact on the redistribution of kinetic energy among the three components of the fluctuating velocity. Consequently, the normalized Reynolds (NR) stress is not objective. Furthermore, because the Reynolds stress is defined as an ensemble average of a product of fluctuating velocity vector fields, its eigenvalues must be non-negative for all turbulent flows. These fundamental properties (realizability and non-objectivity) of the NR-stress cannot be compromised in computational fluid dynamic (CFD) simulations of turbulent flows in either inertial frames or in rotating frames. The recently developed universal realizable anisotropic prestress (URAPS) closure for the NR-stress depends explicitly on the local mean velocity gradient and the Coriolis operator. The URAPS-closure is a significant paradigm shift from turbulent closure models that assume that dyadic-valued operators associated with turbulent fluctuations are objective.

Feasibility of lane closures using probe data.

DOT National Transportation Integrated Search

2017-04-01

To develop an adequate traffic operations management and congestion mitigation plan for every roadway : maintenance and construction project requiring lane closures, transportation agencies need accurate and : reliable estimates of traffic impacts as...

40 CFR 264.120 - Certification of completion of post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... certification that the post-closure care period for the hazardous waste disposal unit was performed in...) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND... later than 60 days after completion of the established post-closure care period for each hazardous waste...

Tissue adhesives for closure of surgical incisions.

PubMed

Dumville, Jo C; Coulthard, Paul; Worthington, Helen V; Riley, Philip; Patel, Neil; Darcey, James; Esposito, Marco; van der Elst, Maarten; van Waes, Oscar J F

2014-11-28

Sutures (stitches), staples and adhesive tapes have been used for many years as methods of wound closure, but tissue adhesives have entered clinical practice more recently. Closure of wounds with sutures enables the closure to be meticulous, but the sutures may show tissue reactivity and can require removal. Tissue adhesives offer the advantages of an absence of risk of needlestick injury and no requirement to remove sutures later. Initially, tissue adhesives were used primarily in emergency room settings, but this review looks at the use of tissue adhesives in the operating room/theatre where surgeons are using them increasingly for the closure of surgical skin incisions. To determine the effects of various tissue adhesives compared with conventional skin closure techniques for the closure of surgical wounds. In March 2014 for this second update we searched the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We did not restrict the search and study selection with respect to language, date of publication or study setting. Only randomised controlled trials were eligible for inclusion. We conducted screening of eligible studies, data extraction and risk of bias assessment independently and in duplicate. We expressed results as random-effects models using mean difference for continuous outcomes and risk ratios (RR) with 95% confidence intervals (CI) for dichotomous outcomes. We investigated heterogeneity, including both clinical and methodological factors. This second update of the review identified 19 additional eligible trials resulting in a total of 33 studies (2793 participants) that met the inclusion criteria. There was low quality evidence that sutures were significantly better than tissue adhesives for reducing the risk of wound breakdown (dehiscence; RR 3.35; 95% CI 1.53 to 7

14 CFR 95.19 - Hawaii Mountainous Area.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Hawaii Mountainous Area. 95.19 Section 95...) AIR TRAFFIC AND GENERAL OPERATING RULES IFR ALTITUDES Designated Mountainous Areas § 95.19 Hawaii Mountainous Area. The following islands of the State of Hawaii: Kauai, Oahu, Molokai, Lanai, Kehoolawe, Maui...

40 CFR 265.1202 - Closure and post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... post-closure care. (a) At closure of a magazine or unit which stored hazardous waste under this subpart... estimates for closure, and financial responsibility for magazines or units must meet all of the requirements... as long as it remains in service as a munitions or explosives magazine or storage unit. (b) If, after...

Generalized kinetic-neoclassical closure for parallel viscosity in a tokamak.

NASA Astrophysics Data System (ADS)

Smolyakov, A.; Callen, J. D.; Hegna, C.

2000-10-01

We develop a drift-kinetic equation for a Chapman Enskog-type calculations of the parallel viscosity in a tokamak. This approach allows us to uniformly obtain closure relations for the parallel viscosity that include the kinetic effects of wave-particle interactions, such as those of Hammet-Perkins closures, as well as standard neoclassical moment closures induced by collisions and the magnetic field strength variation along field lines. Closures for both these cases can be obtained from our expressions; also, their mutual influences can be investigated. The developed equations allow calculation of parallel vicosity in general kinetic-neoclassical regimes while the main conservation properties remain correct even with an approximate treatment of the collisional operator.

Mountain-Plains Handbook: The Design and Operation of a Residential Family Based Education Program. Appendix. Supplement I to Volume 5. Operational Support: Administrative Services Division.

ERIC Educational Resources Information Center

Anderson, Newell B.; And Others

One of two supplements which accompany chapter 5 of "Mountain-Plains Handbook: The Design and Operation of a Residential, Family Oriented Career Education Model" (CE 014 630), this document contains specific information concerning the reprographic and personnel components of the administrative services division. Several job descriptions…

Lace Up for Healthy Feet: The Impact of Shoe Closure on Plantar Stress Response.

PubMed

Rahemi, Hadi; Armstrong, David G; Enriquez, Ana; Owl, Joshua; Talal, Talal K; Najafi, Bijan

2017-07-01

This study examined the impact of shoe closure on plantar thermal stress response (TSR), which is known to be a surrogate of shear stress and skin perfusion. It is aimed to explore potential impact of shoe closure on increasing risk factors associated with plantar ulcers in people with diabetic peripheral neuropathy (DPN). Fifteen eligible subjects were enrolled. The left foot was used as a reference and fitted to a self-adjusted and habitual lace-tightening method by each subject. The right foot was used as a test closure and fitted into three lace closure conditions: loose, tight, and preset optimal closure (reel clutch, BOA technology). Thermal images were taken after 5 minutes of acclimatization (pre-trial) and immediately after 200 walking steps in each shoe closure condition (post-trial). TSR was calculated from the thermal images. TSR was significantly higher in the test closure with loose (70.24%, P = .000) and tight (66.85%, P = .007) and lower (-206.53%, P = .000) in the preset optimal closure when compared to the reference closure. Only lace closure conditions affected TSR with no significant impact from age, BMI, and gender in our sample in a multivariable regression model. The results from this study suggest that shoelace closure technique can have a profound effect on TSR. It therefore stands to reason that optimal lace closure may have an impact in reducing risk of plantar ulcers in people with DPN. Interestingly, results revealed that even a self-adjusted lace closure may not be necessarily optimal and a preset closure setting like reel clutch might ultimately be recommended to minimize risk. Further study is warranted to confirm or refute these interesting results.

Development of the performance confirmation program at YUCCA mountain, nevada

USGS Publications Warehouse

LeCain, G.D.; Barr, D.; Weaver, D.; Snell, R.; Goodin, S.W.; Hansen, F.D.

2006-01-01

The Yucca Mountain Performance Confirmation program consists of tests, monitoring activities, experiments, and analyses to evaluate the adequacy of assumptions, data, and analyses that form the basis of the conceptual and numerical models of flow and transport associated with a proposed radioactive waste repository at Yucca Mountain, Nevada. The Performance Confirmation program uses an eight-stage risk-informed, performance-based approach. Selection of the Performance Confirmation activities for inclusion in the Performance Confirmation program was done using a risk-informed performance-based decision analysis. The result of this analysis was a Performance Confirmation base portfolio that consists of 20 activities. The 20 Performance Confirmation activities include geologic, hydrologie, and construction/engineering testing. Some of the activities began during site characterization, and others will begin during construction, or post emplacement, and continue until repository closure.

Subcostal closure technique for prevention of postthoracotomy pain syndrome.

PubMed

Hong, Kipyo; Bae, Mikyung; Han, Sora

2016-09-01

The purpose of this study was to evaluate the efficacy of our subcostal closure technique in prevention of postthoracotomy pain syndrome. From July 2012 to March 2015, 29 patients in whom a lobectomy was indicated underwent a thoracotomy. The thoracotomy wounds were closed using a subcostal closure technique (subcostal closure group) and outcomes were compared with 31 patients who underwent video-assisted thoracoscopic surgery (thoracoscopy group). The duration of oral opioid consumption was evaluated from medical records, and postoperative pain was evaluated by telephone interview conducted by a trained nurse practitioner who was unaware of the patient's group. Pain scores were higher in the thoracoscopy group compared to the subcostal closure group, reaching statistical significance (Numeric Rating Scale 0.55 ± 0.948 in the subcostal closure group vs. 1.84 ± 1.614 in the thoracoscopy group; p < 0.001, Clinical Pain Scale 0.24 ± 0.435 in the subcostal closure group vs. 0.81 ± 0.703 in the thoracoscopy group; p < 0.001). The number of patients who consumed oral opioids for longer than 2 months after the operation was significantly greater in the thoracoscopy group than the subcostal closure group (6.9% in the subcostal closure group vs. 32.3% in the thoracoscopy group; p = 0.022). The subcostal closure technique is useful to prevent postthoracotomy pain syndrome. © The Author(s) 2016.

A study of pre-operative sedatives

PubMed Central

Parkhouse, James; Mahoney, Joan

1968-01-01

A state-registered nurse acted as a whole-time investigator following patients through the pre-operative night in hospital and questioning them in the morning, to assess the relative merits of different medications. Two new sedatives were compared with a standard barbiturate and a placebo, and information was collected from patients who elected to have no medication to help them sleep. Subjective assessment enabled the placebo to be distinguished from the active medications, although there was little difference between these. The importance of psychological factors is discussed in relation to those patients who had no medication. PMID:4869880

Kennesaw Mountain National Battlefield Park : Assessment of Management of Kennesaw Mountain Drive and Bus Shuttle Service.

DOT National Transportation Integrated Search

2010-07-06

The purpose of this study is to assess the management of the Kennesaw Mountain Drive, which runs from the Visitor Center to the : summit of Kennesaw Mountain, and assess the future of the shuttle service that operates on the road during weekends, inc...

Impact of value based breast cancer care pathway implementation on pre-operative breast magnetic resonance imaging utilization.

PubMed

McCray, Devina K S; Grobmyer, Stephen R; Pederson, Holly J

2017-02-01

Bilateral breast magnetic resonance imaging (MRI) is commonly used in the diagnostic workup of breast cancer (BC) to assess extent of disease and identify occult foci of disease. However, evidence for routine use of pre-operative MRI is lacking. Breast MRI is costly and can lead to unnecessary tests and treatment delays. Clinical care pathways (care paths) are value-based guidelines, which define management recommendations derived by expert consensus and available evidence based data. At Cleveland Clinic, care paths created for newly diagnosed BC patients recommend selective use of pre-operative MRI. We evaluated the number of pre-operative MRIs ordered before and after implementing an institution wide BC care paths in April 2014. A retrospective review was conducted of BC cases during the years 2012, 2014, and part of 2015. Patient, tumor and treatment characteristics were collected. Pre-operative MRI utilization was compared before and after care path implementation. We identified 1,515 BC patients during the study period. Patients were more likely to undergo pre-operative MRI in 2012 than 2014 (OR: 2.77; P<0.001; 95% CI: 1.94-3.94) or 2015 (OR: 4.14; P<0.001; 95% CI: 2.51-6.83). There was a significant decrease in pre-operative MRI utilization between 2012 and 2014 (P<0.001) after adjustment for pre-operative MRIs ordered for care path indications. Implementation of online BC care paths at our institution was associated with a decreased use of pre-operative MRI overall and in patients without a BC care path indication, driving value based care through the reduction of pre-operative breast MRIs.

The association between radiographic severity and pre-operative function in patients undergoing primary knee replacement for osteoarthritis.

PubMed

Dowsey, Michelle M; Dieppe, Paul; Lohmander, Stefan; Castle, David; Liew, Danny; Choong, Peter F M

2012-12-01

To determine the association between radiographic osteoarthritis (OA) and pre-operative function in patients undergoing primary knee replacement. Single centre study examining pre-operative outcomes in a consecutive series of 525 patients who underwent primary knee replacement for OA between January 2006 and December 2007. Pre-operative data included: demographics, American Society of Anaesthesiologists (ASA) status and OA in the contralateral knee. The International Knee Society (IKS) rating and Short Form-12 (SF-12) were recorded for each patient. Pre-operative radiographs were read by a single observer for Kellgren and Lawrence (K&L) grading and Osteoarthritis Research Society International (OARSI) atlas features. Multiple linear regression was used to assess the strength of associations between radiographic OA severity and function, adjusting for clinically relevant variables. Lateral tibiofemoral osteophyte grade was an independent predictor of pre-operative function as determined by the functional sub-scale of the IKS in patients undergoing primary knee replacement (coefficient=2.58, p=0.033). No associations were evident between pre-operative function and modified K&L, joint space narrowing, Ahlbäck attrition and coronal plane deformity. Other statistically significant predictors of poorer pre-operative function included: advancing age, female gender, knee pain and poorer SF-12 mental component summary scores which including osteophyte grade accounted for 24.6% of the variation in functional scores, (r=0.496). Osteophytes in the lateral compartment of the knee were associated with pre-operative function in patients with advanced knee OA. Further studies are required which examine individual radiographic features specifically in patients with advanced knee OA to determine their relationship to pre-operative pain and function. Copyright © 2012 Elsevier B.V. All rights reserved.

Pre-operative simulation of pediatric mastoid surgery with 3D-printed temporal bone models.

PubMed

Rose, Austin S; Webster, Caroline E; Harrysson, Ola L A; Formeister, Eric J; Rawal, Rounak B; Iseli, Claire E

2015-05-01

As the process of additive manufacturing, or three-dimensional (3D) printing, has become more practical and affordable, a number of applications for the technology in the field of pediatric otolaryngology have been considered. One area of promise is temporal bone surgical simulation. Having previously developed a model for temporal bone surgical training using 3D printing, we sought to produce a patient-specific model for pre-operative simulation in pediatric otologic surgery. Our hypothesis was that the creation and pre-operative dissection of such a model was possible, and would demonstrate potential benefits in cases of abnormal temporal bone anatomy. In the case presented, an 11-year-old boy underwent a planned canal-wall-down (CWD) tympano-mastoidectomy for recurrent cholesteatoma preceded by a pre-operative surgical simulation using 3D-printed models of the temporal bone. The models were based on the child's pre-operative clinical CT scan and printed using multiple materials to simulate both bone and soft tissue structures. To help confirm the models as accurate representations of the child's anatomy, distances between various anatomic landmarks were measured and compared to the temporal bone CT scan and the 3D model. The simulation allowed the surgical team to appreciate the child's unusual temporal bone anatomy as well as any challenges that might arise in the safety of the temporal bone laboratory, prior to actual surgery in the operating room (OR). There was minimal variability, in terms of absolute distance (mm) and relative distance (%), in measurements between anatomic landmarks obtained from the patient intra-operatively, the pre-operative CT scan and the 3D-printed models. Accurate 3D temporal bone models can be rapidly produced based on clinical CT scans for pre-operative simulation of specific challenging otologic cases in children, potentially reducing medical errors and improving patient safety. Copyright © 2015 Elsevier Ireland Ltd. All rights

Surgical Closure of Patent Ductus Arteriosus in Premature Neonates Weighing Less Than 1,000 grams: Contemporary Outcomes.

PubMed

Lehenbauer, David G; Fraser, Charles D; Crawford, Todd C; Hibino, Naru; Aucott, Susan; Grimm, Joshua C; Patel, Nishant; Magruder, J Trent; Cameron, Duke E; Vricella, Luca

2018-07-01

The safety of surgical closure of patent ductus arteriosus (PDA) in very low birth weight premature neonates has been questioned because of associated morbidities. However, these studies are vulnerable to significant bias as surgical ligation has historically been utilized as "rescue" therapy. The objective of this study was to review our institutions' outcomes of surgical PDA ligation. All neonates with operative weight of ≤1.00 kg undergoing surgical PDA ligation from 2003 to 2015 were analyzed. Records were queried to identify surgical complications, perioperative morbidity, and mortality. Outcomes included pre- and postoperative ventilator requirements, pre- and postoperative inotropic support, acute kidney injury, surgical complications, and 30-day mortality. One hundred sixty-six preterm neonates underwent surgical ligation. One hundred twenty-one (70.3%) had failed indomethacin closure. One hundred sixty-four (98.8%) patients required mechanical ventilation prior to surgery. At 17 postoperative days, freedom from the ventilator reached 50%. Of 109 (66.4%) patients requiring prolonged preoperative inotropic support, 59 (54.1%) were liberated from inotropes by postoperative day 1. Surgical morbidity was encountered in four neonates (2.4%): two (1.2%) patients had a postoperative pneumothorax requiring tube thoracostomy, one (0.6%) patient had a recurrent laryngeal nerve injury, and one (0.6%) patient had significant intraoperative bleeding. The 30-day all-cause mortality was 1.8% (n = 3); no deaths occurred intraoperatively. In this retrospective investigation, surgical PDA closure was associated with low 30-day mortality and minimal morbidity and resulted in rapid discontinuation of inotropic support and weaning from mechanical ventilation. Given the safety of this intervention, surgical PDA ligation merits consideration in the management strategy of the preterm neonate with a PDA.

Does the bracket–ligature combination affect the amount of orthodontic space closure over three months? A randomized controlled trial

PubMed Central

Wong, Henry; Collins, Jill; Tinsley, David; Sandler, Jonathan; Benson, Philip

2013-01-01

Objective: To investigate the effect of bracket–ligature combination on the amount of orthodontic space closure over three months. Design: Randomized clinical trial with three parallel groups. Setting: A hospital orthodontic department (Chesterfield Royal Hospital, UK). Participants: Forty-five patients requiring upper first premolar extractions. Methods: Informed consent was obtained and participants were randomly allocated into one of three groups: (1) conventional pre-adjusted edgewise brackets and elastomeric ligatures; (2) conventional pre-adjusted edgewise brackets and Super Slick® low friction elastomeric ligatures; (3) Damon 3MX® passive self-ligating brackets. Space closure was undertaken on 0·019×0·025-inch stainless steel archwires with nickel–titanium coil springs. Participants were recalled at four weekly intervals. Upper alginate impressions were taken at each visit (maximum three). The primary outcome measure was the mean amount of space closure in a 3-month period. Results: A one-way ANOVA was undertaken [dependent variable: mean space closure (mm); independent variable: group allocation]. The amount of space closure was very similar between the three groups (1 mm per 28 days); however, there was a wide variation in the rate of space closure between individuals. The differences in the amount of space closure over three months between the three groups was very small and non-significant (P = 0·718). Conclusion: The hypothesis that reducing friction by modifying the bracket/ligature interface increases the rate of space closure was not supported. The major determinant of orthodontic tooth movement is probably the individual patient response. PMID:23794696

Predicting Peri-Device Leakage of Left Atrial Appendage Device Closure Using Novel Three-Dimensional Geometric CT Analysis.

PubMed

Chung, Hyemoon; Jeon, Byunghwan; Chang, Hyuk-Jae; Han, Dongjin; Shim, Hackjoon; Cho, In Jeong; Shim, Chi Young; Hong, Geu-Ru; Kim, Jung-Sun; Jang, Yangsoo; Chung, Namsik

2015-12-01

After left atrial appendage (LAA) device closure, peri-device leakage into the LAA persists due to incomplete occlusion. We hypothesized that pre-procedural three-dimensional (3D) geometric analysis of the interatrial septum (IAS) and LAA orifice can predict this leakage. We investigated the predictive parameters of LAA device closure obtained from baseline cardiac computerized tomography (CT) using a novel 3D analysis system. We conducted a retrospective study of 22 patients who underwent LAA device closure. We defined peri-device leakage as the presence of a Doppler signal inside the LAA after device deployment (group 2, n = 5) compared with patients without peri-device leakage (group 1, n = 17). Conventional parameters were measured by cardiac CT. Angles θ and φ were defined between the IAS plane and the line, linking the LAA orifice center and foramen ovale. Group 2 exhibited significantly better left atrial (LA) function than group 1 (p = 0.031). Pre-procedural θ was also larger in this group (41.9° vs. 52.3°, p = 0.019). The LAA cauliflower-type morphology was more common in group 2. Overall, the patients' LA reserve significantly decreased after the procedure (21.7 mm(3) vs. 17.8 mm(3), p = 0.035). However, we observed no significant interval changes in pre- and post-procedural values of θ and φ in either group (all p > 0.05). Angles between the IAS and LAA orifice might be a novel anatomical parameter for predicting peri-device leakage after LAA device closure. In addition, 3D CT analysis of the LA and LAA orifice could be used to identify clinically favorable candidates for LAA device closure.

Transcutaneous closure of chronic broncho-pleuro-cutaneous fistula by duct occluder device

PubMed Central

Marwah, Vikas; Ravikumar, R; Rajput, Ashok Kumar; Singh, Amandeep

2016-01-01

Bronchopleural fistula (BPF) is a well known complication of several pulmonary conditions posing challenging management problem and is often associated with high morbidity and mortality. Though no consensus exists on a definite closure management algorithm, strategies for closure widely include various methods like tube thoracostomy with suction, open surgical closure, bronchoscopy directed glue, coiling and sealants which now also includes use of occlusion devices. We report a case in which a novel method of delivery and closure of recurrent post-operative broncho-pleuro-cutaneous fistula by a duct occluder device was done transcutaneously which has not been previously described in literature. PMID:27051115

Combat Operations in Mountainous Terrain: Are United States Army Light Infantry Divisions Preparing Properly?

DTIC Science & Technology

1987-06-05

Mountain Division, Charles Hauptman, Comeany I. 97th Mountain Infantry Regiment by CPT George Earle, and PFC Hugh Graves (1945), and 10th Mountain...training in this country is believed to depend primarily ’Albert H. Jackman , "The Tenth Mountain Division, A Successful Experiment," The Algine Journal...44-48. Houston, Charles S., Dr. "Altitude Sickness and the Army," 112zard. 2d Qtr 1986: n.p. Jackman , Albert H. "The Tenth Mountain Division, A

Development of Infrared Phase Closure Capability in the Infrared-Optical Telescope Array (IOTA)

NASA Technical Reports Server (NTRS)

Traub, Wesley A.

2002-01-01

We completed all major fabrication and testing for the third telescope and phase-closure operation at the Infrared-Optical Telescope Array (IOTA) during this period. In particular we successfully tested the phase-closure operation, using a laboratory light source illuminating the full delay-line optical paths, and using an integrated-optic beam combiner coupled to our Picnic-detector camera. This demonstration is an important and near-final milestone achievement. As of this writing, however, several tasks yet remain, owing to development snags and weather, so the final proof of success, phase-closure observation of a star, is now expected to occur in early 2002, soon after this report has been submitted.

Need for closure and heuristic information processing: the moderating role of the ability to achieve the need for closure.

PubMed

Kossowska, Małgorzata; Bar-Tal, Yoram

2013-11-01

In contrast to the ample research that shows a positive relationship between the need for closure (NFC) and heuristic information processing, this research examines the hypothesis that this relationship is moderated by the ability to achieve closure (AAC), that is, the ability to use information-processing strategies consistent with the level of NFC. Three different operationalizations of heuristic information processing were used: recall of information consistent with the impression (Study 1); pre-decisional information search (Study 2); and stereotypic impression formation (Study 3). The results of the studies showed that there were positive relationships between NFC and heuristic information processing when participants assessed themselves as being able to use cognitive strategies consistent with their level of NFC (high AAC). For individuals with low AAC, the relationships were negative. Our data show that motivation-cognition interactions influence the information-processing style. © 2012 The British Psychological Society.

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

PubMed

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

2018-05-01

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

Full Life Cycle Research at the Ketzin Pilot Site, Germany - From Safe and Successful CO2 Injection Operation to Post-Injection Monitoring and Site Closure

NASA Astrophysics Data System (ADS)

Liebscher, A. H.

2016-12-01

The Ketzin pilot site near Berlin, Germany, was initiated in 2004 as the first European onshore storage project for research and development on geological CO2 storage. The operational CO2 injection period started in June 2008 and ended in August 2013 when the site entered the post-injection closure period. During these five years, a total amount of 67 kt of CO2 was safely injected into a saline aquifer (Upper Triassic sandstone) at a depth of 630 m - 650 m. In fall 2013, the first observation well was partially plugged in the reservoir section; full abandonment of this well finished in 2015 after roughly 2 years of well closure monitoring. Abandonment of the remaining 4 wells will be finished by 2017 and hand-over of liability to the competent authority is planned for end of 2017. The CO2 injected was mainly of food grade quality (purity > 99.9%). In addition, 1.5 kt of CO2 from the pilot capture facility "Schwarze Pumpe" (oxyfuel power plant CO2 with purity > 99.7%) was injected in 2011. The injection period terminated with a CO2-N2 co-injection experiment of 650 t of a 95% CO2/5% N2 mixture in summer 2013 to study the effects of impurities in the CO2 stream on the injection operation. During regular operation, the CO2 was pre-heated on-site to 40 - 45°C prior to injection to ensure a single-phase injection process and avoid any phase transition or transient states within the injection facility or the reservoir. Between March and July 2013, just prior to the CO2-N2 co-injection experiment, the injection temperature was stepwise decreased down to 10°C within a "cold-injection" experiment to study the effects of two-phase injection conditions. During injection operation, the combination of different geochemical and geophysical monitoring methods enabled detection and mapping of the spatial and temporal in-reservoir behaviour of the injected CO2 even for small quantities. After the cessation of CO2 injection, post-injection monitoring continued and two additional

Automated analysis of angle closure from anterior chamber angle images.

PubMed

Baskaran, Mani; Cheng, Jun; Perera, Shamira A; Tun, Tin A; Liu, Jiang; Aung, Tin

2014-10-21

To evaluate a novel software capable of automatically grading angle closure on EyeCam angle images in comparison with manual grading of images, with gonioscopy as the reference standard. In this hospital-based, prospective study, subjects underwent gonioscopy by a single observer, and EyeCam imaging by a different operator. The anterior chamber angle in a quadrant was classified as closed if the posterior trabecular meshwork could not be seen. An eye was classified as having angle closure if there were two or more quadrants of closure. Automated grading of the angle images was performed using customized software. Agreement between the methods was ascertained by κ statistic and comparison of area under receiver operating characteristic curves (AUC). One hundred forty subjects (140 eyes) were included, most of whom were Chinese (102/140, 72.9%) and women (72/140, 51.5%). Angle closure was detected in 61 eyes (43.6%) with gonioscopy in comparison with 59 eyes (42.1%, P = 0.73) using manual grading, and 67 eyes (47.9%, P = 0.24) with automated grading of EyeCam images. The agreement for angle closure diagnosis between gonioscopy and both manual (κ = 0.88; 95% confidence interval [CI), 0.81-0.96) and automated grading of EyeCam images was good (κ = 0.74; 95% CI, 0.63-0.85). The AUC for detecting eyes with gonioscopic angle closure was comparable for manual and automated grading (AUC 0.974 vs. 0.954, P = 0.31) of EyeCam images. Customized software for automated grading of EyeCam angle images was found to have good agreement with gonioscopy. Human observation of the EyeCam images may still be needed to avoid gross misclassification, especially in eyes with extensive angle closure. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

Comparison Of Pre-Operative Curvature With Postoperative Curvature In Root Canals Treated With K-3 Rotary Systems.

PubMed

Nagi, Sana Ehsen; Khan, Farhan Raza

2017-01-01

With root canal treatment, the organic debris and micro-organisms from pulp space is removed and an ideal canal preparation is achieved that is conducive of hermetic obturation. The purpose of this study was to correlate the pre-operative canal curvature with the postoperative curvature in human extracted teeth prepared with K-3 rotary systems. The root canal preparation was carried out on extracted human molars and premolars using K-3 endodontic rotary files. A pre and post-operative image of the teeth using digital radiograph were taken in order to compare pre and post-operative canal curvature. The images were saved in an images retrieval system (Gendex software, USA). Change in the canal curvature was measured using the software measuring tool (Vixwin software, USA). Student paired t-test and Pearson correlation test was applied at 0.05 level of significance. There is a statistically significant difference between pre-operative and post-operative canal curvature (p-value <0.001) and a strong positive correlation (91% correlation) between pre-operative and post-operative canal curvature in teeth prepared with the K-3 rotary files. A significant difference between pre and post instrumentation curvature was found. Degree of canal curvature was not correlated with time taken for canal preparation.

Evolution of endemism on a young tropical mountain.

PubMed

Merckx, Vincent S F T; Hendriks, Kasper P; Beentjes, Kevin K; Mennes, Constantijn B; Becking, Leontine E; Peijnenburg, Katja T C A; Afendy, Aqilah; Arumugam, Nivaarani; de Boer, Hugo; Biun, Alim; Buang, Matsain M; Chen, Ping-Ping; Chung, Arthur Y C; Dow, Rory; Feijen, Frida A A; Feijen, Hans; Feijen-van Soest, Cobi; Geml, József; Geurts, René; Gravendeel, Barbara; Hovenkamp, Peter; Imbun, Paul; Ipor, Isa; Janssens, Steven B; Jocqué, Merlijn; Kappes, Heike; Khoo, Eyen; Koomen, Peter; Lens, Frederic; Majapun, Richard J; Morgado, Luis N; Neupane, Suman; Nieser, Nico; Pereira, Joan T; Rahman, Homathevi; Sabran, Suzana; Sawang, Anati; Schwallier, Rachel M; Shim, Phyau-Soon; Smit, Harry; Sol, Nicolien; Spait, Maipul; Stech, Michael; Stokvis, Frank; Sugau, John B; Suleiman, Monica; Sumail, Sukaibin; Thomas, Daniel C; van Tol, Jan; Tuh, Fred Y Y; Yahya, Bakhtiar E; Nais, Jamili; Repin, Rimi; Lakim, Maklarin; Schilthuizen, Menno

2015-08-20

Tropical mountains are hot spots of biodiversity and endemism, but the evolutionary origins of their unique biotas are poorly understood. In varying degrees, local and regional extinction, long-distance colonization, and local recruitment may all contribute to the exceptional character of these communities. Also, it is debated whether mountain endemics mostly originate from local lowland taxa, or from lineages that reach the mountain by long-range dispersal from cool localities elsewhere. Here we investigate the evolutionary routes to endemism by sampling an entire tropical mountain biota on the 4,095-metre-high Mount Kinabalu in Sabah, East Malaysia. We discover that most of its unique biodiversity is younger than the mountain itself (6 million years), and comprises a mix of immigrant pre-adapted lineages and descendants from local lowland ancestors, although substantial shifts from lower to higher vegetation zones in this latter group were rare. These insights could improve forecasts of the likelihood of extinction and 'evolutionary rescue' in montane biodiversity hot spots under climate change scenarios.

Branchial cleft anomalies: accuracy of pre-operative diagnosis, clinical presentation and management.

PubMed

Guldfred, L-A; Philipsen, B B; Siim, C

2012-06-01

To examine the accuracy of the pre-operative diagnosis of branchial cleft anomalies, and also to describe their occurrence, clinical presentation and management. Retrospective review of the records of patients diagnosed with a branchial cleft anomaly between 1997 and 2006. One hundred and twenty-six patients were included. Pre-operative diagnosis had a positive predictive value of 0.856 (95 per cent confidence interval, 0.771-0.918) and a sensitivity of 0.944 (95 per cent confidence interval, 0.869-0.979). These patients' demographic data, investigations, findings and management are presented, along with a possible strategy for dealing with solitary cystic masses in the neck. As pre-operative diagnosis has a positive predictive value of 86 per cent, cystic lesions in the neck should be presumed to be carcinomatous until proven otherwise. Branchial fistulae and sinuses seem to be a disease of childhood, while branchial cysts occur mainly in adults. Branchial cleft anomalies are equally frequent in men and women, and equally distributed on the left and right side of the neck.

Meta-analysis of pre-operative magnetic resonance imaging (MRI) and surgical treatment for breast cancer.

PubMed

Houssami, Nehmat; Turner, Robin M; Morrow, Monica

2017-09-01

Although there is no consensus on whether pre-operative MRI in women with breast cancer (BC) benefits surgical treatment, MRI continues to be used pre-operatively in practice. This meta-analysis examines the association between pre-operative MRI and surgical outcomes in BC. A systematic review was performed to identify studies reporting quantitative data on pre-operative MRI and surgical outcomes (without restriction by type of surgery received or type of BC) and using a controlled design. Random-effects logistic regression calculated the pooled odds ratio (OR) for each surgical outcome (MRI vs. no-MRI groups), and estimated ORs stratified by study-level age. Subgroup analysis was performed for invasive lobular cancer (ILC). Nineteen studies met eligibility criteria: 3 RCTs and 16 comparative studies that included newly diagnosed BC of any type except for three studies restricted to ILC. Primary analysis (85,975 subjects) showed that pre-operative MRI was associated with increased odds of receiving mastectomy [OR 1.39 (1.23, 1.57); p < 0.001]; similar findings were shown in analyses stratified by study-level median age. Secondary analyses did not find statistical evidence of an effect of MRI on the rates of re-excision, re-operation, or positive margins; however, MRI was significantly associated with increased odds of receiving contralateral prophylactic mastectomy [OR 1.91 (1.25, 2.91); p = 0.003]. Subgroup analysis for ILC did not find any association between MRI and the odds of receiving mastectomy [OR 1.00 (0.75, 1.33); p = 0.988] or the odds of re-excision [OR 0.65 (0.35, 1.24); p = 0.192]. Pre-operative MRI is associated with increased odds of receiving ipsilateral mastectomy and contralateral prophylactic mastectomy as surgical treatment in newly diagnosed BC patients.

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

PubMed

Zakkar, Mustafa; Kanagasabay, Robin; Hunt, Ian

2014-04-01

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

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

PubMed Central

Zakkar, Mustafa; Kanagasabay, Robin; Hunt, Ian

2014-01-01

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

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

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

Not Available

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

Oblique view to south OvertheHorizon Backscatter Radar Network, Mountain ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Oblique view to south - Over-the-Horizon Backscatter Radar Network, Mountain Home Air Force Operations Building, On Desert Street at 9th Avenue Mountain Home Air Force Base, Mountain Home, Elmore County, ID

Pre-surgery briefings and safety climate in the operating theatre.

PubMed

Allard, Jon; Bleakley, Alan; Hobbs, Adrian; Coombes, Lee

2011-08-01

In 2008, the WHO produced a surgical safety checklist against a background of a poor patient safety record in operating theatres. Formal team briefings are now standard practice in high-risk settings such as the aviation industry and improve safety, but are resisted in surgery. Research evidence is needed to persuade the surgical workforce to adopt safety procedures such as briefings. To investigate whether exposure to pre-surgery briefings is related to perception of safety climate. Three Safety Attitude Questionnaires, completed by operating theatre staff in 2003, 2004 and 2006, were used to evaluate the effects of an educational intervention introducing pre-surgery briefings. Individual practitioners who agree with the statement 'briefings are common in the operating theatre' also report a better 'safety climate' in operating theatres. The study reports a powerful link between briefing practices and attitudes towards safety. Findings build on previous work by reporting on the relationship between briefings and safety climate within a 4-year period. Briefings, however, remain difficult to establish in local contexts without appropriate team-based patient safety education. Success in establishing a safety culture, with associated practices, may depend on first establishing unidirectional, positive change in attitudes to create a safety climate.

Combining task-evoked and spontaneous activity to improve pre-operative brain mapping with fMRI

PubMed Central

Fox, Michael D.; Qian, Tianyi; Madsen, Joseph R.; Wang, Danhong; Li, Meiling; Ge, Manling; Zuo, Huan-cong; Groppe, David M.; Mehta, Ashesh D.; Hong, Bo; Liu, Hesheng

2016-01-01

Noninvasive localization of brain function is used to understand and treat neurological disease, exemplified by pre-operative fMRI mapping prior to neurosurgical intervention. The principal approach for generating these maps relies on brain responses evoked by a task and, despite known limitations, has dominated clinical practice for over 20 years. Recently, pre-operative fMRI mapping based on correlations in spontaneous brain activity has been demonstrated, however this approach has its own limitations and has not seen widespread clinical use. Here we show that spontaneous and task-based mapping can be performed together using the same pre-operative fMRI data, provide complimentary information relevant for functional localization, and can be combined to improve identification of eloquent motor cortex. Accuracy, sensitivity, and specificity of our approach are quantified through comparison with electrical cortical stimulation mapping in eight patients with intractable epilepsy. Broad applicability and reproducibility of our approach is demonstrated through prospective replication in an independent dataset of six patients from a different center. In both cohorts and every individual patient, we see a significant improvement in signal to noise and mapping accuracy independent of threshold, quantified using receiver operating characteristic curves. Collectively, our results suggest that modifying the processing of fMRI data to incorporate both task-based and spontaneous activity significantly improves functional localization in pre-operative patients. Because this method requires no additional scan time or modification to conventional pre-operative data acquisition protocols it could have widespread utility. PMID:26408860

Pre-operative stroke and neurological disability do not independently affect short- and long-term mortality in infective endocarditis patients.

PubMed

Diab, Mahmoud; Guenther, Albrecht; Sponholz, Christoph; Lehmann, Thomas; Faerber, Gloria; Matz, Anna; Franz, Marcus; Witte, Otto W; Pletz, Mathias W; Doenst, Torsten

2016-10-01

Infective endocarditis (IE) is still associated with high morbidity and mortality. The impact of pre-operative stroke on mortality and long-term survival is controversial. In addition, data on the severity of neurological disability due to pre-operative stroke are scarce. We analysed the impact of pre-operative stroke and the severity of its related neurological disability on short- and long-term outcome. We retrospectively reviewed our data from patients operated for left-sided IE between 01/2007 and 04/2013. We performed univariate (Chi-Square and independent samples t test) and multivariate analyses. Among 308 consecutive patients who underwent cardiac surgery for left-sided IE, pre-operative stroke was present in 87 (28.2 %) patients. Patients with pre-operative stroke had a higher pre-operative risk profile than patient without it: higher Charlson comorbidity index (8.1 ± 2.6 vs. 6.6 ± 3.3) and higher incidence of Staphylococcus aureus infection (43 vs. 17 %) and septic shock (37 vs. 19 %). In-hospital mortality was equal but 5-year survival was significantly worse with pre-operative stroke (33.1 % vs. 45 %, p = 0.006). 5-year survival was worst in patients with severe neurological disability compared to mild disability (19.0 vs. 0.58 %, p = 0.002). However, neither pre-operative stroke nor the degree of neurological disability appeared as an independent risk factor for short or long-term mortality by multivariate analysis. Pre-operative stroke and the severity of neurological disability do not independently affect short- and long-term mortality in patients with infective endocarditis. It appears that patients with pre-operative stroke present with a generally higher risk profile. This information may substantially affect decision-making.

Study of relationship between clinical factors and velopharyngeal closure in cleft palate patients

PubMed Central

Chen, Qi; Zheng, Qian; Shi, Bing; Yin, Heng; Meng, Tian; Zheng, Guang-ning

2011-01-01

BACKGROUND: This study was carried out to analyze the relationship between clinical factors and velopharyngeal closure (VPC) in cleft palate patients. METHODS: Chi-square test was used to compare the postoperative velopharyngeal closure rate. Logistic regression model was used to analyze independent variables associated with velopharyngeal closure. RESULTS: Difference of postoperative VPC rate in different cleft types, operative ages and surgical techniques was significant (P=0.000). Results of logistic regression analysis suggested that when operative age was beyond deciduous dentition stage, or cleft palate type was complete, or just had undergone a simple palatoplasty without levator veli palatini retropositioning, patients would suffer a higher velopharyngeal insufficiency rate after primary palatal repair. CONCLUSIONS: Cleft type, operative age and surgical technique were the contributing factors influencing VPC rate after primary palatal repair of cleft palate patients. PMID:22279464

Left ventricular remodeling and change of systolic function after closure of patent ductus arteriosus in adults: device and surgical closure.

PubMed

Jeong, Young-Hoon; Yun, Tae-Jin; Song, Jong-Min; Park, Jung-Jun; Seo, Dong-Man; Koh, Jae-Kon; Lee, Se-Whan; Kim, Mi-Jeong; Kang, Duk-Hyun; Song, Jae-Kwan

2007-09-01

Left ventricular (LV) remodeling and predictors of LV systolic function late after closure of patent ductus arteriosus (PDA) in adults remain to be clearly demonstrated. In 45 patients with PDA, including 28 patients who received successful occlusion using the Amplatzer device (AD group) (AGA, Golden Valley, MN) and 17 patients who received surgical closure (OP group), echocardiography studies were performed before closure and 1 day (AD group) or within 7 days (OP group) after closure, and then were repeated at > or = 6 months (17 +/- 13 months). In both groups, LV ejection fraction (EF) and end-diastolic volume index were significantly decreased immediately after closure, whereas end-systolic volume index did not change. During the long-term follow-up period, end-systolic as well as end-diastolic volume indices decreased significantly in both groups and LV EF recovered compared to the immediate postclosure state. However, LV EF remained low compared to the preclosure state. Five patients (11.1%) including 3 patients in the AD group and 2 patients in the OP group showed persistent late LV systolic dysfunction (EF <50%). In stepwise, multiple logistic regression analysis, preclosure EF was the only independent predictor of late normal postclosure EF (odds ratio, 1.230; 95% CI, 1.054-1.434; P = .008). Receiver operating characteristic curve analysis showed that preclosure EF > or = 62% had a sensitivity of 72% and a specificity of 83% for predicting late normal LV EF after closure. Left ventricular EF remains low late after PDA closure compared with preclosure state in adults. Preclosure LV EF is the best index to predict late postclosure LV EF.

Overview of the role of pre-operative breast MRI in the absence of evidence on patient outcomes.

PubMed

Sardanelli, Francesco

2010-02-01

The role of pre-operative breast MRI is outlined on the basis of the existing evidence in favor of a superior capability in comparison with mammography and sonography to detect ipsilateral and contralateral malignant lesions and to evaluate the disease extent, including the extensive intraductal component associated with invasive cancers. Patients with a potential higher anticipated benefit from pre-operative MRI can be identified as those: with mammographically dense breasts; with a unilateral multifocal/multicentric cancer or a synchronous bilateral cancer already diagnosed at mammography and sonography; with a lobular invasive cancer; at high-risk for breast cancer; with a cancer which shows a discrepancy in size of >1 cm between mammography and sonography; or under consideration for partial breast irradiation. More limited evidence exists in favor of MRI for evaluating candidates for total skin sparing mastectomy or for patients with Paget's disease. Irrespective of whether the clinical team routinely uses preoperative MRI or not: women newly diagnosed with breast cancer should always be informed of the potential risks and benefits of pre-operative MRI; results of pre-operative MRI should be interpreted taking into account clinical breast examination, mammography, sonography and verified by percutaneous biopsy; MRI-only detected lesions require MR-guidance for needle biopsy and pre-surgical localization, and these should be available or potentially accessible if pre-operative MRI is to be implemented; total therapy delay due to pre-operative MRI (including MRI-induced work-up) should not exceed one month; changes in therapy planning resulting from pre-operative MRI should be decided by a multidisciplinary team. Copyright (c) 2009 Elsevier Ltd. All rights reserved.

Theater gateway closure: a strategic level barricade

DTIC Science & Technology

that at the strategic level the effects are based on the economic and diplomatic elements of the national power, affecting proportionally sustainment...Seven months of detrimental political implications, expensive effects on military operations, and strategic level barricades during 2011 and 2012 in...logistical planners at the strategic level can anticipate or mitigate the effects of a theater gateway closure on military operations. Through two

Interferometric Imaging Directly with Closure Phases and Closure Amplitudes

NASA Astrophysics Data System (ADS)

Chael, Andrew A.; Johnson, Michael D.; Bouman, Katherine L.; Blackburn, Lindy L.; Akiyama, Kazunori; Narayan, Ramesh

2018-04-01

Interferometric imaging now achieves angular resolutions as fine as ∼10 μas, probing scales that are inaccessible to single telescopes. Traditional synthesis imaging methods require calibrated visibilities; however, interferometric calibration is challenging, especially at high frequencies. Nevertheless, most studies present only a single image of their data after a process of “self-calibration,” an iterative procedure where the initial image and calibration assumptions can significantly influence the final image. We present a method for efficient interferometric imaging directly using only closure amplitudes and closure phases, which are immune to station-based calibration errors. Closure-only imaging provides results that are as noncommittal as possible and allows for reconstructing an image independently from separate amplitude and phase self-calibration. While closure-only imaging eliminates some image information (e.g., the total image flux density and the image centroid), this information can be recovered through a small number of additional constraints. We demonstrate that closure-only imaging can produce high-fidelity results, even for sparse arrays such as the Event Horizon Telescope, and that the resulting images are independent of the level of systematic amplitude error. We apply closure imaging to VLBA and ALMA data and show that it is capable of matching or exceeding the performance of traditional self-calibration and CLEAN for these data sets.

Comment on "Relict Basin Closure and Crustal Shortening Budgets During Continental Collision: An Example From Caucasus Sediment Provenance" by Cowgill et al. (2016)

NASA Astrophysics Data System (ADS)

Vincent, Stephen J.; Saintot, Aline; Mosar, Jon; Okay, Aral I.; Nikishin, Anatoly M.

2018-03-01

The southern slope of the Greater Caucasus mountains is the site of a former rift basin. In order to explain shortening deficits, plate deceleration, and the 5 Ma reorganization of the Arabia-Eurasia collision zone Cowgill et al. (2016) proposed that this basin closed 5 Myrs ago. Within the western Greater Caucasus, at least, careful examination of sedimentological, provenance, and seismic data, however, supports an earlier 35 Ma basin closure age. Basin closure cannot therefore be the driving mechanism for the 5 Ma deceleration of the Arabian plate and reorganization of the Arabia-Eurasia collision zone.

40 CFR 264.111 - Closure performance standard.

Code of Federal Regulations, 2013 CFR

2013-07-01

... Section 264.111 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... eliminates, to the extent necessary to protect human health and the environment, post-closure escape of...

40 CFR 264.111 - Closure performance standard.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Section 264.111 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES... eliminates, to the extent necessary to protect human health and the environment, post-closure escape of...

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

PubMed

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

2011-11-01

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

Influence of Different Container Closure Systems and Capping Process Parameters on Product Quality and Container Closure Integrity (CCI) in GMP Drug Product Manufacturing.

PubMed

Mathaes, Roman; Mahler, Hanns-Christian; Roggo, Yves; Huwyler, Joerg; Eder, Juergen; Fritsch, Kamila; Posset, Tobias; Mohl, Silke; Streubel, Alexander

2016-01-01

Capping equipment used in good manufacturing practice manufacturing features different designs and a variety of adjustable process parameters. The overall capping result is a complex interplay of the different capping process parameters and is insufficiently described in literature. It remains poorly studied how the different capping equipment designs and capping equipment process parameters (e.g., pre-compression force, capping plate height, turntable rotating speed) contribute to the final residual seal force of a sealed container closure system and its relation to container closure integrity and other drug product quality parameters. Stopper compression measured by computer tomography correlated to residual seal force measurements.In our studies, we used different container closure system configurations from different good manufacturing practice drug product fill & finish facilities to investigate the influence of differences in primary packaging, that is, vial size and rubber stopper design on the capping process and the capped drug product. In addition, we compared two large-scale good manufacturing practice manufacturing capping equipment and different capping equipment settings and their impact on product quality and integrity, as determined by residual seal force.The capping plate to plunger distance had a major influence on the obtained residual seal force values of a sealed vial, whereas the capping pre-compression force and the turntable rotation speed showed only a minor influence on the residual seal force of a sealed vial. Capping process parameters could not easily be transferred from capping equipment of different manufacturers. However, the residual seal force tester did provide a valuable tool to compare capping performance of different capping equipment. No vial showed any leakage greater than 10(-8)mbar L/s as measured by a helium mass spectrometry system, suggesting that container closure integrity was warranted in the residual seal force range

Combined screw-cap and rubber-stopper closure for Hungate tubes (pre-reduced anaerobically sterilized roll tubes and liquid media).

PubMed

Attebery, H R; Finegold, S M

1969-10-01

A double-closured method introduced for Hungate tubes eliminates clamps or special racks to hold the rubber stoppers in place while the tubes are being processed. The system prevents stoppers from being dislodged by gas-producing anaerobes and keeps the stoppers sterile so that the closed system of transfer can be conveniently utilized. Open and closed systems for handling a gas-producing anaerobe were compared. Ten tubes containing Clostridium perfringens were opened; the organism was detected in the air by use of an impingement collector. The gloved hand of the operator also revealed the test organism. A similar trial with culture material removed by the closed system (syringe transfer) resulted in no detectable contamination of the environment.

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2014 CFR

2014-07-01

... FACILITIES Hazardous Waste Munitions and Explosives Storage § 264.1202 Closure and post-closure care. (a) At... it remains in service as a munitions or explosives magazine or storage unit. (b) If, after removing...

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2011 CFR

2011-07-01

... FACILITIES Hazardous Waste Munitions and Explosives Storage § 264.1202 Closure and post-closure care. (a) At... it remains in service as a munitions or explosives magazine or storage unit. (b) If, after removing...

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... FACILITIES Hazardous Waste Munitions and Explosives Storage § 264.1202 Closure and post-closure care. (a) At... it remains in service as a munitions or explosives magazine or storage unit. (b) If, after removing...

40 CFR 264.1202 - Closure and post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... FACILITIES Hazardous Waste Munitions and Explosives Storage § 264.1202 Closure and post-closure care. (a) At... it remains in service as a munitions or explosives magazine or storage unit. (b) If, after removing...

The association between pre-operative sepsis and 30-day mortality in hip fracture patients-A cohort study.

PubMed

Mørch, S S; Tantholdt-Hansen, S; Pedersen, N E; Duus, C L; Petersen, J A; Andersen, C Ø; Jarløv, J O; Meyhoff, C S

2018-05-24

Post-operative sepsis considerably increases mortality, but the extent of pre-operative sepsis in hip fracture patients and its consequences are sparsely elucidated. The aim of this study was to assess the association between pre-operative sepsis and 30-day mortality after hip fracture surgery. We conducted a retrospective analysis of data collected among 1894 patients who underwent hip fracture surgery in the Capital Region of Denmark in 2014 (NCT03201679). Data on vital signs, cultures and laboratory data were obtained. Sepsis was defined as a positive culture of any kind and presence of systemic inflammatory response syndrome within 24 hours and was assessed within 72 hours before surgery and 30 days post-operatively. Primary outcome was 30-day mortality. Secondary outcomes included length of hospital stay and admission to intensive care unit. A total of 144 (7.6%) of the hip fracture patients met the criteria for pre-operative sepsis. The 30-day mortality was 13.9% in patients with pre-operative sepsis as compared to 9.0% in those without (OR 1.69, 95% CI [1.00; 2.85], P = .08). Patients with pre-operative sepsis had longer hospital stays (median 10 days vs 9 days, mean difference 2.1 [SD 9.4] days, P = .03), and higher frequency of ICU admission (11.1% vs 2.7%, OR 4.15, 95% CI [2.19; 7.87], P < .0001). Pre-operative sepsis in hip fracture patients was associated with an increased length of hospital stay and tended to increase mortality. Pre-operative sepsis in hip fracture patients merits more intensive surveillance and increased attention to timely treatment. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Pre-operative nutrition support in patients undergoing gastrointestinal surgery.

PubMed

Burden, Sorrel; Todd, Chris; Hill, James; Lal, Simon

2012-11-14

Post-operative management in gastrointestinal (GI) surgery is becoming well established with 'Enhanced Recovery After Surgery' protocols starting 24 hours prior to surgery with carbohydrate loading and early oral or enteral feeding given to patients the first day following surgery. However, whether or not nutritional intervention should be initiated earlier in the preoperative period remains unclear. Poor pre-operative nutritional status has been linked consistently to an increase in post-operative complications and poorer surgical outcome. To review the literature on preoperative nutritional support in patients undergoing gastrointestinal surgery (GI). The searches were initially run in March 2011 and subsequently updated in February 2012. Databases including all EBM Reviews (Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA and NHSEED) MEDLINE, EMBASE, AMED, British Nursing Index Archive using OvidSP were included and a search was run on each database separately after which duplicates were excluded. The inclusion criteria were randomised controlled trials that evaluated pre-operative nutritional support in GI surgical participants using a nutritional formula delivered by a parenteral, enteral or oral route. The primary outcomes included post-operative complications and length of hospital stay. Two observers screened the abstracts for inclusion in the review and performed data extraction. Bias was assessed for each of the included studies using the bias assessment tables in the Cochrane Software Review Manager (version 5.1, Cochrane Collaboration). The trials were analysed using risk ratios with Mantel-Haenszel in fixed effects methods displayed with heterogeneity. Meta-analyses were undertaken on trials evaluating immune enhancing (IE) nutrition, standard oral supplements, enteral and parenteral nutrition (PN) which were administered pre-operatively.Study characteristics were summarised in tables. Dichotomous and ratio data were entered into meta-analyses for

Quick actuating closure

NASA Technical Reports Server (NTRS)

White, III, Dorsey E. (Inventor); Updike, deceased, Benjamin T. (Inventor); Allred, Johnny W. (Inventor)

1989-01-01

A quick actuating closure for a pressure vessel 80 in which a wedge ring 30 with a conical outer surface 31 is moved forward to force shear blocks 40, with conical inner surfaces 41, radially outward to lock an end closure plug 70 within an opening 81 in the pressure vessel 80. A seal ring 60 and a preload ramp 50 sit between the shear blocks 40 and the end closure plug 70 to provide a backup sealing capability. Conical surfaces 44 and 55 of the preload ramp 50 and the shear blocks 40 interact to force the seal ring 60 into shoulders 73 and 85 in the end closure plug 70 and opening 81 to form a tight seal. The end closure plug 70 is unlocked by moving the wedge ring 30 rearward, which causes T-bars 32 of the wedge ring 30 riding within T -slots 42 of the shear blocks 40 to force them radially inward. The end closure plug 70 is then removed, allowing access to the interior of the pressure vessel 80.

Pre-operative Asymptomatic Bacteriuria: A Risk Factor For Prosthetic Joint Infection?

PubMed

Weale, R; El-Bakri, F; Saeed, Kordo

2018-04-13

Infection is a rare complication following implantation of prosthetic material into a joint. The impact of asymptomatic bacteriuria (ASB) before elective operations and the subsequent risk of prosthetic joint infection (PJI) are not well understood. • Assess the prevalence of ASB amongst patients undergoing total arthroplasty of the hip and knee. • Determine the rates of PJI diagnosed within two years of the arthroplasty and if ASB is an independent risk factor for developing PJI. Patients who had total/unicondylar knee or total hip arthroplasty were retrospectively reviewed over a five-year period. Pre-operative urine samples within one year of surgery were analysed and those with ASB identified. Primary outcome was prosthetic joint infection (PJI) within the first postoperative year. 5542 patients were included. 4368 had a pre-operative urine culture recorded. The prevalence of ASB was 140 of 4368 (3.2%). The overall PJI rate was 56 of 5542 (1.01%). Of those with a PJI, 33 had a pre-operative urine sample recorded. The infection rate in the ASB group was 5% (7 of 140), in the no-ASB group it was 0.61% (26 of 4228) and in the group without a urine sample it was 1.96% (23 of 1174) (p value <0.001). The ASB isolate was the same microorganism as the PJI isolate in only one of the seven cases. The association between ASB and PJI is statistically significant, but the urine isolates did not relate to the isolates in the prosthetic joint, suggestive the relationship is unlikely causal. Copyright © 2018. Published by Elsevier Ltd.

Surface mass balance of Greenland mountain glaciers and ice caps

NASA Astrophysics Data System (ADS)

Benson, R. J.; Box, J. E.; Bromwich, D. H.; Wahr, J. M.

2009-12-01

Mountain glaciers and ice caps contribute roughly half of eustatic sea-level rise. Greenland has thousands of small mountain glaciers and several ice caps > 1000 sq. km that have not been included in previous mass balance calculations. To include small glaciers and ice caps in our study, we use Polar WRF, a next-generation regional climate data assimilation model is run at grid resolution less than 10 km. WRF provides surface mass balance data at sufficiently high resolution to resolve not only the narrow ice sheet ablation zone, but provides information useful in downscaling melt and accumulation rates on mountain glaciers and ice caps. In this study, we refine Polar WRF to simulate a realistic surface energy budget. Surface melting is calculated in-line from surface energy budget closure. Blowing snow sublimation is computed in-line. Melt water re-freeze is calculated using a revised scheme. Our results are compared with NASA's Gravity Recovery and Climate Experiment (GRACE) and associated error is calculated on a regional and local scale with validation from automated weather stations (AWS), snow pits and ice core data from various regions along the Greenland ice sheet.

Gestalt concept of closure: a construct without closure.

PubMed

Wasserstein, Jeanette

2002-12-01

This comment reviews the original Gestalt literature which introduced the concept of 'closure'. It is argued that the meaning of 'closure' was confounded in the source literature and, thus, the term connotes more than it denotes. Research based on different measures of this ambiguous construct inevitably may not always converge.

Effect of Pre-operative Anaemia on Post-operative Complications in Low-Resource Settings.

PubMed

White, Michelle C; Longstaff, Lydia; Lai, Peggy S

2017-03-01

In high-resource settings, even mild anaemia is associated with an increased risk of post-operative complications. Whether this is true in low-resource settings is unclear. We aimed to evaluate the effect of anaemia on surgical outcomes in the Republic of Congo and Madagascar. It is a retrospective chart review of 2064 non-pregnant patients undergoing elective surgery with Mercy Ships. Logistic regression was used to determine the association between pre-operative anaemia and pre-defined surgical complications, adjusted for age, gender, surgical specialty, and country. The average age of patients was 27.2 years; 56.7% were male. Sixty-two percent of patients were not anaemic, and 22.7, 13.9 and 1.4% met sex-related criteria for mild, moderate and severe anaemia, respectively. In adjusted analyses, the severe anaemia group had an 8.58 [3.65, 19.49] higher odds of experiencing any surgical complication (p < 0.001) compared to non-anaemic patients. Analysis of each complication showed a 33.13 [9.57, 110.39] higher odds of unexpected ICU admission (p < 0.001); a 7.29 [1.98, 21.45] higher odds of surgical site infection (p < 0.001); and 7.48 [1.79, 25.78] higher odds of requiring hospital readmission (p < 0.001). Evaluating other anaemia categories, only those with moderate anaemia had a higher risk of requiring ICU admission (odds ratio 2.75 [1.00, 7.04], p = 0.04) compared to those without anaemia. Our results indicate that in low-income settings, severe anaemia is associated with an increased risk of post-operative complications including unexpected ICU admission, surgical site infection and hospital readmission, whereas mild anaemia was not associated with increased post-operative complications.

Port closure techniques.

PubMed

Shaher, Z

2007-08-01

Laparoscopic trocars do create wounds. This article aims to review and list different techniques used for closure of the fascia incision at trocar sites. A literature search was performed for articles dealing with closure techniques. The author searched this subject in English on Medline by combining the words "trocar" and "hernia," as well as "Deschamps" and "Reverdin." All articles reporting techniques with their references were reviewed. The articles described many techniques in addition to classical closure using curved needles, including Grice needle, Maciol needles, Endoclose device, Carter-Thomason device, Tahoe ligature device, Endo-Judge device, eXit puncture closure device, Lowsley retractor, spinal cord needles, dual hemostat, suture carrier, Riverdin and Deschamps needles, and Gore-Tex closure device. Three main groups of techniques were found with favor of extracorporeal manipulations under direct visualization. Old methods are sufficient and cost-effective.

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

PubMed

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

2017-03-01

The purpose of our study was to compare the outcome after minimally invasive reconstruction and internal fixation with and without the use of pre- and intra-operative real size 3D printing for patients with displaced tibial plateau fractures (TPFs). We prospectively followed up 40 consecutive adult patients with closed TPF who underwent surgical treatment of reconstruction of the tibial plateau with the use of minimally invasive fixation. Sixteen patients (group 1) were operated using a pre-operative and intra-operative real size 3D-model, while 24 patients (group 2) were operated without 3D-model printing, but using only pre-operative and intra-operative 3D Tc-scan images. The mean operating time was 148.2±15.9min for group 1 and 174.5±22.2min for group 2 (p=0.041). In addition, the mean intraoperative blood loss was less in group 1 (520mL) than in group 2 (546mL) (p=0.534). After discharge, all patients were followed up at 6 weeks, 12 weeks, 6 months, 1year and then every year post surgically and radiographic evaluation was carried out each time using clinical and radiological Rasmussen's score, with no significant differences between the two groups. Two patients (group 2) developed infection which resolved within 3 weeks after usage of antibiotics. Neither superficial nor deep infections were present in group 1. In all patients, no non-union occurred. No intraoperative, perioperative, or postoperative complications, such as loss of valgus correction, bone fractures, or metallic plate failures were detected at follow-up. In patients operated with the use of 3D-model printing, we found a significant reduction in surgical time. Moreover, the technique without a 3D-model increased the patient's and the surgeon's exposure to radiation. Copyright © 2016 Elsevier Ltd. All rights reserved.

Transcranial magnetic stimulation in the semi-quantitative, pre-operative assessment of patients undergoing spinal deformity surgery.

PubMed

Glasby, Michael A; Tsirikos, Athanasios I; Henderson, Lindsay; Horsburgh, Gillian; Jordan, Brian; Michaelson, Ciara; Adams, Christopher I; Garrido, Enrique

2017-08-01

To compare measurements of motor evoked potential latency stimulated either magnetically (mMEP) or electrically (eMEP) and central motor conduction time (CMCT) made pre-operatively in conscious patients using transcranial and intra-operatively using electrical cortical stimulation before and after successful instrumentation for the treatment of adolescent idiopathic scoliosis. A group initially of 51 patients with adolescent idiopathic scoliosis aged 12-19 years was evaluated pre-operatively in the outpatients' department with transcranial magnetic stimulation. The neurophysiological data were then compared statistically with intra-operative responses elicited by transcranial electrical stimulation both before and after successful surgical intervention. MEPs were measured as the cortically evoked compound action potentials of Abductor hallucis. Minimum F-waves were measured using conventional nerve conduction methods and the lower motor neuron conduction time was calculated and this was subtracted from MEP latency to give CMCT. Pre-operative testing was well tolerated in our paediatric/adolescent patients. No neurological injury occurred in any patient in this series. There was no significant difference in the values of mMEP and eMEP latencies seen pre-operatively in conscious patients and intra-operatively in patients under anaesthetic. The calculated quantities mCMCT and eCMCT showed the same statistical correlations as the quantities mMEP and eMEP latency. The congruency of mMEP and eMEP and of mCMCT and eCMCT suggests that these measurements may be used comparatively and semi-quantitatively for the comparison of pre-, intra-, and post-operative spinal cord function in spinal deformity surgery.

Lineations and structural mapping of Io's paterae and mountains: Implications for internal stresses

NASA Astrophysics Data System (ADS)

Ahern, Alexandra A.; Radebaugh, Jani; Christiansen, Eric H.; Harris, Ronald A.; Tass, E. Shannon

2017-11-01

The mountains of Jupiter's volcanic moon Io are tall, steep, and tectonic in origin, yet their precise modes of formation and their associations with volcanic paterae are not fully understood. Global spatial statistics of paterae and mountains and their associated lineations reveal that both types of features are more common at low latitudes and tectonic lineations have preferred orientations, whereas straight patera margins are randomly oriented. Additionally, structurally controlled lineations tend to cluster with each other, and in areas of high concentrations these tectonic lineations are shorter in length than their global average. These results indicate that global-scale (rather than local or regional) processes are involved in forming Io's tectonic structures, but that the diversity of mountain characteristics and the collapse of paterae adjacent to mountain complexes are more locally controlled. Regional structural mapping of the Hi'iaka, Shamshu, Tohil, and Zal regions reveals Io's mountains reside in large, fault-bounded crustal blocks that have undergone modification through local responses of subsurface structures to variable stresses. Strike-slip motion along reactivated faults led to the formation of transpressional and transtensional features, creating tall peaks and low basins, some of which are now occupied by paterae. We propose Io's mountains result from a combination of crustal stresses involving global and local-scale processes, dominantly volcanic loading and tidal flexing. These stresses sometimes are oriented at oblique angles to pre-existing faults, reactivating them as reverse, normal, or strike-slip faults, modifying the large, cohesive crustal blocks that many of Io's mountains reside in. Further degradation of mountains and burial of faults has occurred from extensive volcanism, mass wasting, gravitational collapse, and erosion by sublimation and sapping of sulfur-rich layers. This model of fault-bounded blocks being modified by global

40 CFR 265.118 - Post-closure plan; amendment of plan.

Code of Federal Regulations, 2014 CFR

2014-07-01

...: (i) Changes in operating plans or facility design affect the post-closure plan, or (ii) Events which... operation, or no later than 60 days after an unexpected event has occurred which has affected the post... operation, or no more than 60 days after an unexpected event has occurred which has affected the post...

40 CFR 265.118 - Post-closure plan; amendment of plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

...: (i) Changes in operating plans or facility design affect the post-closure plan, or (ii) Events which... operation, or no later than 60 days after an unexpected event has occurred which has affected the post... operation, or no more than 60 days after an unexpected event has occurred which has affected the post...

Improving operating room first start efficiency - value of both checklist and a pre-operative facilitator.

PubMed

Panni, M K; Shah, S J; Chavarro, C; Rawl, M; Wojnarwsky, P K; Panni, J K

2013-10-01

There are multiple components leading to improved operating room efficiency. We undertook a project focusing on first case starts; accounting for each delay component on a global basis. Our hypothesis was there would be a reduction in first start delays after we implemented strategies to address the issues identified through this accounting process. An orange sheet checklist was implemented, with specific items that needed to be clear prior to roll back to the operating room (OR), and an OR facilitator was employed to intervene whenever there were any missing items needed for a specific patient. We present the data from this quality improvement project over an 18-month period. Initially, 10.07 (± 0.73) delayed first starts occurred per day but declined steadily over time to a low of 4.95 (± 0.38) per day after 6 months (-49.2 %, P < 0.001). By the end of the project, the most common reasons for delay still included late surgical attending (19%), schedule changes (14%) as well as 'other reasons' (13%), but with an overall reduction per day of each. Total anaesthesia delay initially totalled 11% of the first start delays, but was negligible (< 1%) at the project's completion. While we have a challenging operating room environment based on our patient population, multiple trainees in both the surgery and anaesthesiology teams: an orange sheet - pre-operative checklist in addition to a dedicated pre-operative facilitator; allowed us to make a substantial improvement in our first start on time starts. © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

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

PubMed Central

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

2016-01-01

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

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

PubMed

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

2016-01-01

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

Pre- to Post-operative Changes in Physical Activity: Report from the Longitudinal Assessment of Bariatric Surgery-2

PubMed Central

King, Wendy C; Hsu, Jesse Y; Belle, Steven H; Courcoulas, Anita P; Eid, George M; Flum, David R; Mitchell, James E; Pender, John R; Smith, Mark D; Steffen, Kristine J; Wolfe, Bruce M

2011-01-01

Background Numerous studies report that bariatric surgery patients report more physical activity (PA) after surgery than before, but the quality of PA assessment has been questionable. Methods The Longitudinal Assessment of Bariatric Surgery-2 is a 10-center longitudinal study of adults undergoing bariatric surgery. Of 2458 participants, 455 were given an activity monitor, which records steps/minute, and an exercise diary before and 1 year after surgery. Mean step/day, active minutes/day, and high-cadence minutes/week were calculated for 310 participants who wore the monitor at least 10 hours/day for at least 3 days at both time points. Pre- and post-surgery PA were compared for differences using the Wilcoxon signed-rank test. Generalized Estimating Equations identified independent pre-operative predictors of post-operative PA. Results PA increased significantly (p<.0001) pre- to post-operative for all PA measures. Median values pre- and post-operative were: 7563 and 8788 steps/day; 309 and 340 active minutes/day; and 72 and 112 high-cadence minutes/week, respectively. However, depending on the PA measure, 24–29% of participants were at least 5% less active post-operative than pre-operative. Controlling for surgical procedure, sex, age and BMI, higher PA preoperative independently predicted higher PA post-operative (p<.0001, all PA measures). Less pain, not having asthma and self-report of increasing PA as a weight loss strategy pre-operative also independently predicted more high-cadence minutes/week post-operative (p<.05). Conclusion The majority of adults increase their PA level following bariatric surgery. However, most remain insufficiently active and some become less active. Increasing PA, addressing pain and treating asthma prior to surgery may have a positive impact on post-operative PA. PMID:21944951

Pre-operative Functional Cardiovascular Reserve Is Associated with Acute Kidney Injury after Intervention.

PubMed

Saratzis, A; Shakespeare, J; Jones, O; Bown, M J; Mahmood, A; Imray, C H E

2017-05-01

Acute kidney injury (AKI) is a common complication after endovascular intervention, associated with poor short and long-term outcomes. However, the mechanisms underlying AKI development remain poorly understood. The impact of pre-existing cardiovascular disease and low cardiovascular reserve (CVR) in AKI is unclear; it remains unknown whether AKI is primarily related to pre-existing comorbidity or to procedural parameters. The association between CVR and AKI after EVAR was therefore assessed. This is a case control study. From a database of 484 patients, 292 undergoing elective endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA) in two tertiary centres were included. Of these, 73 patients who had developed AKI after EVAR were case matched, based on pre-operative estimated glomerular filtration rate (eGFR; within 5 mL/min/1.73 m 2 ) and age, with patients who had not developed AKI. Cardiopulmonary exercise testing (CPET) was used to assess CVR using the anaerobic threshold (AT). Development of AKI was defined using the Kidney Disease Improving Outcomes (KDIGO) guidance. Associations between CVR (based on AT levels) and AKI development were then analysed. Pre-operative AT levels were significantly different between those who did and did not develop AKI (12.1±2.9 SD vs. 14.8±3.0 mL/min/kg, p < .001). In multivariate analysis, a higher level of AT (per 1 mL/min/kg) was associated with a lower odds ratio (OR) of 0.72 (95% CI, 0.63-0.82, p < .001), relative to AKI development. A pre-operative AT level of < 11 mL/min/kg was associated with post-operative AKI development in adjusted analysis, with an OR of 7.8 (95% CI, 3.75-16.51, p < .001). The area under the curve (receiver operating characteristic) for AT as a predictor of post-operative AKI was 0.81 (standard error, 0.06, 95% CI, 0.69-0.93, p < .001). Poor CVR was strongly associated with the development of AKI. This provides pathophysiological insights into the

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

PubMed

Horisberger, Karoline; Beldi, Guido; Candinas, Daniel

2010-12-01

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

Open abdomen treatment for septic patients with gastrointestinal fistula: from fistula control to definitive closure.

PubMed

Ren, Jianan; Yuan, Yujie; Zhao, Yunzhao; Gu, Guosheng; Wang, Gefei; Chen, Jun; Fan, Chaogang; Wang, Xinbo; Li, Jieshou

2014-04-01

The use of open abdomen in the management of gastrointestinal fistula complicated with severe intra-abdominal infection is uncommon. This study was designed to evaluate outcomes of our staged approach for the infected open abdomen. Patients who had gastrointestinal fistula and underwent open abdomen treatment were retrospectively reviewed. Various materials such as polypropylene mesh and a modified sandwich package were used to achieve temporary abdominal closure followed by skin grafting when the granulation bed matured. A delayed definitive operation was performed for final abdominal closure without implant of prosthetic mesh. Between 1999 and 2009, 56 (68.3%) of 82 patients survived through this treatment. Among them, 42 patients achieved final abdominal closure. Spontaneous fistula closure occurred in 16 patients with secondary fistula recorded in six patients. Besides, wound complications occurred in 13 patients with two cases for pulmonary infection. Within a 12-month follow-up period after definitive closure, no additional fistula was recorded excluding planned ventral hernia repair. Open abdomen treatment was effective for gastrointestinal fistula complicated by severe intra-abdominal infection. A delayed and deliberate operative strategy aiming at fistula excision and fascial closure, with simultaneous abdominal wall reconstruction, was required for the infected open abdomen.

Pre-operative inspiratory muscle training preserves postoperative inspiratory muscle strength following major abdominal surgery - a randomised pilot study.

PubMed

Kulkarni, S R; Fletcher, E; McConnell, A K; Poskitt, K R; Whyman, M R

2010-11-01

The aim of this pilot study was to assess the effect of pre-operative inspiratory muscle training (IMT) on respiratory variables in patients undergoing major abdominal surgery. Respiratory muscle strength (maximum inspiratory [MIP] and expiratory [MEP] mouth pressure) and pulmonary functions were measured at least 2 weeks before surgery in 80 patients awaiting major abdominal surgery. Patients were then allocated randomly to one of four groups (Group A, control; Group B, deep breathing exercises; Group C, incentive spirometry; Group D, specific IMT). Patients in groups B, C and D were asked to train twice daily, each session lasting 15 min, for at least 2 weeks up to the day before surgery. Outcome measurements were made immediately pre-operatively and postoperatively. In groups A, B and C, MIP did not increase from baseline to pre-operative assessments. In group D, MIP increased from 51.5 cmH(2)O (median) pre-training to 68.5 cmH(2)O (median) post-training pre-operatively (P < 0.01). Postoperatively, groups A, B and C showed a fall in MIP from baseline (P < 0.01, P < 0.01) and P = 0.06, respectively). No such significant reduction in postoperative MIP was seen in group D (P = 0.36). Pre-operative specific IMT improves MIP pre-operatively and preserves it postoperatively. Further studies are required to establish if this is associated with reduced pulmonary complications.

Combined Screw-Cap and Rubber-Stopper Closure for Hungate Tubes (Pre-reduced Anaerobically Sterilized Roll Tubes and Liquid Media)

PubMed Central

Attebery, H. R.; Finegold, S. M.

1969-01-01

A double-closured method introduced for Hungate tubes eliminates clamps or special racks to hold the rubber stoppers in place while the tubes are being processed. The system prevents stoppers from being dislodged by gas-producing anaerobes and keeps the stoppers sterile so that the closed system of transfer can be conveniently utilized. Open and closed systems for handling a gas-producing anaerobe were compared. Ten tubes containing Clostridium perfringens were opened; the organism was detected in the air by use of an impingement collector. The gloved hand of the operator also revealed the test organism. A similar trial with culture material removed by the closed system (syringe transfer) resulted in no detectable contamination of the environment. Images PMID:4312921

[Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

PubMed

Avila-Alvarez, Alejandro; Serantes Lourido, Marta; Barriga Bujan, Rebeca; Blanco Rodriguez, Carolina; Portela-Torron, Francisco; Bautista-Hernandez, Victor

2017-05-01

Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Prediction of chronic post-operative pain: pre-operative DNIC testing identifies patients at risk.

PubMed

Yarnitsky, David; Crispel, Yonathan; Eisenberg, Elon; Granovsky, Yelena; Ben-Nun, Alon; Sprecher, Elliot; Best, Lael-Anson; Granot, Michal

2008-08-15

Surgical and medical procedures, mainly those associated with nerve injuries, may lead to chronic persistent pain. Currently, one cannot predict which patients undergoing such procedures are 'at risk' to develop chronic pain. We hypothesized that the endogenous analgesia system is key to determining the pattern of handling noxious events, and therefore testing diffuse noxious inhibitory control (DNIC) will predict susceptibility to develop chronic post-thoracotomy pain (CPTP). Pre-operative psychophysical tests, including DNIC assessment (pain reduction during exposure to another noxious stimulus at remote body area), were conducted in 62 patients, who were followed 29.0+/-16.9 weeks after thoracotomy. Logistic regression revealed that pre-operatively assessed DNIC efficiency and acute post-operative pain intensity were two independent predictors for CPTP. Efficient DNIC predicted lower risk of CPTP, with OR 0.52 (0.33-0.77 95% CI, p=0.0024), i.e., a 10-point numerical pain scale (NPS) reduction halves the chance to develop chronic pain. Higher acute pain intensity indicated OR of 1.80 (1.28-2.77, p=0.0024) predicting nearly a double chance to develop chronic pain for each 10-point increase. The other psychophysical measures, pain thresholds and supra-threshold pain magnitudes, did not predict CPTP. For prediction of acute post-operative pain intensity, DNIC efficiency was not found significant. Effectiveness of the endogenous analgesia system obtained at a pain-free state, therefore, seems to reflect the individual's ability to tackle noxious events, identifying patients 'at risk' to develop post-intervention chronic pain. Applying this diagnostic approach before procedures that might generate pain may allow individually tailored pain prevention and management, which may substantially reduce suffering.

Mountain-Plains Handbook: The Design and Operation of a Residential Family Based Education Program. Appendix. Supplement Four to Volume Three. Measurement and Evaluation: The Research Services Division.

ERIC Educational Resources Information Center

Coyle, David A.; And Others

One of five supplements which accompany chapter 3 of "Mountain-Plains Handbook: The Design and Operation of a Residential, Family Oriented Career Education Model" (CE 014 630), this document contains a master listing of all Mountain-Plains curriculum, compiled by job title, course, unit, and Learning activity package (LAPS) and arranged…

Impact of Different Standard Type A7A Drum Closure-Ring Practices on Gasket Contraction and Bolt Closure Distance– 15621

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

Ketusky, Edward; Blanton, Paul; Bobbitt, John H.

The Department of Energy, the Savannah River National Laboratory, several manufacturers of specification drums, and the United States Department of Transportation (DOT) are collaborating in the development of a guidance document for DOE contractors and vendors who wish to qualify containers to DOT 7A Type A requirements. Currently, the effort is focused on DOT 7A Type A 208-liter (55-gallons) drums with a standard 12-gauge bolted closure ring. The U.S. requirements, contained in Title 49, Part 178.350 “Specification 7A; general packaging, Type A specifies a competent authority review of the packaging is not required for the transport of (Class 7) radioactivemore » material containing less than Type A quantities of radioactive material. For Type AF drums, a 4 ft. regulatory free drop must be performed, such that the drum “suffers maximum damage.” Although the actual orientation is not defined by the specification, recent studies suggest that maximum damage would result from a shallow angle top impact, where kinetic energy is transferred to the lid, ultimately causing heavy damage to the lid, or even worse, causing the lid to come off. Since each vendor develops closure recommendations/procedures for the drums they manufacture, key parameters applied to drums during closing vary based on vendor. As part of the initial phase of the collaboration, the impact of the closure variants on the ability of the drum to suffer maximum damage is investigated. Specifically, closure testing is performed varying: 1) the amount of torque applied to the closure ring bolt; and, 2) stress relief protocol, including: a) weight of hammer; and, b) orientation that the hammer hits the closure ring. After closure, the amount of drum lid gasket contraction and the distance that the closure bolt moves through the closure ring is measured.« less

40 CFR 264.280 - Closure and post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure and post-closure care. 264.280 Section 264.280 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... § 264.278, except that soil-pore liquid monitoring may be terminated 90 days after the last application...

40 CFR 264.119 - Post-closure notices.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 264.119 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED... closure of each hazardous waste disposal unit, the owner or operator must submit to the local zoning... required by §§ 264.116 and 264.119(a) have been filed with the local zoning authority or the authority with...

40 CFR 264.119 - Post-closure notices.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 264.119 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED... closure of each hazardous waste disposal unit, the owner or operator must submit to the local zoning... required by §§ 264.116 and 264.119(a) have been filed with the local zoning authority or the authority with...

Interim Status Closure Plan Open Burning Treatment Unit Technical Area 16-399 Burn Tray

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

Vigil-Holterman, Luciana R.

2012-05-07

This closure plan describes the activities necessary to close one of the interim status hazardous waste open burning treatment units at Technical Area (TA) 16 at the Los Alamos National Laboratory (LANL or the Facility), hereinafter referred to as the 'TA-16-399 Burn Tray' or 'the unit'. The information provided in this closure plan addresses the closure requirements specified in the Code of Federal Regulations (CFR), Title 40, Part 265, Subparts G and P for the thermal treatment units operated at the Facility under the Resource Conservation and Recovery Act (RCRA) and the New Mexico Hazardous Waste Act. Closure of themore » open burning treatment unit will be completed in accordance with Section 4.1 of this closure plan.« less

Is pre-operative imaging essential prior to ureteric stone surgery?

PubMed

Youssef, F R; Wilkinson, B A; Hastie, K J; Hall, J

2012-09-01

The aim of this study was to identify patients not requiring ureteric stone surgery based on pre-operative imaging (within 24 hours) prior to embarking on semirigid ureteroscopy (R-URS) for urolithiasis. The imaging of all consecutive patients on whom R-URS for urolithiasis was performed over a 12-month period was reviewed. All patients had undergone a plain x-ray of the kidney, ureters and bladder (KUB), abdominal non-contrast computed tomography (NCCT-KUB) or both on the day of surgery. A total of 96 patients were identified for the study. Stone sizes ranged from 3 mm to 20 mm. Thirteen patients (14%) were cancelled as no stone(s) were identified on pre-operative imaging. Of the patients cancelled, 8 (62%) required NCCT-KUB to confirm spontaneous stone passage. One in seven patients were stone free on the day of surgery. This negates the need for unnecessary anaesthetic and instrumentation of the urinary tract, with the associated morbidity. Up-to-date imaging prior to embarking on elective ureteric stone surgery is highly recommended.

Composite three-layer closure of oral antral communication with 10 months follow-up-a case study.

PubMed

Weinstock, Robert J; Nikoyan, Levon; Dym, Harry

2014-02-01

We propose a 3-layer composite closure technique for an oral antral communication (OAC) while avoiding secondary donor site morbidity. A patient had developed a 1-cm OAC after extraction of right maxillary first molar. The patient subsequently developed acute maxillary sinusitis. The patient was taken to the operating room, and a Caldwell-Luc procedure was performed. The bony window from the Caldwell-Luc was "press fit" over the bony OAC defect. Soft tissue closure was then achieved with a buccal fat pad flap and a buccal mucosal advancement flap. The patient was examined on postoperative day 5 and 1, 2, 3, 6, and 10 months postoperatively. The acute sinusitis had resolved. The soft tissue closure was successful. The bone graft remained intact, prevented sinus pneumatization, and restored continuity to the floor of the maxillary sinus. The presented technique for 3-layer closure of OACs allows for the stability of a double-layer closure of OAC with the added benefit of bone grafting from single operative site, achieving stable oral antral closure, bone grafting, and the avoidance of secondary donor site morbidity. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

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

PubMed

Eliya-Masamba, Martha C; Banda, Grace W

2013-10-22

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

Patient-specific instrumentation for total knee arthroplasty does not match the pre-operative plan as assessed by intra-operative computer-assisted navigation.

PubMed

Scholes, Corey; Sahni, Varun; Lustig, Sebastien; Parker, David A; Coolican, Myles R J

2014-03-01

The introduction of patient-specific instruments (PSI) for guiding bone cuts could increase the incidence of malalignment in primary total knee arthroplasty. The purpose of this study was to assess the agreement between one type of patient-specific instrumentation (Zimmer PSI) and the pre-operative plan with respect to bone cuts and component alignment during TKR using imageless computer navigation. A consecutive series of 30 femoral and tibial guides were assessed in-theatre by the same surgeon using computer navigation. Following surgical exposure, the PSI cutting guides were placed on the joint surface and alignment assessed using the navigation tracker. The difference between in-theatre data and the pre-operative plan was recorded and analysed. The error between in-theatre measurements and pre-operative plan for the femoral and tibial components exceeded 3° for 3 and 17% of the sample, respectively, while the error for total coronal alignment exceeded 3° for 27% of the sample. The present results indicate that alignment with Zimmer PSI cutting blocks, assessed by imageless navigation, does not match the pre-operative plan in a proportion of cases. To prevent unnecessary increases in the incidence of malalignment in primary TKR, it is recommended that these devices should not be used without objective verification of alignment, either in real-time or with post-operative imaging. Further work is required to identify the source of discrepancies and validate these devices prior to routine use. II.

Comparison of rate of surgical wound infection, length of hospital stay and patient convenience in complicated appendicitis between primary closure and delayed primary closure.

PubMed

Khan, Khizar Ishtiaque; Mahmood, Shahid; Akmal, Muhammad; Waqas, Ahmed

2012-06-01

To compare the difference in the rate of surgical wound infection, patient's convenience and length of hospital stay between Primary Closure and Delayed Primary Closure in cases of complicated appendicitis in adults. This randomised control trial was conducted at the Combined Military Hospital, Kharian and Malir from June 5, 2006, to September 10, 2009. Patients > or = 15 years of both gender who underwent appendectomy through grid iron or Lanz incision and having complicated appendicitis were included. The 100 patients who were included in the study out of the initial size of 393, were randomised into two equal groups of 50 each (Group A: Primary Closure; Group B: Delayed Primary Closure) using a computer-generated table. All the surgeries were done by the same surgeon and the operative steps and antibiotic coverage were standardised. The rate of surgical wound infection, patient's convenience (on visual analogue scale in mm) and the length of hospital stay were recorded. Data was analysed using SPSS version 11, and p value was calculated. Demographic data, comorbids and medication of both the groups was comparable. There was no significant difference in rate of surgical wound infection (p > 0.05). The difference in patient's convenience and length of hospital stay were significant (p < 0.05), showing superiority of Primary Closure over Delayed Primary Closure with no added morbidity/mortality. Primary Closure in complicated appendicitis not only reduces the cost of treatment, but is also more convenient and satisfying for the patients, with no added risk of surgical wound infection.

Primary closure after carotid endarterectomy is not inferior to other closure techniques.

PubMed

Avgerinos, Efthymios D; Chaer, Rabih A; Naddaf, Abdallah; El-Shazly, Omar M; Marone, Luke; Makaroun, Michel S

2016-09-01

Primary closure after carotid endarterectomy (CEA) has been much maligned as an inferior technique with worse outcomes than in patch closure. Our purpose was to compare perioperative and long-term results of different CEA closure techniques in a large institutional experience. A consecutive cohort of CEAs between January 1, 2000, and December 31, 2010, was retrospectively analyzed. Closure technique was used to divide patients into three groups: primary longitudinal arteriotomy closure (PRC), patch closure (PAC), and eversion closure (EVC). End points were perioperative events, long-term strokes, and restenosis ≥70%. Multivariate regression models were used to assess the effect of baseline predictors. There were 1737 CEA cases (bilateral, 143; mean age, 71.4 ± 9.3 years; 56.2% men; 35.3% symptomatic) performed during the study period with a mean clinical follow-up of 49.8 ± 36.4 months (range, 0-155 months). More men had primary closure, but other demographic and baseline symptoms were similar between groups. Half the patients had PAC, with the rest evenly distributed between PRC and EVC. The rate of nerve injury was 2.7%, the rate of reintervention for hematoma was 1.5%, and the length of hospital stay was 2.4 ± 3.0 days, with no significant differences among groups. The combined stroke and death rate was 2.5% overall and 3.9% and 1.7% in the symptomatic and asymptomatic cohort, respectively. Stroke and death rates were similar between groups: PRC, 11 (2.7%); PAC, 19 (2.2%); EVC, 13 (2.9%). Multivariate analysis showed baseline symptomatic disease (odds ratio, 2.4; P = .007) and heart failure (odds ratio, 3.1; P = .003) as predictors of perioperative stroke and death, but not the type of closure. Cox regression analysis demonstrated, among other risk factors, no statin use (hazard ratio, 2.1; P = .008) as a predictor of ipsilateral stroke and severe (glomerular filtration rate <30 mL/min/1.73 m(2)) renal insufficiency (hazard ratio, 2.6; P�

DNA denaturation bubbles: free-energy landscape and nucleation/closure rates.

PubMed

Sicard, François; Destainville, Nicolas; Manghi, Manoel

2015-01-21

The issue of the nucleation and slow closure mechanisms of non-superhelical stress-induced denaturation bubbles in DNA is tackled using coarse-grained MetaDynamics and Brownian simulations. A minimal mesoscopic model is used where the double helix is made of two interacting bead-spring rotating strands with a prescribed torsional modulus in the duplex state. We demonstrate that timescales for the nucleation (respectively, closure) of an approximately 10 base-pair bubble, in agreement with experiments, are associated with the crossing of a free-energy barrier of 22 kBT (respectively, 13 kBT) at room temperature T. MetaDynamics allows us to reconstruct accurately the free-energy landscape, to show that the free-energy barriers come from the difference in torsional energy between the bubble and duplex states, and thus to highlight the limiting step, a collective twisting, that controls the nucleation/closure mechanism, and to access opening time scales on the millisecond range. Contrary to small breathing bubbles, those more than 4 base-pair bubbles are of biological relevance, for example, when a pre-existing state of denaturation is required by specific DNA-binding proteins.

Mountain Heavy Rainfall Measurement Experiments in a Subtropical Monsoon Environment

NASA Astrophysics Data System (ADS)

Jong-Dao Jou, Ben; Chi-June Jung, Ultimate; Lai, Hsiao-Wei; Feng, Lei

2014-05-01

Quantitative rainfall measurement experiments have been conducted in Taiwan area for the past 5 years (since 2008), especially over the complex terrain region. In this paper, results from these experiments will be analyzed and discussed, especially those associated with heavy rain events in the summer monsoon season. Observations from s-band polarimetric radar (SPOL of NCAR) and also x-band vertically-pointing radar are analyzed to reveal the high resolution temporal and spatial variation of precipitation structure. May and June, the Meiyu season in the area, are months with subtropical frontal rainfall events. Mesoscale convective systems, i.e., pre-frontal squall lines and frontal convective rainbands, are very active and frequently produce heavy rain events over mountain areas. Accurate quantitative precipitation measurements are needed in order to meet the requirement for landslide and flood early warning purpose. Using ground-based disdrometers and vertically-pointing radar, we have been trying to modify the quantitative precipitation estimation in the mountain region by using coastal operational radar. In this paper, the methodology applied will be presented and the potential of its application will be discussed. *corresponding author: Ben Jong-Dao Jou, jouben43@gmail.com

Pore formation and pore closure in poly(D,L-lactide-co-glycolide) films.

PubMed

Fredenberg, Susanne; Wahlgren, Marie; Reslow, Mats; Axelsson, Anders

2011-03-10

Pore formation and pore closure in poly(D,L-lactide-co-glycolide)-based drug delivery systems are two important processes as they control the release of the encapsulated drug. The phenomenon pore closure was investigated by studying the effects of the pH and the temperature of the release medium, and the properties of the polymer. Poly(D,L-lactide-co-glycolide) (PLG) films were subjected to a pore forming pre-treatment, and then pore closure was observed simultaneously with changes in glass transition temperature, wettability (contact angle), water absorption and mass remaining. To further understand the effect of pH, combined pore formation and pore closure were studied at different pH values. Pore closure was increased in a release medium with low pH, with a low-molecular-weight PLG of relatively low degree of hydrophobicity, or at high temperature. Pore closure occurred by two different mechanisms, one based on polymer-polymer interactions and one on polymer-water interactions. The mobility of the PLG chains also played an important role. The surface of the PLG films were more porous at pH 5-6 than at lower or higher pH, as pore formation was relatively fast and pore closure were less pronounced in this pH range. The pH had a significant impact on the porous structure, which should be kept in mind when evaluating experimental results, as the pH may be significantly decreased in vitro, in vivo and in situ. The results also show that the initial porosity is very important when using a high-molecular-weight PLG. Copyright © 2010 Elsevier B.V. All rights reserved.

Pre-operative imaging of rectal cancer and its impact on surgical performance and treatment outcome.

PubMed

Beets-Tan, R G H; Lettinga, T; Beets, G L

2005-08-01

To discuss the ability of pre-operative MRI to have a beneficial effect on surgical performance and treatment outcome in patients with rectal cancer. A description on how MRI can be used as a tool so select patients for differentiated neoadjuvant treatment, how it can be used as an anatomical road map for the resection of locally advanced cases, and how it can serve as a tool for quality assurance of both the surgical procedure and overall patient management. As an illustration the proportion of microscopically complete resections of the period 1993-1997, when there was no routine pre-operative imaging, is compared to that of the period 1998-2002, when pre-operative MR imaging was standardized. The proportion of R0 resections increased from 92.5 to 97% (p=0.08) and the proportion of resections with a lateral tumour free margin of >1mm increased from 84.4 to 92.1% (p=0.03). The incomplete resections in the first period were mainly due to inadequate surgical management of unsuspected advanced or bulky tumours, whereas in the second period insufficient consideration was given to extensive neoadjuvant treatment when the tumour was close to or invading the mesorectal fascia on MR. There are good indications that in our setting pre-operative MR imaging, along with other improvements in rectal cancer management, had a beneficial effect on patient outcome. Audit and discussion of the incomplete resections can lead to an improved operative and perioperative management.

14 CFR 95.21 - Puerto Rico Mountainous Area.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Puerto Rico Mountainous Area. 95.21 Section 95.21 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES IFR ALTITUDES Designated Mountainous Areas § 95.21 Puerto Rico...

14 CFR 95.21 - Puerto Rico Mountainous Area.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Puerto Rico Mountainous Area. 95.21 Section 95.21 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES IFR ALTITUDES Designated Mountainous Areas § 95.21 Puerto Rico...

14 CFR 95.21 - Puerto Rico Mountainous Area.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Puerto Rico Mountainous Area. 95.21 Section 95.21 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES IFR ALTITUDES Designated Mountainous Areas § 95.21 Puerto Rico...

14 CFR 95.21 - Puerto Rico Mountainous Area.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false Puerto Rico Mountainous Area. 95.21 Section 95.21 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES IFR ALTITUDES Designated Mountainous Areas § 95.21 Puerto Rico...

14 CFR 95.21 - Puerto Rico Mountainous Area.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Puerto Rico Mountainous Area. 95.21 Section 95.21 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES IFR ALTITUDES Designated Mountainous Areas § 95.21 Puerto Rico...

Influence of glottal closure on the phonatory process in ex vivo porcine larynges.

PubMed

Birk, Veronika; Kniesburges, Stefan; Semmler, Marion; Berry, David A; Bohr, Christopher; Döllinger, Michael; Schützenberger, Anne

2017-10-01

Many cases of disturbed voice signals can be attributed to incomplete glottal closure, vocal fold oscillation asymmetries, and aperiodicity. Often these phenomena occur simultaneously and interact with each other, making a systematic, isolated investigation challenging. Therefore, ex vivo porcine experiments were performed which enable direct control of glottal configurations. Different pre-phonatory glottal gap sizes, adduction levels, and flow rates were adjusted. The resulting glottal closure types were identified in a post-processing step. Finally, the acoustic quality, aerodynamic parameters, and the characteristics of vocal fold oscillation were analyzed in reference to the glottal closure types. Results show that complete glottal closure stabilizes the phonation process indicated through a reduced left-right phase asymmetry, increased amplitude and time periodicity, and an increase in the acoustic quality. Although asymmetry and periodicity parameter variation covers only a small range of absolute values, these small variations have a remarkable influence on the acoustic quality. Due to the fact that these parameters cannot be influenced directly, the authors suggest that the (surgical) reduction of the glottal gap seems to be a promising method to stabilize the phonatory process, which has to be confirmed in future studies.

Ratio-driven resuscitation predicts early fascial closure in the combat wounded.

PubMed

Glaser, Jacob; Vasquez, Matthew; Cardarelli, Cassandra; Dunne, James; Elster, Eric; Hathaway, Emily; Bograd, Benjamin; Safford, Shawn; Rodriguez, Carlos

2015-10-01

Operation Iraqi Freedom and Operation Enduring Freedom have seen the highest rates of combat casualties since Vietnam. These casualties often require massive transfusion (MT) and immediate surgical attention to control hemorrhage. Clinical practice guidelines dictate ratio-driven resuscitation (RDR) for patients requiring MT. With the transition from crystalloid to blood product resuscitation, we have seen fewer open abdomens in combat casualties. We sought to determine the effect RDR has on achieving early definitive abdominal fascial closure in combat casualties undergoing exploratory laparotomy. Records of 1,977 combat casualties admitted to a single US military hospital from April 2003 to December 2011 were reviewed. Patients receiving an MT and laparotomy in theater constituted the study cohort. The cohort was divided into RDR, defined as a ratio of 0.8-U to 1.2-U packed red blood cells to 1-U fresh frozen plasma, and No-RDR groups. Age, injury patterns, mechanism of injury, injury severity, blood products, number of laparotomies, and days to fascial closure were collected. Assessed outcomes were number of days (early ≤ 2 days) and number of laparotomies to achieve fascial closure. The mean age of the study cohort (n = 172) was 24.0 years, and mean Injury Severity Score (ISS) was 24.8. Improvised explosive device blast was the most common mechanism of injury (74.4%). The cohort was divided into RDR patients (n = 73) and no RDR (n = 99). There was no difference in mean age, mean ISS, or rate of nontherapeutic exploratory laparotomies between the groups. RDR patients had a significantly lower abdominal injury rate (34.2% vs. 72.7%, p < 0.01), had fewer laparotomies (2.7 vs. 4.3, p = 0.003), and achieved primary fascial closure faster (2.4 days vs. 7.2 days, p = 0.004). On multivariate analysis, RDR (2.74; 95% confidence interval, 1.44-5.2) was an independent predictor for early fascial closure. Adherence to RDR guidelines resulted in significantly decreased

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

PubMed

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

2012-07-01

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

Association of pre-operative medication use with post-operative delirium in surgical oncology patients receiving comprehensive geriatric assessment.

PubMed

Jeong, Young Mi; Lee, Eunsook; Kim, Kwang-Il; Chung, Jee Eun; In Park, Hae; Lee, Byung Koo; Gwak, Hye Sun

2016-07-07

Older patients undergoing surgery tend to have a higher frequency of delirium. Delirium is strongly associated with poor surgical outcomes. This study evaluated the association between pre-operative medication use and post-operative delirium (POD) in surgical oncology patients receiving comprehensive geriatric assessment (CGA). A total of 475 patients who were scheduled for cancer surgery and received CGA from January 2014 to June 2015 were included. Pre-operative medication review through CGA was conducted on polypharmacy (≥5 medications), delirium-inducing medications (DIMs), fall-inducing medications (FIMs), and potentially inappropriate medications (PIMs). POD was confirmed by psychiatric consultation, and DSM-V criteria were used for diagnosing delirium. The model fit of the prediction model was assessed by computing the Hosmer-Lemeshow goodness-of-fit test. Effect size was measured using the Nagelkerke R(2). Discrimination of the model was assessed by an analysis of the area under receiver operating curve (AUROC). Two models were constructed for multivariate analysis based on univariate analysis; model I included dementia and DIM in addition to age and sex, and model II included PIM instead of DIM of model I. Every one year increase of age increased the risk of POD by about 1.1-fold. DIM was a significant factor for POD after adjusting for confounders (AOR 12.78, 95 % CI 2.83-57.74). PIM was also a significant factor for POD (AOR 5.53, 95 % CI 2.03-15.05). The Hosmer-Lemeshow test results revealed good fits for both models (χ(2) = 3.842, p = 0.871 for model I and χ(2) = 8.130, p = 0.421 for model II). The Nagelkerke R(2) effect size and AUROC for model I was 0.215 and 0.833, respectively. Model II had the Nagelkerke R(2)effect size of 0.174 and AUROC of 0.819. These results suggest that pharmacists' comprehensive review for pre-operative medication use is critical for the post-operative outcomes like delirium in older patients.

Full road closure for work zone operations, a cross-cutting study : reducing congestion and crashes through full road closure for maintenance and construction.

DOT National Transportation Integrated Search

2003-08-01

The objective of this report is to raise awareness among designers construction engineers, and managers of the applications and benefits of full road closure during rehabilitation and construction activities. Based on interviews with project personne...

Identification of Selected Child-Resistant Closures (Continuous Thread, Lug-Bayonet, and Snap Closures).

ERIC Educational Resources Information Center

Gross, Rosalind L.; White, Harry E.

This publication describes a selected group of child-resistant closures used in packaging five categories of medicine and household products. The material in the document was collected to train survey personnel to identify closures for a planned household study of the effectiveness of child-resistant packaging. The 39 closures described are of…

Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis.

PubMed

Smith, Toby; Pelpola, Kelum; Ball, Martin; Ong, Alice; Myint, Phyo Kyaw

2014-07-01

hip fracture is a common and serious condition associated with high mortality. This study aimed to identify pre-operative characteristics which are associated with an increased risk of mortality after hip fracture surgery. systematic search of published and unpublished literature databases, including EMBASE, MEDLINE, AMED, CINAHL, PubMed and the Cochrane Library, was undertaken to identify all clinical studies on pre-operative predictors of mortality after surgery in hip fracture with at least 3-month follow-up. Data pertaining to the study objectives was extracted by two reviewers independently. Where study homogeneity was evidence, a meta-analysis of pooled relative risk and 95% confidence intervals was performed for mortality against pre-admission characteristics. fifty-three studies including 544,733 participants were included. Thirteen characteristics were identified as possible pre-operative indicators for mortality. Following meta-analysis, the four key characteristics associated with the risk of mortality up to 12 months were abnormal ECG (RR: 2.00; 95% CI: 1.45, 2.76), cognitive impairment (RR: 1.91; 95% CI: 1.35, 2.70), age >85 years (RR: 0.42; 95% CI: 0.20, 0.90) and pre-fracture mobility (RR: 0.13; 95% CI: 0.05, 0.34). Other statistically significant pre-fracture predictors of increased mortality were male gender, being resident in a care institution, intra-capsular fracture type, high ASA grade and high Charlson comorbidity score on admission. this review has identified the characteristics of patients with a high risk of mortality after a hip fracture surgery beyond the peri-operative period who may benefit from comprehensive assessment and appropriate management. CRD42012002107. © The Author 2014. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

40 CFR 265.120 - Certification of completion of post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... each hazardous waste disposal unit, the owner or operator must submit to the Regional Administrator, by registered mail, a certification that the post-closure care period for the hazardous waste disposal unit was...) SOLID WASTES (CONTINUED) INTERIM STATUS STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT...

Clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing open heart surgery.

PubMed

Campbell, Miranda; Rabbidge, Bridgette; Ziviani, Jenny; Sakzewski, Leanne

2017-08-01

Assessing the neurodevelopmental status of infants with congenital heart disease before surgery provides a means of identifying those at heightened risk of developmental delay. This study aimed to investigate factors impacting clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing early open heart surgery. Infants who underwent open heart surgery prior to 4 months of age participated in this cross-sectional study. The Test of Infant Motor Performance and Prechtl's Assessment of General Movements were undertaken on infants pre-operatively. When assessments could not be undertaken, reasons were ascribed to either infant or environmental circumstances. Demographic data and Aristotle scores were compared between groups of infants who did or did not undergo assessment. Binary logistic regression was used to explore associations. A total of 60 infants participated in the study. Median gestational age was 38.78 weeks (interquartile range: 36.93-39.72). Of these infants, 37 (62%) were unable to undergo pre-operative assessment. Twenty-four (40%) could not complete assessment due to infant-related factors and 13 (22%) due to environmental-related factors. For every point increase in the Aristotle Patient-Adjusted Complexity score, the infants likelihood of being unable to undergo assessment increased by 35% (odds ratio: 0.35; 95% confidence interval: 1.03-1.77, P = 0.03). Over half of the infants undergoing open heart surgery were unable to complete pre-operative neurodevelopmental assessment. The primary reason for this was infant-related medical instability. Findings suggest further research is warranted to investigate whether the Aristotle Patient-Adjusted Complexity score might serve as an indicator to inform developmental surveillance with this medically fragile cohort. © 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

Association between Pre-Operative Cefazolin Dose and Surgical Site Infection in Obese Patients.

PubMed

Peppard, William J; Eberle, David G; Kugler, Nathan W; Mabrey, Danielle M; Weigelt, John A

A fixed dose of cefazolin results in serum concentrations that decrease as body mass increases. Current national guidelines suggest a pre-operative cefazolin dose of two grams may be insufficient for patients ≥120 kg; thus a three gram dose is recommended. These recommendations, however, are based on pharmacokinetic rather than outcome data. We evaluate the efficacy of pre-operative cefazolin two gram and three gram doses as measured by the rate of surgical site infection (SSI). We conducted a retrospective review of adult patients ≥100 kg who were prescribed cefazolin as surgical prophylaxis between September 1, 2012 and May 31, 2013 at an academic medical center. Patients were excluded if cefazolin was prescribed but not administered, had a known infection at the site of surgery, or inappropriately received cefazolin prophylaxis based on surgical indication. The SSIs were identified by documentation of SSI in the medical record or findings consistent with the standard Centers for Disease Control and Prevention definition. Inpatient and outpatient records up to 90 days post-operative were reviewed for delayed SSI. Four hundred eighty-three surgical cases were identified in which pre-operative cefazolin was prescribed. Forty-seven patients were excluded leaving a total of 436 patients for final analysis: 152 in the cefazolin two gram group and 284 in the three gram group. Baseline demographics were similar between groups with a mean follow-up duration of 77 days for both groups. Unadjusted SSI rates were 7.2% and 7.4% (odds ratio [OR] 0.98, p = 0.95), for the two gram and three gram groups, respectively. When differences in follow-up between groups were considered and logistic regression was adjusted with propensity score, there remained no difference in SSI rates (OR 0.87, 95% confidence interval 0.36-2.06, p = 0.77). In otherwise similar obese surgical patients weighing ≥100 kg, the administration of a pre-operative cefazolin two gram dose is

40 CFR 258.71 - Financial assurance for closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

....71 Section 258.71 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... closure. (a) The owner or operator must have a detailed written estimate, in current dollars, of the cost.... (1) The cost estimate must equal the cost of closing the largest area of all MSWLF unit ever...

40 CFR 258.71 - Financial assurance for closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

....71 Section 258.71 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... closure. (a) The owner or operator must have a detailed written estimate, in current dollars, of the cost.... (1) The cost estimate must equal the cost of closing the largest area of all MSWLF unit ever...

A View from the Mountain Top: The Purple Mountain Observatory Library, China

ERIC Educational Resources Information Center

Zhang, Jian

2012-01-01

This paper discusses the author's experience directing the Purple Mountain Observatory Library, Chinese Academy of Sciences (CAS) in Nanjing, China. Routine collection development, management and preservation issues are described, and the unique challenges and opportunities involved in operating a remote observatory library are highlighted.

Using pre-operative MRI to predict intraoperative hamstring graft size for anterior cruciate ligament reconstruction.

PubMed

Leiter, Jeff; Elkurbo, Mohamed; McRae, Sheila; Chiu, James; Froese, Warren; MacDonald, Peter

2017-01-01

Large variation in tendon size between individuals makes hamstring graft diameter for anterior cruciate ligament (ACL) reconstruction unpredictable. Inadequate graft diameter may necessitate an alternative source of tissue requiring pre-operative planning. The purpose of this study was to determine whether magnetic resonance image (MRI) measurements and clinical anthropometric data are predictive of hamstring tendon graft diameter. Data from 109 patients having ACL reconstruction with semitendinosus-gracilis (STGT) autograft were retrospectively evaluated. Cross-sectional area (CSA) of the gracilis tendon (GT) and semitendinosus tendon (ST) were determined from pre-operative MRI scans. Variables included pre-operative height, weight, body mass index (BMI), age and gender; and intra-operative graft diameter. Correlations between anthropometric variables, hamstring tendons CSA and intra-operative graft diameter were calculated. Multiple stepwise regression was performed to assess the predictive value of these variables to graft diameter. Sensitivity and specificity were calculated to evaluate the utility of MRI CSA measurements in accurately identifying inadequate graft diameter (<8 mm). All anthropometric variables were positively correlated with intraoperative graft diameter (p < 0.01). Semitendinosus-gracilis tendon CSA (p < 0.001) and STGT CSA and weight (p < 0.001) were significantly predictive models of graft diameter. Sensitivity and specificity were 79 and 74 %, respectively. The strongest indicators of a four-stranded STGT graft for primary ACL reconstruction were STGT CSA on MRI plus weight. Measurement of graft diameter can be performed pre-operatively via MRI to identify tendons that may be of inadequate size for ACL reconstruction. This can assist with surgical planning to determine the most appropriate graft choice. III.

Ore Deposits of the Jerome and Bradshaw Mountains Quadrangles, Arizona

USGS Publications Warehouse

Lindgren, Waldemar; Heikes, V.C.

1926-01-01

In the summer of 1922, at the request of the Director of the United States Geological Survey, I undertook an examination of the ore deposits in the Jerome and Bradshaw Mountains quadrangles, Ariz. (See fig. 1.) The object of this work was not a detailed investigation of each deposit but rather a coordination and classification of the occurrences and an attempt to ascertain their origin and economic importance. Almost all the deposits occur in pre-Cambrian rocks or in rocks that are not readily differentiated from the pre-Cambrian. In the northern part of the Jerome quadrangle there are large areas of almost horizontal Paleozoic beds, and in both quadrangles there are also large areas of lava flows of Tertiary age. Finally there are wide spaces occupied by Tertiary tuff and limestone, or by Tertiary and Quaternary wash filling the valleys between the mountain ranges. But all these rocks except the pre-Cambrian are practically barren of ore deposits, and the problem therefore narrowed itself to an examination of the pre-Cambrian areas. This task was greatly facilitated by the careful work of Jaggar and Palache, set forth in the Bradshaw Mountains folio,l in which the southern quadrangle of the two under present consideration is mapped geologically and described, and which also includes a comprehensive though brief discussion of the mineral deposits. There is no published geologic map of the Jerome quadrangle, but I had the opportunity through the courtesy of Dr. G. M. Butler, Director of the Arizona Bureau of Mines, to use a manuscript map of this area prepared for the State by Mr. L. E. Reber, jr., and Mr. Olaf Jenkins.

Chronic pre-operative opioid use is a risk factor for increased complications, resource use and costs after cervical fusion.

PubMed

Jain, Nikhil; Brock, John L; Phillips, Frank M; Weaver, Tristan; Khan, Safdar N

2018-04-27

As healthcare transitions to value-based models, there has been an increased focus on patient factors that can influence peri- and post-operative adverse events, resource use, and costs. Many studies have reported risk factors for systemic complications after cervical fusion, but none have studied chronic opioid therapy (COT) as a risk factor. To answer the following questions from a large cohort of patients who underwent primary cervical fusion for degenerative pathology: (1) What is the patient profile associated with pre-operative COT? (2) Is pre-operative COT a risk factor for 90-day systemic complications, emergency department (ED) visits, readmission, and one-year adverse events? (3) What are the risk factors and one-year adverse events related to long-term post-operative opioid use? and (4) How much did payers reimburse for management of complications and adverse events? Retrospective review of Humana commercial insurance data (2007-Q3 2015). 29,101 patients undergoing primary cervical fusion for degenerative pathology. Patients and procedures of interest were included using International Classification of Diseases (ICD) coding. Patients with opioid prescriptions for >6 months before surgery were considered as having pre-operative COT. Patients with continued opioid use till one-year after surgery were considered as long-term users. Descriptive analysis of patient cohorts has been done. Multiple-variable logistic regression analyses adjusting for approach, number of levels of surgery, discharge disposition, and comorbidities were done to answer first three study questions. Reimbursement data from insurers has been reported to answer our fourth study question. Of the entire cohort, 6,643 (22.8%) had pre-operative COT. Pre-operative COT was associated with a higher risk of 90-day wound complications (OR 1.39, 95% CI:1.16-1.66), all-cause 90-day ED visits (adjusted OR 1.22, 95% CI:1.13-1.32), and pain-related ED visits (adjusted OR 1.39, 95% CI:1

Pre-operative ultrasound identification of thyroiditis helps predict the need for thyroid hormone replacement after thyroid lobectomy.

PubMed

Morris, Lilah F; Iupe, Isabella M; Edeiken-Monroe, Beth S; Warneke, Carla L; Hansen, Mandy O; Evans, Douglas B; Lee, Jeffrey E; Grubbs, Elizabeth G; Perrier, Nancy D

2013-01-01

To evaluate whether pre-operative thyroiditis identified by ultrasound (US) could help predict the need for thyroid hormone replacement (THR) following thyroid lobectomy. Data from patients who underwent thyroid lobectomy in 2006-2011, were not taking THR pre-operatively, and had ≥1 month of follow-up were reviewed retrospectively. THR was prescribed for relatively elevated thyroid-stimulating hormone (TSH) and hypothyroid symptoms. The Kaplan-Meier method was used to estimate the percentage of patients who required THR at 6, 12, 18, and 24 months postoperatively, and Cox proportional hazards regression models were used to evaluate prognostic factors for requiring post-thyroid lobectomy THR. During follow-up, 45 of 98 patients required THR. Median follow-up among patients not requiring THR was 11.6 months (range, 1.2 to 51.3 months). Six months after thyroid lobectomy, 22% of patients were taking THR (95% confidence interval [CI], 15-32%); the proportion increased to 46% at 12 months (95% CI, 36-57%) and 55% at 18 months (95% CI, 43-67%). On univariate analysis, significant prognostic factors for postoperative THR included a pre-operative TSH level >2.5 μ international units [IU]/mL (hazard ratio [HR], 2.8; 95% CI, 1.4-5.5; P = .004) and pathology-identified thyroiditis (HR, 2.4; 95% CI, 1.3-4.3; P = .005). Patients with both pre-operative TSH >2.5 μIU/mL and US-identified thyroiditis had a 5.8-fold increased risk of requiring postoperative THR (95% CI, 2.4-13.9; P<.0001). A pre-operative TSH level >2.5 μIU/mL significantly increases the risk of requiring THR after thyroid lobectomy. Thyroiditis can add to that prediction and guide pre-operative patient counseling and surgical decision making. US-identified thyroiditis should be reported and post-thyroid lobectomy patients followed long-term (≥18 months).

Effect of stapedotomy on pre-operative tinnitus and its psychosomatic burden.

PubMed

Bast, Florian; Mazurek, Birgit; Schrom, Thomas

2013-12-01

According to the literature, between 40 and 90% of otosclerosis patients suffering from hearing loss also suffer from tinnitus on the affected side. For a lot of these patients tinnitus represents a handicap that is just as debilitating as the hearing loss itself. The main goal of the surgical treatment of otosclerosis is a significant improvement in hearing loss, but frequent reports of reduced tinnitus after surgery suggest that this can be a positive side effect. All patients who underwent stapedotomy were initially included in the study. Retrospectively, the tinnitus questionnaire as compiled by Goebel and Hiller was sent to the patients, and 34 patients (37 ears) replied. The pre- and postoperative cases of tinnitus were divided into compensated and non-compensated tinnitus. In addition the following tinnitus-related factors were evaluated: emotional, cognitive and mental burden; intrusiveness of the tinnitus; hearing problems; somatic ailments; and sleep disturbances. Over 80% of the patients surveyed suffered from tinnitus pre-operation. The tinnitus disappeared or improved in over 60% of the cases after stapedotomy. In addition, the related factors surveyed also improved appreciably post surgery and reached a significant level in patients with compensated tinnitus. Besides a significant improvement in hearing loss the intensity and the psychosomatic burden of a pre-operative tinnitus can be reduced by stapedotomy. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Flying Fast and High: Operational Flight Planning for Maximum Data Return for Airborne Snow Observatory Mountain Surveys

NASA Astrophysics Data System (ADS)

Berisford, D. F.; Painter, T. H.; Richardson, M.; Wallach, A.; Deems, J. S.; Bormann, K. J.

2017-12-01

The Airborne Snow Observatory (ASO - http://aso.jpl.nasa.gov) uses an airborne laser scanner to map snow depth, and imaging spectroscopy to map snow albedo in order to estimate snow water equivalent and melt rate over mountainous, hydrologic basin-scale areas. Optimization of planned flight lines requires the balancing of many competing factors, including flying altitude and speed, bank angle limitation, laser pulse rate and power level, flightline orientation relative to terrain, surface optical properties, and data output requirements. These variables generally distill down to cost vs. higher resolution data. The large terrain elevation variation encountered in mountainous terrain introduces the challenge of narrow swath widths over the ridgetops, which drive tight flightline spacing and possible dropouts over the valleys due to maximum laser range. Many of the basins flown by ASO exceed 3,000m of elevation relief, exacerbating this problem. Additionally, sun angle may drive flightline orientations for higher-quality spectrometer data, which may change depending on time of day. Here we present data from several ASO missions, both operational and experimental, showing the lidar performance and accuracy limitations for a variety of operating parameters. We also discuss flightline planning strategies to maximize data density return per dollar, and a brief analysis on the effect of short turn times/steep bank angles on GPS position accuracy.

Pre-K-8 Prospective Teachers' Understanding of Fractions: An Extension of Fractions Schemes and Operations Research

ERIC Educational Resources Information Center

Lovin, LouAnn H.; Stevens, Alexis L.; Siegfried, John; Wilkins, Jesse L. M.; Norton, Anderson

2018-01-01

In an effort to expand our knowledge base pertaining to pre-K-8 prospective teachers' understanding of fractions, the present study was designed to extend the work on fractions schemes and operations to this population. One purpose of our study was to validate the fractions schemes and operations hierarchy with the pre-K-8 prospective teacher…

Helicopter Mountain Rescue in Slovenia from 2011 to 2015.

PubMed

Deeb, Janina Golob; Walter, Nicholas; Carrico, Caroline; Gašperin, Miha; Deeb, George R

2018-03-01

The popularity of adventure recreation in wilderness areas across the world continues to increase. Nevertheless, the risk of injury and illness remains significant. The purpose of this study is to analyze the mountain rescue operations performed in Slovenia between 2011 and 2015. This retrospective study reports mountain rescue operations documented by the Slovenian National Mountain Rescue Association. The annual number of ground-based and helicopter-based rescues were identified and compared. For 2015, the indication for rescue and the severity of injury were also analyzed, specifically for interventions requiring the use of a helicopter. From 2011 through 2015, the number of rescues remained consistent with an annual average of 413 (SD ±15; range, 393-434) rescues. However, the percentage of ground-based rescues varied significantly year by year (P=0.016), with highest rate in 2014 (68%) and the lowest in 2015 (56%). In 2015, 434 mountain rescue operations were reported in Slovenia. Injury accounted for 44%, illness for 10%, and fatality for 9% of the rescues. In 37%, no illness or injury was reported. Helicopter rescue was used in 190 (44%) of all interventions. Among the 190 helicopter rescues, 49% of patients had nonfatal injuries, 29% required no medical treatment, 15% had illness, and 7% had fatal injuries. A significant number of mountain rescue operations were conducted in Slovenia from 2011 through 2015. Most of these were needed for injured, ill, or deceased persons. A notable number of rescues in 2015 required a helicopter. Copyright © 2017 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

Early Paleozoic development of the Maine-Quebec boundary Mountains region

USGS Publications Warehouse

Gerbi, C.C.; Johnson, S.E.; Aleinikoff, J.N.; Bedard, J.H.; Dunning, G.R.; Fanning, C.M.

2006-01-01

Pre-Silurian bedrock units played key roles in the early Paleozoic history of the Maine-Quebec Appalachians. These units represent peri-Laurentian material whose collision with the craton deformed the Neoproteozoic passive margin and initiated the Appalachian mountain-building cycle. We present new field, petrological, geochronological, and geochemical data to support the following interpretations related to these units. (1) The Boil Mountain Complex and Jim Pond Formation do not represent part of a coherent ophiolite. (2) Gabbro and tonalite of the Boil Mountain Complex intruded the Chain Lakes massif at ca. 477 Ma. (3) The Skinner pluton, an arc-related granodiorite, intruded the Chain Lakes massif at ca. 472 Ma. (4) The Attean pluton, with a reconfirmed age of ca. 443 Ma, is unrelated to Early Ordovician orogenesis. (5) The most likely timing for the juxtaposition of the Jim Pond Formation and the Boil Mountain Complex was during regional Devonian deformation. These interpretations suggest that the Boundary Mountains were once part of a series of arcs extending at least from central New England through Newfoundland. ?? 2006 NRC Canada.

Rates and causes of accidents for general aviation aircraft operating in a mountainous and high elevation terrain environment.

PubMed

Aguiar, Marisa; Stolzer, Alan; Boyd, Douglas D

2017-10-01

Flying over mountainous and/or high elevation terrain is challenging due to rapidly changeable visibility, gusty/rotor winds and downdrafts and the necessity of terrain avoidance. Herein, general aviation accident rates and mishap cause/factors were determined (2001-2014) for a geographical region characterized by such terrain. Accidents in single piston engine-powered aircraft for states west of the US continental divide characterized by mountainous terrain and/or high elevation (MEHET) were identified from the NTSB database. MEHET-related-mishaps were defined as satisfying any one, or more, criteria (controlled flight into terrain/obstacles (CFIT), downdrafts, mountain obscuration, wind-shear, gusting winds, whiteout, instrument meteorological conditions; density altitude, dust-devil) cited as factors/causal in the NTSB report. Statistics employed Poisson distribution and contingency tables. Although the MEHET-related accident rate declined (p<0.001) 57% across the study period, the high proportion of fatal accidents showed little (40-43%) diminution (χ 2 =0.935). CFIT and wind gusts/shear were the most frequent accident cause/factor categories. For CFIT accidents, half occurred in degraded visibility with only 9% operating under instrument flight rules (IFR) and the majority (85%) involving non-turbo-charged engine-powered aircraft. For wind-gust/shear-related accidents, 44% occurred with a cross-wind exceeding the maximum demonstrated aircraft component. Accidents which should have been survivable but which nevertheless resulted in a fatal outcome were characterized by poor accessibility (60%) and shoulder harness under-utilization (41%). Despite a declining MEHET-related accident rate, these mishaps still carry an elevated risk of a fatal outcome. Airmen should be encouraged to operate in this environment utilizing turbo-charged-powered airplanes and flying under IFR to assure terrain clearance. Copyright © 2017 Elsevier Ltd. All rights reserved.

Non-destructive vacuum decay method for pre-filled syringe closure integrity testing compared with dye ingress testing and high-voltage leak detection.

PubMed

Simonetti, Andrea; Amari, Filippo

2015-01-01

In reaction to the limitations of the traditional sterility test methods, in 2008, the U.S. Food and Drug Administration issued the guidance "Container and Closure System Integrity Testing in Lieu of Sterility Testing as a Component of the Stability Protocol for Sterile Products" encouraging sterile drug manufacturers to use properly validated physical methods, apart from conventional microbial challenge testing, to confirm container closure integrity as part of the stability protocol. The case study presented in this article investigated the capability of four container closure integrity testing methods to detect simulated defects of different sizes and types on glass syringes, prefilled both with drug product intended for parenteral administration and sterile water. The drug product was a flu vaccine (Agrippal, Novartis Vaccines, Siena, Italy). Vacuum decay, pharmacopoeial dye ingress test, Novartis specific dye ingress test, and high-voltage leak detection were, in succession, the methods involved in the comparative studies. The case study execution was preceded by the preparation of two independent sets of reference prefilled syringes, classified, respectively, as examples of conforming to closure integrity requirements (negative controls) and as defective (positive controls). Positive controls were, in turn, split in six groups, three of with holes laser-drilled through the prefilled syringe glass barrel, while the other three with capillary tubes embedded in the prefilled syringe plunger. These reference populations were then investigated by means of validated equipment used for container closure integrity testing of prefilled syringe commercial production; data were collected and analyzed to determine the detection rate and the percentage of false results. Results showed that the vacuum decay method had the highest performance in terms of detection sensitivity and also ensured the best reliability and repeatability of measurements. An innovative technical

Pressurized Slot Testing to Determine Thermo-Mechanical Properties of Lithophysal Tuff at Yucca Mountain Nevada.

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

George, James T.; Sobolik, Steven R.; Lee, Moo Y.

The study described in this report involves heated and unheated pressurized slot testing to determine thermo-mechanical properties of the Tptpll (Tertiary, Paintbrush, Topopah Spring Tuff Formation, crystal poor, lower lithophysal) and Tptpul (upper lithophysal) lithostratigraphic units at Yucca Mountain, Nevada. A large volume fraction of the proposed repository at Yucca Mountain may reside in the Tptpll lithostratigraphic unit. This unit is characterized by voids, or lithophysae, which range in size from centimeters to meters, making a field program an effective method of measuring bulk thermal-mechanical rock properties (thermal expansion, rock mass modulus, compressive strength, time-dependent deformation) over a range ofmore » temperature and rock conditions. The field tests outlined in this report provide data for the determination of thermo-mechanical properties of this unit. Rock-mass response data collected during this field test will reduce the uncertainty in key thermal-mechanical modeling parameters (rock-mass modulus, strength and thermal expansion) for the Tptpll lithostratigraphic unit, and provide a basis for understanding thermal-mechanical behavior of this unit. The measurements will be used to evaluate numerical models of the thermal-mechanical response of the repository. These numerical models are then used to predict pre- and post-closure repository response. ACKNOWLEDGEMENTS The authors would like to thank David Bronowski, Ronnie Taylor, Ray E. Finley, Cliff Howard, Michael Schuhen (all SNL) and Fred Homuth (LANL) for their work in the planning and implementation of the tests described in this report. This is a reprint of SAND2004-2703, which was originally printed in July 2004. At that time, it was printed for a restricted audience. It has now been approved for unlimited release.« less

One-stage closure of isolated cleft palate with the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification. I. Comparison of operative results.

PubMed

Heliövaara, A; Rintala, A; Ranta, R

1993-01-01

The long term operative results of one-stage closure of isolated cleft palate with either the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification were evaluated and compared retrospectively. A total of 116 consecutive patients with isolated cleft palate who had been operated on at the age of 18-24 months were followed up until 17-20 years of age. Twenty-four of the patients needed one or more additional operations on the palate, mainly pharyngeal flaps (20%) and repair of fistulas (10%). There was no significant difference in the number of patients who needed further operations, either between the two different operations or between the sexes, but the patients who presented with the most extensive clefts required the most operations.

10 CFR 60.51 - License amendment for permanent closure.

Code of Federal Regulations, 2014 CFR

2014-01-01

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

10 CFR 60.51 - License amendment for permanent closure.

Code of Federal Regulations, 2013 CFR

2013-01-01

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

10 CFR 60.51 - License amendment for permanent closure.

Code of Federal Regulations, 2010 CFR

2010-01-01

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

10 CFR 60.51 - License amendment for permanent closure.

Code of Federal Regulations, 2011 CFR

2011-01-01

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

10 CFR 60.51 - License amendment for permanent closure.

Code of Federal Regulations, 2012 CFR

2012-01-01

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

Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis.

PubMed

Yassa, Rafik Rd; Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun

2017-03-01

The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. UK University Teaching Hospital. All patients ( n  = 460) presenting across a single year study period with a confirmed hip fracture. The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection ( p -value: 0.0005). The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection.

Yearly report, Yucca Mountain project

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

Brune, J.N.

1992-09-30

We proposed to (1) Develop our data logging and analysis equipment and techniques for analyzing seismic data from the Southern Great Basin Seismic Network (SGBSN), (2) Investigate the SGBSN data for evidence of seismicity patterns, depth distribution patterns, and correlations with geologic features (3) Repair and maintain our three broad band downhole digital seismograph stations at Nelson, nevada, Troy Canyon, Nevada, and Deep Springs, California (4) Install, operate, and log data from a super sensitive microearthquake array at Yucca Mountain (5) Analyze data from micro-earthquakes relative to seismic hazard at Yucca Mountain.

Cow and calf weight trends on mountain summer range.

Treesearch

Jon M. Skovlin

1962-01-01

Mountain range furnishes the bulk of summer forage for commercial cow-calf operations in northeastern Oregon. Herds maintained on valley range and pasture during winter and spring months are annually trailed to mountain ranges and remain there until calves are ready for fall markets (fig. 1).

Innexin 3, a New Gene Required for Dorsal Closure in Drosophila Embryo

PubMed Central

Giuliani, Fabrizio; Giuliani, Giuliano; Bauer, Reinhard; Rabouille, Catherine

2013-01-01

Background Dorsal closure is a morphogenetic event that occurs during mid-embryogenesis in many insects including Drosophila, during which the ectoderm migrates on the extraembryonic amnioserosa to seal the embryo dorsally. The contribution of the ectoderm in this event has been known for a long time. However, amnioserosa tension and contractibility have recently been shown also to be instrumental to the closure. A critical pre-requisite for dorsal closure is integrity of these tissues that in part is mediated by cell-cell junctions and cell adhesion. In this regard, mutations impairing junction formation and/or adhesion lead to dorsal closure. However, no role for the gap junction proteins Innexins has so far been described. Results and Discussion Here, we show that Innexin 1, 2 and 3, are present in the ectoderm but also in the amnioserosa in plaques consistent with gap junctions. However, only the loss of Inx3 leads to dorsal closure defects that are completely rescued by overexpression of inx3::GFP in the whole embryo. Loss of Inx3 leads to the destabilisation of Inx1, Inx2 and DE-cadherin at the plasma membrane, suggesting that these four proteins form a complex. Accordingly, in addition to the known interaction of Inx2 with DE-cadherin, we show that Inx3 can bind to DE-cadherin. Furthermore, Inx3-GFP overexpression recruits DE-cadherin from its wildtype plasma membrane domain to typical Innexin plaques, strengthening the notion that they form a complex. Finally, we show that Inx3 stability is directly dependent on tissue tension. Taken together, we propose that Inx3 is a critical factor for dorsal closure and that it mediates the stability of Inx1, 2 and DE-cadherin by forming a complex. PMID:23894431

Pre-deploy operations with SPARTAN-201 during STS-64

NASA Image and Video Library

1994-09-12

STS064-111-070 (9-20 Sept. 1994) --- The astronauts onboard the space shuttle Discovery used a 70mm camera to capture this view of the pre-deploy operations with the Shuttle Pointed Autonomous Research Tool for Astronomy (SPARTAN-201) 201. In the grasp of the robot arm device of the Remote Manipulator System (RMS), SPARTAN 201 hovers above Discovery's cargo bay prior to its two days of free-flight, some 40 miles away from the parent spacecraft. Photo credit: NASA or National Aeronautics and Space Administration

[Diversity of soil archaea in Tibetan Mila Mountains].

PubMed

Meng, Xiangwei; Mao, Zhenchuan; Chen, Guohua; Yang, Yuhong; Xie, Bingyan

2009-08-01

In order to study the diversity of archaea and ammonia-oxidizing archaea (AOA) of the alp prairie soil in Mila Mountain of Tibet. Total microbial DNA was directly extracted from the alp prairie of Mila Mountain. The clone library of 16S rRNA genes and amoA genes were amplified by PCR with universal primer sets. The sequences of archaea and AOA were defined into operational taxonomic units (OTUs) according to the 97% similarity threshold for OTU assignment was performed using the software program DOTUR. Phylogenetic analysis revealed archaea in the soil of Mila Mountain including the Crenarchaeota (71.7%) and unclassified-Archaea (28.3%) phyla. All the Crenarchaeota belong to the Thermoprotei. Phylogenetic analysis revealed AOA in the alp prairie soil of Mila Mountain belonged to the kingdom Crenarchaeota. Archaea and AOA species composition from Mila Mountain included 64 OTUs and 75 OTUs. These findings show prolific archaeal diversity in the alp prairie soil of Mila Mountain, where they may be actively involved in nitrification.

A Practical Scoring System to Select Optimally Sized Devices for Percutaneous Patent Foramen Ovale Closure.

PubMed

Venturini, Joseph M; Retzer, Elizabeth M; Estrada, J Raider; Mediratta, Anuj; Friant, Janet; Nathan, Sandeep; Paul, Jonathan D; Blair, John; Lang, Roberto M; Shah, Atman P

2016-10-01

Patent foramen ovale (PFO) has been linked to cryptogenic stroke, and closure has been reported to improve clinical outcomes. However, there are no clear guidelines to direct device sizing. This study sought to use patient characteristics and echocardiographic findings to create a prediction score for device sizing. This was a retrospective review of patients undergoing percutaneous PFO closure at our institution between July 2010 and December 2014. Demographic and clinical characteristics were recorded, and all pre- and intraprocedural echocardiography results were evaluated. Thirty-six patients underwent percutaneous PFO closure during the study period. All procedures were performed using an Amplatzer Septal Occluder "Cribriform" (ASOC) device in one of three disc diameters: 25, 30, or 35 mm. Closure was indicated for cryptogenic stroke/transient ischemic attack in 75% of cases. Every case (100%) was successful with durable shunt correction at the 6-month follow-up without complications of erosion or device embolization. The presence of atrial septal aneurysm (ASA) ( p = 0.027) and PFO tunnel length >10 mm ( p = 0.038) were independently associated with increased device size. A scoring system of 1 point for male sex, 1 point for ASA, and 1 point for PFO tunnel >10 mm long was associated with the size of closure device implanted ( p = 0.006). A simple scoring system may be used to select an optimally sized device for percutaneous PFO closure using the ASOC device.

Pre-operative digital templating in cemented hip hemiarthroplasty for neck of femur fractures.

PubMed

Kwok, Iris H Y; Pallett, Scott J C; Massa, Edward; Cundall-Curry, Duncan; Loeffler, Mark D

2016-03-01

Pre-operative digital templating allows the surgeon to foresee any anatomical anomalies which may lead to intra-operative problems, and anticipate appropriate instruments and implants required during surgery. Although its role is well-established in successful elective total hip arthroplasty, little work has been done on its use in hip hemiarthroplasty in neck of femur fractures. We describe our initial experience of digital templating in 40 consecutive patients who have undergone cemented hip hemiarthroplasty, assessing templating accuracy between templated implant sizes to actual implant sizes. 81% of implanted heads were templated to within two head sizes, and 89% of implanted stems were templated to within two sizes. Although there was a moderately strong correlation of 0.52 between templated and actual head sizes, this correlation was not demonstrated in femoral stem sizes. Mean leg length discrepancy was -2.5mm (S.D. 8.5), and the mean difference in femoral offset between the operated and non-operated hip was -1mm (S.D. 4.4). Digital templating is a useful adjunct to the surgeon in pre-operative planning of hip hemiarthroplasty in the restoration of leg length and femoral offset. However, its accuracy is inferior to that of elective total hip arthroplasty. Copyright © 2016 Elsevier Ltd. All rights reserved.

An observational cohort study on pre-operative investigations and referrals: How far are we following recommendations?

PubMed Central

Karim, Habib Md Reazaul; Yunus, Md; Bhattacharyya, Prithwis

2016-01-01

Background and Aims: Pre-operative investigations are often required to supplement information for risk stratification and assessing reserve for undergoing surgery. Although there are evidence-based recommendations for which investigations should be done, clinical practice varies. The present study aimed to assess the pre-operative investigations and referral practices and compare it with the standard guidelines. Methods: The present observational study was carried out during 2014–appen2015 in a teaching institute after the approval from Institute Ethical Committee. A designated anaesthesiologist collected data from the completed pre-anaesthetic check-up (PAC) sheets. Investigations already done, asked by anaesthesiologists as well as referral services sought were noted and compared with an adapted master table prepared from standard recommendations and guidelines. Data were expressed in frequencies, percentage and statistically analysed using INSTAT software (GraphPad Prism software Inc., La Zolla, USA). Results: Seventy-five out of 352 patients (42.67% male, 57.33% female; American Society of Anesthesiologists physical status I to III) were included in this study. Nearly, all patients attended PAC with at least 5 investigations done. Of them, 89.33% were subjected to at least one unnecessary investigation and 91.67% of the referral services were not required which lead to 3.5 ( SD ±1.64) days loss. Anaesthesiologist-ordered testing was more focused than surgeons. Conclusion: More than two-third of pre-operative investigations and referral services are unnecessary. Anaesthesiologists are relatively more rational in ordering pre-operative tests yet; a lot can be done to rationalise the practice as well as reducing healthcare cost. PMID:27601737

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

PubMed

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

2013-06-21

T-tube drainage may prevent bile leak from the biliary tract following bile duct exploration and it offers post-operative access to the bile ducts for visualisation and exploration. Use of T-tube drainage after laparoscopic common bile duct (CBD) exploration is controversial. To assess the benefits and harms of T-tube drainage versus primary closure after laparoscopic common bile duct exploration. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2013. We included all randomised clinical trials comparing T-tube drainage versus primary closure after laparoscopic common bile duct exploration. Two of four authors independently identified the studies for inclusion and extracted data. We analysed the data with both the fixed-effect and the random-effects model meta-analyses using Review Manager (RevMan) Analysis. For each outcome we calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis. We included three trials randomising 295 participants: 147 to T-tube drainage versus 148 to primary closure. All trials had a high risk of bias. No one died during the follow-up period. There was no significant difference in the proportion of patients with serious morbidity (17/147 (weighted percentage 11.3%) in the T-tube drainage versus 9/148 (6.1%) in the primary closure group; RR 1.86; 95% CI 0.87 to 3.96; three trials), and no significant difference was found in the serious morbidity rates (weighted serious morbidity rate = 97 events per 1000 patients) in participants randomised to T-tube drainage versus serious morbidity rate = 61 events per 1000 patients in the primary closure group; RR 1.59; 95% CI 0.66 to 3.83; three trials). Quality of life was not reported in any of the trials. The operating time was significantly longer in the T-tube drainage group compared with the primary

Predictors of Success in Bariatric Surgery: the Role of BMI and Pre-operative Comorbidities.

PubMed

da Cruz, Magda Rosa Ramos; Branco-Filho, Alcides José; Zaparolli, Marília Rizzon; Wagner, Nathalia Farinha; de Paula Pinto, José Simão; Campos, Antônio Carlos Ligocki; Taconeli, Cesar Augusto

2018-05-01

This is a retrospective review of 204 patients who underwent bariatric surgery. The impact of weight regain (WR), pre-operative comorbidities and BMI values on the recurrence of comorbidities was evaluated, and an equation was elaborated to estimate BMI at 5 years of bariatric surgery. Pre-operative data, after 1 year and after 5 years, was collected from the medical records. Descriptive analyses and bivariate hypothesis tests were performed first, and then, a generalised linear regression model with Tweedie distribution was adjusted. The hit rate and the Kendall coefficient of concordance (Kendall's W) of the equation were calculated. At the end, the Mann-Whitney test was performed between the BMI, WR and the presence of comorbidities, after a post-operative period of 5 years. The adjustment of the model resulted in an equation that estimates the mean value of BMI 5 years after surgery. The hit rate was 82.35% and the value of Kendall's W was 0.85 for the equation. It was found that patients with comorbidities presented a higher median WR (10.13%) and a higher mean BMI (30.09 kg/m 2 ) 5 years after the surgery. It is concluded that the equation is useful for estimating the mean BMI at 5 years of surgery and that patients with low pre-operative HDL and folic acid levels, with depression and/or anxiety and a higher BMI, have a higher BMI at 5 years of surgery and higher incidence of comorbid return and dissatisfaction with post-operative results.

Lumbar diskectomy in a human-habituated mountain gorilla (Gorilla beringei beringei).

PubMed

Aryan, Henry E; Jandial, Rahul; Nakaji, Peter; Greenberg, Mark S; Janssen, Don L; Huang, Johnson; Taylor, William R

2006-02-01

The authors report a case of a human-habituated mountain gorilla, Alvila, resident at the San Diego Zoo, who was found to have a herniated intervertebral lumbar disc after being attacked by the gorilla troop's silverback male gorilla. Ultimately, the gorilla required surgical intervention for her disease and made a full recovery. To our knowledge, this is the only known case of spine surgery. A 36-year-old female human-habituated mountain gorilla (Gorilla beringei beringei), resident at the San Diego Zoo, was noticed by caregivers to walk with a substantial limp after being attacked by the gorilla troop's silverback male gorilla. Magnetic resonance (MR) imaging of her lumbar spine revealed a large herniated disk at the L1-2 level on the right. This finding appeared to correlate well with the gorilla's symptoms. The gorilla underwent a lumbar diskectomy under loupe. Post-operatively the gorilla did very well. The right leg weakness was immediately improved post-operatively. The gorilla continued to "crutch walk" initially, swinging on the upper extremities and not bearing weight on the lowers. However, by 2 weeks the limp was no longer noticeable to the zoo caregivers. The wound healed well and there was no evidence of wound infection or CSF leak. The gorilla was reunited with her troop and has reintegrated well socially. With 10 months of follow-up, the gorilla continues to do well. This is the only known case of spine surgery in a gorilla. For best surgical results, one needs to consider the similarities and differences between the gorilla and human vertebral anatomy. We believe that careful pre-operative planning contributed to the good early post-operative result. Ultimate assessment of the long-term outcome will require additional follow-up.

Matrix multiplication operations with data pre-conditioning in a high performance computing architecture

DOEpatents

Eichenberger, Alexandre E; Gschwind, Michael K; Gunnels, John A

2013-11-05

Mechanisms for performing matrix multiplication operations with data pre-conditioning in a high performance computing architecture are provided. A vector load operation is performed to load a first vector operand of the matrix multiplication operation to a first target vector register. A load and splat operation is performed to load an element of a second vector operand and replicating the element to each of a plurality of elements of a second target vector register. A multiply add operation is performed on elements of the first target vector register and elements of the second target vector register to generate a partial product of the matrix multiplication operation. The partial product of the matrix multiplication operation is accumulated with other partial products of the matrix multiplication operation.

Observations on early and delayed colostomy closure.

PubMed

Tade, A O; Salami, B A; Ayoade, B A

2011-06-01

Traditional treatment of a variety of colorectal pathologies had included a diverting colostomy that was closed eight or more weeks later during a readmission. The aim of this retrospective study was to determine the outcomes of early colostomy closure and delayed colostomy closure in patients with temporary colostomies following traumatic and non-traumatic colorectal pathologies. In this study early colostomy closure was the closure of a colostomy within three weeks of its construction, while delayed colostomy closure referred to closure after 3 weeks. Complete records of the 37 adult patients who had temporary colostomy constructed and closed between Jan. 1997 December 2003 for various colorectal pathologies were studied. Fourteen patients had early colostomy closure while 23 had delayed closure. In the early colostomy closure group there were 10 men and 4 women. The mean age of the patients was 28yr with a range of 18-65yr. Colostomies were closed 9-18 days after initial colostomy construction. There was no mortality. Morbidity rate 28.6% (4 out of 14). There were two faecal fistulas (14.3%). Twenty-three patients had delayed colostomy closure 8 weeks to 18 months after initial colostomy construction. These were patients unfit for early surgery after initial colostomy construction because of carcinoma, significant weight loss, or sepsis. There was no mortality. Morbidity rate was 26.1%. There were 3 faecal fistulas (13.2%). Outcomes following early colostomy closure and delayed closure were comparable. Patients fit for surgery should have early closure whilst patients who may have compromised health should have delayed closure.

RCRA, superfund and EPCRA hotline training module. Introduction to: Closure/post-closure (40 cfr parts 264/265, subpart g) updated July 1996

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

NONE

1996-07-01

The module explains the difference between closure and post-closure. It lists the types of facilities that are subject to closure/post-closures and defines the difference between partial and final closure. It specifies who submits a closure plan and when a closure plan must be submitted, lists the steps in the process, and states the time frame for submittal. It identifies when and how a closure must be amended. It explains the time frame for notification of closure and the deadlines for beginning and completing closure. It specifies which facilities need contingent post-closure plans and lists and the elements of post-closure andmore » cites the requirements. It specifies the conditions and timing for amending a post-closure plan and states who must certify closure/post-closure.« less

Five-year operational trial of verbenone to deter mountain pine beetle (Dendroctonus ponderosae); Coleoptera: Scolytidae) attack of lodgepole pine (Pinus contorta).

Treesearch

R.A. Progar

2005-01-01

The antiaggregation pheromone verbenone was operationally tested for 5 yr to deter mass attack by the mountain pine beetle on lodgepole pine in campgrounds and administrative areas surrounding Redfish and Little Redfish Lakes at the Sawtooth National Recreation Area in central Idaho. Each year, five-gram verbenone pouches were evenly distributed (-10 m apart) within...

Comparing pre-operative stereotactic radiosurgery (SRS) to post-operative whole brain radiation therapy (WBRT) for resectable brain metastases: a multi-institutional analysis.

PubMed

Patel, Kirtesh R; Burri, Stuart H; Boselli, Danielle; Symanowski, James T; Asher, Anthony L; Sumrall, Ashley; Fraser, Robert W; Press, Robert H; Zhong, Jim; Cassidy, Richard J; Olson, Jeffrey J; Curran, Walter J; Shu, Hui-Kuo G; Crocker, Ian R; Prabhu, Roshan S

2017-02-01

Pre-operative stereotactic radiosurgery (pre-SRS) has been shown as a viable treatment option for resectable brain metastases (BM). The aim of this study is to compare oncologic outcomes and toxicities for pre-SRS and post-operative WBRT (post-WBRT) for resectable BM. We reviewed records of consecutive patients who underwent resection of BM and either pre-SRS or post-WBRT between 2005 and 2013 at two institutions. Overall survival (OS) was calculated using the Kaplan-Meier method. Cumulative incidence was used for intracranial outcomes. Multivariate analysis (MVA) was performed using the Cox and Fine and Gray models, respectively. Overall, 102 patients underwent surgical resection of BM; 66 patients with 71 lesions received pre-SRS while 36 patients with 42 cavities received post-WBRT. Baseline characteristics were similar except for the pre-SRS cohort having more single lesions (65.2% vs. 38.9%, p = 0.001) and smaller median lesion volume (8.3 cc vs. 15.3 cc, p = 0.006). 1-year OS was similar between cohorts (58% vs. 56%, respectively) (p = 0.43). Intracranial outcomes were also similar (2-year outcomes, pre-SRS vs. post-WBRT): local recurrence: 24.5% vs. 25% (p = 0.81), distant brain failure (DBF): 53.2% vs. 45% (p = 0.66), and leptomeningeal disease (LMD) recurrence: 3.5% vs. 9.0% (p = 0.66). On MVA, radiation cohort was not independently associated with OS or any intracranial outcome. Crude rates of symptomatic radiation necrosis were 5.6 and 0%, respectively. OS and intracranial outcomes were similar for patients treated with pre-SRS or post-WBRT for resected BM. Pre-SRS is a viable alternative to post-WBRT for resected BM. Further confirmatory studies with neuro-cognitive outcomes comparing these two treatment paradigms are needed.

Time to first take-back operation predicts successful primary fascial closure in patients undergoing damage control laparotomy.

PubMed

Pommerening, Matthew J; DuBose, Joseph J; Zielinski, Martin D; Phelan, Herb A; Scalea, Thomas M; Inaba, Kenji; Velmahos, George C; Whelan, James F; Wade, Charles E; Holcomb, John B; Cotton, Bryan A

2014-08-01

Failure to achieve primary fascial closure (PFC) after damage control laparotomy is costly and carries great morbidity. We hypothesized that time from the initial laparotomy to the first take-back operation would be predictive of successful PFC. Trauma patients managed with open abdominal techniques after damage control laparotomy were prospectively followed at 14 Level 1 trauma centers during a 2-year period. Time to the first take-back was evaluated as a predictor of PFC using hierarchical multivariate logistic regression analysis. A total of 499 patients underwent damage control laparotomy and were included in this analysis. PFC was achieved in 327 (65.5%) patients. Median time to the first take-back operation was 36 hours (interquartile range 24-48). After we adjusted for patient demographics, resuscitation volumes, and operative characteristics, increasing time to the first take-back was associated with a decreased likelihood of PFC. Specifically, each hour delay in return to the operating room (24 hours after initial laparotomy) was associated with a 1.1% decrease in the odds of PFC (odds ratio 0.989; 95% confidence interval 0.978-0.999; P = .045). In addition, there was a trend towards increased intra-abdominal complications in patients returning after 48 hours (odds ratio 1.80; 95% confidence interval 1.00-3.25; P = .05). Data from this prospective, multicenter study demonstrate that delays in returning to the operating room after damage control laparotomy are associated with reductions in PFC. These findings suggest that emphasis should be placed on returning to the operating room within 24 hours after the initial laparotomy if possible (and no later than 48 hours). Copyright © 2014 Mosby, Inc. All rights reserved.

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

PubMed

Nightingale, C; Jones, S P

2003-09-01

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

Early decision-analytic modeling - a case study on vascular closure devices.

PubMed

Brandes, Alina; Sinner, Moritz F; Kääb, Stefan; Rogowski, Wolf H

2015-10-27

As economic considerations become more important in healthcare reimbursement, decisions about the further development of medical innovations need to take into account not only medical need and potential clinical effectiveness, but also cost-effectiveness. Already early in the innovation process economic evaluations can support decisions on development in specific indications or patient groups by anticipating future reimbursement and implementation decisions. One potential concept for early assessment is value-based pricing. The objective is to assess the feasibility of value-based pricing and product design for a hypothetical vascular closure device in the pre-clinical stage which aims at decreasing bleeding events. A deterministic decision-analytic model was developed to estimate the cost-effectiveness of established vascular closure devices from the perspective of the Statutory Health Insurance system. To identify early benchmarks for pricing and product design, three strategies of determining the product's value are explored: 1) savings from complications avoided by the new device; 2) valuation of the avoided complications based on an assumed willingness-to-pay-threshold (the efficiency frontier approach); 3) value associated with modifying the care pathways within which the device would be applied. Use of established vascular closure devices is dominated by manual compression. The hypothetical vascular closure device reduces overall complication rates at higher costs than manual compression. Maximum cost savings of only about €4 per catheterization could be realized by applying the hypothetical device. Extrapolation of an efficiency frontier is only possible for one subgroup where vascular closure devices are not a dominated strategy. Modifying care in terms of same-day discharge of patients treated with vascular closure devices could result in cost savings of €400-600 per catheterization. It was partially feasible to calculate value-based prices for the

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

PubMed

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

2007-07-01

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

Pre-operative renal volume predicts peak creatinine after congenital heart surgery in neonates.

PubMed

Carmody, J Bryan; Seckeler, Michael D; Ballengee, Cortney R; Conaway, Mark; Jayakumar, K Anitha; Charlton, Jennifer R

2014-10-01

Acute kidney injury is common in neonates following surgery for congenital heart disease. We conducted a retrospective analysis to determine whether neonates with smaller pre-operative renal volume were more likely to develop post-operative acute kidney injury. We conducted a retrospective review of 72 neonates who underwent congenital heart surgery for any lesion other than patent ductus arteriosus at our institution from January 2007 to December 2011. Renal volume was calculated by ultrasound using the prolate ellipsoid formula. The presence and severity of post-operative acute kidney injury was determined both by measuring the peak serum creatinine in the first 7 days post-operatively and by using the Acute Kidney Injury Network scoring system. Using a linear change point model, a threshold renal volume of 17 cm³ was identified. Below this threshold, there was an inverse linear relationship between renal volume and peak post-operative creatinine for all patients (p = 0.036) and the subgroup with a single morphologic right ventricle (p = 0.046). There was a non-significant trend towards more acute kidney injury using Acute Kidney Injury Network criteria in all neonates with renal volume ≤17 cm³ (p = 0.11) and in the subgroup with a single morphologic right ventricle (p = 0.17). Pre-operative renal volume ≤17 cm³ is associated with a higher peak post-operative creatinine and potentially greater risk for post-operative acute kidney injury for neonates undergoing congenital heart surgery. Neonates with a single right ventricle may be at higher risk.

Final closure of a low level waste disposal facility

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

Potier, J.M.

1995-12-31

The low-level radioactive waste disposal facility operated by the Agence Nationale pour la Gestion des Dechets Radioactifs near La Hague, France was opened in 1969 and is scheduled for final closure in 1996. The last waste package was received in June 1994. The total volume of disposed waste is approximately 525,000 m{sup 3}. The site closure consists of covering the disposal structures with a multi-layer impervious cap system to prevent rainwater from infiltrating the waste isolation system. A monitoring system has been set up to verify the compliance of infiltration rates with hydraulic performance objectives (less than 10 liters permore » square meter and per year).« less

Closure Plan for the Area 5 Radioactive Waste Management Site at the Nevada Test Site

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

NSTec Environmental Management

The Area 5 Radioactive Waste Management Site (RMWS) at the Nevada Test Site (NTS) is managed and operated by National Security Technologies, LLC (NSTec), for the U.S. Department of Energy (DOE), National Nuclear Security Administration Nevada Site Office (NNSA/NSO). This document is the first update of the preliminary closure plan for the Area 5 RWMS at the NTS that was presented in the Integrated Closure and Monitoring Plan (DOE, 2005a). The major updates to the plan include a new closure schedule, updated closure inventory, updated site and facility characterization data, the Title II engineering cover design, and the closure processmore » for the 92-Acre Area of the RWMS. The format and content of this site-specific plan follows the Format and Content Guide for U.S. Department of Energy Low-Level Waste Disposal Facility Closure Plans (DOE, 1999a). This interim closure plan meets closure and post-closure monitoring requirements of the order DOE O 435.1, manual DOE M 435.1-1, Title 40 Code of Federal Regulations (CFR) Part 191, 40 CFR 265, Nevada Administrative Code (NAC) 444.743, and Resource Conservation and Recovery Act (RCRA) requirements as incorporated into NAC 444.8632. The Area 5 RWMS accepts primarily packaged low-level waste (LLW), low-level mixed waste (LLMW), and asbestiform low-level waste (ALLW) for disposal in excavated disposal cells.« less

Full closure strategic analysis.

DOT National Transportation Integrated Search

2014-07-01

The full closure strategic analysis was conducted to create a decision process whereby full roadway : closures for construction and maintenance activities can be evaluated and approved or denied by CDOT : Traffic personnel. The study reviewed current...

Crack closure, a literature study

NASA Astrophysics Data System (ADS)

Holmgren, M.

1993-08-01

In this report crack closure is treated. The state of the art is reviewed. Different empirical formulas for determining the crack closure are compared with each other, and their benefits are discussed. Experimental techniques for determining the crack closure stress are discussed, and some results from fatigue tests are also reported. Experimental data from the literature are reported.

Evaluation of circumferential angle closure using iridotrabecular contact index after laser iridotomy by swept-source optical coherence tomography.

PubMed

Cho, Hyun-Kyung; Ahn, Dongsub; Kee, Changwon

2017-05-01

To investigate the quantitative changes of circumferential angle closure after laser iridotomy (LI) using the iridotrabecular contact (ITC) index by Swept-Source optical coherence tomography (OCT). In this prospective observational study conducted in a hospital setting, 42 eyes of 36 patients (five males, 31 females) who underwent LI were included. The mean age was 65.00 ± 8.13 years old and the diagnosis included primary angle closure (PAC, 21 eyes), PAC suspect (16 eyes) and PAC glaucoma (five eyes). Optical coherence tomography (OCT) images were obtained pre-LI and at 1 week post-LI. In each image frame, the scleral spur (SS) and the ITC end-point were marked, from which the ITC index was calculated as a percentage of the angle closure across 360°. Measurements inspected before and after LI included: central anterior chamber depth (ACD), anterior chamber volume (ACV), lens vault (LV), nasal and temporal angle opening distance (AOD), angle recess area (ARA), trabecular-iris space area (TISA), trabecular-iris angle (TIA) at 500 μm and 750 μm from the SS and intraocular pressure (IOP). The ITC index and IOP decreased significantly after LI from 71.52 ± 26.29 to 35.31 ± 27.19 and from 20.64 ± 12.72 mmHg to 14.02 ± 3.49 mmHg, respectively (p < 0.001 and p < 0.001). Central ACD (1.94 ± 0.31 mm pre-LI) and LV (1.13 ± 0.32 mm pre-LI) did not show a significant change after LI (all p > 0.05), but ACV increased significantly after LI (p < 0.001). Most of the angle parameters except for nasal TIAs increased significantly after LI (all p < 0.05). The ITC index from patients with shallow anterior chamber angle showed a significant decrease after LI, but part of the angle closure was not relieved after LI. Other mechanisms besides pupillary block may play a role together in causing angle closure. © 2016 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

27 CFR 26.136 - Affixing closures.

Code of Federal Regulations, 2012 CFR

2012-04-01

... OF THE TREASURY LIQUORS LIQUORS AND ARTICLES FROM PUERTO RICO AND THE VIRGIN ISLANDS Closures for Distilled Spirits From Puerto Rico § 26.136 Affixing closures. Closures or other devices shall be securely...

27 CFR 26.136 - Affixing closures.

Code of Federal Regulations, 2013 CFR

2013-04-01

... OF THE TREASURY ALCOHOL LIQUORS AND ARTICLES FROM PUERTO RICO AND THE VIRGIN ISLANDS Closures for Distilled Spirits From Puerto Rico § 26.136 Affixing closures. Closures or other devices shall be securely...

27 CFR 26.136 - Affixing closures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... OF THE TREASURY LIQUORS LIQUORS AND ARTICLES FROM PUERTO RICO AND THE VIRGIN ISLANDS Closures for Distilled Spirits From Puerto Rico § 26.136 Affixing closures. Closures or other devices shall be securely...

27 CFR 26.136 - Affixing closures.

Code of Federal Regulations, 2014 CFR

2014-04-01

... OF THE TREASURY ALCOHOL LIQUORS AND ARTICLES FROM PUERTO RICO AND THE VIRGIN ISLANDS Closures for Distilled Spirits From Puerto Rico § 26.136 Affixing closures. Closures or other devices shall be securely...

27 CFR 26.136 - Affixing closures.

Code of Federal Regulations, 2011 CFR

2011-04-01

... OF THE TREASURY LIQUORS LIQUORS AND ARTICLES FROM PUERTO RICO AND THE VIRGIN ISLANDS Closures for Distilled Spirits From Puerto Rico § 26.136 Affixing closures. Closures or other devices shall be securely...

System for closure of a physical anomaly

DOEpatents

Bearinger, Jane P; Maitland, Duncan J; Schumann, Daniel L; Wilson, Thomas S

2014-11-11

Systems for closure of a physical anomaly. Closure is accomplished by a closure body with an exterior surface. The exterior surface contacts the opening of the anomaly and closes the anomaly. The closure body has a primary shape for closing the anomaly and a secondary shape for being positioned in the physical anomaly. The closure body preferably comprises a shape memory polymer.

40 CFR 265.112 - Closure plan; amendment of plan.

Code of Federal Regulations, 2013 CFR

2013-07-01

... (CONTINUED) INTERIM STATUS STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND.... By May 19, 1981, or by six months after the effective date of the rule that first subjects a facility... description of other activities necessary during the partial and final closure periods to ensure that all...

Achieving and documenting closure in plant growth facilities

NASA Technical Reports Server (NTRS)

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

1992-01-01

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

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

PubMed

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

2018-05-30

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

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

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

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

1990-09-01

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

ROCKET PORT CLOSURE

DOEpatents

Mattingly, J.T.

1963-02-12

This invention provides a simple pressure-actuated closure whereby windowless observation ports are opened to the atmosphere at preselected altitudes. The closure comprises a disk which seals a windowless observation port in rocket hull. An evacuated instrument compartment is affixed to the rocket hull adjacent the inner surface of the disk, while the outer disk surface is exposed to the atmosphere through which the rocket is traveling. The pressure differential between the evacuated instrument compartment and the relatively high pressure external atmosphere forces the disk against the edge of the observation port, thereby effecting a tight seai. The instrument compartment is evacuated to a pressure equal to the atmospheric pressure existing at the altitude at which it is desiretl that the closure should open. When the rocket reaches this preselected altitude, the inwardly directed atmospheric force on the disk is just equaled by the residual air pressure force within the instrument compartment. Consequently, the closure disk falls away and uncovers the open observation port. The separation of the disk from the rocket hull actuates a switch which energizes the mechanism of a detecting instrument disposed within the instrument compartment. (AE C)

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

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

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

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

Doing Pre-operative Investigations in Emergency Department; a Clinical Audit.

PubMed

Rafiq, Muhammad Salman; Rafiq, Maria; Rafiq, Muhammad Imran; Salman, Seema Gul; Hafeez, Sania

2017-01-01

Pre-operative investigations for emergency surgical patients differ between centers. Following established guidelines can reduce unnecessary investigation, cost of treatment and hospital stay. The present audit was carried out to evaluate the condition of doing pre-operative investigations for three common surgical emergencies compared to National Institute for Health and Care Excellence (NICE) guidelines and local criteria. A retrospective clinical audit of acute-appendicitis, abscess and hernia patients admitted to the emergency department was carried out over a one-year period from July 2014 to July 2015. Data of laboratory investigations, their indication, cost and duration of hospital stay was collected and compared with NICE-guidelines. A total of 201 patients were admitted to the emergency department during the audit period. These included 77(38.3%) cases of acute-appendicitis, 112 (55.7%) cases of abscesses, and 12 (6%) cases of hernia. Investigations not indicated by NICE-guidelines included 42 (20.9%) full blood counts, 29 (14.4%) random blood sugars, 26 (12.9%) urea tests, 4 (2%) chest x-rays, 13 (6.5%) electrocardiographs, and 58 (28.9%) urine analyses. These cost 25,675 Rupees (245.46 Dollars) in unnecessary investigation costs and 65.7 days of additional hospital stay. Unnecessary investigations for emergency surgical patients can be reduced by following NICE-guidelines. This will reduce workload on emergency services, treatment costs and the length of hospital stay.

Hurricane Mountain Formation melange: history of Cambro-Ordovician accretion of the Boundary Mountains terrane within the northern Appalachian orthotectonic zone

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

Boone, G.M.; Boudette, E.L.

1985-01-01

The Hurricane Mountain Formation (HMF) melange and associated ophiolitic and volcanogenic formations of Cambrian and lowermost Ordovician age bound the SE margin of the Precambrian Y (Helikian) Chain Lakes Massif in western Maine. HMF melange matrix, though weakly metamorphosed, contains a wide variety of exotic greenschist to amphibolite facies blocks as components of its polymictic assemblage, but blocks of high-grade cratonal rocks such as those of Chain Lakes or Grenville affinity are lacking. Formations of melange exposed in structural culminations of Cambrian and Ordovician rocks NE of the HMF in Maine and in the Fournier Group in New Brunswick aremore » lithologically similar and probably tectonically correlative with the HMF; taken together, they may delineate a common pre-Middle Ordovician tectonic boundary. The authors infer that the Hurricane Mountain and St. Daniel melange belts define the SE and NW margins of the Boundary Mountains accreted terrane (BMT), which may consist of cratonal basement of Chain Lakes affinity extending from eastern Gaspe (deBroucker and St. Julien, 1985) to north-central New Hampshire. The Laurentian continental margin, underlain by Grenville basement, underplated the NW margin of this terrane, marked by the SDF suture zone, in late Cambrian to early Ordovician time, while terranes marked by Cambrian to Tremadocian (.) lithologies dissimilar to the Boundary Mountains terrane were accreted to its outboard margin penecontemporaneously. The docking of the Boundary Mountains terrane and the initiation of its peripheral melanges are equated to the Penobscottian disturbance.« less

Short-term high-altitude pre-exposure improves neurobehavioral ability

PubMed Central

Guo, Wenyun; Chen, Guozhu; Qin, Jun; Zhang, Jihang; Guo, Xubin; Yu, Jie; Song, Pan; Lu, Wei; Xu, Baida; Li, Jiabei; Ding, Xiaohan

2016-01-01

This study aims to evaluate the effect of the duration of high-altitude (HA) pre-exposure on human neurobehavioral parameters including mood states and cognitive performance at HA. One hundred and eleven healthy individuals (ranging in age from 18 to 35 years) were recruited to participate in this study. They were divided into two groups: a 4-day short-term HA pre-exposure group (n=57) and a 3-month long-term HA pre-exposure group (n=54). All participants lived in the area at 400 m altitude above sea level before pre-exposure to HA. They were then transported to 3700 m plateau for either a 4-day or a 3-month HA pre-exposure, and finally delivered to 4400 m plateau. On the last day of pre-exposure at 3700 m and on the 10th day at 4400 m, neurobehavioral parameters of the participants in the two groups were evaluated. At the end of pre-exposure and on the 10th day of HA exposure, participants in the short-term group had significantly lower negative mood states, better cognitive performance with higher sensorimotor, attention, and psychomotor abilities, and less acute mountain sickness in comparison with the participants in the long-term pre-exposure group. Our field study with large samples showed that in comparison with 3-month long-term pre-exposure, 4-day short-term HA pre-exposure at 3700 m has a better effect in improving human neurobehavioral parameters including mood states and cognitive performance and reducing acute mountain sickness when exposed to a HA at 4400 m. PMID:26966781

77 FR 22608 - Notice of Intent To Prepare an Environmental Impact Statement for the Proposed Bald Mountain Mine...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-16

... normal business hours. SUPPLEMENTARY INFORMATION: Bald Mountain Mine (BMM), owned by Barrick Gold US Inc... Statement for the Proposed Bald Mountain Mine North and South Operations Area Projects, White Pine County.... ADDRESSES: You may submit comments related to the Bald Mountain Mine North and South Operations Area...

The Granite Mountain Atmospheric Sciences Testbed (GMAST): A Facility for Long Term Complex Terrain Airflow Studies

NASA Astrophysics Data System (ADS)

Zajic, D.; Pace, J. C.; Whiteman, C. D.; Hoch, S.

2011-12-01

This presentation describes a new facility at Dugway Proving Ground (DPG), Utah that can be used to study airflow over complex terrain, and to evaluate how airflow over a mountain barrier affects wind patterns over adjacent flatter terrain. DPG's primary mission is to conduct testing, training, and operational assessments of chemical and biological weapon systems. These operations require very precise weather forecasts. Most test operations at DPG are conducted on fairly flat test ranges having uniform surface cover, where airflow patterns are generally well-understood. However, the DPG test ranges are located alongside large, isolated mountains, most notably Granite Mountain, Camelback Mountain, and the Cedar Mountains. Airflows generated over, or influenced by, these mountains can affect wind patterns on the test ranges. The new facility, the Granite Mountain Atmospheric Sciences Testbed, or GMAST, is designed to facilitate studies of airflow interactions with topography. This facility will benefit DPG by improving understanding of how mountain airflows interact with the test range conditions. A core infrastructure of weather sensors around and on Granite Mountain has been developed including instrumented towers and remote sensors, along with automated data collection and archival systems. GMAST is expected to be in operation for a number of years and will provide a reference domain for mountain meteorology studies, with data useful for analysts, modelers and theoreticians. Visiting scientists are encouraged to collaborate with DPG personnel to utilize this valuable scientific resource and to add further equipment and scientific designs for both short-term and long-term atmospheric studies. Several of the upcoming MATERHORN (MountAin TERrain atmospHeric mOdeling and obseRvatioNs) project field tests will be conducted at DPG, giving an example of GMAST utilization and collaboration between DPG and visiting scientists.

Angle closure in younger patients.

PubMed Central

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

2002-01-01

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

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

PubMed

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

2005-09-01

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

40 CFR 146.73 - Financial responsibility for post-closure care.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 24 2012-07-01 2012-07-01 false Financial responsibility for post... Standards Applicable to Class I Hazardous Waste Injection Wells § 146.73 Financial responsibility for post-closure care. The owner or operator shall demonstrate and maintain financial responsibility for post...

40 CFR 146.73 - Financial responsibility for post-closure care.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 24 2013-07-01 2013-07-01 false Financial responsibility for post... Standards Applicable to Class I Hazardous Waste Injection Wells § 146.73 Financial responsibility for post-closure care. The owner or operator shall demonstrate and maintain financial responsibility for post...

40 CFR 146.73 - Financial responsibility for post-closure care.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Financial responsibility for post... Standards Applicable to Class I Hazardous Waste Injection Wells § 146.73 Financial responsibility for post-closure care. The owner or operator shall demonstrate and maintain financial responsibility for post...

Liver Resections Combined with Closure of Loop Ileostomies: A Retrospective Analysis

PubMed Central

Lordan, Jeffrey T.; Riga, Angela T.; Karanjia, Nariman D.

2008-01-01

Background. The management of patients with colorectal liver metastases and loop ileostomies remains controversial. This study was performed to assess the outcome of combined liver resection and loop ileostomy closure. Methods. Analysis of prospectively collected perioperative data, including morbidity and mortality, of 283 consecutive hepatectomies for colorectal liver metastases was undertaken. Consecutive liver resections were performed from 1996 to 2006 in one centre by a single surgeon (NDK). Fourteen of these patients had combined liver resection and ileostomy closure. Case-matched analysis was undertaken. Results. Six (2.2%) patients died in the hepatectomy only group and none died in the combined group. There was no difference in operative blood loss between the two groups (0.09). Perioperative morbidity was 36% in the combined group and 23% in the hepatectomy alone group (P = 0.33). Mean hospital stay was 14 days in the combined group and 11 days in the hepatectomy only group (P = 0.046). Case-matched analysis showed a significant increase in hospital stay (P = 0.03) and complications (P = 0.049) in the combined group. Conclusion. In patients with CRLM, combined liver resection and closure of ileostomy may be associated with a higher operative morbidity and a prolonged hospital stay. PMID:19096524

Occupancy estimation and the closure assumption

USGS Publications Warehouse

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

2009-01-01

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

3718-F Alkali Metal Treatment and Storage Facility Closure Plan. Revision 1

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

None

The Hanford Site, located northwest of the city of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials, as well as for activities associated with nuclear energy development. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. The 3718-F Alkali Metal Treatment and Storage Facility (3718-F Facility), located in the 300 Area, was used to store and treat alkali metal wastes. Therefore, it is subject to the regulatory requirements for the storage and treatment of dangerous wastes. Closure will be conducted pursuant tomore » the requirements of the Washington Administrative Code (WAC) 173-303-610 (Ecology 1989) and 40 CFR 270.1. Closure also will satisfy the thermal treatment facility closure requirements of 40 CFR 265.381. This closure plan presents a description of the 3718-F Facility, the history of wastes managed, and the approach that will be followed to close the facility. Only hazardous constituents derived from 3718-F Facility operations will be addressed.« less

Impact of pre-operative body mass index in head and neck cancer patients undergoing microvascular reconstruction.

PubMed

Hyun, D-J; Joo, Y-H; Kim, M-S

2017-11-01

To analyse the relationship of pre-operative body mass index with surgical complications and oncological outcomes in patients undergoing microvascular reconstruction for head and neck squamous cell cancer. A retrospective review was conducted of 259 patients who underwent microvascular free flap reconstruction after head and neck ablative surgery. Mean body mass index was 22.48 kg/m2. There were no correlations between body mass index and: flap failure (p = 0.739), flap ischaemia (p = 0.644), pharyngocutaneous fistula (p = 0.141) or wound infection (p = 0.224). The five-year disease-specific survival rate was 63 per cent. On univariate analysis, the five-year disease-specific survival rate was significantly correlated with pre-operative body mass index, based on Kaplan-Meier survival curves (p = 0.028). The five-year disease-specific survival rates in underweight, normal weight, overweight and obese groups were 47 per cent, 55 per cent, 65 per cent and 80 per cent, respectively. Pre-operative body mass index was a useful predictor for recurrence and survival in patients who underwent microvascular reconstruction for head and neck squamous cell cancer.

Does pre-operative breast magnetic resonance imaging in addition to mammography and breast ultrasonography change the operative management of breast carcinoma?

PubMed

Lim, Hye In; Choi, Jae Hyuck; Yang, Jung-Hyun; Han, Boo-Kyung; Lee, Jeong Eon; Lee, Se-Kyung; Kim, Wan Wook; Kim, Sangmin; Kim, Jee Soo; Kim, Jung-Han; Choe, Jun-Ho; Cho, Eun Yoon; Kang, Seok Seon; Shin, Jung Hee; Ko, Eun Young; Kim, Sang Wook; Nam, Seok Jin

2010-01-01

Magnetic resonance imaging (MRI) has been used for the local staging of breast cancer, especially to determine the extent of multiple lesions and to identify occult malignancies. The aim of this study was to evaluate the effect of pre-operative MRI on the surgical treatment of breast cancer. Between January 2006 and May 2007, 535 newly diagnosed breast cancer patients who planned to undergo breast conserving surgery had clinical examinations, bilateral mammography, breast ultrasonography, and breast MRI. The radiologic findings and clinicopathologic data were reviewed retrospectively. Ninety-eight (18.3%) patients had additional lesions, shown as suspicious lesions on breast MRI, but not detected with conventional methods. Eighty-four (15.7%) of these patients had a change in surgical treatment plans based on the MRI results. Forty-seven (8.8%) of the 84 patients had additional malignancies;the other 37 patients (6.9%) had benign lesions. The positive predictive value for MRI-based surgery was 56.0% (47 of 84 patients). During the period of study, the use of pre-operative MRI was increased with time (OR 1.20; 95% CI 1.16-1.23; P < 0.001), but the mastectomy rate did not change significantly (OR 0.98; 95% CI 0.95-1.00; P = 0.059). Multiple factors were analyzed to identify the patients more likely to undergo appropriate and complete surgery based on the additional findings of the pre-operative MRI, but the results were not statistically significant. This research suggests that a pre-operative MRI can potentially lower the rate of incompletely excised malignancies by identifying additional occult cancer prior to surgery and does not lead to an increase in the mastectomy rate; however, because some benign lesions are indistinguishable from suspicious or malignant lesions, excessive surgical procedures are unnecessarily performed in a significant portion of patients. In the future, the criteria for the use of MRI in local staging of breast cancer should be established.

The physiology of mountain biking.

PubMed

Impellizzeri, Franco M; Marcora, Samuele M

2007-01-01

Mountain biking is a popular outdoor recreational activity and an Olympic sport. Cross-country circuit races have a winning time of approximately equal 120 minutes and are performed at an average heart rate close to 90% of the maximum, corresponding to 84% of maximum oxygen uptake (VO2max). More than 80% of race time is spent above the lactate threshold. This very high exercise intensity is related to the fast starting phase of the race; the several climbs, forcing off-road cyclists to expend most of their effort going against gravity; greater rolling resistance; and the isometric contractions of arm and leg muscles necessary for bike handling and stabilisation. Because of the high power output (up to 500W) required during steep climbing and at the start of the race, anaerobic energy metabolism is also likely to be a factor of off-road cycling and deserves further investigation. Mountain bikers' physiological characteristics indicate that aerobic power (VO2max >70 mL/kg/min) and the ability to sustain high work rates for prolonged periods of time are prerequisites for competing at a high level in off-road cycling events. The anthropometric characteristics of mountain bikers are similar to climbers and all-terrain road cyclists. Various parameters of aerobic fitness are correlated to cross-country performance, suggesting that these tests are valid for the physiological assessment of competitive mountain bikers, especially when normalised to body mass. Factors other than aerobic power and capacity might influence off-road cycling performance and require further investigation. These include off-road cycling economy, anaerobic power and capacity, technical ability and pre-exercise nutritional strategies.

Floods in mountain environments: A synthesis

NASA Astrophysics Data System (ADS)

Stoffel, Markus; Wyżga, Bartłomiej; Marston, Richard A.

2016-11-01

Floods are a crucial agent of geomorphic change in the channels and valley floors of mountains watercourses. At the same time, they can be highly damaging to property, infrastructure, and life. Because of their high energy, mountain watercourses are highly vulnerable to environmental changes affecting their catchments and channels. Many factors have modified and frequently still tend to modify the environmental conditions in mountain areas, with impacts on geomorphic processes and the frequency, magnitude, and timing of floods in mountain watercourses. The ongoing climate changes vary between regions but may affect floods in mountain areas in many ways. In many mountain regions of Europe, widespread afforestation took place over the twentieth century, considerably increasing the amounts of large wood delivered to the channels and the likelihood of jamming bridges. At the same time, deforestation continues in other mountain areas, accelerating runoff and amplifying the magnitude and frequency of floods in foreland areas. In many countries, in-channel gravel mining has been a common practice during recent decades; the resultant deficit of bed material in the affected channels may suddenly manifest during flood events, resulting in the failure of scoured bridges or catastrophic channel widening. During the past century many rivers in mountain and foreland areas incised deeply; the resultant loss of floodplain water storage has decreased attenuation of flood waves, hence increasing flood hazard to downstream river reaches. On the other hand, a large amount of recent river restoration activities worldwide may provide examples of beneficial changes to flood risk, attained as a result of increased channel storage or reestablished floodplain water storage. Relations between geomorphic processes and floods operate in both directions, which means that changes in flood probability or the character of floods (e.g., increased wood load) may significantly modify the morphology

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

PubMed

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

2015-02-01

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

Boundary Closures for Fourth-order Energy Stable Weighted Essentially Non-Oscillatory Finite Difference Schemes

NASA Technical Reports Server (NTRS)

Fisher, Travis C.; Carpenter, Mark H.; Yamaleev, Nail K.; Frankel, Steven H.

2009-01-01

A general strategy exists for constructing Energy Stable Weighted Essentially Non Oscillatory (ESWENO) finite difference schemes up to eighth-order on periodic domains. These ESWENO schemes satisfy an energy norm stability proof for both continuous and discontinuous solutions of systems of linear hyperbolic equations. Herein, boundary closures are developed for the fourth-order ESWENO scheme that maintain wherever possible the WENO stencil biasing properties, while satisfying the summation-by-parts (SBP) operator convention, thereby ensuring stability in an L2 norm. Second-order, and third-order boundary closures are developed that achieve stability in diagonal and block norms, respectively. The global accuracy for the second-order closures is three, and for the third-order closures is four. A novel set of non-uniform flux interpolation points is necessary near the boundaries to simultaneously achieve 1) accuracy, 2) the SBP convention, and 3) WENO stencil biasing mechanics.

Associations between pre-operative radiographic changes and outcomes after total knee joint replacement for osteoarthritis.

PubMed

Dowsey, M M; Nikpour, M; Dieppe, P; Choong, P F M

2012-10-01

To assess the influence of pre-operative X-ray changes on the response to total knee joint replacement (TKR). We included patients from one centre who underwent primary TKR (n = 478) for osteoarthritis in 2006 and 2007. The International Knee Society score (IKSS) and short form health survey were collected pre-operatively and at 1 and 2 years after surgery. Pre-operative radiographs were read to assess Kellgren and Lawrence (K-L) grading, individual radiographic features using the OARSI atlas, and subchondral bone attrition using the Ahlbach method. The main independent variable was a modified (K-L) grade. The outcome variables were the IKSS pain and function scores. Covariates included demographic features, co-morbidities, baseline pain and function, prosthesis type, and the use of patella resurfacing. Multivariable linear regression models were created to assess the relationships between pre-operative X-ray findings and pain and function outcomes. On average, pain and function improved greatly following surgery. However, pain relief was unsatisfactory in about 30%, and functional improvement suboptimal in about 50%. OR (95% CI) for ongoing moderate-severe pain at 12 months for modified K-L grades; <3: 5.39 (1.23-15.69), 3a: 2.62 (1.21-5.67), 3b: 1.81 (1.00-3.26), 4a: 2.06 (1.05-4.05) when compared to 4b. OR (95% CI) for poor function at 12 months were; 3a: 2.81 (1.23-6.39) and 4a: 2.45 (1.22-4.91), when compared to 4b. Patients with more severe radiographic knee damage at the time of surgery are most likely to have substantial gains in terms of both pain relief and improved function as a result of a TKR. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Middle Miocene Displacement Along the Rand Detachment Fault, Rand Mountains

NASA Astrophysics Data System (ADS)

Shulaker, D. Z.; Grove, M. J.

2015-12-01

Laramide flat-slab subduction extinguished Sierra Nevada pluton emplacement in southern California by ca. 85 Ma as trench-derived sediments were underthrust and accreted beneath arc basement. These relationships are well illustrated in the Rand Mountains, situated just south of the Garlock fault in the northwestern Mojave Desert. Here, accreted rocks within the Rand Mountains are referred to as Rand Schist. The Rand Detachment fault juxtaposes Rand Schist beneath 87 Ma Sierran granitoids. New zircon (U-Th)/He age results from schist and basement juxtaposed across the Rand Detachment fault are 15 ± 3 Ma and 30 ± 5 Ma, respectively. When considered within the context of previously reported thermochronology from the Rand Mountains, our data shows that the Rand Detachment fault in the Rand Mountains is a middle Miocene fault that facilitated extension of the northwest Mojave Desert. This timing is in temporal and spatial agreement with regional extension throughout the Mojave triggered by northern migration of the slab window after collision of the Mendocino Triple Junction with the southern California margin. Further evidence of slab-window-related magmatism in the easternmost Rand Mountains is provided by the 19 Ma Yellow Aster pluton and 19 Ma rhyolite porphyry. It is possible that Miocene extension re-activated an older structure within the Rand Mountains. For example, a similar low-angle fault juxtaposing schist and basement present in the San Emigdio Mountains is believed to have accommodated large scale Late Cretaceous displacement, exhuming Rand Schist and overlying deepest Sierran basement to shallow crustal levels by 77 Ma [1]. However, 68-72 Ma phengite cooling ages and other thermochronology from the Rand Mountains indicates that any pre-Miocene extension in this area must postdate that in the San Emigdio Mountains. [1] Chapman et al., 2012. Geosphere, 8, 314-341.

Comparison of different bronchial closure techniques following pneumonectomy in dogs

PubMed Central

Bayram, A. Sami; Ozyigit, Ozgur; Gebitekin, Cengiz; Gorgul, O. Sacit

2007-01-01

The comparison of the histologic healing and bronchopleural fistula (BPF) complications encountered with three different BS closure techniques (manual suture, stapler and manual suture plus tissue flab) after pneumonectomy in dogs was investigated for a one-month period. The dogs were separated into two groups: group I (GI) (n = 9) and group II (GII) (n = 9). Right and left pneumonectomies were performed on the animals in GI and GII, respectively. Each group was further divided into three subgroups according to BS closure technique: subgroup I (SGI) (n = 3), manual suture; subgroup II (SGII) (n = 3), stapler; and subgroup III (SGIII) (n = 3), manual suture plus tissue flab. The dogs were sacrificed after one month of observation, and the bronchial stumps were removed for histological examination. The complications observed during a one-month period following pneumonectomy in nine dogs (n = 9) were: BPF (n = 5), peri-operative cardiac arrest (n = 1), post-operative respiratory arrest (n = 1), post-operative cardiac failure (n = 1) and cardio-pulmonary failure (n = 1). Histological healing was classified as complete or incomplete healing. Histological healing and BPF complications in the subgroups were analyzed statistically. There was no significant difference in histological healing between SGI and SGIII (p = 1.00; p > 0.05), nor between SGII and SGIII (p = 1.00; p > 0.05). Similarly, no significant difference was observed between the subgroups in terms of BPF (p = 0.945; p > 0.05). The results of the statistical analysis indicated that manual suture, stapler or manual suture plus tissue flab could be alternative methods for BS closure following pneumonectomy in dogs. PMID:17993754

Comparison of different bronchial closure techniques following pneumonectomy in dogs.

PubMed

Salci, Hakan; Bayram, A Sami; Ozyigit, Ozgur; Gebitekin, Cengiz; Gorgul, O Sacit

2007-12-01

The comparison of the histologic healing and bronchopleural fistula (BPF) complications encountered with three different BS closure techniques (manual suture, stapler and manual suture plus tissue flab) after pneumonectomy in dogs was investigated for a one-month period. The dogs were separated into two groups: group I (GI) (n = 9) and group II (GII) (n = 9). Right and left pneumonectomies were performed on the animals in GI and GII, respectively. Each group was further divided into three subgroups according to BS closure technique: subgroup I (SGI) (n = 3), manual suture; subgroup II (SGII) (n = 3), stapler; and subgroup III (SGIII) (n = 3), manual suture plus tissue flab. The dogs were sacrificed after one month of observation, and the bronchial stumps were removed for histological examination. The complications observed during a one-month period following pneumonectomy in nine dogs (n = 9) were: BPF (n = 5), peri-operative cardiac arrest (n = 1), post-operative respiratory arrest (n = 1), post-operative cardiac failure (n = 1) and cardio-pulmonary failure (n = 1). Histological healing was classified as complete or incomplete healing. Histological healing and BPF complications in the subgroups were analyzed statistically. There was no significant difference in histological healing between SGI and SGIII (p = 1.00; p > 0.05), nor between SGII and SGIII (p = 1.00; p > 0.05). Similarly, no significant difference was observed between the subgroups in terms of BPF (p = 0.945; p > 0.05). The results of the statistical analysis indicated that manual suture, stapler or manual suture plus tissue flab could be alternative methods for BS closure following pneumonectomy in dogs.

The sensitivity of pre-operative axillary staging in breast cancer: comparison of invasive lobular and ductal carcinoma.

PubMed

Topps, A; Clay, V; Absar, M; Howe, M; Lim, Y; Johnson, R; Bundred, N

2014-07-01

Axillary ultrasound (AUS) with fine-needle aspiration (FNA) biopsy of abnormal lymph nodes is important for pre-operative staging and planning the surgical management of the axilla. Invasive lobular carcinoma (ILC) metastases are thought to be difficult to detect because the cells are small and on cytology resemble lymphocytes. To investigate this we directly compared the sensitivity of pre-operative axillary staging between ILC and invasive ductal carcinoma (IDC). Consecutive patients that presented in a single breast unit with pure IDC between April 2005 and December 2006 and pure ILC between January 2008 and December 2012 were retrospectively identified from pathology records. Pre-operative axillary ultrasound and FNA biopsy results were compared with post-operative histopathology from the sentinel node biopsy (SNB) or axillary lymph node dissection (ALND). A total of 275 and 142 axillae were identified in the IDC and ILC groups respectively. In the node positive patients there was no significant difference in the sensitivity of AUS (IDC vs. ILC; 58.7% vs. 52.8%). However, there was a significant difference in the sensitivity of ultrasound-guided FNA biopsy of abnormal nodes (IDC vs. ILC; 98.4% vs. 53.6%; p < 0.001). AUS has comparative sensitivities between IDC and ILC populations. In contrast, FNA biopsy of abnormal axillary nodes is clearly less sensitive in the ILC group. In these patients, who have abnormal AUS, we suggest that a core biopsy is required to improve the pre-operative staging and prevent unnecessary surgical procedures. Copyright © 2014 Elsevier Ltd. All rights reserved.

40 CFR 265.404 - Closure.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., Physical, and Biological Treatment § 265.404 Closure. At closure, all hazardous waste and hazardous waste residues must be removed from treatment processes or equipment, discharge control equipment, and discharge...

40 CFR 265.404 - Closure.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., Physical, and Biological Treatment § 265.404 Closure. At closure, all hazardous waste and hazardous waste residues must be removed from treatment processes or equipment, discharge control equipment, and discharge...

40 CFR 265.404 - Closure.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., Physical, and Biological Treatment § 265.404 Closure. At closure, all hazardous waste and hazardous waste residues must be removed from treatment processes or equipment, discharge control equipment, and discharge...

40 CFR 265.404 - Closure.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., Physical, and Biological Treatment § 265.404 Closure. At closure, all hazardous waste and hazardous waste residues must be removed from treatment processes or equipment, discharge control equipment, and discharge...

40 CFR 265.404 - Closure.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., Physical, and Biological Treatment § 265.404 Closure. At closure, all hazardous waste and hazardous waste residues must be removed from treatment processes or equipment, discharge control equipment, and discharge...

Site Development, Operations, and Closure Plan Topical Report 5 An Assessment of Geologic Carbon Sequestration Options in the Illinois Basin. Phase III

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

Finley, Robert; Payne, William; Kirksey, Jim

2015-06-01

The Midwest Geological Sequestration Consortium (MGSC) has partnered with Archer Daniels Midland Company (ADM) and Schlumberger Carbon Services to conduct a large-volume, saline reservoir storage project at ADM’s agricultural products processing complex in Decatur, Illinois. The Development Phase project, named the Illinois Basin Decatur Project (IBDP) involves the injection of 1 million tonnes of carbon dioxide (CO 2) into a deep saline formation of the Illinois Basin over a three-year period. This report focuses on objectives, execution, and lessons learned/unanticipated results from the site development (relating specifically to surface equipment), operations, and the site closure plan.

Ergonomic factors and production target evaluation in eucalyptus timber harvesting operations in mountainous terrains.

PubMed

de Souza, Amaury Paulo; Minette, Luciano José; Sanches, André Luis Petean; da Silva, Emília Pio; Rodrigues, Valéria Antônia Justino; de Oliveira, Luciana Aparecida

2012-01-01

There are several forest operations involved in Eucalyptus timber harvesting. This study was carried out during brush-cutting; tree felling, bucking, delimbing, piling and manual extraction operations, with the following objectives: a) analyzing, ergonomically, two systems of brush-cutting: one manual and the other semi-mechanized, using two different machines; b) ergonomically evaluating three different brands of pruner machines used in delimbing felled trees. c) determining the feasible target of productivity as a function of ergonomic factors relevant to establish the time of resting pauses for workers in manual and semi-mechanized timber harvesting systems in mountainous terrain. Brush-cutting, either manual or semimechanized, is an activity carried out prior to timber harvesting. It is usually a hard work, with low productivity when compared with mechanized systems. Pruner machines have been used by forest companies, due to the great possibilities to improve productivity, quality and the health of workers. Ergonomics is a discipline that promotes the adequacy of work to the physical and mental characteristics of human beings, seeking to design production systems and products considering relevant aspects, including social, organizational and environmental factors. Companies should consider the ergonomic factor in the determination of daily worker production targets.

Pre- and post-operative evaluations of eight dogs following right nephrectomy due to Dioctophyma renale.

PubMed

Mesquita, L R; Rahal, S C; Faria, L G; Takahira, R K; Rocha, N S; Mamprim, M J; Oliveira, H S

2014-01-01

Dioctophyma renale is a large nematode distributed worldwide that may cause progressive and severe destruction of renal parenchyma. The present study aimed to evaluate pre- and post-operatively dogs submitted to right nephrectomy due to D. renale and to assess the histopathological damage of the removed kidney. Eight crossbred dogs, aged from 12 to 48 months that were unilaterally nephrectomized due to the presence of D. renale were evaluated. Physical examination, urinalysis, complete blood count, serum biochemistry, and abdominal ultrasound were performed immediately before and one month after nephrectomy. The nephrectomized right kidneys were submitted to macroscopic and microscopic evaluations. Urinalysis preoperatively detected occult blood in all dogs and D. renale eggs in five cases. Complete blood count showed all parameters within the reference range, except one dog post-operatively. Serum biochemistry performed before and after surgery verified that urea, creatinine and sodium were within the reference range values in all dogs. Other findings varied among the dogs. The length and arterial resistive index mean values of the left kidney were similar pre- and post-operatively. Thus, the inconsiderable change in laboratory findings pre- and post-operatively was attributable to compensation by left kidney function for the removed abnormal right kidney. Right kidney histology revealed chronic nephropathy due to D. renale. Imaging diagnosis should be performed on dogs suspected as carrying the disease or on those from an enzootic area since the laboratory findings are not specific except eggs in the urine.

Lease Operations Environmental Guidance Document

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

Bureau of Land Management

This report contains discussions in nine different areas as follows: (1) Good Lease Operating Practices; (2) Site Assessment and Sampling; (3) Spills/Accidents; (4) Containment and Disposal of Produced Waters; (5) Restoration of Hydrocarbon Impacted Soils; (6) Restoration of Salt Impacted Soils; (7) Pit Closures; (8) Identification, Removal and Disposal of Naturally Occurring Radioactive Materials (NORM); and (9) Site Closure and Construction Methods for Abandonment Wells/Locations. This report is primary directed towards the operation of oil and gas producing wells.

Changes in forest species composition and structure after stand-replacing wildfire in the mountains of southeastern Arizona

Treesearch

Ronald D. Quinn; Lin Wu

2005-01-01

A wildfire in the Chiricahua Mountains of southeastern Arizona apparently altered the long-term structure of the forest. The pre-fire canopy forest, which had not burned for 100 years, was an even mixture of Arizona pines and Rocky Mountain Douglas-firs. A decade later the new forest was numerically dominated by quaking aspen seedlings in clumps separated by persistent...

Anesthesiologists' and surgeons' perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians' decisions to order pre-operative tests.

PubMed

Patey, Andrea M; Islam, Rafat; Francis, Jill J; Bryson, Gregory L; Grimshaw, Jeremy M

2012-06-09

Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists' and surgeons' perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians' statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Seven of the twelve domains were identified as likely relevant to changing clinicians' behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with reducing testing, from negative

50 CFR 648.161 - Closures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Bluefish Fishery § 648.161 Closures. (a) EEZ closure. NMFS shall close the EEZ to fishing for bluefish by... dealer permit holders that no commercial quota is available for landing bluefish in that state. ...

Robotics Scoping Study to Evaluate Advances in Robotics Technologies that Support Enhanced Efficiencies for Yucca Mountain Repository Operations

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

T. Burgess; M. Noakes; P. Spampinato

This paper presents an evaluation of robotics and remote handling technologies that have the potential to increase the efficiency of handling waste packages at the proposed Yucca Mountain High-Level Nuclear Waste Repository. It is expected that increased efficiency will reduce the cost of operations. The goal of this work was to identify technologies for consideration as potential projects that the U.S. Department of Energy Office of Civilian Radioactive Waste Management, Office of Science and Technology International Programs, could support in the near future, and to assess their ''payback'' value. The evaluation took into account the robotics and remote handling capabilitiesmore » planned for incorporation into the current baseline design for the repository, for both surface and subsurface operations. The evaluation, completed at the end of fiscal year 2004, identified where significant advantages in operating efficiencies could accrue by implementing any given robotics technology or approach, and included a road map for a multiyear R&D program for improvements to remote handling technology that support operating enhancements.« less

Application of inert wastes in the construction, operation and closure of landfills: Calculation tool.

PubMed

Colomer Mendoza, Francisco J; Esteban Altabella, Joan; Gallardo Izquierdo, Antonio

2017-01-01

Waste from construction and demolition activities represents one of the highest volumes of waste in Europe. 500 million tonnes are produced throughout the whole EU every year. In some EU members like Spain, approximately 83 per cent of such waste is disposed in landfills. The remaining part is classified and processed in treatment facilities so that it can later be used as recycled aggregates in the construction sector (sand, gravel, aggregates, etc.) but without much commercial success. The aim of this study is to use recycled aggregates from inert wastes (IW) in the different phases of a landfill (construction, operation and closure) with the aid of a new computer tool called LABWASTE.14. This tool incorporates the mathematical relationship among the activities of the landfill and provides as a result the economic viability of using recycled aggregates compared to aggregates from quarries. Therefore, knowing the needs of aggregates in landfills (dams, drainage layers, covering layers, collection wells, etc.) may determine the amount of IW that could be recovered. These calculations can be obtained from some of the data that is introduced (population, land physiography, etc.). Furthermore, the use of LABWASTE.14 makes it possible to reduce the demand for aggregates from quarries. Copyright © 2016 Elsevier Ltd. All rights reserved.

Fire effects on the Point Reyes Mountain Beaver (Aplodontia rufa phaea) at Point Reyes National Seashore, 10 years after the Vision Fire

USGS Publications Warehouse

Fellers, Gary M.; Osbourn, Michael

2009-01-01

The 1995 Vision Fire burned 5000 ha and destroyed 40% of the habitat of the Point Reyes Mountain Beaver (Aplodontia rufa phaea). Surveys immediately post-fire and in 2000 showed that only 0.4 to 1.7% of Mountain Beavers within the burn area survived. In 2000, dense, ground-hugging Blue-blossom Ceanothus (Ceanothus thrysiflorus) appeared to make coastal scrub thickets much less suitable for Mountain Beavers even though the number of burrows at our 11 study sites had returned to 88% of pre-fire numbers. In 2005 (10 y post-fire), the habitat appeared to be better for Mountain Beavers; Blue-blossom Ceanothus had diminished and vegetation more typical of northern coastal scrub, such as Coyote Brush (Baccharis pilularis) overstory with a lower layer of herbaceous vegetation, had greatly increased; but the number of Mountain Beaver burrows had declined to 52% of pre-fire numbers and there was little change in the number of sites occupied between our 2000 and 2005 surveys. With the expected successional changes in thicket structure, Mountain Beaver populations are likely to recover further, but there will probably be considerable variation in how each population stabilizes.

Inside the beating heart: an in vivo feasibility study on fusing pre- and intra-operative imaging for minimally invasive therapy.

PubMed

Linte, Cristian A; Moore, John; Wedlake, Chris; Bainbridge, Daniel; Guiraudon, Gérard M; Jones, Douglas L; Peters, Terry M

2009-03-01

An interventional system for minimally invasive cardiac surgery was developed for therapy delivery inside the beating heart, in absence of direct vision. A system was developed to provide a virtual reality (VR) environment that integrates pre-operative imaging, real-time intra-operative guidance using 2D trans-esophageal ultrasound, and models of the surgical tools tracked using a magnetic tracking system. Detailed 3D dynamic cardiac models were synthesized from high-resolution pre-operative MR data and registered within the intra-operative imaging environment. The feature-based registration technique was employed to fuse pre- and intra-operative data during in vivo intracardiac procedures on porcine subjects. This method was found to be suitable for in vivo applications as it relies on easily identifiable landmarks, and hence, it ensures satisfactory alignment of pre- and intra-operative anatomy in the region of interest (4.8 mm RMS alignment accuracy) within the VR environment. Our initial experience in translating this work to guide intracardiac interventions, such as mitral valve implantation and atrial septal defect repair demonstrated feasibility of the methods. Surgical guidance in the absence of direct vision and with no exposure to ionizing radiation was achieved, so our virtual environment constitutes a feasible candidate for performing various off-pump intracardiac interventions.

Dam pre-release as an important operation strategy in reducing flood impact in Malaysia

NASA Astrophysics Data System (ADS)

Hidayah Ishak, Nurul; Mustafa Hashim, Ahmad

2018-03-01

The 2014 flood was reported to be one of the worst natural disaster has ever affected several states in the northern part of Peninsular Malaysia. Overwhelming rainfall was noted as one of the main factors causing such impact, which was claimed to be unprecedented to some extent. The state of Perak, which is blessed with four cascading dams had also experienced flood damage at a scale that was considered the worst in history. The rainfall received had caused the dam to reach danger level that necessitated additional discharge to be released. Safety of the dams was of great importance and such unavoidable additional discharge was allowed to avoid catastrophic failure of the dam structures. This paper discusses the dam pre-release as a significant dam management strategy in reducing flood impact. An important balance between required dam storage to be maintained and the risk element that can be afforded is the crucial factor in such enhanced operation strategy. While further possibility in developing a carefully engineered dam pre-release strategy can be explored for dam operation in Malaysia, this has already been introduced in some developed countries. Australia and South Africa are examples where pre-release has been practiced and proven to reduce flood risk. The concept involves controlling the dam lake level throughout the year, in reference to the rainfall data and the hydrological properties for the catchment area of the dams. Plentiful data analysis need to be done in contemplation of producing the optimal pre-release model. The amount of heavy rainfalls received is beyond human control but the distribution of the discharge from the dams can be further managed with the appropriate pre-release strategy.

76 FR 47577 - Rocky Mountain Natural Gas LLC; Notice of Filing

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-05

... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket No. PR11-121-000] Rocky Mountain Natural Gas LLC; Notice of Filing Take notice that on July 28, 2011, Rocky Mountain Natural Gas LLC filed a revised Statement of Operating Conditions to comply with an unpublished Delegated letter order...

Meta-image navigation augmenters for GPS denied mountain navigation of small UAS

NASA Astrophysics Data System (ADS)

Wang, Teng; ćelik, Koray; Somani, Arun K.

2014-06-01

We present a novel approach to use mountain drainage patterns for GPS-Denied navigation of small unmanned aerial systems (UAS) such as the ScanEagle, utilizing a down-looking fixed focus monocular imager. Our proposal allows extension of missions to GPS-denied mountain areas, with no assumption of human-made geographic objects. We leverage the analogy between mountain drainage patterns, human arteriograms, and human fingerprints, to match local drainage patterns to Graphics Processing Unit (GPU) rendered parallax occlusion maps of geo-registered radar returns (GRRR). Details of our actual GPU algorithm is beyond the subject of this paper, and is planned as a future paper. The matching occurs in real-time, while GRRR data is loaded on-board the aircraft pre-mission, so as not to require a scanning aperture radar during the mission. For recognition purposes, we represent a given mountain area with a set of spatially distributed mountain minutiae, i.e., details found in the drainage patterns, so that conventional minutiae-based fingerprint matching approaches can be used to match real-time camera image against template images in the training set. We use medical arteriography processing techniques to extract the patterns. The minutiae-based representation of mountains is achieved by first exposing mountain ridges and valleys with a series of filters and then extracting mountain minutiae from these ridges/valleys. Our results are experimentally validated on actual terrain data and show the effectiveness of minutiae-based mountain representation method. Furthermore, we study how to select landmarks for UAS navigation based on the proposed mountain representation and give a set of examples to show its feasibility. This research was in part funded by Rockwell Collins Inc.

Mitigation of infectious disease at school: targeted class closure vs school closure.

PubMed

Gemmetto, Valerio; Barrat, Alain; Cattuto, Ciro

2014-12-31

School environments are thought to play an important role in the community spread of infectious diseases such as influenza because of the high mixing rates of school children. The closure of schools has therefore been proposed as an efficient mitigation strategy. Such measures come however with high associated social and economic costs, making alternative, less disruptive interventions highly desirable. The recent availability of high-resolution contact network data from school environments provides an opportunity to design models of micro-interventions and compare the outcomes of alternative mitigation measures. We model mitigation measures that involve the targeted closure of school classes or grades based on readily available information such as the number of symptomatic infectious children in a class. We focus on the specific case of a primary school for which we have high-resolution data on the close-range interactions of children and teachers. We simulate the spread of an influenza-like illness in this population by using an SEIR model with asymptomatics, and compare the outcomes of different mitigation strategies. We find that targeted class closure affords strong mitigation effects: closing a class for a fixed period of time--equal to the sum of the average infectious and latent durations--whenever two infectious individuals are detected in that class decreases the attack rate by almost 70% and significantly decreases the probability of a severe outbreak. The closure of all classes of the same grade mitigates the spread almost as much as closing the whole school. Our model of targeted class closure strategies based on readily available information on symptomatic subjects and on limited information on mixing patterns, such as the grade structure of the school, shows that these strategies might be almost as effective as whole-school closure, at a much lower cost. This may inform public health policies for the management and mitigation of influenza

Numerical Modeling of ROM Panel Closures at WIPP

NASA Astrophysics Data System (ADS)

Herrick, C. G.

2016-12-01

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

[Comparative description and retrospective analisis of modern methods of surgical wounds closure for intraoperative prophylaxis of development of pathologic cutaneous cicatrices].

PubMed

Stavyts'kyĭ, S O; Avetikov, D S; Lokes, K P; Rozkolupa, O O; Boĭko, I V

2014-05-01

The experience of application of various methods of closure was presented for the head and neck cutaneous wound surfaces after elective operative interventions. The variant of the postoperative results estimation and optimization of the wounds healing by primary closure was proposed.

Prevalence of and risk factors for acute mountain sickness among a cohort of high-altitude travellers who received pre-travel counselling.

PubMed

Santantonio, Maud; Chapplain, Jean-Marc; Tattevin, Pierre; Leroy, Hélène; Mener, Eric; Gangneux, Jean-Pierre; Michelet, Christian; Revest, Matthieu

2014-01-01

Acute mountain sickness (AMS) is common in high-altitude travellers, and may lead to life-threatening high-altitude cerebral oedema. To better target pre-travel counselling, we aimed to characterize the risk factors for AMS that may be identified prior to departure. We performed a descriptive study of high-altitude travellers who consulted at a travel clinic before departure. Data were collected by phone after their return, using a standardized questionnaire. 162 adults were enrolled. Most subjects (81.5%) were informed about AMS before departure, by a medical doctor in 40% of cases. AMS symptoms were reported by 77 travellers (47.5%). Variables significantly associated with AMS symptoms were female sex (56% versus 38.5%, p = 0.01), trip organised by a travel agency (55.2% versus 43.3%, p = 0.03), travel duration (mean, 4.2 ± 3.5 weeks in patients with AMS, versus 6.6 ± 7.5 weeks in patients without AMS, p = 0.014), and acetazolamide use (71.4% versus 47.5%, p = 0.045). In multivariate analysis, only female sex was independently predictive of AMS (adjusted OR 2.15 [1.14-4.40]). AMS symptoms occur in almost half of high-altitude travellers. Women, and travellers leaving for short duration, within trips organised by travel agencies, should be targeted for enhanced pre-travel counselling to prevent AMS. Copyright © 2014 Elsevier Ltd. All rights reserved.

Ethnic differences in primary angle-closure glaucoma.

PubMed

Yip, Jennifer L Y; Foster, Paul J

2006-04-01

Observational studies from different countries have shown that populations of East Asian origin have a higher frequency of primary angle-closure glaucoma compared with those of European or African descent. As half of all cases of glaucoma reside in Asia, and with primary angle-closure glaucoma carrying a higher rate of visual morbidity, primary angle-closure glaucoma poses an important public health problem; however, the inconsistent use of techniques and definitions to detect and diagnose primary angle-closure glaucoma has resulted in difficulties in interpreting the accuracy and comparability of such data. Therefore it is important to review these studies in the light of a consistent classification system. There are increasing reports that support previous findings on the incidence and prevalence of primary angle-closure glaucoma in different ethnic groups. There have also been further investigations into the mechanism and natural history of primary angle-closure glaucoma in Asian populations. International investigations into primary angle-closure glaucoma have demonstrated reproducible evidence that ethnic variations do exist. Cross-sectional studies in this area have also suggested that differences in anterior chamber depth, together with its association with peripheral anterior synechiae, may be part of the underlying mechanism behind these differences. The ideas generated need to be further explored with longitudinal data of changes in anterior chamber depth and peripheral anterior synechiae in different populations. The detailed mechanisms behind the development of angle-closure and primary angle-closure glaucoma should also be investigated.

The pre-operative levels of haemoglobin in the blood can be used to predict the risk of allogenic blood transfusion after total knee arthroplasty.

PubMed

Maempel, J F; Wickramasinghe, N R; Clement, N D; Brenkel, I J; Walmsley, P J

2016-04-01

The pre-operative level of haemoglobin is the strongest predictor of the peri-operative requirement for blood transfusion after total knee arthroplasty (TKA). There are, however, no studies reporting a value that could be considered to be appropriate pre-operatively. This study aimed to identify threshold pre-operative levels of haemoglobin that would predict the requirement for blood transfusion in patients who undergo TKA. Analysis of receiver operator characteristic (ROC) curves of 2284 consecutive patients undergoing unilateral TKA was used to determine gender specific thresholds predicting peri-operative transfusion with the highest combined sensitivity and specificity (area under ROC curve 0.79 for males; 0.78 for females). Threshold levels of 13.75 g/dl for males and 12.75 g/dl for females were identified. The rates of transfusion in males and females, respectively above these levels were 3.37% and 7.11%, while below these levels, they were 16.13% and 28.17%. Pre-operative anaemia increased the rate of transfusion by 6.38 times in males and 6.27 times in females. Blood transfusion was associated with an increased incidence of early post-operative confusion (odds ratio (OR) = 3.44), cardiac arrhythmia (OR = 5.90), urinary catheterisation (OR = 1.60), the incidence of deep infection (OR = 4.03) and mortality (OR = 2.35) one year post-operatively, and increased length of stay (eight days vs six days, p < 0.001). Uncorrected low pre-operative levels of haemoglobin put patients at potentially modifiable risk and attempts should be made to correct this before TKA. Target thresholds for the levels of haemoglobin pre-operatively in males and females are proposed. Low pre-operative haemoglobin levels put patients at unnecessary risk and should be corrected prior to surgery. ©2016 The British Editorial Society of Bone & Joint Surgery.

Fluoroscopically guided nose tube drainage of mediastinal abscesses in post-operative gastro-oesophageal anastomotic leakage.

PubMed

Xu, Q Y; Yin, G W; Chen, S X; Jiang, F; Bai, X J; Wu, J D

2012-11-01

The aim of this study was to retrospectively evaluate the technical success rates and clinical effectiveness of fluoroscopically guided nose tube drainage of mediastinal abscesses and a nasojejunum feeding tube in post-operative gastro-oesophageal anastomotic leakage (GEAL). From January 2006 to June 2011, 18 cases of post-operative GEAL with mediastinal abscesses after oesophagectomy with intrathoracic oesophagogastric anastomotic procedures for oesophageal and cardiac carcinoma were treated by insertion of a nose drainage tube and nasojejunum feeding tube under fluoroscopic guidance. We evaluated the feasibility of two-tube insertion to facilitate leakage site closure and complete resolution of the abscess, and the patients' nutritional benefit was also evaluated by checking the serum albumin level between pre- and post-enteral feeding via the feeding tube. The two tubes were placed successfully under fluoroscopic guidance in 18 patients (100%). The procedure time for two-tube insertion ranged from 20 to 40 min (mean 30 min). 17 patients (94%) achieved leakage site closure after two-tube insertion and had a good tolerance of two tubes in the nasal cavity. The serum albumin level was significant, increased from pre-enteral feeding (2.49 ± 0.42 g dl(-1)) to the post-enteral feeding (3.58 ± 0.47 g dl(-1)) via the feeding tube (p<0.001). The duration of follow-up ranged from 1 to 49 months (mean 19 months). The insertion of nose tube drainage and a nasojejunum feeding tube under fluoroscopic guidance is safe, and it provides effective relief from mediastinal abscesses in GEAL after oesophagectomy. Moreover, our findings indicate that two-tube insertion may be used as a selective procedure to treat mediastinal abscesses in post-operative GEAL. Advances in knowledge Directive drainage of mediastinal abscesses in post-operative GEAL may be an effective treatment.

ASD Closure in Structural Heart Disease.

PubMed

Wiktor, Dominik M; Carroll, John D

2018-04-17

While the safety and efficacy of percutaneous ASD closure has been established, new data have recently emerged regarding the negative impact of residual iatrogenic ASD (iASD) following left heart structural interventions. Additionally, new devices with potential advantages have recently been studied. We will review here the potential indications for closure of iASD along with new generation closure devices and potential late complications requiring long-term follow-up. With the expansion of left-heart structural interventions and large-bore transseptal access, there has been growing experience gained with management of residual iASD. Some recently published reports have implicated residual iASD after these procedures as a potential source of diminished clinical outcomes and mortality. Additionally, recent trials investigating new generation closure devices as well as expanding knowledge regarding late complications of percutaneous ASD closure have been published. While percutaneous ASD closure is no longer a novel approach to managing septal defects, there are several contemporary issues related to residual iASD following large-bore transseptal access and new generation devices which serve as an impetus for this review. Ongoing attention to potential late complications and decreasing their incidence with ongoing study is clearly needed.

32 CFR 989.25 - Base closure and realignment.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Base closure and realignment. 989.25 Section 989... PROTECTION ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.25 Base closure and realignment. Base closure or realignment may entail special requirements for environmental analysis. The permanent base closure...

32 CFR 989.25 - Base closure and realignment.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 6 2012-07-01 2012-07-01 false Base closure and realignment. 989.25 Section 989... PROTECTION ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.25 Base closure and realignment. Base closure or realignment may entail special requirements for environmental analysis. The permanent base closure...

The high prevalence of pathologic calcium crystals in pre-operative knees.

PubMed

Derfus, Beth A; Kurian, Jason B; Butler, Jeffrey J; Daft, Laureen J; Carrera, Guillermo F; Ryan, Lawrence M; Rosenthal, Ann K

2002-03-01

Calcium pyrophosphate dihydrate (CPPD) and basic calcium phosphate (BCP) crystals are important in the pathogenesis of osteoarthritis (OA) but are under recognized even in end stage disease. We determined the prevalence of these calcium crystals in synovial fluid (SF) of persons undergoing total knee arthroplasty for degenerative arthritis. SF samples were obtained from 53 knee joints undergoing total arthroplasty for a pre-operative diagnosis of OA. SF were analyzed via compensated light microscopy for CPPD crystals and a semiquantitative radiometric assay for BCP crystals. Fifty pre-operative radiographs were analyzed and graded according to the scale of Kellgren and Lawrence. Patients had an average age of 70 years at the time of surgery. CPPD and/or BCP crystals were identified in 60% of SF. Overall radiographic scores correlated with mean concentrations of BCP crystals. Higher mean radiographic scores correlated with the presence of calcium-containing crystals of either type in SF Radiographic chondrocalcinosis was identified in only 31% of those with SF CPPD. Pathologic calcium crystals were present in a majority of SF at the time of total knee arthroplasty. Intraoperative SF analysis could conveniently identify pathologic calcium crystals providing information that may be relevant to the future care of the patient's replaced joint and that of other joints. This information could also potentially aid in predicting the likelihood of the need for contralateral total knee arthroplasty.

ESTIMATES OF CLOUD WATER DEPOSITION AT MOUNTAIN DEPOSITION AT MOUNTAIN ACID DEPOSITION PROGRAM SITES IN THE APPALACHIAN MOUNTAINS

EPA Science Inventory

Cloud water deposition was estimated at three high elevation sites in the Appalachian Mountains of the eastern United States (Whiteface Mountain, NY, Whitetop Mountain, VA, and Clingrnan's Dome, TN) from 1994 through 1999 as part of the Mountain Acid Deposition Program (MADPro). ...

Does the use of an acellular dermal graft in abdominal closure after rectus flap harvest impact the occurrence of post-operative hernia?

PubMed

Saman, Masoud; Kadakia, Sameep; Ducic, Yadranko

2015-12-01

Patients with rectus free flap harvest extending below the arcuate line are predisposed to postoperative hernia formation. As such, many authors have advocated the use of closure adjuncts to increase the integrity of the closure and prevent hernia or abdominal wall bulging. Busy level 1 public trauma center in metropolitan Fort Worth, Texas Following harvest of the rectus free flap, 48 patients underwent primary closure; 24 of these patients had defects extending below the arcuate line. Forty patients were closed with an acellular dermal graft; 22 of these patients had defects extending below the arcuate line. Postoperative hernia formation and local infection rate were examined in a minimum follow-up period of 1 year. Regardless of closure method, no hernias were observed in the postoperative period. Using an unpaired t test and an alpha value of 0.05, there was no statistically significant difference in the infection rate between the two groups. Following rectus abdominis myocutaneous free flap harvest, the use of an acellular dermal graft in abdominal wall closure may not be of any further advantage in the prevention of hernia. Retrospective (Level III).

Patent ductus arteriosus closure using an Amplatzer™ ventricular septal defect closure device

PubMed Central

Fernando, Rajeev; Koranne, Ketan; Loyalka, Pranav; Kar, Biswajit; Gregoric, Igor

2013-01-01

The ductus arteriosus originates from the persistence of the distal portion of the left sixth aortic arch. It connects the descending aorta (immediately distal to the left subclavian artery) to the roof of the main pulmonary artery, near the origin of the left pulmonary artery. Persistence of the duct beyond 48 h after birth is abnormal and results in patent ductus arteriosus (PDA). PDA is rare in adults because it is usually discovered and treated in childhood. Mechanical closure remains the definitive therapy because the patency of ductus arteriosus may lead to multiple complications, depending on the size and flow through the ductus. PDA closure is indicated in patients with symptoms and evidence of left heart enlargement, and in patients with elevated pulmonary pressures when reversal is possible. Transcatheter closure is the preferred technique in adults because it avoids sternotomy, reduces the length of hospital stay and is associated with fewer complications compared with surgery. First demonstrated in 1967, both the technique and the occluder devices used have since evolved. However, designing an ideal PDA occluder has been a challenge due to the variability in size, shape and orientation of PDAs. The present article describes a case involving a 35-year-old woman who presented to the Center for Advanced Heart Failure (Houston, USA) with congestive heart failure due to a large PDA, which was successfully occluded using an Amplatzer (St Jude Medical, USA) muscular ventricular septal defect closure device. The wider waist and dual-retention discs of these ventricular septal defect closure devices may be important factors to consider in the future development of devices for the occlusion of large PDAs. PMID:24294051

Pre-operative function, motivation and duration of symptoms predict sporting participation after total hip replacement.

PubMed

Ollivier, M; Frey, S; Parratte, S; Flecher, X; Argenson, J N

2014-08-01

There is little in the literature on the level of participation in sports which patients undertake after total hip replacement (THR). Our aims in this study were to determine first, the level of sporting activity, second, the predictive factors for returning to sporting activity, and third, the correlation between participation in sports and satisfaction after THR. We retrospectively identified 815 patients who had undergone THR between 1995 and 2005. All were asked to complete a self-administered questionnaire regarding their sporting activity. A total of 571 patients (71%) met the inclusion criteria and completed the evaluation. At a mean follow-up of 9.8 years (sd 2.9), 366 patients (64%) returned to sporting activity as defined by a University of California at Los Angeles (UCLA) score of > 5. The main reasons that patients had for refraining from sports were fear of dislocation (65; 31.6%), avoiding wear (52; 25.4%), and the recommendation of the surgeon (34; 16.6%). There was a significant relationship between higher post-operative participation in sport in those patients with a higher pre-operative Harris hip score (HHS) (p = 0.0074), motivation to participate in sporting activities (p = 0.00022) and a shorter duration of symptoms (p = 0.0034). Finally, there was a correlation between age (p = 0.00013), UCLA score (p = 0.012) and pre-operative HHS (p = 0.00091) and satisfaction. In conclusion, we found that most patients participate in sporting activity after THR, regardless of the advice of their surgeon, and that there is a correlation between the level of participation and pre-operative function, motivation, duration of symptoms and post-operative satisfaction. ©2014 The British Editorial Society of Bone & Joint Surgery.

Evaluation of the Momentum Closure Schemes in MPAS-Ocean

NASA Astrophysics Data System (ADS)

Zhao, Shimei; Liu, Yudi; Liu, Wei

2018-04-01

In order to compare and evaluate the performances of the Laplacian viscosity closure, the biharmonic viscosity closure, and the Leith closure momentum schemes in the MPAS-Ocean model, a variety of physical quantities, such as the relative reference potential energy (RPE) change, the RPE time change rate (RPETCR), the grid Reynolds number, the root mean square (RMS) of kinetic energy, and the spectra of kinetic energy and enstrophy, are calculated on the basis of results of a 3D baroclinic periodic channel. Results indicate that: 1) The RPETCR demonstrates a saturation phenomenon in baroclinic eddy tests. The critical grid Reynolds number corresponding to RPETCR saturation differs between the three closures: the largest value is in the biharmonic viscosity closure, followed by that in the Laplacian viscosity closure, and that in the Leith closure is the smallest. 2) All three closures can effectively suppress spurious dianeutral mixing by reducing the grid Reynolds number under sub-saturation conditions of the RPETCR, but they can also damage certain physical processes. Generally, the damage to the rotation process is greater than that to the advection process. 3) The dissipation in the biharmonic viscosity closure is strongly dependent on scales. Most dissipation concentrates on small scales, and the energy of small-scale eddies is often transferred to large-scale kinetic energy. The viscous dissipation in the Laplacian viscosity closure is the strongest on various scales, followed by that in the Leith closure. Note that part of the small-scale kinetic energy is also transferred to large-scale kinetic energy in the Leith closure. 4) The characteristic length scale L and the dimensionless parameter D in the Leith closure are inherently coupled. The RPETCR is inversely proportional to the product of D and L. When the product of D and L is constant, both the simulated RPETCR and the inhibition of spurious dianeutral mixing are the same in all tests using the Leith

Oil prospects attract workover dollars. [Rocky Mountains

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

Stremel, K.

1983-12-01

Anticipating stable crude oil prices and low service costs, Rocky Mountain operators plan to maintain strong workover programs next year. Deflated service costs are allowing operators to complete more workovers without appropriating more capital, and they plan to take advantage of the bargain prices available in the oilpatch. Workover activity next year will be concentrated in major oil producing basins of the Rockies.

16. INTERIOR, PORTLAND FILTER FROM SOUTHEAST, PRE1934. FILTERS WERE IN ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

16. INTERIOR, PORTLAND FILTER FROM SOUTHEAST, PRE-1934. FILTERS WERE IN USE FROM 1918 TO 1934. CREDIT WR. - Bald Mountain Gold Mill, Nevada Gulch at head of False Bottom Creek, Lead, Lawrence County, SD

Duct closure

DOEpatents

Vowell, Kennison L.

1987-01-01

A closure for an inclined duct having an open upper end and defining downwardly extending passageway. The closure includes a cap for sealing engagement with the open upper end of the duct. Associated with the cap are an array of vertically aligned plug members, each of which has a cross-sectional area substantially conforming to the cross-sectional area of the passageway at least adjacent the upper end of the passageway. The plug members are interconnected in a manner to provide for free movement only in the plane in which the duct is inclined. The uppermost plug member is attached to the cap means and the cap means is in turn connected to a hoist means which is located directly over the open end of the duct.

Few Skewed Disks Found in First Closure-Phase Survey of Herbig Ae/Be Stars

NASA Astrophysics Data System (ADS)

Monnier, J. D.; Berger, J.-P.; Millan-Gabet, R.; Traub, W. A.; Schloerb, F. P.; Pedretti, E.; Benisty, M.; Carleton, N. P.; Haguenauer, P.; Kern, P.; Labeye, P.; Lacasse, M. G.; Malbet, F.; Perraut, K.; Pearlman, M.; Zhao, M.

2006-08-01

Using the three-telescope IOTA interferometer on Mount Hopkins, we report results from the first near-infrared (λ=1.65 μm) closure-phase survey of young stellar objects (YSOs). These closure phases allow us to unambiguously detect departures from centrosymmetry (i.e., skew) in the emission pattern from YSO disks on the scale of ~4 mas, expected from generic ``flared disk'' models. Six of 14 targets showed small, yet statistically significant nonzero closure phases, with largest values from the young binary system MWC 361-A and the (pre-main-sequence?) Be star HD 45677. Our observations are quite sensitive to the vertical structure of the inner disk, and we confront the predictions of the ``puffed-up inner wall'' models of Dullemond, Dominik, & Natta (DDN). Our data support disk models with curved inner rims because the expected emission appears symmetrically distributed around the star over a wide range of inclination angles. In contrast, our results are incompatible with the models possessing vertical inner walls because they predict extreme skewness (i.e., large closure phases) from the near-IR disk emission that is not seen in our data. In addition, we also present the discovery of mysterious H-band ``halos'' (~5%-10% of light on scales 0.01"-0.50") around a few objects, a preliminary ``parametric imaging'' study for HD 45677, and the first astrometric orbit for the young binary MWC 361-A.

Three point-advancement closure for skin defects.

PubMed

Tamir, G; Birkby, C S; Berg, D

1999-10-01

Circular skin defects are common following Mohs' surgery. Traditional closure (primary, flap, or graft) may involve extensive surgery. Multidirectional advancement closures such as the purse-string closure have been advocated as another useful tool in such cases. To describe a variation on purse-string closure that, in certain cases, is an excellent alternative to other reconstructions, and will provide good cosmetic and functional outcome. A three-point anchoring suture is placed after undermining to advance the surrounding tissue toward the centre, creating a "Mercedes Benz" or tripod closure following removal of "dog-ears." Circular wounds in designated areas can be more easily closed, creating well-tolerated, favourable scars. Large wounds may be closed with the advantage of avoidance of larger flaps, of decreased wound healing compared to second intention, and of minimizing removal of healthy tissue. An initial trial of closure with this method does not limit subsequent use of other repairs should it be less than satisfactory.

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

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

Feist, E.T.

2012-07-01

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

Elective laparoscopic cholecystectomy for surgical trainees: predictive factors of operative time.

PubMed

Haji, A; Khan, A; Haq, A; Ribeiro, B

2009-08-01

To determine pre-operative criteria to predict duration and technical difficulty of laparoscopic cholecystectomies that will aid in identifying patients suitable for training lists. A prospective analysis of 835 consecutive patients who underwent laparoscopic cholecystectomies. Data collected included patient demographics, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic sphincterotomy (ES), duration of surgery (from skin incision to skin closure), peri-operative and postoperative complications and histological gallbladder wall thickness. Post-operative complications were seen in 3% (n=20). Overall open conversion rate was 2%. The mean duration of surgery was 78.76 +/- 1.75 minutes. Age, ERCP and ES were not independent predictors of a long operation time. However, a positive correlation was seen with histological gallbladder wall thickness and duration of surgery (p=0.001). The mean operating time for gallbladder wall thickness < 3 mm was 72.1 +/- 1.62 minutes whereas that for > 3 mm thickness was 83.3 +/- 2.05 minutes (p=<0.001). Gallbladder wall thickness can be used as an independent predictor of a long operation time.

SANTA LUCIA WILDERNESS, AND GARCIA MOUNTAIN, BLACK MOUNTAIN, LA PANZA, MACHESNA MOUNTAIN, LOS MACHOS HILLS, BIG ROCKS, AND STANLEY MOUNTAIN ROADLESS AREAS, CALIFORNIA.

USGS Publications Warehouse

Frizzell, Virgil A.; Kuizon, Lucia

1984-01-01

The Santa Lucia Wilderness Area and Garcia Mountain, Black Mountain, La Panza, Machesna Mountain, Los Machos Hills, Big Rocks, and Stanley Mountain Roadless Areas together occupy an area of about 218 sq mi in the Los Padres National Forest, California. On the basis of a mineral-resource evaluation a small area in the Black Mountain Roadless Area has a probable mineral-resource potential for uranium, and a small area in the Stanley Mountain Roadless Area has probable potential for low-grade mercury resources. Although petroleum resources occur in rocks similar to those found in the study area, no potential for petroleum resources was identified in the wilderness or any of the roadless areas. No resource potential for other mineral resources was identified in any of the areas. Detailed geologic mapping and geochemical sampling probably would increase knowledge about distribution and modes of occurrence of uranium and cinnabar in those areas, respectively.

Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF) to identify factors that influence physicians’ decisions to order pre-operative tests

PubMed Central

2012-01-01

Background Routine pre-operative tests for anesthesia management are often ordered by both anesthesiologists and surgeons for healthy patients undergoing low-risk surgery. The Theoretical Domains Framework (TDF) was developed to investigate determinants of behaviour and identify potential behaviour change interventions. In this study, the TDF is used to explore anaesthesiologists’ and surgeons’ perceptions of ordering routine tests for healthy patients undergoing low-risk surgery. Methods Sixteen clinicians (eleven anesthesiologists and five surgeons) throughout Ontario were recruited. An interview guide based on the TDF was developed to identify beliefs about pre-operative testing practices. Content analysis of physicians’ statements into the relevant theoretical domains was performed. Specific beliefs were identified by grouping similar utterances of the interview participants. Relevant domains were identified by noting the frequencies of the beliefs reported, presence of conflicting beliefs, and perceived influence on the performance of the behaviour under investigation. Results Seven of the twelve domains were identified as likely relevant to changing clinicians’ behaviour about pre-operative test ordering for anesthesia management. Key beliefs were identified within these domains including: conflicting comments about who was responsible for the test-ordering (Social/professional role and identity); inability to cancel tests ordered by fellow physicians (Beliefs about capabilities and social influences); and the problem with tests being completed before the anesthesiologists see the patient (Beliefs about capabilities and Environmental context and resources). Often, tests were ordered by an anesthesiologist based on who may be the attending anesthesiologist on the day of surgery while surgeons ordered tests they thought anesthesiologists may need (Social influences). There were also conflicting comments about the potential consequences associated with

Anterior Segment Imaging for Angle Closure.

PubMed

Chansangpetch, Sunee; Rojanapongpun, Prin; Lin, Shan C

2018-04-01

To summarize the role of anterior segment imaging (AS-imaging) in angle closure diagnosis and management, and the possible advantages over the current standard of gonioscopy. Literature review and perspective. Review of the pertinent publications with interpretation and perspective in relation to the use of AS-imaging in angle closure assessment focusing on anterior segment optical coherence tomography and ultrasound biomicroscopy. Several limitations have been encountered with the reference standard of gonioscopy for angle assessment. AS-imaging has been shown to have performance in angle closure detection compared to gonioscopy. Also, imaging has greater reproducibility and serves as better documentation for long-term follow-up than conventional gonioscopy. The qualitative and quantitative information obtained from AS-imaging enables better understanding of the underlying mechanisms of angle closure and provides useful parameters for risk assessment and possible prediction of the response to laser and surgical intervention. The latest technologies-including 3-dimensional imaging-have allowed for the assessment of the angle that simulates the gonioscopic view. These advantages suggest that AS-imaging has a potential to be a reference standard for the diagnosis and monitoring of angle closure disease in the future. Although gonioscopy remains the primary method of angle assessment, AS-imaging has an increasing role in angle closure screening and management. The test should be integrated into clinical practice as an adjunctive tool for angle assessment. It is arguable that AS-imaging should be considered first-line screening for patients at risk for angle closure. Copyright © 2018 Elsevier Inc. All rights reserved.

Purse-string double-layer closure: a novel technique for repairing the uterine incision during cesarean section.

PubMed

Turan, Cem; Büyükbayrak, Esra Esim; Yilmaz, Aylin Onan; Karsidag, Yasemin Karageyim; Pirimoglu, Meltem

2015-04-01

To compare the classical double-layer uterine closure to a double-layer purse-string uterine closure (Turan technique) in cesarean section regarding short- and long-term results. Patients were randomized into either the double-layer purse-string uterine closure arm (study group, 84 patients) or the classical double-layer uterine closure arm (control group, 84 patients). For short-term comparison, a detailed transvaginal ultrasound examination was planned in all patients 6 weeks after the operation and a wedge-shaped defect in the uterine incision scar was accepted as uterine scar defect and recorded. For the long-term comparison, subsequent pregnancies of these patients were followed up for any complication. The number of patients with ultrasonographically visible uterine scar defect was 12 (23.5% of all scar defects) in the study group whereas it was 39 (76.5% of all scar defects) in the control group (P < 0.001, χ(2) = 15.42). Demographic data, operation time, hospitalization time, preoperative and postoperative hemoglobin values were not significantly different between the groups. During the 2-year of the follow-up period, five patients in the study group and six patients in the control group became pregnant again. No complication during their pregnancies and second cesarean operation were encountered. With the Turan technique, the uterine incision length becomes shorter, and the frequency of uterine scar defect is lower regarding short-term results. More data is needed for long-term results. ClinicalTrials.gov NCT01287611. © 2014 The Authors. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Mountains: An Overview.

ERIC Educational Resources Information Center

Byers, Alton; Gilligan, Nancy; Golston, Syd; Linville, Rex

1999-01-01

Introduces the lessons from "Mountain: A Global Resource" that were developed by the National Council for the Social Studies (NCSS) and The Mountain Institute for use by NCSS members and their students. Provides an overview that introduces the mountains, mountain cultures, historical perceptions, and the geographical importance of…

Late Neogene deformation of the Chocolate Mountains Anticlinorium: Implications for deposition of the Bouse Formation and early evolution of the Lower Colorado River

USGS Publications Warehouse

Beard, Sue; Haxel, Gordon B.; Dorsey, Rebecca J.; McDougall, Kristin A.; Jacobsen, Carl E.

2016-01-01

Deformation related to late Neogene dextral shear can explain a shift from an estuarine to lacustrine depositional environment in the southern Bouse Formation north of Yuma, Arizona. We infer that late Neogene deformation in the Chocolate Mountain Anticlinorium (CMA) created a barrier that blocked an estuary inlet, and that pre-existing and possibly active structures subsequently controlled the local course of the lower Colorado River. Structural patterns summarized below suggest that the CMA absorbed transpressional strain caused by left-stepping segments of dextral faults of the San Andreas fault system and/or the eastern California shear zone and Gulf of California shear zone. For this hypothesis to be correct, about 200-250 m of post-6 Ma, pre- ~5.3 Ma uplift along the CMA crest would be required to cut off a marine inlet. The 220-km-long CMA, cored by the early Paleogene Orocopia Schist subduction complex, extends from the Orocopia Mountains (Calif.) southeastward through the Chocolate Mountains (parallel to the southern San Andreas fault). Where Highway 78 crosses the Chocolate Mountains (Fig. 1), the CMA turns eastward through the Black Mountain-Picacho area (Calif.) and Trigo Mountains (Ariz.) into southwest Arizona. It separates southernmost Bouse Formation outcrops of the Blythe basin from subsurface Bouse outcrops to the south in the Yuma area. South of Blythe basin the CMA is transected by the lower Colorado River along a circuitous path. Here we focus on the geology of an area between the central Chocolate Mountains and the Yuma Proving Grounds in Arizona. Specific landmarks include the southeast Chocolate Mountains, Midway Mountains, Peter Kane Mountain, Black Mountain, Picacho Peak, and Gavilan Hills. For simplicity, we refer to this as the eastern Chocolate Mountains.

Thunder Mountain School Is Something Special.

ERIC Educational Resources Information Center

NJEA Review, 1979

1979-01-01

This article describes Thunder Mountain School, operated year round by the Newton Board of Education under a special use permit granted by the National Park Service. The center includes sports facilities, nature preserves, a farm, and historic sites for use by residential and day students, kindergarten through college. (SJL)

Assessment of pre-operative maropitant citrate use in macaque (Macaca fasicularis & Macaca mulatta) neurosurgical procedures.

PubMed

Steinbach, Jaclyn R; MacGuire, Jamus; Chang, Shu; Dierks, Elizabeth; Roble, Gordon S

2018-06-01

Retrospective analysis of post-operative vomiting (POV) in non-human primates at our institution was 11%. Based on this additional risk factor for post-operative complications, we aimed to eliminate or decrease POV by adding an antiemetic, maropitant citrate, to the pre-medication protocol. Retrospective and prospective data were collected over a 5-year period from 46 macaques of two species during 155 procedures. Additionally, blood was collected from five Macaca mulatta to perform a pharmacokinetic analysis. A 1 mg/kg subcutaneous dose of maropitant given pre-operatively significantly decreased POV. Findings indicated post-neurosurgical emesis in Macaca fasicularis was significantly greater than in Macaca mulatta. Pharmacokinetic analysis of maropitant in Macaca mulatta determined the mean maximum plasma concentration to be 113 ng/mL. Maropitant administration prior to anesthesia for neurosurgeries decreased our incidence of POV to 1%. The plasma concentration reaches the proposed plasma level for clinical efficacy approximately 20 minutes after administration. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Automatic joint alignment measurements in pre- and post-operative long leg standing radiographs.

PubMed

Goossen, A; Weber, G M; Dries, S P M

2012-01-01

For diagnosis or treatment assessment of knee joint osteoarthritis it is required to measure bone morphometry from radiographic images. We propose a method for automatic measurement of joint alignment from pre-operative as well as post-operative radiographs. In a two step approach we first detect and segment any implants or other artificial objects within the image. We exploit physical characteristics and avoid prior shape information to cope with the vast amount of implant types. Subsequently, we exploit the implant delineations to adapt the initialization and adaptation phase of a dedicated bone segmentation scheme using deformable template models. Implant and bone contours are fused to derive the final joint segmentation and thus the alignment measurements. We evaluated our method on clinical long leg radiographs and compared both the initialization rate, corresponding to the number of images successfully processed by the proposed algorithm, and the accuracy of the alignment measurement. Ground truth has been generated by an experienced orthopedic surgeon. For comparison a second reader reevaluated the measurements. Experiments on two sets of 70 and 120 digital radiographs show that 92% of the joints could be processed automatically and the derived measurements of the automatic method are comparable to a human reader for pre-operative as well as post-operative images with a typical error of 0.7° and correlations of r = 0.82 to r = 0.99 with the ground truth. The proposed method allows deriving objective measures of joint alignment from clinical radiographs. Its accuracy and precision are on par with a human reader for all evaluated measurements.

ICPP tank farm closure study. Volume 2: Engineering design files

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

NONE

1998-02-01

Volume 2 contains the following topical sections: Tank farm heel flushing/pH adjustment; Grouting experiments for immobilization of tank farm heel; Savannah River high level waste tank 20 closure; Tank farm closure information; Clean closure of tank farm; Remediation issues; Remote demolition techniques; Decision concerning EIS for debris treatment facility; CERCLA/RCRA issues; Area of contamination determination; Containment building of debris treatment facility; Double containment issues; Characterization costs; Packaging and disposal options for the waste resulting from the total removal of the tank farm; Take-off calculations for the total removal of soils and structures at the tank farm; Vessel off-gas systems; Jet-groutedmore » polymer and subsurface walls; Exposure calculations for total removal of tank farm; Recommended instrumentation during retrieval operations; High level waste tank concrete encasement evaluation; Recommended heavy equipment and sizing equipment for total removal activities; Tank buoyancy constraints; Grout and concrete formulas for tank heel solidification; Tank heel pH requirements; Tank cooling water; Evaluation of conservatism of vehicle loading on vaults; Typical vault dimensions and approximately tank and vault void volumes; Radiological concerns for temporary vessel off-gas system; Flushing calculations for tank heels; Grout lift depth analysis; Decontamination solution for waste transfer piping; Grout lift determination for filling tank and vault voids; sprung structure vendor data; Grout flow properties through a 2--4 inch pipe; Tank farm load limitations; NRC low level waste grout; Project data sheet calculations; Dose rates for tank farm closure tasks; Exposure and shielding calculations for grout lines; TFF radionuclide release rates; Documentation of the clean closure of a system with listed waste discharge; and Documentation of the ORNL method of radionuclide concentrations in tanks.« less

The Gamburtsev mountains and the origin and early evolution of the Antarctic Ice Sheet.

PubMed

Bo, Sun; Siegert, Martin J; Mudd, Simon M; Sugden, David; Fujita, Shuji; Xiangbin, Cui; Yunyun, Jiang; Xueyuan, Tang; Yuansheng, Li

2009-06-04

Ice-sheet development in Antarctica was a result of significant and rapid global climate change about 34 million years ago. Ice-sheet and climate modelling suggest reductions in atmospheric carbon dioxide (less than three times the pre-industrial level of 280 parts per million by volume) that, in conjunction with the development of the Antarctic Circumpolar Current, led to cooling and glaciation paced by changes in Earth's orbit. Based on the present subglacial topography, numerical models point to ice-sheet genesis on mountain massifs of Antarctica, including the Gamburtsev mountains at Dome A, the centre of the present ice sheet. Our lack of knowledge of the present-day topography of the Gamburtsev mountains means, however, that the nature of early glaciation and subsequent development of a continental-sized ice sheet are uncertain. Here we present radar information about the base of the ice at Dome A, revealing classic Alpine topography with pre-existing river valleys overdeepened by valley glaciers formed when the mean summer surface temperature was around 3 degrees C. This landscape is likely to have developed during the initial phases of Antarctic glaciation. According to Antarctic climate history (estimated from offshore sediment records) the Gamburtsev mountains are probably older than 34 million years and were the main centre for ice-sheet growth. Moreover, the landscape has most probably been preserved beneath the present ice sheet for around 14 million years.

Analytic closures for M1 neutrino transport

DOE PAGES

Murchikova, E. M.; Abdikamalov, E.; Urbatsch, T.

2017-04-25

Carefully accounting for neutrino transport is an essential component of many astrophysical studies. Solving the full transport equation is too expensive for most realistic applications, especially those involving multiple spatial dimensions. For such cases, resorting to approximations is often the only viable option for obtaining solutions. One such approximation, which recently became popular, is the M1 method. It utilizes the system of the lowest two moments of the transport equation and closes the system with an ad hoc closure relation. The accuracy of the M1 solution depends on the quality of the closure. Several closures have been proposed in themore » literature and have been used in various studies. We carry out an extensive study of these closures by comparing the results of M1 calculations with precise Monte Carlo calculations of the radiation field around spherically symmetric protoneutron star models. We find that no closure performs consistently better or worse than others in all cases. The level of accuracy that a given closure yields depends on the matter configuration, neutrino type and neutrino energy. As a result, given this limitation, the maximum entropy closure by Minerbo on average yields relatively accurate results in the broadest set of cases considered in this work.« less

Factors associated with increasing nursing home closures.

PubMed

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

2009-06-01

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

31 CFR 413.1 - Closure of streets.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 31 Money and Finance:Treasury 2 2012-07-01 2012-07-01 false Closure of streets. 413.1 Section 413.1 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.1 Closure of streets. (a) District...

31 CFR 413.1 - Closure of streets.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 31 Money and Finance:Treasury 2 2013-07-01 2013-07-01 false Closure of streets. 413.1 Section 413.1 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.1 Closure of streets. (a) District...

31 CFR 413.1 - Closure of streets.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 31 Money and Finance:Treasury 2 2011-07-01 2011-07-01 false Closure of streets. 413.1 Section 413.1 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.1 Closure of streets. (a) District...

31 CFR 413.1 - Closure of streets.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false Closure of streets. 413.1 Section 413.1 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.1 Closure of streets. (a) District...

31 CFR 413.1 - Closure of streets.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 31 Money and Finance: Treasury 2 2014-07-01 2014-07-01 false Closure of streets. 413.1 Section 413.1 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) SECRET SERVICE, DEPARTMENT OF THE TREASURY CLOSURE OF STREETS NEAR THE WHITE HOUSE § 413.1 Closure of streets. (a) District...

Effects of transcatheter closure of Fontan fenestration on exercise tolerance. kidecho@yahoo.com.

PubMed

Momenah, Tarek S; Eltayb, Haifa; Oakley, Reida El; Qethamy, Howeida Al; Faraidi, Yahya Al

2008-05-01

Baffle fenestration is associated with a significantly better outcome in standard and high-risk patients undergoing completion of Fontan. We report the effects of subsequent transcatheter closure of fenestration on exercise capacity and oxygen saturation. Sixteen patients with a mean age of 10.3 years underwent Amplatzer septal occluder (ASO) device transcatheter closure of Fontan fenestration. All had a fenestrated Fontan operation 6 month to 8 years prior to the procedure. A stress test was performed before and after device closure of fenestration in 14 patients (2 patients did not tolerate stress test before the procedure). The fenestrations in all patients were successfully occluded with the use of the Amplatzer device occluder. No complications occurred during or after the procedure. O2 saturation increased from a mean 85.1 +/- 7.89% to 94.5 +/- 3.63% (p < 0.01) at rest and from 66.2 +/- 12.86% to 87.2 +/- 8.64% (p < 0.01) following exercise. Exercise duration has also increased from 8.22 +/- 2.74 min to 10.29 +/- 1.91 min (p < 0.05). Transcatheter closure of Fontan fenestration increases the duration of exercise capacity and increases O2 saturation at rest and after exercise.

Geophysical expression of elements of the Rio Grande rift in the northeast Tusas Mountains - Preliminary interpretations

USGS Publications Warehouse

Drenth, Benjamin J.; Turner, Kenzie J.; Thompson, Ren A.; Grauch, V. J.; Cosca, Michael A.; Lee, John

2011-01-01

New interpretations of the nature of the Rio Grande rift and pre-existing rocks in the northeast Tusas Mountains region are derived from new and existing gravity and aeromagnetic data. 12-15 mGal amplitude gravity lows are interpreted to mainly reflect large thicknesses of the upper Oligocene to upper Miocene, syn-rift Los Pinos Formation and possibly significant amounts of the Eocene El Rito Formation. The Broke Off Mountain sub basin, named after the location of its greatest inferred depth, is interpreted to be a ~40 km long and ~13 km wide structure elongated in a northwest trend at the western margin of the San Luis Basin. The sub basin is interpreted to contain a maximum combined thickness of 900-2300 m of the Los Pinos Formation and El Rito Formation, with the Los Pinos Formation constituting the majority of the section. Sub basin age is constrained to be older than 21.6 ± 1.4 Ma, the age of a Hinsdale Formation basalt flow that caps the Los Pinos Formation section at Broke Off Mountain. This age constraint and surface geology indicate a pre- and early-rift age. The structural fabric of the northeast Tusas Mountains region is dominated by northwest-trending normal faults, as indicated by geologic mapping and interpretation of aeromagnetic data. Preliminary analysis of the aeromagnetic data suggests that lineaments, possibly reflecting faulting, trend through volcanic rocks as young as Pliocene in age. If correct, these interpretations challenge commonly held beliefs regarding two stages in the structural style of rifting, where early (Oligocene-Miocene) rifting was characterized by broad, shallow basins bounded by northwest-trending faults and later (Miocene-Pliocene) rifting was characterized by deep, narrow basins bounded by north-trending faults. The Broke Off Mountain sub basin is a counter example of a pre- and early-rift, deep and narrow basin. We hypothesize that the Broke Off Mountain sub basin may represent a southward extension of the Monte Vista

303-K Storage Facility closure plan. Revision 2

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

Not Available

1993-12-15

Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 303-K Storage Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 303-K Storage Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Codemore » (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 303-K Storage Facility, the history of materials and waste managed, and the procedures that will be followed to close the 303-K Storage Facility. The 303-K Storage Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5.« less

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

PubMed

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

2014-11-01

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

USING A CONTAINMENT VESSEL LIFTING APPARATUS FOR REMOTE OPERATIONS OF SHIPPING PACKAGES

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

Loftin, Bradley; Koenig, Richard

2013-08-08

The 9977 and the 9975 shipping packages are used in various nuclear facilities within the Department of Energy. These shipping packages are often loaded in designated areas with designs using overhead cranes or A-frames with lifting winches. However, there are cases where loading operations must be performed in remote locations where these facility infrastructures do not exist. For these locations, a lifting apparatus has been designed to lift the containment vessels partially out of the package for unloading operations to take place. Additionally, the apparatus allows for loading and closure of the containment vessel and subsequent pre-shipment testing. This papermore » will address the design of the apparatus and the challenges associated with the design, and it will describe the use of the apparatus.« less

Rocky Mountain National Park dynamic message sign/highway advisory radio : operations plan.

DOT National Transportation Integrated Search

2011-07-01

Visitation to Rocky Mountain National Park (ROMO) has remained consistent over the last few : years, with approximately 3 million annual visitors (1). It is the most visited National Park site : in Colorado (2). The Town of Estes Park is the gateway ...

APPARATUS AND METHOD FOR WELDING END CLOSURE TO CONTAINER

DOEpatents

Frantz, C.E.; Correy, T.B.

1959-08-01

A semi-automatic apparatus is described for welding a closure to the open end of a can containing a nuclear fuel slug. An arc is struck at the center of the closure and is shifted to a region near its periphery. Then the assembly of closure, can, and fuel slug is rotated so that the peripheral region of the closure is preheated. Next the arc is shifted to the periphery itself of the closure, and the assembly is rotated so that the closure is welded to the can.

Visualization of heterogeneous forest structures following treatment in the southern Rocky Mountains

Treesearch

Wade T. Tinkham; Yvette Dickinson; Chad M. Hoffman; Mike A. Battaglia; Seth Ex; Jeffrey Underhill

2017-01-01

Manipulation of forest spatial patterns has become a common objective in restoration prescriptions throughout the central and southern Rocky Mountain dry-mixed conifer forest systems. Pre-Euro-American settlement forest reconstructions indicate that frequent-fire regimes developed forests with complex mosaics of individual trees, tree clumps of varying size, and...

Anterior Segment Imaging Predicts Incident Gonioscopic Angle Closure.

PubMed

Baskaran, Mani; Iyer, Jayant V; Narayanaswamy, Arun K; He, Yingke; Sakata, Lisandro M; Wu, Renyi; Liu, Dianna; Nongpiur, Monisha E; Friedman, David S; Aung, Tin

2015-12-01

To investigate the incidence of gonioscopic angle closure after 4 years in subjects with gonioscopically open angles but varying degrees of angle closure detected on anterior segment optical coherence tomography (AS OCT; Visante; Carl Zeiss Meditec, Dublin, CA) at baseline. Prospective, observational study. Three hundred forty-two subjects, mostly Chinese, 50 years of age or older, were recruited, of whom 65 were controls with open angles on gonioscopy and AS OCT at baseline, and 277 were cases with baseline open angles on gonioscopy but closed angles (1-4 quadrants) on AS OCT scans. All subjects underwent gonioscopy and AS OCT at baseline (horizontal and vertical single scans) and after 4 years. The examiner performing gonioscopy was masked to the baseline and AS OCT data. Angle closure in a quadrant was defined as nonvisibility of the posterior trabecular meshwork by gonioscopy and visible iridotrabecular contact beyond the scleral spur in AS OCT scans. Gonioscopic angle closure in 2 or 3 quadrants after 4 years. There were no statistically significant differences in age, ethnicity, or gender between cases and controls. None of the control subjects demonstrated gonioscopic angle closure after 4 years. Forty-eight of the 277 subjects (17.3%; 95% confidence interval [CI], 12.8-23; P < 0.0001) with at least 1 quadrant of angle closure on AS OCT at baseline demonstrated gonioscopic angle closure in 2 or more quadrants, whereas 28 subjects (10.1%; 95% CI, 6.7-14.6; P < 0.004) demonstrated gonioscopic angle closure in 3 or more quadrants after 4 years. Individuals with more quadrants of angle closure on baseline AS OCT scans had a greater likelihood of gonioscopic angle closure developing after 4 years (P < 0.0001, chi-square test for trend for both definitions of angle closure). Anterior segment OCT imaging at baseline predicts incident gonioscopic angle closure after 4 years among subjects who have gonioscopically open angles and iridotrabecular contact on AS OCT at

Rubber closures for freeze-dried products.

PubMed

Hopkins, G H

1976-10-01

Once a biological product has been developed to perform its required medical or pharmaceutical function, it is essential that a container-closure system by chosen which will preserve the efficacy of the product up to the point of administration. The general requirements applicable to proper closure function will be reviewed and the suitability of natural and synthetic elastomers to perform these functions will be discussed. The specialized application of elastomeric materials as closures for freeze-dried products presents additional requirements which are superimposed upon those previously discussed. The first of these unique considerations relates to the proper physical design which will permit the outgassing of water vapor during the sublimation step in the lyophilizing chamber. During this outgassing the design must also permit the closure to remain affixed in the neck while only partially inserted. Since these preparations are lyophilized because they are unstable in aqueous solutions, the elastomer used must constitute an effective barrier to the transmission of moisture vapor through the closure. The MVT and gas transmission properties of elastomers will be discussed. Special consideration will be given to the extremely low temperatures used in the sublimation, stoppering, and storage before use of lyophilized products. The phenomenon of glass transition points with different elastomers will be explained as its relation to satisfactory performance of the closure function at low temperatures.

Hanford Facility Dangerous Waste Closure Plan - Plutonium Finishing Plant Treatment Unit Glovebox HA-20MB

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

PRIGNANO, A.L.

2003-06-25

This closure plan describes the planned activities and performance standards for closing the Plutonium Finishing Plant (PFP) glovebox HA-20MB that housed an interim status ''Resource Conservation and Recovery Act'' (RCRA) of 1976 treatment unit. This closure plan is certified and submitted to Ecology for incorporation into the Hanford Facility RCRA Permit (HF RCRA Permit) in accordance with Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement; TPA) Milestone M-83-30 requiring submittal of a certified closure plan for ''glovebox HA-20MB'' by July 31, 2003. Glovebox HA-20MB is located within the 231-5Z Building in the 200 West Area of the Hanford Facility.more » Currently glovebox HA-20MB is being used for non-RCRA analytical purposes. The schedule of closure activities under this plan supports completion of TPA Milestone M-83-44 to deactivate and prepare for dismantlement the above grade portions of the 234-5Z and ZA, 243-Z, and 291-Z and 291-Z-1 stack buildings by September 30, 2015. Under this closure plan, glovebox HA-20MB will undergo clean closure to the performance standards of Washington Administrative Code (WAC) 173-303-610 with respect to all dangerous waste contamination from glovebox HA-20MB RCRA operations. Because the intention is to clean close the PFP treatment unit, postclosure activities are not applicable to this closure plan. To clean close the unit, it will be demonstrated that dangerous waste has not been left at levels above the closure performance standard for removal and decontamination. If it is determined that clean closure is not possible or is environmentally impractical, the closure plan will be modified to address required postclosure activities. Because dangerous waste does not include source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of this documentation. Any information on radionuclides is provided only for general knowledge. Clearance form only

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

PubMed

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

2013-06-21

Between 5% and 11% of people undergoing cholecystectomy have common bile duct stones. Stones may be removed at the time of cholecystectomy by opening and clearing the common bile duct. The optimal technique is unclear. The aim is to assess the benefits and harms of T-tube drainage versus primary closure without biliary stent after open common bile duct exploration for common bile duct stones. We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until April 2013. We included all randomised clinical trials comparing T-tube drainage versus primary closure after open common bile duct exploration. Two of four authors independently identified the studies for inclusion and extracted data. We analysed the data with both the fixed-effect and the random-effects model using Review Manager (RevMan) analyses. For each outcome we calculated the risk ratio (RR), rate ratio (RaR), or mean difference (MD) with 95% confidence interval (CI) based on intention-to-treat analysis. We included six trials randomising 359 participants, 178 to T-tube drainage and 181 to primary closure. All trials were at high risk of bias. There was no significant difference in mortality between the two groups (4/178 (weighted percentage 1.2%) in the T-tube group versus 1/181 (0.6%) in the primary closure group; RR 2.25; 95% CI 0.55 to 9.25; six trials). There was no significant difference in the serious morbidity rate between the two groups (24/136 (weighted serious morbidity rate, 145 events per 1000 patients) in the T-tube group versus 9/136 (weighted serious morbidity rate, 66 events per 1000 patients) in the primary closure group; RaR 2.19; 95% CI 0.98 to 4.91; four trials). Quality of life and return to work were not reported in any of the trials. The operating time was significantly longer in the T-tube drainage group compared with the primary