User's operating procedures. Volume 3: Projects directorate information programs

NASA Technical Reports Server (NTRS)

Haris, C. G.; Harris, D. K.

1985-01-01

A review of the user's operating procedures for the scout project automatic data system, called SPADS is presented. SPADS is the results of the past seven years of software development on a prime mini-computer. SPADS was developed as a single entry, multiple cross-reference data management and information retrieval system for the automation of Project office tasks, including engineering, financial, managerial, and clerical support. This volume, three of three, provides the instructions to operate the projects directorate information programs in data retrieval and file maintenance via the user friendly menu drivers.

Current operator volumes of invasive coronary procedures in Medicare patients: implications for future manpower needs in the catheterization laboratory.

PubMed

Maroney, Justin; Khan, Saba; Powell, Wayne; Klein, Lloyd W

2013-01-01

We seek to assess the per-operator volume of diagnostic catheterizations and percutaneous coronary interventions (PCI) among US cardiologists, and its implication for future manpower needs in the catheterization laboratory. The number of annual Medicare PCIs peaked in 2004 and has trended downward since, however the total number of catheterization laboratories nationwide has increased. It is unknown whether these trends have resulted in a dilution of per-operator volumes, and whether the current supply of interventional cardiologists is appropriate to meet future needs. We analyzed the Centers for Medicare and Medicaid Services 2008 Medicare 5% sample file, and extracted the total number of Medicare fee-for-service (Medicare FFS) diagnostic catheterizations and PCIs performed in 2008. We then determined per-physician procedure volumes using National Provider Identifier numbers. There were 1,198,610 Medicare FFS diagnostic catheterizations performed by 11,029 diagnostic cardiologists, and there were 378,372 Medicare FFS PCIs performed by 6,443 interventional cardiologists in 2008. The data reveal a marked difference in the 2008 distribution of diagnostic catheterizations and PCIs among operators. Just over 10% of diagnostic catheterizations were performed by operators performing 40 or fewer Medicare FFS diagnostic catheterizations, contrasted with almost 30% of PCIs performed by operators with 40 of fewer Medicare FFS PCIs. A significant majority of interventional cardiologists (61%) performed 40 or fewer Medicare FFS PCIs in 2008. There is a high percentage of low-volume operators performing PCI, raising questions regarding annual volume recommendations for procedural skill maintenance, and the future manpower requirements in the catheterization laboratory. Copyright © 2012 Wiley Periodicals, Inc.

Hospital Volume and Operative Mortality in the Modern Era

PubMed Central

Reames, Bradley N.; Ghaferi, Amir A.; Birkmeyer, John D.; Dimick, Justin B.

2014-01-01

Background It is generally accepted that hospital volume is associated with mortality in high-risk procedures. However, as surgical safety has improved over the last decade, recent evidence has suggested that the inverse relationship has diminished or been eliminated. Objective To determine whether the relationship between hospital volume and mortality has changed over time. Methods Using national Medicare claims data from 2000 through 2009, we examined mortality among 3,282,127 patients who underwent one of eight gastrointestinal, cardiac, or vascular procedures. Hospitals were stratified into quintiles of operative volume. Using multivariable logistic regression models to adjust for patient characteristics, we examined the relationship between hospital volume and mortality, and assessed for changes over time. We performed sensitivity analyses using hierarchical logistic regression modeling with hospital-level random effects to confirm our results. Results Throughout the ten-year period, a significant inverse relationship was observed in all procedures. In five of the eight procedures studied, the strength of the volume-outcome relationship increased over time. In esophagectomy, for example, the adjusted odds ratio of mortality in very low volume hospitals compared to very high volume hospitals increased from 2.25 [95%CI: 1.57-3.23] in 2000-2001 to 3.68 [95%CI: 2.66-5.11] in 2008-2009. Only pancreatectomy showed a notable decrease in strength of the relationship over time, from 5.83 [95%CI: 3.64-9.36] in 2000-2001, to 3.08 [95%CI: 2.07 - 4.57] in 2008-2009. Conclusion For all procedures examined, higher volume hospitals had significantly lower mortality rates compared to lower volume hospitals. Despite recent improvements in surgical safety, the strong inverse relationship between hospital volume and mortality persists in the modern era. PMID:24368634

Specialization and the Current Practices of General Surgeons

PubMed Central

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

Background The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons’ operative practices to inform surgical education and workforce planning. Study Design We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project (HCUP) for three US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and the percentage of practice comprised of their most common operation were calculated. Correlation was measured between general surgeons’ case volume and the number of other specialists in a health service area. Results There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure comprised no more than 30% of total practice. The most common operations, ranked by the frequency that they appeared as general surgeons’ top procedure, included: cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice comprised of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (Rho = - 0.50, p = 0.005). Conclusions Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. PMID:24210145

Influence of operator experience and PCI volume on transfemoral access techniques: A collaboration of international cardiovascular societies.

PubMed

Nelson, Daniel W; Damluji, Abdulla A; Patel, Nish; Valgimigli, Marco; Windecker, Stephan; Byrne, Robert; Nolan, James; Patel, Tejas; Brilakis, Emmanouil; Banerjee, Subhash; Mayol, Jorge; Cantor, Warren J; Alfonso, Carlos E; Rao, Sunil V; Moscucci, Mauro; Cohen, Mauricio G

2018-03-01

Transfemoral access (TFA) is widely used for coronary angiography and percutaneous coronary intervention (PCI). The influence of operator age, gender, experience, and procedural volume on performance of femoral arterial access has not been studied. A survey instrument was developed and distributed via e-mail from professional societies to interventional cardiologists worldwide from March to December 2016. A total of 988 physicians from 88 countries responded to the survey. TFA is the preferred approach for patients with cardiogenic shock, left main or bifurcation PCI, and procedures with mechanical circulatory support. Older (<50years: 56.4%; ≥50years: 66.8%, p<0.0039) and high PCI volume operators (<100 PCI: 57.3%; 100-299 PCI: 58.7%; ≥300 PCI: 64.3%, p<0.134) preferred palpation only without imaging (fluoroscopy or ultrasound (US)) for TFA. Most respondents preferred not to use micropuncture needle to puncture the femoral artery. Older (≥50years: 64.4%; <50years: 71.5%, p<0.04) and high PCI volume operators (≥300 PCI: 64.1%; 100-299 PCI: 72.6%; <100 PCI: 67.9%, p<0.072) tended not to perform femoral angiography (FA). Of those performing FA, the majority opted to do it at the end of the procedure. Despite best practice guideline recommendations, older and high PCI volume interventional cardiologists prefer not to use imaging for femoral access or perform femoral angiography during TF procedures. These data highlight opportunities to further reduce TFA complications. Copyright © 2017 Elsevier Inc. All rights reserved.

SATS HVO Concept Validation Experiment

NASA Technical Reports Server (NTRS)

Consiglio, Maria; Williams, Daniel; Murdoch, Jennifer; Adams, Catherine

2005-01-01

A human-in-the-loop simulation experiment was conducted at the NASA Langley Research Center s (LaRC) Air Traffic Operations Lab (ATOL) in an effort to comprehensively validate tools and procedures intended to enable the Small Aircraft Transportation System, Higher Volume Operations (SATS HVO) concept of operations. The SATS HVO procedures were developed to increase the rate of operations at non-towered, non-radar airports in near all-weather conditions. A key element of the design is the establishment of a volume of airspace around designated airports where pilots accept responsibility for self-separation. Flights operating at these airports, are given approach sequencing information computed by a ground based automated system. The SATS HVO validation experiment was conducted in the ATOL during the spring of 2004 in order to determine if a pilot can safely and proficiently fly an airplane while performing SATS HVO procedures. Comparative measures of flight path error, perceived workload and situation awareness were obtained for two types of scenarios. Baseline scenarios were representative of today s system utilizing procedure separation, where air traffic control grants one approach or departure clearance at a time. SATS HVO scenarios represented approaches and departure procedures as described in the SATS HVO concept of operations. Results from the experiment indicate that low time pilots were able to fly SATS HVO procedures and maintain self-separation as safely and proficiently as flying today's procedures.

Field Operations and Enforcement Manual for Air Pollution Control. Volume II: Control Technology and General Source Inspection.

ERIC Educational Resources Information Center

Weisburd, Melvin I.

The Field Operations and Enforcement Manual for Air Pollution Control, Volume II, explains in detail the following: technology of source control, modification of operations, particulate control equipment, sulfur dioxide removal systems for power plants, and control equipment for gases and vapors; inspection procedures for general sources, fuel…

Perioperative Management of Sickle Cell Disease

PubMed Central

Adjepong, Kwame Ofori; Otegbeye, Folashade

2018-01-01

Over 30 million people worldwide have sickle cell disease (SCD). Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlusive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Pre-operative assessment must include a careful review of the patient’s known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and opioid use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss. Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged. PMID:29755709

Perioperative Management of Sickle Cell Disease.

PubMed

Adjepong, Kwame Ofori; Otegbeye, Folashade; Adjepong, Yaw Amoateng

2018-01-01

Over 30 million people worldwide have sickle cell disease (SCD). Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlusive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury. Pre-operative assessment must include a careful review of the patient's known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and opioid use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss. Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.

Specialization and the current practices of general surgeons.

PubMed

Decker, Marquita R; Dodgion, Christopher M; Kwok, Alvin C; Hu, Yue-Yung; Havlena, Jeff A; Jiang, Wei; Lipsitz, Stuart R; Kent, K Craig; Greenberg, Caprice C

2014-01-01

The impact of specialization on the practice of general surgery has not been characterized. Our goal was to assess general surgeons' operative practices to inform surgical education and workforce planning. We examined the practices of general surgeons identified in the 2008 State Inpatient and Ambulatory Surgery Databases of the Healthcare Cost and Utilization Project for 3 US states. Operations were identified using ICD-9 and CPT codes linked to encrypted physician identifiers. For each surgeon, total operative volume and percentage of practice that made up their most common operation were calculated. Correlation was measured between general surgeons' case volume and the number of other specialists in a health service area. There were 1,075 general surgeons who performed 240,510 operations in 2008. The mean operative volume for each surgeon was 224 annual procedures. General surgeons performed an average of 23 different types of operations. For the majority of general surgeons, their most common procedure constituted no more than 30% of total practice. The most common operations, ranked by the frequency they appeared as general surgeons' top procedure, included cholecystectomy, colonoscopy, endoscopy, and skin excision. The proportion of general surgery practice composed of endoscopic procedures inversely correlated with the number of gastroenterologists in the health service area (rho = -0.50; p = 0.005). Despite trends toward specialization, the current practices of general surgeons remain heterogeneous. This indicates a continued demand for broad-based surgical education to allow future surgeons to tailor their practices to their environment. Copyright © 2014 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

User's operating procedures. Volume 2: Scout project financial analysis program

NASA Technical Reports Server (NTRS)

Harris, C. G.; Haris, D. K.

1985-01-01

A review is presented of the user's operating procedures for the Scout Project Automatic Data system, called SPADS. SPADS is the result of the past seven years of software development on a Prime mini-computer located at the Scout Project Office, NASA Langley Research Center, Hampton, Virginia. SPADS was developed as a single entry, multiple cross-reference data management and information retrieval system for the automation of Project office tasks, including engineering, financial, managerial, and clerical support. This volume, two (2) of three (3), provides the instructions to operate the Scout Project Financial Analysis program in data retrieval and file maintenance via the user friendly menu drivers.

Incidence and Risk Factors for Health-Care Associated Infections after Hip Operation.

PubMed

Hessels, Amanda J; Agarwal, Mansi; Liu, Jianfang; Larson, Elaine L

2016-12-01

Hip operation reduces pain and improves mobility and quality of life for more than 300,000 people annually, most of whom are more than 65 years old. Substantial increases in surgical volume are projected between 2005 and 2030 in primary total (174%) and revision (137%) procedures. This projection demands that the impact of increasing age on the relative risk of health-care associated infections (HAI) after hip surgical procedures be assessed. Our aim was to examine the incidence and risk factors of HAI among patients who underwent hip operations between 2006 and 2012. This secondary analysis included data from patients 18 years old or older and having a hip prosthesis procedure in three New York City hospitals between 2006 and 2012. Procedures were categorized as total or partial hip replacements or revision and re-surfacing procedures. Outcomes of interest were blood stream infections (BSI), urinary tract infections (UTI), or surgical site infections (SSI). Patients in whom an infection developed during the hospital visit in which the hip procedure occurred were counted as cases. Of 2021 patients, approximately 11% (n = 218) had an HAI. There was no difference in infection rates by admission year despite an increase in surgical volume. SSI was associated with younger age, previous hospitalization, and hip revision surgical procedure whereas UTI and BSI were associated with older age, greater co-morbidity, longer pre-operative length of stay and intensive care unit stay, (p < 0.05). HAI after hip operation affected approximately one in 10 patients over a 7-year period in three high-volume hospitals. SSI occurred least frequently, predominantly among patients who underwent revision surgery (without previous SSI), were younger, and had a history of previous hospitalization. Infections such as BSI and UTI, although rare, occurred more frequently and in patients with more co-morbidities, longer pre-operative length of stay, and who required higher level care. Further research to understand these unexpected findings and target interventions is warranted.

Very Large Data Volumes Analysis of Collaborative Systems with Finite Number of States

ERIC Educational Resources Information Center

Ivan, Ion; Ciurea, Cristian; Pavel, Sorin

2010-01-01

The collaborative system with finite number of states is defined. A very large database is structured. Operations on large databases are identified. Repetitive procedures for collaborative systems operations are derived. The efficiency of such procedures is analyzed. (Contains 6 tables, 5 footnotes and 3 figures.)

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

ERIC Educational Resources Information Center

Schwing, Carl M.

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

The Small Aircraft Transportation System (SATS), Higher Volume Operations (HVO) Off-Nominal Operations

NASA Technical Reports Server (NTRS)

Baxley, B.; Williams, D.; Consiglio, M.; Conway, S.; Adams, C.; Abbott, T.

2005-01-01

The ability to conduct concurrent, multiple aircraft operations in poor weather, at virtually any airport, offers an important opportunity for a significant increase in the rate of flight operations, a major improvement in passenger convenience, and the potential to foster growth of charter operations at small airports. The Small Aircraft Transportation System, (SATS) Higher Volume Operations (HVO) concept is designed to increase traffic flow at any of the 3400 nonradar, non-towered airports in the United States where operations are currently restricted to one-in/one-out procedural separation during Instrument Meteorological Conditions (IMC). The concept's key feature is pilots maintain their own separation from other aircraft using procedures, aircraft flight data sent via air-to-air datalink, cockpit displays, and on-board software. This is done within the Self-Controlled Area (SCA), an area of flight operations established during poor visibility or low ceilings around an airport without Air Traffic Control (ATC) services. The research described in this paper expands the HVO concept to include most off-nominal situations that could be expected to occur in a future SATS environment. The situations were categorized into routine off-nominal operations, procedural deviations, equipment malfunctions, and aircraft emergencies. The combination of normal and off-nominal HVO procedures provides evidence for an operational concept that is safe, requires little ground infrastructure, and enables concurrent flight operations in poor weather.

Study of airborne science experiment management concepts for application to space shuttle. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

Mulholland, D. R.; Reller, J. O., Jr.; Neel, C. B.; Haughney, L. C.

1973-01-01

The management concepts and operating procedures are documented as they apply to the planning of shuttle spacelab operations. Areas discussed include: airborne missions; formulation of missions; management procedures; experimenter involvement; experiment development and performance; data handling; safety procedures; and applications to shuttle spacelab planning. Characteristics of the airborne science experience are listed, and references and figures are included.

The Centrifuge Facility Life Sciences Glovebox configuration study

NASA Technical Reports Server (NTRS)

Sun, Sidney C.; Goulart, Carla V.

1992-01-01

Crew operations associated with nonhuman life sciences research on Space Station Freedom will be conducted in the Life Sciences Glovebox, whose enclosed work volume must accommodate numerous life science procedures. Two candidate Glovebox work volume concepts have been developed: one in which two operators work side-by-side, and another that conforms to the reach envelope of a single operator. Six test volunteers tested the concepts according to preestablished operational criteria. The wrap-around, single-operator concept has been judged the superior system.

Small Aircraft Transportation System, Higher Volume Operations Concept: Off-Nominal Operations

NASA Technical Reports Server (NTRS)

Abbott, Terence S.; Consiglio, Maria C.; Baxley, Brian T.; Williams, Daniel M.; Conway, Sheila R.

2005-01-01

This document expands the Small Aircraft Transportation System, (SATS) Higher Volume Operations (HVO) concept to include off-nominal conditions. The general philosophy underlying the HVO concept is the establishment of a newly defined area of flight operations called a Self-Controlled Area (SCA). During periods of poor weather, a block of airspace would be established around designated non-towered, non-radar airports. Aircraft flying enroute to a SATS airport would be on a standard instrument flight rules flight clearance with Air Traffic Control providing separation services. Within the SCA, pilots would take responsibility for separation assurance between their aircraft and other similarly equipped aircraft. Previous work developed the procedures for normal HVO operations. This document provides details for off-nominal and emergency procedures for situations that could be expected to occur in a future SCA.

Operative Treatment of Lymphedema Using Suction-Assisted Lipectomy.

PubMed

Greene, Arin K; Maclellan, Reid A

2016-09-01

Surgical management of lymphedema includes removal of affected tissues (excisional procedures), or operations that create new lymphatic connections (physiologic procedures). The purpose of this study was to determine the efficacy of one type of excisional procedure, suction-assisted lipectomy, for extremity lymphedema. Patients treated in our Lymphedema Program between 2007 and 2015 with liposuction that had postoperative follow-up were reviewed. The diagnosis of lymphedema was made by history/physical examination and confirmed with lymphoscintigraphy. Patient sex, age, type of lymphedema (primary or secondary), location of disease, infection history, volume of lipoaspirate, and reduction of extremity volume were recorded. Fifteen patients were included, mean age was 45 years (range, 17-71). Six patients had secondary upper extremity lymphedema, and 9 patients had lower limb disease. Eight patients had a history of repeated cellulitis involving the lymphedematous extremity. Mean lipoaspirate volume was 1612 mL (range, 1200-2800) for the upper extremity and 2902 mL (range, 2000-4800) for the lower limb. Postoperative follow-up averaged 3.1 years. The mean reduction in excess extremity volume was 73% (range, 48% to 94%), and patients reported improvement in their quality of life. Suction-assisted lipectomy is an effective technique to reduce extremity volume for patients with lymphedema.

Flying SATS Higher Volume Operations: Training, Lessons Learned, and Pilots' Experiences

NASA Technical Reports Server (NTRS)

Conway, Sheila; Williams, Dan; Adams, Catherine; Consiglio, Maria; Murdoch, Jennifer

2005-01-01

Developments in aviation, including new surveillance technologies and quicker, more economical small aircraft, have been identified as driving factors in a potential expansion of the use of non-towered, non-radar airports. The Small Aircraft Transportation System (SATS) project has developed the Higher Volume Operations (HVO) concept that enables pilots to safely arrive and depart these airports in instrument conditions at an increased rate as compared to today's procedures. This is achieved by transferring some traffic management tasks to centralized, ground-based automation, while assigning others to participating pilots aided by on-board tools. This paper describes strategies and lessons learned while training pilots to fly these innovative operations. Pilot approaches to using the experimental displays and dynamic altering systems during training are discussed. Potential operational benefits as well as pit-falls and frustrations expressed by subjects while learning to fly these new procedures are presented. Generally, pilots were comfortable with the procedures and the training process, and expressed interest in its near-term implementation.

Management plan documentation standard and Data Item Descriptions (DID). Volume of the information system life-cycle and documentation standards, volume 2

NASA Technical Reports Server (NTRS)

Callender, E. David; Steinbacher, Jody

1989-01-01

This is the second of five volumes of the Information System Life-Cycle and Documentation Standards. This volume provides a well-organized, easily used standard for management plans used in acquiring, assuring, and developing information systems and software, hardware, and operational procedures components, and related processes.

Effect of Hospital Volume on Prosthesis Use and Mortality in Aortic Valve Operations in the Elderly.

PubMed

McNeely, Christian; Markwell, Stephen; Filson, Kathryn; Hazelrigg, Stephen; Vassileva, Christina

2016-02-01

This study was designed to examine the effect of hospital procedural volume on outcomes in aortic valve replacement (AVR) in the elderly. The study included 277,928 Medicare beneficiaries who underwent AVR from 2000 through 2009 at one of 1,255 participating hospitals. Operative mortality and the use of mechanical prostheses were analyzed according to hospital annual procedural volume. Annual AVR volume was divided into 5 different categories: the smallest volume group with less than 10 AVRs per year to the largest group averaging more than 70 AVRs per year. The overall observed operative mortality rate was 7.3%; for isolated AVR it was 5.5%. Lower-volume hospitals exhibited increased adjusted operative mortality: 10 cases or fewer per year--odds ratio (OR), 1.55; 95% confidence interval (CI), 1.39 to 1.72; 11 to 20 cases per year--OR, 1.35; 95% CI, 1.23 to 1.47; 21 to 40 cases per year--OR, 1.15; 95% CI, 1.06 to 1.25; 41 to 70 cases per year--OR, 1.10; 95% CI, 1.01 to 1.20 relative to those hospitals performing more than 70 cases per year. The discrepancy in operative mortality between low- and high-volume hospitals diverged during the study. Mechanical valve use decreased with increasing hospital volume (p = 0.0001). Mechanical valves were used in 64.5% of AVRs in hospitals with an annual AVR volume less than 10 in contrast to only 25.4% in hospitals with an annual AVR volume more than 70. After adjustment, the use of mechanical valves was independently associated with increased operative mortality (OR, 1.15; 95% CI, 1.11-1.19). Low-volume centers were characterized by increased adjusted operative mortality and greater use of mechanical prostheses, a trend that persisted during the 10-year course of the study. These data would support the center-of-excellence concept for AVR and may be particularly relevant in the elderly population. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

No Correlation Between Work-Hours and Operative Volumes--A Comparison Between United States and Danish Operative Volumes Achieved During Surgical Residency.

PubMed

Kjærgaard, Jane; Sillesen, Martin; Beier-Holgersen, Randi

2016-01-01

Since 2003, United States residents have been limited to an 80-hour workweek. This has prompted concerns of reduced educational quality, especially inadequate operating exposure. In contrast, the Danish surgical specialty-training program mandates a cap on working hours of 37 per week. We hypothesize that there is no direct correlation between work-hours and operative volume achieved during surgical residency. To test the hypothesis, we compare Danish and US operative volumes achieved during surgical residency training. Retrospective comparative study. The data from the US population was extracted from the Accreditation Council for Graduate Medical Education database for General Surgery residents from 2012 to 2013. For Danish residents, a questionnaire with case categories matching the Accreditation Council for Graduate Medical Education categories were sent to all Danish surgeons graduating the national surgical residency program in 2012 or 2013, 54 in total. In all, 30 graduated residents (55%) responded to the Danish survey. We found no significant differences in mean total major procedures (1002.4 vs 976.9, p = 0.28) performed during residency training, but comparing average major procedures per year, the US residents achieve significantly more (132.3 vs 195.4, p <0.01). When factoring in differences in time spent in training, this amounts to a weekly average difference of 1.2 cases throughout training. In this study, we find no difference in overall surgical volumes between Danes and US residents during their surgical training. When time in training was accounted for, differences between weekly surgical volumes achieved were minor, indicating a lack of direct correlation between weekly work-hours and operative volumes achievable. Factors other than work-hours seem to effect on operative volumes achieved during training. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

USEPA MANUAL OF METHODS FOR VIROLOGY | Science ...

EPA Pesticide Factsheets

This chapter describes procedures for the detection of coliphases in water matrices. These procedures are based on those presented in the Supplement to the 20th Edition of Standard Methods for the Examination of Water and Eastewater and EPA Methods 1601 and 1602. Two quantitative procedures and one qualitative, presence-absence procedures are presented. The procedures can be used, without supplementary methods, to assay small volumes of water (10 mL to 1L). For larger volumes (>100L), large-scale concentration methods such as described in Chapter 14 may be incorporated into the assay scheme. However, as some concentration procedures may result in appreciable loss or inactivation of coliphage, it is recommended that the suitability of any large volume concentration method be evaluated in measured recovery trials before implementation. Develop sensitive techniques to detect and identify emerging human waterborne pathogenic viruses and viruses on the CCL.Determine effectiveness of viral indicators to measure microbial quality in water matrices.Support activities: (a) culture and distribution of mammalian cells for Agency and scientific community research needs, (b) provide operator expertise for research requiring confocal and electron microscopy, (c) glassware cleaning, sterilization and biological waste disposal for the Cincinnati EPA facility, (d) operation of infectious pathogenic suite, (e) maintenance of walk-in constant temperature rooms and (f) provid

Computer Modeling to Evaluate the Impact of Technology Changes on Resident Procedural Volume.

PubMed

Grenda, Tyler R; Ballard, Tiffany N S; Obi, Andrea T; Pozehl, William; Seagull, F Jacob; Chen, Ryan; Cohn, Amy M; Daskin, Mark S; Reddy, Rishindra M

2016-12-01

As resident "index" procedures change in volume due to advances in technology or reliance on simulation, it may be difficult to ensure trainees meet case requirements. Training programs are in need of metrics to determine how many residents their institutional volume can support. As a case study of how such metrics can be applied, we evaluated a case distribution simulation model to examine program-level mediastinoscopy and endobronchial ultrasound (EBUS) volumes needed to train thoracic surgery residents. A computer model was created to simulate case distribution based on annual case volume, number of trainees, and rotation length. Single institutional case volume data (2011-2013) were applied, and 10 000 simulation years were run to predict the likelihood (95% confidence interval) of all residents (4 trainees) achieving board requirements for operative volume during a 2-year program. The mean annual mediastinoscopy volume was 43. In a simulation of pre-2012 board requirements (thoracic pathway, 25; cardiac pathway, 10), there was a 6% probability of all 4 residents meeting requirements. Under post-2012 requirements (thoracic, 15; cardiac, 10), however, the likelihood increased to 88%. When EBUS volume (mean 19 cases per year) was concurrently evaluated in the post-2012 era (thoracic, 10; cardiac, 0), the likelihood of all 4 residents meeting case requirements was only 23%. This model provides a metric to predict the probability of residents meeting case requirements in an era of changing volume by accounting for unpredictable and inequitable case distribution. It could be applied across operations, procedures, or disease diagnoses and may be particularly useful in developing resident curricula and schedules.

The Regionalization of Lumbar Spine Procedures in New York State: A 10-Year Analysis.

PubMed

Jancuska, Jeffrey; Adrados, Murillo; Hutzler, Lorraine; Bosco, Joseph

2016-01-01

A retrospective review of an administrative database. The purpose of this study is to determine the current extent of regionalization by mapping lumbar spine procedures according to hospital and patient zip code, as well as examine the rate of growth of lumbar spine procedures performed at high-, medium-, and low-volume institutions in New York State. The association between hospital and spine surgeon volume and improved patient outcomes is well established. There is no study investigating the actual process of patient migration to high-volume hospitals. New York Statewide Planning and Research Cooperative System (SPARCS) administrative data were used to identify 228,695 lumbar spine surgery patients from 2005 to 2014. The data included the patients' zip code, hospital of operation, and year of discharge. The volume of lumbar spine surgery in New York State was mapped according to patient and hospital 3-digit zip code. New York State hospitals were categorized as low, medium, and high volume and descriptive statistics were used to determine trends in changes in hospital volume. Lumbar spine surgery recipients are widely distributed throughout the state. Procedures are regionalized on a select few metropolitan centers. The total number of procedures grew 2.5% over the entire 10-year-period. High-volume hospital caseload increased 50%, from 7253 procedures in 2005 to 10,915 procedures in 2014. The number of procedures at medium and low-volume hospitals decreased 30% and 13%, respectively. Despite any concerted effort aimed at moving orthopedic patients to high-volume hospitals, migration to high-volume centers occurred. Public interest in quality outcomes and cost, as well as financial incentives among medical centers to increase market share, potentially influence the migration of patients to high-volume centers. Further regionalization has the potential to exacerbate the current level of disparities among patient populations at low and high-volume hospitals. 3.

76 FR 62074 - Proposed Revision of Performance Standards for State Medicaid Fraud Control Units

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-06

... volume of case referrals and workload for each location. Performance Standard 3--Policies and Procedures A Unit establishes written policies and procedures for its operations and ensures that staff are familiar with, and adhere to, policies and procedures. In meeting this standard, the following performance...

Impact of the 80-hour work week on resident emergency operative experience.

PubMed

Feanny, Mark A; Scott, Bradford G; Mattox, Kenneth L; Hirshberg, Asher

2005-12-01

The goal of this study was to analyze the impact of the 80-hour work week on the emergency operative experience of surgical residents. A 2-year retrospective comparison of the operative experience in emergency abdominal procedures of postgraduate year 4 and 5 residents in a city hospital before (group 1) and after (group 2) duty hour restriction. There was no difference between groups in the mean number of procedures performed as the primary surgeon, but group 2 showed a 40% decrease in technically advanced procedures with a 44% increase in basic procedures. The study also demonstrated a 54% decrease in the operative volume as first assistant. Operative continuity of care by residents decreased from 60% to 26% of cases. The ACGME regulatory environment is adversely affecting the emergency operative experience of surgical residents. Our findings underscore the need to develop alternative methods to augment the residents' operative experience.

Predicting recurrence after chronic subdural haematoma drainage.

PubMed

Jack, Andrew; O'Kelly, Cian; McDougall, Cameron; Findlay, J Max

2015-01-01

Recurrence of chronic subdural haematomas (CSDHs) after surgical drainage is a significant problem with rates up to 20%. This study focuses on determining factors predictive of haematoma recurrence and presents a scoring system stratifying recurrence risk for individual patients. Between the years 2005 and 2009, 331 consecutive patients with CSDHs treated with surgery were included in this study. Univariate and multivariate analyses were performed searching for risk factors of increased post-operative haematoma volume and haematoma recurrence requiring repeat drainage. We found a 12% reoperation rate. CSDH septation (seen on computed tomogram scan) was found to be an independent risk factor for recurrence requiring reoperation (p=0.04). Larger post-operative subdural haematoma volume was also significantly associated with requiring a second drainage procedure (p<0.001). Independent risk factors of larger post-operative haematoma volume included septations within a CSDH (p<0.01), increased pre-operative haematoma volume (p<0.01), and a greater amount of parenchymal atrophy (p=0.04). A simple scoring system for quantifying recurrence risk was created and validated based on patient age (< or ≥ 80 years), haematoma volume (< or ≥ 160 cc), and presence of septations within the subdural collection (yes or no). Septations within CSDHs are associated with larger post-operative residual haematoma collections requiring repeat drainage. When septations are clearly visible within a CSDH, craniotomy might be more suitable as a primary procedure as it allows greater access to a septated subdural collection. Our proposed scoring system combining haematoma volume, age, and presence of septations might be useful in identifying patients at higher risk for recurrence.

Inductive interference in rapid transit signaling systems. volume 2. suggested test procedures.

DOT National Transportation Integrated Search

1987-03-31

These suggested test procedures have been prepared in order to develop standard methods of analysis and testing to quantify and resolve issues of electromagnetic compatibility in rail transit operations. Electromagnetic interference, generated by rai...

The effect of economic downturn on the volume of surgical procedures: A systematic review.

PubMed

Fujihara, Nasa; Lark, Meghan E; Fujihara, Yuki; Chung, Kevin C

2017-08-01

Economic downturn can have a wide range of effects on medicine at both individual and national levels. We aim to describe these effects in relation to surgical volume to guide future planning for physician specialization, patient expectations in the face of economic crises, or estimating healthcare expenditure. We hypothesized that because of high out-of-pocket costs, cosmetic procedure volumes would be most affected by economic decline. A systematic review was conducted using MEDLINE, Embase, and ABI/INFORMS. The main search terms were "economic recession" and "surgical procedures, operative". Studies were included if surgical volumes were measured and economic indicators were used as predictors of economic conditions. Twelve studies were included, and the most common subject was cosmetic (n = 5), followed by orthopedic (n = 2) and cardiac surgeries (n = 2). The majority of studies found that in periods of economic downturn, surgical volume decreased. Among the eight studies using Pearson's correlation analysis, there were no significant differences between cosmetic procedures and other elective procedures, indicating that cosmetic procedures may display trends similar to those of non-cosmetic elective procedures in periods of economic downturn. Surgical volume generally decreased when economic indicators declined, observed for both elective and non-elective surgery fields. However, a few specific procedure volumes such as vasectomy and caesarean section for male babies increased during the economic downturn. Knowledge of these trends can be useful for future surgical planning and distribution of healthcare resources. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States.

PubMed

Sosa, Julie Ann; Hanna, John W; Robinson, Karen A; Lanman, Richard B

2013-12-01

To provide population-based estimates of trends in thyroid nodule fine-needle aspirations (FNA) and operative volumes, we used multiple claims databases to quantify rates of these procedures and their association with the increasing incidence of thyroid cancer in the United States. Private and public insurance claims databases were used to estimate procedure volumes from 2006 to 2011. Rates of FNA and thyroid operations related to thyroid nodules were defined by CPT4 codes associated with International Classification of Diseases, Ninth Revision Clinical Modification codes for nontoxic uni- or multinodular goiter and thyroid neoplasms. Use of thyroid FNA more than doubled during the 5-year study period (16% annual growth). The number of thyroid operations performed for thyroid nodules increased by 31%. Total thyroidectomies increased by 12% per year, whereas lobectomies increased only 1% per year. In 2011, total thyroidectomies accounted for more than half (56%) of the operations for thyroid neoplasms in the United States. Thyroid operations became increasingly (62%) outpatient procedures. Thyroid FNA and operative procedures have increased rapidly in the United States, with an associated increase in the incidence of thyroid cancer. The more substantial increase in number of total versus partial thyroid resections suggests that patients undergoing thyroid operation are perceived to have a greater risk of cancer as determined by preoperative assessments, but this trend could also increase detection of incidental microcarcinomas. Copyright © 2013 Mosby, Inc. All rights reserved.

Small Aircraft Transportation System, Higher Volume Operations Concept: Normal Operations

NASA Technical Reports Server (NTRS)

Abbott, Terence S.; Jones, Kenneth M.; Consiglio, Maria C.; Williams, Daniel M.; Adams, Catherine A.

2004-01-01

This document defines the Small Aircraft Transportation System (SATS), Higher Volume Operations (HVO) concept for normal conditions. In this concept, a block of airspace would be established around designated non-towered, non-radar airports during periods of poor weather. Within this new airspace, pilots would take responsibility for separation assurance between their aircraft and other similarly equipped aircraft. Using onboard equipment and procedures, they would then approach and land at the airport. Departures would be handled in a similar fashion. The details for this operational concept are provided in this document.

Impact of an electronic health record operating room management system in ophthalmology on documentation time, surgical volume, and staffing.

PubMed

Sanders, David S; Read-Brown, Sarah; Tu, Daniel C; Lambert, William E; Choi, Dongseok; Almario, Bella M; Yackel, Thomas R; Brown, Anna S; Chiang, Michael F

2014-05-01

Although electronic health record (EHR) systems have potential benefits, such as improved safety and quality of care, most ophthalmology practices in the United States have not adopted these systems. Concerns persist regarding potential negative impacts on clinical workflow. In particular, the impact of EHR operating room (OR) management systems on clinical efficiency in the ophthalmic surgery setting is unknown. To determine the impact of an EHR OR management system on intraoperative nursing documentation time, surgical volume, and staffing requirements. For documentation time and circulating nurses per procedure, a prospective cohort design was used between January 10, 2012, and January 10, 2013. For surgical volume and overall staffing requirements, a case series design was used between January 29, 2011, and January 28, 2013. This study involved ophthalmic OR nurses (n = 13) and surgeons (n = 25) at an academic medical center. Electronic health record OR management system implementation. (1) Documentation time (percentage of operating time documenting [POTD], absolute documentation time in minutes), (2) surgical volume (procedures/time), and (3) staffing requirements (full-time equivalents, circulating nurses/procedure). Outcomes were measured during a baseline period when paper documentation was used and during the early (first 3 months) and late (4-12 months) periods after EHR implementation. There was a worsening in total POTD in the early EHR period (83%) vs paper baseline (41%) (P < .001). This improved to baseline levels by the late EHR period (46%, P = .28), although POTD in the cataract group remained worse than at baseline (64%, P < .001). There was a worsening in absolute mean documentation time in the early EHR period (16.7 minutes) vs paper baseline (7.5 minutes) (P < .001). This improved in the late EHR period (9.2 minutes) but remained worse than in the paper baseline (P < .001). While cataract procedures required more circulating nurses in the early EHR (mean, 1.9 nurses/procedure) and late EHR (mean, 1.5 nurses/procedure) periods than in the paper baseline (mean, 1.0 nurses/procedure) (P < .001), overall staffing requirements and surgical volume were not significantly different between the periods. Electronic health record OR management system implementation was associated with worsening of intraoperative nursing documentation time especially in shorter procedures. However, it is possible to implement an EHR OR management system without serious negative impacts on surgical volume and staffing requirements.

Systems Design and Pilot Operation of a Regional Center for Technical Processing for the Libraries of the New England State Universities. NELINET, New England Library Information Network. Progress Report, July 1, 1967 - March 30, 1968, Volume II, Appendices.

ERIC Educational Resources Information Center

Agenbroad, James E.; And Others

Included in this volume of appendices to LI 000 979 are acquisitions flow charts; a current operations questionnaire; an algorithm for splitting the Library of Congress call number; analysis of the Machine-Readable Cataloging (MARC II) format; production problems and decisions; operating procedures for information transmittal in the New England…

PRT Impact Study - Operational Phase : Volume 2. Data Collection Procedure and Coding Manual.

DOT National Transportation Integrated Search

1979-07-01

The report documents the procedures used by researchers at West Virginia University (WVU) in collecting data which describes transportation-related conditions in Morgantown, West Virginia following the commencement of passenger service on Phase I of ...

Freight Transportation Energy Use : Volume 3. Freight Network and Operations Database.

DOT National Transportation Integrated Search

1979-07-01

The data sources, procedures, and assumptions used to generate the TSC national freight network and operations database are documented. National rail, highway, waterway, and pipeline networks are presented, and estimates of facility capacity, travel ...

Test Plans and Procedures for the Baseline SAF for BDS-D Sites (ModSAF). Volume 2

DTIC Science & Technology

1993-12-20

operations editor will no longer editor, appear in the EditorI Area. 64 I ADST/WDL/TR-93-W003271 VOLUME 2 of 2; Ver 1.0I 44200 Repeat steps 44120 thru...The unit operations 44200 to task the orange editor will no longer platoon to Move on the appear in the Editor route labeled "ort. Area. The vehicles

Development and testing of laser Doppler system components for wake vortex monitoring. Volume 2: Scanner operations manual

NASA Technical Reports Server (NTRS)

Edwards, B. B.; Coffey, E. W.

1974-01-01

The theory and operation of the scanner portion of the laser Doppler system for detecting and monitoring aircraft trailing vortices in an airport environment are discussed. Schematics, wiring diagrams, component values, and operation and checkout procedures are included.

Orbital operations study. Volume 2: Interfacing activities analysis. Part 4: Support operations activity group

NASA Technical Reports Server (NTRS)

Steinwachs, W. L.; Patrick, J. W.; Galvin, D. M.; Turkel, S. H.

1972-01-01

The findings of the support operations activity group of the orbital operations study are presented. Element interfaces, alternate approaches, design concepts, operational procedures, functional requirements, design influences, and approach selection are presented. The following areas are considered: (1) crew transfer, (2) cargo transfer, (3) propellant transfer, (4) attached element operations, and (5) attached element transport.

Assurance specification documentation standard and Data Item Descriptions (DID). Volume of the information system life-cycle and documentation standards, volume 4

NASA Technical Reports Server (NTRS)

Callender, E. David; Steinbacher, Jody

1989-01-01

This is the fourth of five volumes on Information System Life-Cycle and Documentation Standards. This volume provides a well organized, easily used standard for assurance documentation for information systems and software, hardware, and operational procedures components, and related processes. The specifications are developed in conjunction with the corresponding management plans specifying the assurance activities to be performed.

Management control and status reports documentation standard and Data Item Descriptions (DID). Volume of the information system life-cycle and documentation standards, volume 5

NASA Technical Reports Server (NTRS)

Callender, E. David; Steinbacher, Jody

1989-01-01

This is the fifth of five volumes on Information System Life-Cycle and Documentation Standards. This volume provides a well organized, easily used standard for management control and status reports used in monitoring and controlling the management, development, and assurance of informations systems and software, hardware, and operational procedures components, and related processes.

Which Kind of Provider’s Operation Volumes Matters? Associations between CABG Surgical Site Infection Risk and Hospital and Surgeon Operation Volumes among Medical Centers in Taiwan

PubMed Central

Yu, Tsung-Hsien; Tung, Yu-Chi; Chung, Kuo-Piao

2015-01-01

Background Volume-infection relationships have been examined for high-risk surgical procedures, but the conclusions remain controversial. The inconsistency might be due to inaccurate identification of cases of infection and different methods of categorizing service volumes. This study takes coronary artery bypass graft (CABG) surgical site infections (SSIs) as an example to examine whether a relationship exists between operation volumes and SSIs, when different SSIs case identification, definitions and categorization methods of operation volumes were implemented. Methods A population-based cross-sectional multilevel study was conducted. A total of 7,007 patients who received CABG surgery between 2006 and 2008 from19 medical centers in Taiwan were recruited. SSIs associated with CABG surgery were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) codes and a Classification and Regression Trees (CART) model. Two definitions of surgeon and hospital operation volumes were used: (1) the cumulative CABG operation volumes within the study period; and (2) the cumulative CABG operation volumes in the previous one year before each CABG surgery. Operation volumes were further treated in three different ways: (1) a continuous variable; (2) a categorical variable based on the quartile; and (3) a data-driven categorical variable based on k-means clustering algorithm. Furthermore, subgroup analysis for comorbidities was also conducted. Results This study showed that hospital volumes were not significantly associated with SSIs, no matter which definitions or categorization methods of operation volume, or SSIs case identification approaches were used. On the contrary, the relationships between surgeon’s volumes varied. Most of the models demonstrated that the low-volume surgeons had higher risk than high-volume surgeons. Conclusion Surgeon volumes were more important than hospital volumes in exploring the relationship between CABG operation volumes and SSIs in Taiwan. However, the relationships were not robust. Definitions and categorization methods of operation volume and correct identification of SSIs are important issues for future research. PMID:26053035

Small Aircraft Transportation System Higher Volume Operations Concept

NASA Technical Reports Server (NTRS)

Abbott, Terence S.; Consiglio, Maria C.; Baxley, Brian T.; Williams, Daniel M.; Jones, Kenneth M.; Adams, Catherine A.

2006-01-01

This document defines the Small Aircraft Transportation System (SATS) Higher Volume Operations concept. The general philosophy underlying this concept is the establishment of a newly defined area of flight operations called a Self-Controlled Area (SCA). Within the SCA, pilots would take responsibility for separation assurance between their aircraft and other similarly equipped aircraft. This document also provides details for a number of off-nominal and emergency procedures which address situations that could be expected to occur in a future SCA. The details for this operational concept along with a description of candidate aircraft systems to support this concept are provided.

PRT Impact Study Pre-PRT Phase : Volume 2. Data Collection Procedure and Coding Manual.

DOT National Transportation Integrated Search

1976-03-01

The report describes the procedures utilized for collection of data on transportation demand and supply prior to the revenue operation of the Personal Rapid Transit (PRT) System in Morgantown, West Virginia. Most of the report is devoted to describin...

Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines.

PubMed

Rath, Ehud; Sharfman, Zachary T; Paret, Matan; Amar, Eyal; Drexler, Michael; Bonin, Nicolas

2017-01-01

The objectives of this study are to survey the weight-bearing limitation practices and delay for returning to running and impact sports of high volume hip arthroscopy orthopedic surgeons. The study was designed in the form of expert survey questionnaire. Evidence-based data are scares regarding hip arthroscopy post-operative weight-bearing protocols. An international cross-sectional anonymous Internet survey of 26 high-volume hip arthroscopy specialized surgeons was conducted to report their weight-bearing limitations and rehabilitation protocols after various arthroscopic hip procedures. The International Society of Hip Arthroscopy invited this study. The results were examined in the context of supporting literature to inform the studies suggestions. Four surgeons always allow immediate weight bearing and five never offer immediate weight bearing. Seventeen surgeons provide weight bearing depending on the procedures performed: 17 surgeons allowed immediate weight bearing after labral resection, 10 after labral repair and 8 after labral reconstruction. Sixteen surgeons allow immediate weight bearing after psoas tenotomy. Twenty-one respondents restrict weight bearing after microfracture procedures for 3-8 weeks post-operatively. Return to running and impact sports were shorter for labral procedures and bony procedures and longer for cartilaginous and capsular procedures. Marked variability exists in the post-operative weight-bearing practices of hip arthroscopy surgeons. This study suggests that most surgeons allow immediate weight bearing as tolerated after labral resection, acetabular osteoplasty, chondroplasty and psoas tenotomy. For cartilage defect procedures, 6 weeks or more non-weight bearing is suggested depending on the area of the defect and lateral central edge angle. Delayed return to sports activities is suggested after microfracture procedures. The level of evidence was Level V expert opinions.

Hip arthroscopy protocol: expert opinions on post-operative weight bearing and return to sports guidelines

PubMed Central

Rath, Ehud; Paret, Matan; Amar, Eyal; Drexler, Michael; Bonin, Nicolas

2017-01-01

Abstract The objectives of this study are to survey the weight-bearing limitation practices and delay for returning to running and impact sports of high volume hip arthroscopy orthopedic surgeons. The study was designed in the form of expert survey questionnaire. Evidence-based data are scares regarding hip arthroscopy post-operative weight-bearing protocols. An international cross-sectional anonymous Internet survey of 26 high-volume hip arthroscopy specialized surgeons was conducted to report their weight-bearing limitations and rehabilitation protocols after various arthroscopic hip procedures. The International Society of Hip Arthroscopy invited this study. The results were examined in the context of supporting literature to inform the studies suggestions. Four surgeons always allow immediate weight bearing and five never offer immediate weight bearing. Seventeen surgeons provide weight bearing depending on the procedures performed: 17 surgeons allowed immediate weight bearing after labral resection, 10 after labral repair and 8 after labral reconstruction. Sixteen surgeons allow immediate weight bearing after psoas tenotomy. Twenty-one respondents restrict weight bearing after microfracture procedures for 3–8 weeks post-operatively. Return to running and impact sports were shorter for labral procedures and bony procedures and longer for cartilaginous and capsular procedures. Marked variability exists in the post-operative weight-bearing practices of hip arthroscopy surgeons. This study suggests that most surgeons allow immediate weight bearing as tolerated after labral resection, acetabular osteoplasty, chondroplasty and psoas tenotomy. For cartilage defect procedures, 6 weeks or more non-weight bearing is suggested depending on the area of the defect and lateral central edge angle. Delayed return to sports activities is suggested after microfracture procedures. The level of evidence was Level V expert opinions. PMID:28630722

V/STOL tilt rotor research aircraft. Volume 1: General information, revision C

NASA Technical Reports Server (NTRS)

Kimbell, M.; Whitener, A.

1980-01-01

The configuration, operation and maintenance requirements for the contractor-furnished portion of the XV-15 research instrumentation and data acquisition system are defined. Descriptions of systems operation, maintenance and checkout procedures, and cable designations are given.

Orbital operations study. Volume 2: Interfacing activities analyses. Part 3: Data management activity group

NASA Technical Reports Server (NTRS)

Mehrbach, E.; Turkel, S. H.

1972-01-01

A summary of the findings of the data management group of the orbital operations study is presented. Element interfaces, alternate approaches, design concepts, operational procedures, functional requirements, design influences, and approach selection are described. The following interfacing activities are considered: (1) communications, (2) rendezvous, (3) stationkeeping, and (4) detached element operations.

Design and Mechanical Evaluation of a Capacitive Sensor-Based Indexed Platform for Verification of Portable Coordinate Measuring Instruments

PubMed Central

Avila, Agustín Brau; Mazo, Jorge Santolaria; Martín, Juan José Aguilar

2014-01-01

During the last years, the use of Portable Coordinate Measuring Machines (PCMMs) in industry has increased considerably, mostly due to their flexibility for accomplishing in-line measuring tasks as well as their reduced costs and operational advantages as compared to traditional coordinate measuring machines (CMMs). However, their operation has a significant drawback derived from the techniques applied in the verification and optimization procedures of their kinematic parameters. These techniques are based on the capture of data with the measuring instrument from a calibrated gauge object, fixed successively in various positions so that most of the instrument measuring volume is covered, which results in time-consuming, tedious and expensive verification procedures. In this work the mechanical design of an indexed metrology platform (IMP) is presented. The aim of the IMP is to increase the final accuracy and to radically simplify the calibration, identification and verification of geometrical parameter procedures of PCMMs. The IMP allows us to fix the calibrated gauge object and move the measuring instrument in such a way that it is possible to cover most of the instrument working volume, reducing the time and operator fatigue to carry out these types of procedures. PMID:24451458

Design and mechanical evaluation of a capacitive sensor-based indexed platform for verification of portable coordinate measuring instruments.

PubMed

Avila, Agustín Brau; Mazo, Jorge Santolaria; Martín, Juan José Aguilar

2014-01-02

During the last years, the use of Portable Coordinate Measuring Machines (PCMMs) in industry has increased considerably, mostly due to their flexibility for accomplishing in-line measuring tasks as well as their reduced costs and operational advantages as compared to traditional coordinate measuring machines (CMMs). However, their operation has a significant drawback derived from the techniques applied in the verification and optimization procedures of their kinematic parameters. These techniques are based on the capture of data with the measuring instrument from a calibrated gauge object, fixed successively in various positions so that most of the instrument measuring volume is covered, which results in time-consuming, tedious and expensive verification procedures. In this work the mechanical design of an indexed metrology platform (IMP) is presented. The aim of the IMP is to increase the final accuracy and to radically simplify the calibration, identification and verification of geometrical parameter procedures of PCMMs. The IMP allows us to fix the calibrated gauge object and move the measuring instrument in such a way that it is possible to cover most of the instrument working volume, reducing the time and operator fatigue to carry out these types of procedures.

Does operative experience during residency correlate with reported competency of recent general surgery graduates?

PubMed Central

Safavi, Arash; Lai, Sarah; Butterworth, Sonia; Hameed, Morad; Schiller, Dan; Skarsgard, Erik

2012-01-01

Background Identification of attributes of residency training that predict competency would improve surgical education. We hypothesized that case experience during residency would correlate with self-reported competency of recent graduates. Methods Aggregate case log data of residents enrolled in 2 general surgery programs were collected over a 12-month period and stratified into Surgical Council on Resident Education (SCORE) categories. We surveyed recent (< 5 yr) residency graduates on procedural competency. Resident case volumes were correlated with survey responses by SCORE category. Results In all, 75 residents performed 11 715 operations, which were distributed by SCORE category as follows: essential-common (EC) 9935 (84.8%), essential-uncommon (EU) 889 (7.6%) and complex 891 (7.6%). Alimentary tract procedures were the most commonly performed EC (2386, 24%) and EU (504, 56.7%) procedures. The least common EC procedure was plastic surgery (4, 0.04%), and the least common EU procedure was abdomen–spleen (1, 0.1%). The questionnaire response rate was 45%. For EC procedures, self-reported competency was highest in skin and soft tissue, thoracic and head and neck (each 100%) and lowest in vascular–venous (54%), whereas for EU procedures it was highest in abdomen–general (100%) and lowest in vascular–arterial (62%). The correlation between case volume and self-reported competency was poor (R = 0.2 for EC procedures). Conclusion Self-reported competency correlates poorly with operative case experience during residency. Other curriculum factors, including specific rotations and timing, balance between inpatient and outpatient surgical experience and competition for cases, may contribute to procedural competency acquisition during residency. PMID:22854144

The Small Aircraft Transportation System (SATS), Higher Volume Operations (HVO) Concept and Research

NASA Technical Reports Server (NTRS)

Baxley, B.; Williams, D.; Consiglio, M.; Adams, C.; Abbott, T.

2005-01-01

The ability to conduct concurrent, multiple aircraft operations in poor weather at virtually any airport offers an important opportunity for a significant increase in the rate of flight operations, a major improvement in passenger convenience, and the potential to foster growth of operations at small airports. The Small Aircraft Transportation System, (SATS) Higher Volume Operations (HVO) concept is designed to increase capacity at the 3400 non-radar, non-towered airports in the United States where operations are currently restricted to one-in/one-out procedural separation during low visibility or ceilings. The concept s key feature is that pilots maintain their own separation from other aircraft using air-to-air datalink and on-board software within the Self-Controlled Area (SCA), an area of flight operations established during poor visibility and low ceilings around an airport without Air Traffic Control (ATC) services. While pilots self-separate within the SCA, an Airport Management Module (AMM) located at the airport assigns arriving pilots their sequence based on aircraft performance, position, winds, missed approach requirements, and ATC intent. The HVO design uses distributed decision-making, safe procedures, attempts to minimize pilot and controller workload, and integrates with today's ATC environment. The HVO procedures have pilots make their own flight path decisions when flying in Instrument Metrological Conditions (IMC) while meeting these requirements. This paper summarizes the HVO concept and procedures, presents a summary of the research conducted and results, and outlines areas where future HVO research is required. More information about SATS HVO can be found at http://ntrs.nasa.gov.

Locomotive cab design development. volume 2 : operator's manual - Interim Report

DOT National Transportation Integrated Search

1976-10-01

Locomotive Cab 913 designed as a result of Contract DOT-TSC- 913 has been built as a hard mock-up. This Operator's Manual is to familiarize the user with the mock-up. Normal and emergency procedures and cab facilities are described.

Considerations in the Integration of Small Aircraft Transportation System Higher Volume Operations (SATSHVO) in the National Airspace System (NAS)

NASA Technical Reports Server (NTRS)

Lohr, Gary W.; Williams, Dan; Abbott, Terence; Baxley, Brian; Greco, Adam; Ridgway, Richard

2005-01-01

The Small Aircraft Transportation System Higher Volume Operations (SATS HVO) concept holds the promise for increased efficiency and throughput at many of the nations under-used airports. This concept allows for concurrent operations at uncontrolled airports that under today s procedures are restricted to one arrival or one departure operation at a time, when current-day IFR separation standards are applied. To allow for concurrent operations, SATS HVO proposes several fundamental changes to today's system. These changes include: creation of dedicated airspace, development of new procedures and communications (phraseologies), and assignment of roles and responsibilities for pilots and controllers, among others. These changes would affect operations on the airborne side (pilot) as well as the groundside (controller and air traffic flow process). The focus of this paper is to discuss some of the issues and potential problems that have been considered in the development of the SATS HVO concept, in particular from the ground side perspective. Reasonable solutions to the issues raised here have been proposed by the SATS HVO team, and are discussed in this paper.

User's operating procedures. Volume 1: Scout project information programs

NASA Technical Reports Server (NTRS)

Harris, C. G.; Harris, D. K.

1985-01-01

A review of the user's operating procedures for the Scout Project Automatic Data System, called SPADS is given. SPADS is the result of the past seven years of software development on a Prime minicomputer located at the Scout Project Office. SPADS was developed as a single entry, multiple cross reference data management and information retrieval system for the automation of Project office tasks, including engineering, financial, managerial, and clerical support. The instructions to operate the Scout Project Information programs in data retrieval and file maintenance via the user friendly menu drivers is presented.

Magnetic bearings for a high-performance optical disk buffer, volume 2

NASA Technical Reports Server (NTRS)

1990-01-01

The operating instructions for the magnetic bearings of a high-performance optical disk buffer are provided. Among the topics that are discussed are the following: front panel layout, turn-on procedure, shut-down procedure, and latch-up protection. Additionally, comprehensive engineering drawings are presented for the design.

Flight Technical Error Analysis of the SATS Higher Volume Operations Simulation and Flight Experiments

NASA Technical Reports Server (NTRS)

Williams, Daniel M.; Consiglio, Maria C.; Murdoch, Jennifer L.; Adams, Catherine H.

2005-01-01

This paper provides an analysis of Flight Technical Error (FTE) from recent SATS experiments, called the Higher Volume Operations (HVO) Simulation and Flight experiments, which NASA conducted to determine pilot acceptability of the HVO concept for normal operating conditions. Reported are FTE results from simulation and flight experiment data indicating the SATS HVO concept is viable and acceptable to low-time instrument rated pilots when compared with today s system (baseline). Described is the comparative FTE analysis of lateral, vertical, and airspeed deviations from the baseline and SATS HVO experimental flight procedures. Based on FTE analysis, all evaluation subjects, low-time instrument-rated pilots, flew the HVO procedures safely and proficiently in comparison to today s system. In all cases, the results of the flight experiment validated the results of the simulation experiment and confirm the utility of the simulation platform for comparative Human in the Loop (HITL) studies of SATS HVO and Baseline operations.

Semiautomatic regional segmentation to measure orbital fat volumes in thyroid-associated ophthalmopathy. A validation study.

PubMed

Comerci, M; Elefante, A; Strianese, D; Senese, R; Bonavolontà, P; Alfano, B; Bonavolontà, B; Brunetti, A

2013-08-01

This study was designed to validate a novel semi-automated segmentation method to measure regional intra-orbital fat tissue volume in Graves' ophthalmopathy. Twenty-four orbits from 12 patients with Graves' ophthalmopathy, 24 orbits from 12 controls, ten orbits from five MRI study simulations and two orbits from a digital model were used. Following manual region of interest definition of the orbital volumes performed by two operators with different levels of expertise, an automated procedure calculated intra-orbital fat tissue volumes (global and regional, with automated definition of four quadrants). In patients with Graves' disease, clinical activity score and degree of exophthalmos were measured and correlated with intra-orbital fat volumes. Operator performance was evaluated and statistical analysis of the measurements was performed. Accurate intra-orbital fat volume measurements were obtained with coefficients of variation below 5%. The mean operator difference in total fat volume measurements was 0.56%. Patients had significantly higher intra-orbital fat volumes than controls (p<0.001 using Student's t test). Fat volumes and clinical score were significantly correlated (p<0.001). The semi-automated method described here can provide accurate, reproducible intra-orbital fat measurements with low inter-operator variation and good correlation with clinical data.

Risk of failure of primary hip arthroscopy—a population-based study

PubMed Central

Degen, Ryan M.; Pan, Ting J.; Chang, Brenda; Mehta, Nabil; Chamberlin, Peter D.; Ranawat, Anil S.; Nawabi, Danyal H.; Kelly, Bryan T.

2017-01-01

Abstract The aims of this study are (i) to report on the rates of subsequent surgery following hip arthroscopy and (ii) to identify prognostic variables associated with revision surgery, survival rates and complication rates. The Statewide Planning and Research Cooperative System database, a census of hospital admissions and ambulatory surgery in New York State, was used to identify cases of primary hip arthroscopy. Demographic information and rates of subsequent revision hip arthroscopy or arthroplasty were collected. The risks were modeled with use of age, sex, procedure and surgeon volume as risk factors. Survival analyses were also performed, and 30-day complication was recorded. We identified 8267 procedures in 7836 patients from 1998 to 2012. Revision surgery occurred in 1087 cases (13.2%) at a mean of 1.7 ± 1.6 (mean ± SD) years. Revision arthroscopy accounted for 311 cases (3.8%), and arthroplasty for 796 (9.7%) cases. Survival analysis showed a 2-year survival rate of 88.1%, 5-year of 80.7% and 10-year of 74.9%. Regression analysis revealed that age >50 years [hazard ratio (HR) 2.09; confidence interval (CI) 1.82–2.39, P < 0.01] and a diagnosis of osteoarthritis (HR 2.72; CI 2.21–3.34, P < 0.01) were associated with increased risk of re-operation. Labral repair was associated with a lower risk of re-operation (HR 0.71; CI 0.54–0.93, P = 0.01). Finally, higher surgeon volume (>164 cases/year) resulted in a lower risk of re-operation versus lower volume (<102 cases/year) (HR 0.42; CI 0.32–0.54, P < 0.01). The 30-day complication rate was 0.2%. Older age and pre-existing osteoarthritis increased the likelihood of re-operation following hip arthroscopy, whereas performing a labral repair and having the procedure performed by a higher-volume surgeon lowered the risk of re-operation. PMID:28948033

Preintervention lesion remodelling affects operative mechanisms of balloon optimised directional coronary atherectomy procedures: a volumetric study with three dimensional intravascular ultrasound

PubMed Central

von Birgelen, C; Mintz, G; de Vrey, E A; Serruys, P; Kimura, T; Nobuyoshi, M; Popma, J; Leon, M; Erbel, R; de Feyter, P J

2000-01-01

AIMS—To classify atherosclerotic coronary lesions on the basis of adequate or inadequate compensatory vascular enlargement, and to examine changes in lumen, plaque, and vessel volumes during balloon optimised directional coronary atherectomy procedures in relation to the state of adaptive remodelling before the intervention.
DESIGN—29 lesion segments in 29 patients were examined with intravascular ultrasound before and after successful balloon optimised directional coronary atherectomy procedures, and a validated volumetric intravascular ultrasound analysis was performed off-line to assess the atherosclerotic lesion remodelling and changes in plaque and vessel volumes that occurred during the intervention. Based on the intravascular ultrasound data, lesions were classified according to whether there was inadequate (group I) or adequate (group II) compensatory enlargement.
RESULTS—There was no significant difference in patient and lesion characteristics between groups I and II (n = 10 and 19), including lesion length and details of the intervention. Quantitative coronary angiographic data were similar for both groups. However, plaque and vessel volumes were significantly smaller in group I than in II. In group I, 9 (4)% (mean (SD)) of the plaque volume was ablated, while in group II 16 (11)% was ablated (p = 0.01). This difference was reflected in a lower lumen volume gain in group I than in group II (46 (18) mm3 v 80 (49) mm3 (p < 0.02)).
CONCLUSIONS—Preintervention lesion remodelling has an impact on the operative mechanisms of balloon optimised directional coronary atherectomy procedures. Plaque ablation was found to be particularly low in lesions with inadequate compensatory vascular enlargement.


Keywords: intravascular ultrasound; ultrasonics; remodelling; coronary artery disease; atherectomy PMID:10648496

Orbital operations study. Volume 2: Interfacing activities analysis. Part 2: Structural and mechanical group

NASA Technical Reports Server (NTRS)

Mattson, H. L.; Gianformaggio, A.; Anderson, N. R.

1972-01-01

The activities of the structural and mechanical activity group of the orbital operations study project are discussed. Element interfaces, alternate approaches, design concepts, operational procedures, functional requirements, design influences, and approach selection are presented. The following areas are considered: (1) mating, (2) orbital assembly, (3) separation, EOS payload deployment, and EOS payload retraction.

Conceptual design and feasibility evaluation model of a 10 to the 8th power bit oligatomic mass memory. Volume 3: Operation manual

NASA Technical Reports Server (NTRS)

Horst, R. L.; Nordstrom, M. J.

1972-01-01

An operation manual is presented for the oligatomic mass memory feasibility model. It includes a brief description of the memory and exerciser units, a description of the controls and their functions, the operating procedures, the test points and adjustments, and the circuit diagram.

Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers.

PubMed

Chang, Alex L; Kim, Young; Ertel, Audrey E; Hoehn, Richard S; Wima, Koffi; Abbott, Daniel E; Shah, Shimul A

2017-05-01

Efforts to regionalize surgery based on thresholds in procedure volume may have consequences on the cost of health care delivery. This study aims to delineate the relationship between hospital volume, case mix, and variability in the cost of operative intervention using colectomy as the model. All patients undergoing colectomy (n = 90,583) at 183 academic hospitals from 2009-2012 in The University HealthSystems Consortium Database were studied. Patient and procedure details were used to generate a case mix-adjusted predictive model of total direct costs. Observed to expected costs for each center were evaluated between centers based on overall procedure volume. Patient and procedure characteristics were significantly different between volume tertiles. Observed costs at high-volume centers were less than at middle- and low-volume centers. According to our predictive model, high-volume centers cared for a less expensive case mix than middle- and low-volume centers ($12,786 vs $13,236 and $14,497, P < .01). Our predictive model accounted for 44% of the variation in costs. Overall efficiency (standardized observed to expected costs) was greatest at high-volume centers compared to middle- and low-volume tertiles (z score -0.16 vs 0.02 and -0.07, P < .01). Hospital costs and cost efficiency after an elective colectomy varies significantly between centers and may be attributed partially to the patient differences at those centers. These data demonstrate that a significant proportion of the cost variation is due to a distinct case mix at low-volume centers, which may lead to perceived poor performance at these centers. Copyright © 2016 Elsevier Inc. All rights reserved.

40 CFR 60.313 - Performance tests and compliance provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... applied (G). (1) An owner or operator shall use the following procedures for any affected facility which... applied (G) during each calendar month for each affected facility, except as provided under § 60.313(c)(2... volume of coating solids applied (G) each calendar month will be determined by the following procedures...

A simple and cheap system to speed up and to control the tumescent technique procedure: the Tedde's system.

PubMed

Rubino, C; Marongiu, F; Manzo, M J; Tedde, G; Madonia, M; Campus, G V; Farace, F

2014-06-01

We have devised a low cost system to quickly infiltrate tumescent solution: we call it the "Tedde's system". This low-cost system offers an improvement in quality and quantity of the infiltration because all the procedure depends on the operators, reducing also the time of the infiltration and consequently of the whole surgical procedure. Moreover, this system can be applied to other surgical procedure that requires large infiltration volumes.

Stone volume is best predictor of operative time required in retrograde intrarenal surgery for renal calculi: implications for surgical planning and quality improvement.

PubMed

Sorokin, Igor; Cardona-Grau, Diana K; Rehfuss, Alexandra; Birney, Alan; Stavrakis, Costas; Leinwand, Gabriel; Herr, Allen; Feustel, Paul J; White, Mark D

2016-11-01

Retrograde intrarenal surgery (RIRS) is highly successful at eliminating renal stones of various sizes and compositions. As urologists are taking on more complex procedures using RIRS, this has led to an increase in operative (OR) times. Our objective was to determine the best predictor of OR time in patients undergoing RIRS. We retrospectively reviewed the records of patients undergoing unilateral RIRS for solitary stones over a 10 year time span. Stones were fragmented and actively extracted using a basket. Variables potentially affecting OR time such as patient age, sex, BMI, lower pole stone location, volume, Hounsfield units (HU), composition, ureteral access sheath (UAS) use, and pre-operative stenting were collected. Multivariable linear and stepwise regression was used to evaluate the predictors of OR time. There were 118 patients that met inclusion criteria. The median stone volume was 282.6 mm 3 (IQR 150.7-644.7) and the mean OR time was 50 min (±25.9 SD). On univariate linear regression, stone volume had a moderate correlation with OR time (y = 0.022x + 38.2, r 2  = 0.363, p < 0.01). On multivariable stepwise regression, stone volume had the strongest impact on OR time, increasing time by 2.0 min for each 100 mm 3 increase in stone volume (p < 0.001). UAS added 13.5 (SE 3.9, p = 0.001) minutes and renal lower pole location added 9 min (SE 4.3, p = 0.03) in each case they were used. Pre-operative stenting, HU, calcium oxalate stone composition, sex, and age had no significant effect on OR time. Amongst the main stone factors in RIRS, stone volume has the strongest impact on operative time. This can be used to predict the length of the procedure by roughly adding 2 min per 100 mm 3 increase in stone volume.

7 CFR 58.442 - Laboratory and quality control tests.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 3 2010-01-01 2010-01-01 false Laboratory and quality control tests. 58.442 Section... Service 1 Operations and Operating Procedures § 58.442 Laboratory and quality control tests. (a) Chemical... Methods or by other methods giving equivalent results. (b) Weight or volume control. Representative...

7 CFR 58.442 - Laboratory and quality control tests.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 3 2011-01-01 2011-01-01 false Laboratory and quality control tests. 58.442 Section... Service 1 Operations and Operating Procedures § 58.442 Laboratory and quality control tests. (a) Chemical... Methods or by other methods giving equivalent results. (b) Weight or volume control. Representative...

Photovoltaic system criteria documents. Volume 5: Safety criteria for photovoltaic applications

NASA Technical Reports Server (NTRS)

Koenig, John C.; Billitti, Joseph W.; Tallon, John M.

1979-01-01

Methodology is described for determining potential safety hazards involved in the construction and operation of photovoltaic power systems and provides guidelines for the implementation of safety considerations in the specification, design and operation of photovoltaic systems. Safety verification procedures for use in solar photovoltaic systems are established.

Standardization and program effect analysis (Study 2.4). Volume 3: Design-to-cost analysis

NASA Technical Reports Server (NTRS)

Shiokari, T.

1975-01-01

The program procedures that were incorporated into an on-going "design-to-cost" spacecraft program are examined. Program procedures are the activities that support the development and operations of the flight unit: contract management, documents, integration meetings, engineering, and testing. This report is limited to the program procedures that were implemented, with emphasis on areas that may depart from normal satellite development practices.

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

Not Available

This volume contains the interim change notice for the safety operation procedure for hot cell. It covers the master-slave manipulators, dry waste removal, cell transfers, hoists, cask handling, liquid waste system, and physical characterization of fluids.

40 CFR 98.344 - Monitoring and QA/QC requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... minutes between samples and determine the methane composition of the landfill gas using one of the methods.... ER30OC09.136 Where: CCH4 = Methane concentration in the landfill gas (volume %) for use in Equation HH-4 of... landfill gas (volume %, dry basis). (f) The owner or operator shall document the procedures used to ensure...

Zero/zero rotorcraft certification issues. Volume 2: Plenary session presentations

NASA Technical Reports Server (NTRS)

Adams, Richard J.

1988-01-01

This report analyzes the Zero/Zero Rotorcraft Certification Issues from the perspectives of manufacturers, operators, researchers and the FAA. The basic premise behind this analysis is that zero/zero, or at least extremely low visibility, rotorcraft operations are feasible today from both a technological and an operational standpoint. The questions and issues that need to be resolved are: What certification requirements do we need to ensure safety. Can we develop procedures which capitalize on the performance and maneuvering capabilities unique to rotorcraft. Will extremely low visibility operations be economically feasible. This is Volume 2 of three. It presents the operator perspectives (system needs), applicable technology and zero/zero concepts developed in the first 12 months of research of this project.

Robot-assisted versus open radical prostatectomy: the differential effect of regionalization, procedure volume and operative approach.

PubMed

Sammon, Jesse D; Karakiewicz, Pierre I; Sun, Maxine; Sukumar, Shyam; Ravi, Praful; Ghani, Khurshid R; Bianchi, Marco; Peabody, James O; Shariat, Shahrokh F; Perrotte, Paul; Hu, Jim C; Menon, Mani; Trinh, Quoc-Dien

2013-04-01

The use of robot-assisted radical prostatectomy has increased rapidly despite the absence of randomized, controlled trials showing the superiority of this approach. While recent studies suggest an advantage for perioperative complication rates, they fail to account for the volume-outcome relationship. We compared perioperative outcomes after robot-assisted and open radical prostatectomy, while considering the impact of this established relationship. Using the NIS (Nationwide Inpatient Sample), we abstracted data on patients treated with radical prostatectomy in 2009. Univariable and multivariable logistic regression analyses were done to compare the rates of blood transfusion, intraoperative and postoperative complications, prolonged length of stay, increased hospital charges and mortality between robot-assisted and open radical prostatectomy overall and across volume quartiles. An estimated 77,616 men underwent radical prostatectomy, including a robot-assisted and an open procedure in 63.9% and 36.1%, respectively. Low volume centers averaged 26.2 robot-assisted and 5.2 open cases, while very high volume centers averaged 578.8 robot-assisted and 150.2 open cases. Overall, patients treated with the robot-assisted procedure experienced a lower rate of adverse outcomes than those treated with the open procedure for all measured categories. Across equivalent volume quartiles robot-assisted radical prostatectomy outcomes were generally favorable. However, the open procedure at high volume centers resulted in a lower postoperative complication rate (OR 0.59, 95% CI 0.46-0.75), elevated hospital charges (OR 0.75, 95% CI 0.64-0.87) and a comparable blood transfusion rate (OR 1.38, 95% CI 0.93-2.02) relative to the robot-assisted procedure at low volume centers. Regionalization has occurred to a greater extent for robot-assisted than for open radical prostatectomy with an associated benefit in overall outcomes. Nonetheless, low volume institutions experienced inferior outcomes relative to the highest volume centers irrespective of approach. These findings demonstrate the importance of accounting for hospital volume when examining the benefit of a surgical technique. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Optimization of Skill Retention in the U. S. Army through Initial Training Analysis and Design: Skill Sustainment Exercises. Volume 3.

DTIC Science & Technology

1983-05-01

Firing data cards. PROCEDURES I. Prior to live fire exercises all firers must be oriented on range procedures. 2. Preparatory marksmanship training...Ordnance detail. 2. Range safety officer. 7. Medical personnel. 3. Firing line safety NCOs. 8. Control tower operators. i 4. Scorer (I per firer ). 9. Pit...phones and wire (for PIT commo). PROCEDURES I. Prior to live fire exercises, all firers must be oriented on range procedures. 2. Scorers are responsible

[The state of pediatric anesthesia in Japan: an analysis of the Japanese society of anesthesiologists survey of critical incidents in the operating room].

PubMed

Irita, Kazuo; Tsuzaki, Koichi; Sawa, Tomohiro; Sanuki, Michiyoshi; Nakatsuka, Hideki; Makita, Koshi; Morita, Kiyoshi

2007-01-01

The Japanese Society of Anesthesiologists (JSA) survey of critical incidents in the operating room and other reports have shown that pediatric patients undergoing anesthesia are at an increased risk. Purpose was to examine the state of pediatric anesthesia in Japan. This might clarify the role of children's hospitals for pediatric anesthesia, and the relationship between critical incidents and volume of pediatric anesthetic procedures. The JSA has conducted annual surveys of critical incidents in the operating room by sending to and collecting confidential questionnaires from all JSA Certified Training Hospitals. From 1999 to 2003, 342,840 pediatric (0-5 yr) anesthetic procedures were registered. During this period, only 15 cardiac arrests and 3 deaths within 7 postoperative days totally attributable to anesthetic management were reported. Therefore, we analyzed cardiac arrests and deaths due to all etiologies. The hospitals were classified as children's hospitals, university hospitals, and other hospitals, and the incidence of cardiac arrest, the recovery rate from cardiac arrest without any sequelae, and the mortality rate were compared according to types of the hospitals. The relationship between death due to intraoperative critical incidents and the volume of pediatric anesthetic procedures was examined using data from the 2003 survey, the recovery rate of which was 85.7%. In 2003, 739 JSA Certified Training Hospitals responded to the survey: 7 children's hospitals, 109 university hospitals, and 623 other hospitals. Among these hospitals, 707 and 270 hospitals conducted pediatric and newborn (<1 mo) anesthesia, respectively. In 2003, 4,630 newborn, 17,890 infant (<1 yr), and 60,524 child (1-5 yr) anesthetic procedures were registered. Odds ratios were determined to compare the risks among the hospital groups, and the 95% confidential interval (CI) was shown. The Chi square test was used to compare the background of patients with cardiac arrest. P values less than 0.05 were considered significant. In 2003, 95.7% and 36.5% of JSA Certified Training Hospitals which responded to the survey had conducted pediatric and newborn anesthesia, respectively. Children's hospitals, university hospitals, and other hospitals were responsible for 10.7%, 31.0%, and 58.3% of pediatric anesthetic procedures, respectively. Seven children's hospitals (100.0%), 54 university hospitals (50.5%), and 54 other hospitals (9.1%) conducted more than 201 annual pediatric anesthetic procedures, respectively, and these 115 hospitals conducted 62.5% of all pediatric anesthetic procedures in Japan. There was no significant difference between the overall mortality rate in hospitals with an annual pediatric anesthetic volume of less than 200 and that in hospitals with an annual pediatric anesthetic volume of more than 201 (5.46 versus 7.12/10,000 anesthetic procedures). However, the overall mortality rate was 4.87 times higher (95% confidential interval: 1.53-15.66) in hospitals with an annual pediatric anesthetic volume of more than 101 (7.91/10,000 anesthetic procedures) than in those with an annual pediatric anesthetic volume of less than 100 (1.62/10,000 anesthetic procedures). The situation was quite different when we focused on newborn anesthetic procedures : the overall mortality was 2.63 times higher (95% confidential interval : 1.19-5.84) in hospitals with an annual newborn anesthetic volume of less than 12 (126.6/ 10,000 anesthetic procedures) than those with an annual newborn anesthetic volume of more than 13 (48.5/10,000 anesthetic procedures). Between 1999 and 2003, the incidences of cardiac arrest in children's hospitals, university hospitals, and other hospitals were 9.54 (1.89 times higher than the other hospitals; CI 1.31-2.67), 10.30, and 5.11/10,000 anesthetic procedures, respectively. Among the children who developed cardiac arrest, the ratio of poor preoperative conditions with an American Society of Anesthesiologists physical status classification of more than 3 was significantly lower in the children's hospitals (68.9%) than the university hospitals (84.3%) and the other hospitals (84.0%). The recovery rate from cardiac arrest was 51.1% (2.49 times higher than the university hospitals; CI 1.23-5.06, and 3.05 times higher than the other hospitals ; CI 1.45-6.43), 29.6%, and 25.5%, respectively. The mortality rate was 9.54 (1.77 times higher than the other hospitals; CI 1.25-2.52), 8.87, and 5.38/10,000 anesthetic procedures in children's hospitals, university hospitals and other hospitals, respectively. Almost all JSA Certified Training Hospitals conducted pediatric anesthesia, although only 15.6% of them had an annual pediatric anesthetic volume of more than 200. It was suggested that general pediatric anesthesia was conduced safely in JSA Certified Training Hospitals, even if they had a low annual pediatric anesthetic volume. The exception was newborn anesthetic procedures : the mortality was high in hospitals with an annual newborn anesthetic volume of less than 12. Analysis of critical incidents in the operating room failed to show the superiority of children's hospitals in comparison with the university hospitals and other hospitals. Collecting and analyzing data including the patients without critical incidents are required for further analysis.

40 CFR Appendix F to Part 75 - Conversion Procedures

Code of Federal Regulations, 2011 CFR

2011-07-01

... pollutant concentration during unit operation, ppm. 3.3.4%O2, %CO2 = Oxygen or carbon dioxide volume during....6.1H, C, S, N, and O are content by weight of hydrogen, carbon, sulfur, nitrogen, and oxygen... procedures in section 2.4 of appendix D of this part. If a daily coal consumption value is not available...

Effect of the full implementation of the European Working Time Directive on operative training in adult cardiac surgery.

PubMed

Mahesh, Balakrishnan; Sharples, Linda; Codispoti, Massimiliano

2014-01-01

Surgical specialties rely on practice and apprenticeship to acquire technical skills. In 2009, the final reduction in working hours to 48 per week, in accordance with the European Working Time Directive (EWTD), has also led to an expansion in the number of trainees. We examined the effect of these changes on operative training in a single high-volume [>1500 procedures/year] adult cardiac surgical center. Setting: A single high-volume [>1500 procedures/year] adult cardiac surgical center. Design: Consecutive data were prospectively collected into a database and retrospectively analyzed. Procedures and Main Outcome Measures: Between January 2006 and August 2010, 6688 consecutive adult cardiac surgical procedures were analyzed. The proportion of cases offered for surgical training were compared for 2 non-overlapping consecutive time periods: 4504 procedures were performed before the final implementation of the EWTD (Phase 1: January 2006-December 2008) and 2184 procedures after the final implementation of the EWTD (Phase 2: January 2009-August 2010). Other predictors of training considered in the analysis were grade of trainee, logistic European system for cardiac operative risk evaluation (EuroSCORE), type of surgical procedure, weekend or late procedure, and consultant. Logistic regression analysis was used to determine the predictors of training cases (procedure performed by trainee) and to evaluate the effect of the EWTD on operative surgical training after correcting for confounding factors. Proportion of training cases rose from 34.6% (1558/4504) during Phase 1 to 43.6% (953/2184) in Phase 2 (p < 0.0001), despite higher mean logistic EuroSCORE [4.29 (6.8) during Phase 1 vs 4.95 (7.2) during Phase 2, p < 0.0001] and higher proportion of cases performed out of hours [153 (3.4) during Phase 1 vs 116 (5.3) during Phase 2, p < 0.0001]. During Phase 1, senior trainees (last 2 years of training) performed 803 (17.8%) procedures, whereas other trainees (first 4 years of training) performed 755(16.8%) cases. During Phase 2, senior trainees performed 763 (34.9%) procedures, whereas other trainees performed 190 (8.7%) cases (p < 0.0001). Independent positive predictors of training cases emerging from the multivariable logistic regression model included consultant in charge, final EWTD, and senior trainees. Independent negative predictors of training cases included logistic EuroSCORE, out-of-hours' procedures, and surgery other than coronary artery bypass grafts. Implementation of the final phase of EWTD has not decreased training in a high-volume center. The positive adjustment of trainers' attitudes and efforts to match trainees' needs allow maintenance of adequate training, despite reduction in working hours and increasing patients' risk profile. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Rapid fusion of 2D X-ray fluoroscopy with 3D multislice CT for image-guided electrophysiology procedures

NASA Astrophysics Data System (ADS)

Zagorchev, Lyubomir; Manzke, Robert; Cury, Ricardo; Reddy, Vivek Y.; Chan, Raymond C.

2007-03-01

Interventional cardiac electrophysiology (EP) procedures are typically performed under X-ray fluoroscopy for visualizing catheters and EP devices relative to other highly-attenuating structures such as the thoracic spine and ribs. These projections do not however contain information about soft-tissue anatomy and there is a recognized need for fusion of conventional fluoroscopy with pre-operatively acquired cardiac multislice computed tomography (MSCT) volumes. Rapid 2D-3D integration in this application would allow for real-time visualization of all catheters present within the thorax in relation to the cardiovascular anatomy visible in MSCT. We present a method for rapid fusion of 2D X-ray fluoroscopy with 3DMSCT that can facilitate EP mapping and interventional procedures by reducing the need for intra-operative contrast injections to visualize heart chambers and specialized systems to track catheters within the cardiovascular anatomy. We use hardware-accelerated ray-casting to compute digitally reconstructed radiographs (DRRs) from the MSCT volume and iteratively optimize the rigid-body pose of the volumetric data to maximize the similarity between the MSCT-derived DRR and the intra-operative X-ray projection data.

Training potential in minimally invasive surgery in a tertiary care, paediatric urology centre.

PubMed

Schroeder, R P J; Chrzan, R J; Klijn, A J; Kuijper, C F; Dik, P; de Jong, T P V M

2015-10-01

Minimally invasive surgery (MIS) is being utilized more frequently as a surgical technique in general surgery and in paediatric urology. It is associated with a steep learning curve. Currently, the centre does not offer a MIS training programme. It is hypothesized that the number of MIS procedures performed in the low-volume specialty of paediatric urology will offer insufficient training potential for surgeons. To assess the MIS training potential of a highly specialized, tertiary care, paediatric urology training centre that has been accredited by the Joint Committee of Paediatric Urology (JCPU). The clinical activity of the department was retrospectively reviewed by extracting the annual number of admissions, outpatient consultations and operative procedures. The operations were divided into open procedures and MIS. Major ablative procedures (nephrectomy) and reconstructive procedures (pyeloplasty) were analysed with reference to the patients' ages. The centre policy is not to perform major MIS in children who are under 2 years old or who weigh less than 12 kg. Every year, this institution provides approximately 4300 out-patient consultations, 600 admissions, and 1300 procedures under general anaesthesia for children with urological problems. In 2012, 35 patients underwent major intricate MIS: 16 pyeloplasties, eight nephrectomies and 11 operations for incontinence (seven Burch, and four bladder neck procedures). In children ≥2 years of age, 16/21 of the pyeloplasties and 8/12 of the nephrectomies were performed laparoscopically. The remaining MIS procedures included 25 orchidopexies and one intravesical ureteral reimplantation. There is no consensus on how to assess laparoscopic training. It would be valuable to reach a consensus on a standardized laparoscopic training programme in paediatric urology. Often training potential is based on operation numbers only. In paediatric urology no minimum requirement has been specified. The number of procedures quoted for proficiency in MIS remains controversial. The MIS numbers for this centre correspond to, or exceed, numbers mentioned in other literature. To provide high-quality MIS training, exposure to laparoscopic procedures should be expanded. This may be achieved by centralizing patients into a common centre, collaborating with other specialities, modular training and training outside the operating theatre. Even in a high-volume, paediatric urology educational centre, the number of major MIS procedures performed remains relatively low, leading to limited training potential. Copyright © 2015. Published by Elsevier Ltd.

Safety in earth orbit study. Volume 5: Space shuttle payloads: Safety requirements and guidelines on-orbit phase

NASA Technical Reports Server (NTRS)

1972-01-01

Safety requirements and guidelines are listed for the sortie module, upper stage vehicle, and space station for the earth orbit operations of the space shuttle program. The requirements and guidelines are for vehicle design, safety devices, warning devices, operational procedures, and residual hazards.

Evaluation of spacecraft technology programs (effects on communication satellite business ventures), volume 2

NASA Technical Reports Server (NTRS)

Greenburg, J. S.; Kaplan, M.; Fishman, J.; Hopkins, C.

1985-01-01

The computational procedures used in the evaluation of spacecraft technology programs that impact upon commercial communication satellite operations are discussed. Computer programs and data bases are described.

Product specification documentation standard and Data Item Descriptions (DID). Volume of the information system life-cycle and documentation standards, volume 3

NASA Technical Reports Server (NTRS)

Callender, E. David; Steinbacher, Jody

1989-01-01

This is the third of five volumes on Information System Life-Cycle and Documentation Standards which present a well organized, easily used standard for providing technical information needed for developing information systems, components, and related processes. This volume states the Software Management and Assurance Program documentation standard for a product specification document and for data item descriptions. The framework can be applied to any NASA information system, software, hardware, operational procedures components, and related processes.

Pre-College Science Curriculum Activities of the National Science Foundation. Report of Science Curriculum Review Team, Volume II-Appendix.

ERIC Educational Resources Information Center

National Science Foundation, Washington, DC.

Presented is a detailed study of National Science Foundation (NSF) programs in pre-college science education. The development of policies and operational procedures are traced over the past quarter century and their impact on management practice analyzed. The report is presented in two parts: Volume 1, the findings and recommendations, and Volume…

Reading with Television: An Evaluation of The Electric Company. A Report to the Children's Television Workshop. Volumes 1 and 2.

ERIC Educational Resources Information Center

Ball, Samuel; And Others

An evaluation of the first year of "The Electric Company" is provided. Volume 1 is comprised of the following chapters: I. Introduction; II. Preparing for the Evaluation (Research Design and Sampling Procedures; Field Operations; The Treatment--the in-school viewing treatment, the at-home viewing treatment, and the content of The…

Racial and socioeconomic disparities in access to mechanical revascularization procedures for acute ischemic stroke.

PubMed

Attenello, Frank J; Adamczyk, Peter; Wen, Ge; He, Shuhan; Zhang, Katie; Russin, Jonathan J; Sanossian, Nerses; Amar, Arun P; Mack, William J

2014-02-01

Mechanical revascularization procedures performed for treatment of acute ischemic stroke have increased in recent years. Data suggest association between operative volume and mortality rates. Understanding procedural allocation and patient access patterns is critical. Few studies have examined these demographics. Data were collected from the 2008 Nationwide Inpatient Sample database. Patients hospitalized with ischemic stroke and the subset of individuals who underwent mechanical thrombectomy were characterized by race, payer source, population density, and median wealth of the patient's zip code. Demographic data among patients undergoing mechanical thrombectomy procedures were examined. Stroke admission demographics were analyzed according to thrombectomy volume at admitting centers and patient demographics assessed according to the thrombectomy volume at treating centers. Significant allocation differences with respect to frequency of mechanical thrombectomy procedures among stroke patients existed according to race, expected payer, population density, and wealth of the patient's zip code (P < .0001). White, Hispanic, and Asian/Pacific Islander patients received endovascular treatment at higher rates than black and Native American patients. Compared with the white stroke patients, black (P < .001), Hispanic (P < .001), Asian/Pacific Islander (P < .001), and Native American stroke patients (P < .001) all demonstrated decreased frequency of admission to hospitals performing mechanical thrombectomy procedures at high volumes. Among treated patients, blacks (P = .0876), Hispanics (P = .0335), and Asian/Pacific Islanders (P < .001) demonstrated decreased frequency in mechanical thrombectomy procedures performed at high-volume centers when compared with whites. While present, socioeconomic disparities were not as consistent or pronounced as racial differences. We demonstrate variances in endovascular acute stroke treatment allocation according to racial and socioeconomic factors in 2008. Efforts should be made to monitor and address potential disparities in treatment utilization. Published by Elsevier Inc.

Variability in Accreditation Council for Graduate Medical Education Resident Case Log System practices among orthopaedic surgery residents.

PubMed

Salazar, Dane; Schiff, Adam; Mitchell, Erika; Hopkinson, William

2014-02-05

The Accreditation Council for Graduate Medical Education (ACGME) Resident Case Log System is designed to be a reflection of residents' operative volume and an objective measure of their surgical experience. All operative procedures and manipulations in the operating room, Emergency Department, and outpatient clinic are to be logged into the Resident Case Log System. Discrepancies in the log volumes between residents and residency programs often prompt scrutiny. However, it remains unclear if such disparities truly represent differences in operative experiences or if they are reflections of inconsistent logging practices. The purpose of this study was to investigate individual recording practices among orthopaedic surgery residents prior to August 1, 2011. Orthopaedic surgery residents received a questionnaire on case log practices that was distributed through the Council of Orthopaedic Residency Directors list server. Respondents were asked to respond anonymously about recording practices in different clinical settings as well as types of cases routinely logged. Hypothetical scenarios of common orthopaedic procedures were presented to investigate the differences in the Current Procedural Terminology codes utilized. Two hundred and ninety-eight orthopaedic surgery residents completed the questionnaire; 37% were fifth-year residents, 22% were fourth-year residents, 18% were third-year residents, 15% were second-year residents, and 8% were first-year residents. Fifty-six percent of respondents reported routinely logging procedures performed in the Emergency Department or urgent care setting. Twenty-two percent of participants routinely logged procedures in the clinic or outpatient setting, 20% logged joint injections, and only 13% logged casts or splints applied in the office setting. There was substantial variability in the Current Procedural Terminology codes selected for the seven clinical scenarios. There has been a lack of standardization in case-logging practices among orthopaedic surgery residents prior to August 1, 2011. ACGME case log data prior to this date may not be a reliable measure of residents' procedural experience.

Advanced laparoscopic bariatric surgery Is safe in general surgery training.

PubMed

Kuckelman, John; Bingham, Jason; Barron, Morgan; Lallemand, Michael; Martin, Matthew; Sohn, Vance

2017-05-01

Bariatric surgery makes up an increasing percentage of general surgery training. The safety of resident involvement in these complex cases has been questioned. We evaluated patient outcomes in resident performed laparoscopic bariatric procedures. Retrospective review of patients undergoing a laparoscopic bariatric procedure over seven years at a tertiary care single center. Procedures were primarily performed by a general surgery resident and proctored by an attending surgeon. Primary outcomes included operative volume, operative time and leak rate with perioperative outcomes evaluated as secondary outcomes. A total of 1649 bariatric procedures were evaluated. Operations included laparoscopic bypass (690) and laparoscopic sleeve gastrectomy (959). Average operating time was 136 min. Eighteen leaks (0.67%) were identified. Graduating residents performed an average of 89 laparoscopic bariatric cases during their training. There were no significant differences between resident levels with concern to operative time or leak rate (p 0.97 and p = 0.54). General surgery residents can safely perform laparoscopic bariatric surgery. When proctored by a staff surgeon, a resident's level of training does not significantly impact leak rate. Published by Elsevier Inc.

Zero/zero rotorcraft certification issues. Volume 3: Working group results

NASA Technical Reports Server (NTRS)

Adams, Richard J.

1988-01-01

This report analyzes the Zero/Zero Rotorcraft Certification Issues from the perspectives of manufacturers, operators, researchers and the FAA. The basic premise behind this analysis is that zero/zero, or at least extremely low visibility, rotorcraft operations are feasible today from both a technological and an operational standpoint. The questions and issues that need to be resolved are: What certification requirements do we need to ensure safety. Can we develop procedures which capitalize on the performance and maneuvering capabilities unique to rotorcraft. Will extremely low visibility operations be economically feasible. This is Volume 3 of three. It provides the issue-by-issue deliberations of the experts involved in the Working Groups assigned to deal with them in the Issues Forum.

Recommended operating procedure No. 51: Glass source assessment sampling system (glass SASS). Final report, Jul 90-Jan 91

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

Grote, R.A.

1991-05-01

The report is a recommended operating procedure (ROP), prepared for use in research activities conducted by EPA's Air and Energy Engineering Research Laboratory (AEERL). The method described is applicable to the stack sampling of flue gas from a rotary kiln and to associated equipment of AEERL's Combustion Research Branch. It has been the standard method of sampling kiln flue gas due to the transient nature of the puff development and its capability to sample the maximum volume over the shortest time period. ROPs describe non-routine or experimental research operations where some judgment in application may be warranted. ROPs may notmore » be applicable to activities conducted by other research groups, and should not be used in place of standard operating procedures. Use of ROPs must be accompanied by an understanding of the purpose and scope. Questions should be directed to the author.« less

Optimizing traffic counting procedures.

DOT National Transportation Integrated Search

1986-01-01

Estimates of annual average daily traffic volumes are important in the planning and operations of state highway departments. These estimates are used in the planning of new construction and improvement of existing facilities, and, in some cases, in t...

Randomized clinical trial of ligasure™ versus conventional splenectomy for injured spleen in blunt abdominal trauma.

PubMed

Amirkazem, Vejdan Seyyed; Malihe, Khosravi

2017-02-01

Spleen is the most common organ damaged in cases of blunt abdominal trauma and splenectomy and splenorrhaphy are the main surgical procedures that are used in surgical treatment of such cases. In routine open splenectomy cases, after laparotomy, application of sutures in splenic vasculature is the most widely used procedure to cease the bleeding. This clinical trial evaluates the role and benefits of the Ligasure™ system in traumatic splenectomy without using any suture materials and compares the result with conventional method of splenectomy. After making decision for splenectomy secondary to a blunt abdominal trauma, patients in control group (39) underwent splenectomy using conventional method with silk suture ligation of splenic vasculature. In the interventional group (41) a Ligasure™ vascular sealing system was used for ligating of the splenic vein and artery. The results of operation time, volume of intra-operation bleeding and post-operative complications were compared in both groups. The mean operation times in control and interventional group were 21 and 12 min respectively (p < 0.05). The average volume of bleeding in control group during open splenectomy was 280 cc, but in the interventional group decreased significantly to 80 ml (p < 0.05) using the Ligasure system. Post-operative complications such as bleeding were non-existent in both groups. The application of Ligasure™ in blunt abdominal trauma for splenectomy not only can decrease the operation time but also can decrease the volume of bleeding during operation without any additional increase in post-operative complications. This method is recommendable in traumatic splenic injuries that require splenectomy in order to control the bleeding as opposed to use of traditional silk sutures. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Comparison of pre/post-operative CT image volumes to preoperative digitization of partial hepatectomies: a feasibility study in surgical validation

NASA Astrophysics Data System (ADS)

Dumpuri, Prashanth; Clements, Logan W.; Li, Rui; Waite, Jonathan M.; Stefansic, James D.; Geller, David A.; Miga, Michael I.; Dawant, Benoit M.

2009-02-01

Preoperative planning combined with image-guidance has shown promise towards increasing the accuracy of liver resection procedures. The purpose of this study was to validate one such preoperative planning tool for four patients undergoing hepatic resection. Preoperative computed tomography (CT) images acquired before surgery were used to identify tumor margins and to plan the surgical approach for resection of these tumors. Surgery was then performed with intraoperative digitization data acquire by an FDA approved image-guided liver surgery system (Pathfinder Therapeutics, Inc., Nashville, TN). Within 5-7 days after surgery, post-operative CT image volumes were acquired. Registration of data within a common coordinate reference was achieved and preoperative plans were compared to the postoperative volumes. Semi-quantitative comparisons are presented in this work and preliminary results indicate that significant liver regeneration/hypertrophy in the postoperative CT images may be present post-operatively. This could challenge pre/post operative CT volume change comparisons as a means to evaluate the accuracy of preoperative surgical plans.

Space tug point design study. Volume 2: Operations, performance and requirements

NASA Technical Reports Server (NTRS)

1973-01-01

A design study to determine the configuration and characteristics of a space tug was conducted. Among the subjects analyzed in the study are: (1) flight and ground operations, (2) vehicle flight performance and performance enhancement techniques, (3) flight requirements, (4) basic design criteria, and (5) functional and procedural interface requirements between the tug and other systems.

The Use of Educational Knowledge; Evaluation of the Pilot State Dissemination Program. Volume 1: Goals, Operations and Training. Final Report.

ERIC Educational Resources Information Center

Sieber, Sam D.; And Others

The Pilot State Dissemination Program of the National Center for Educational Communication, carried out in three target states by field agents, is evaluated as to goals, procedures, and outcomes. The seven parts of Volume I, and their chapters, are as follows: Part I, Goals: Alternative Goals of Extension-Retrieval Projects; Part II, Field Agent…

[Total laparoscopic hysterectomy--indications and complications of 158 patients].

PubMed

Malinowski, Andrzej; Makowska, Justyna; Antosiak, Beata

2013-04-01

Hysterectomy is one of the most common gynecological procedures. Development of modern laparoscopic techniques made it a crucial tool in contemporary gynecology both in diagnosis and treatment. Increasing experience and improved laparoscopic instruments enabled gynecologists to extend indications for laparoscopic procedures as well as the range of the operation itself. 1) to present data (particularly perioperative) of patients who underwent laparoscopic hysterectomy 2) to analyze various information including: indication for the procedure, surgery duration, evaluation of different parameters like: volume of the excised uterus, postoperative HB and HCT drop, length of hospital stay as well as short- and long-term complications. The analysis included peri- and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Indication for hysterectomy and duration of operation were analyzed. Uterine volume, postoperative HB and HCT drop, time of hospital stay and complications were evaluated. In the study a description of the method of laparoscopic hysterectomy was presented. Mean time of procedure was 68 min. (58-135 min.). Basing on operational protocols, the time of operation was measured from the moment laparoscopy started until the patient was fully awake after anesthesia. No adjustments were made for longer anesthetic recovery period. Estimated blood loss was 166.6 ml. Mean HB drop was 1.29 g/dl (0, 1-3 g/dl). Mean volume of the excised uterus was 108.24 cm3 (25.27-440.86 cm3). In 44 patients (27.84%) bilateral salpingo-oophorectomy was performed. In 4 cases (2.53%) there was an indication for postoperative antibiotics. None of the patients required blood transfusion or conversion to open surgery or the need to re-operate. Mean hospital stay after the surgery was 2.9 days. Overall, only 2 patients suffered long-term complications (1.26%): three weeks after the surgery urethro-vaginal fistulas occurred due to thermal injury to the ureter. That complication was noted during the first year of using this technique. Between 2008 and 2011 that type of adverse effect was not reported. The analysis included perioperative and postoperative data of 158 patients who underwent laparoscopic hysterectomy. Data suggest that patients benefit from this procedure which is safe, associated with short postoperative recovery time, minimal blood loss and low complication rate, as well as good plastic result. We recommend laparoscopic hysterectomy as an alternative to open hysterectomy in cases when it can be safely performed.

Space shuttle/payload interface analysis. Volume 4: Business Risk and Value of Operations in Space (BRAVO). Part 1: Summary

NASA Technical Reports Server (NTRS)

1974-01-01

Background information is provided which emphasizes the philosophy behind analytical techniques used in the business risk and value of operations in space (BRAVO) study. The focus of the summary is on the general approach, operation of the procedures, and the status of the study. For Vol. 1, see N74-12493; for Vol. 2, see N74-14530.

Operative Landscape at Canadian Neurosurgery Residency Programs.

PubMed

Tso, Michael K; Dakson, Ayoub; Ahmed, Syed Uzair; Bigder, Mark; Elliott, Cameron; Guha, Daipayan; Iorio-Morin, Christian; Kameda-Smith, Michelle; Lavergne, Pascal; Makarenko, Serge; Taccone, Michael S; Wang, Bill; Winkler-Schwartz, Alexander; Sankar, Tejas; Christie, Sean D

2017-07-01

Background Currently, the literature lacks reliable data regarding operative case volumes at Canadian neurosurgery residency programs. Our objective was to provide a snapshot of the operative landscape in Canadian neurosurgical training using the trainee-led Canadian Neurosurgery Research Collaborative. Anonymized administrative operative data were gathered from each neurosurgery residency program from January 1, 2014, to December 31, 2014. Procedures were broadly classified into cranial, spine, peripheral nerve, and miscellaneous procedures. A number of prespecified subspecialty procedures were recorded. We defined the resident case index as the ratio of the total number of operations to the total number of neurosurgery residents in that program. Resident number included both Canadian medical and international medical graduates, and included residents on the neurosurgery service, off-service, or on leave for research or other personal reasons. Overall, there was an average of 1845 operative cases per neurosurgery residency program. The mean numbers of cranial, spine, peripheral nerve, and miscellaneous procedures were 725, 466, 48, and 193, respectively. The nationwide mean resident case indices for cranial, spine, peripheral nerve, and total procedures were 90, 58, 5, and 196, respectively. There was some variation in the resident case indices for specific subspecialty procedures, with some training programs not performing carotid endarterectomy or endoscopic transsphenoidal procedures. This study presents the breadth of neurosurgical training within Canadian neurosurgery residency programs. These results may help inform the implementation of neurosurgery training as the Royal College of Physicians and Surgeons residency training transitions to a competence-by-design curriculum.

Liquid and gaseous oxygen safety review, volume 2

NASA Technical Reports Server (NTRS)

Lapin, A.

1972-01-01

Guidelines, codes, regulations and special procedures used in the design, installation, fabrication, testing and operations for protection against hazards involved with production, transportation, storage and system handling of oxygen are presented with a list of related references.

Ground Operations Aerospace Language (GOAL). Volume 5: Application Studies

NASA Technical Reports Server (NTRS)

1973-01-01

The Ground Operations Aerospace Language (GOAL) was designed to be used by test oriented personnel to write procedures which would be executed in a test environment. A series of discussions between NASA LV-CAP personnel and IBM resulted in some peripheral tasks which would aid in evaluating the applicability of the language in this environment, and provide enhancement for future applications. The results of these tasks are contained within this volume. The GOAL vocabulary provides a high degree of readability and retainability. To achieve these benefits, however, the procedure writer utilizes words and phrases of considerable length. Brief form study was undertaken to determine a means of relieving this burden. The study resulted in a version of GOAL which enables the writer to develop a dialect suitable to his needs and satisfy the syntax equations. The output of the compiler would continue to provide readability by printing out the standard GOAL language. This task is described.

Graduating general surgery resident operative confidence: perspective from a national survey.

PubMed

Fonseca, Annabelle L; Reddy, Vikram; Longo, Walter E; Gusberg, Richard J

2014-08-01

General surgical training has changed significantly over the last decade with work hour restrictions, increasing subspecialization, the expanding use of minimally invasive techniques, and nonoperative management for solid organ trauma. Given these changes, this study was undertaken to assess the confidence of graduating general surgery residents in performing open surgical operations and to determine factors associated with increased confidence. A survey was developed and sent to general surgery residents nationally. We queried them regarding demographics and program characteristics, asked them to rate their confidence (rated 1-5 on a Likert scale) in performing open surgical procedures and compared those who indicated confidence with those who did not. We received 653 responses from the fifth year (postgraduate year 5) surgical residents: 69% male, 68% from university programs, and 51% from programs affiliated with a Veterans Affairs hospital; 22% from small programs, 34% from medium programs, and 44% from large programs. Anticipated postresidency operative confidence was 72%. More than 25% of residents reported a lack of confidence in performing eight of the 13 operations they were queried about. Training at a university program, a large program, dedicated research years, future fellowship plans, and training at a program that performed a large percentage of operations laparoscopically was associated with decreased confidence in performing a number of open surgical procedures. Increased surgical volume was associated with increased operative confidence. Confidence in performing open surgery also varied regionally. Graduating surgical residents indicated a significant lack of confidence in performing a variety of open surgical procedures. This decreased confidence was associated with age, operative volume as well as type, and location of training program. Analyzing and addressing this confidence deficit merits further study. Copyright © 2014 Elsevier Inc. All rights reserved.

Carotid Artery Stenting – Strategies to Improve Procedural Performance and Reduce the Learning Curve

PubMed Central

Van Herzeele, Isabelle

2013-01-01

Carotid artery stenting (CAS) remains an appealing intervention to reduce the stroke risk because of its minimal invasive nature. Nevertheless, landmark randomised controlled trials have not been able to resolve the controversies surrounding this complex procedure as the peri-operative stroke risk in a non-selected patient population still seems to be higher after CAS in comparison to carotid endarterectomy. What is more, these trials have highlighted that patient outcome after CAS is influenced by patient- and operator-dependant factors. The CAS procedure exhibits a definitive learning curve resulting in higher complication rates if the procedure is performed by inexperienced interventionists or in low-volume centres. This article will outline strategies to improve the performance of physicians carrying out the CAS procedure by means of proficiency-based training, credentialing, virtual reality rehearsal and optimal patient selection. PMID:29588751

Minitrack tracking function description, volume 2

NASA Technical Reports Server (NTRS)

Englar, T. S.; Mango, S. A.; Roettcher, C. A.; Watters, D. L.

1973-01-01

The minitrack tracking function is described and specific operations are identified. The subjects discussed are: (1) preprocessor listing, (2) minitrack hardware, (3) system calibration, (4) quadratic listing, and (5) quadratic flow diagram. Detailed information is provided on the construction of the tracking system and its operation. The calibration procedures are supported by mathematical models to show the application of the computer programs.

A Battalion/Division Fiscal Control System for Training Resource Management.

DTIC Science & Technology

1981-12-01

of each command using it. With many Army fiscal procedures consuming large volumes of time and resources to support operations with questionable...Document (FAD)) spe- cifying the appropriation and budget programs for which the funds may be used . The FAD is the installation’s approved financial...operating budgets. Although a proper term would be operating targets, budget is used for ease of understanding. These funds are principally for general

Completeness of breast cancer operative reports in a community care setting.

PubMed

Eng, Jordan Lang; Baliski, Christopher Ronald; McGahan, Colleen; Cai, Eric

2017-10-01

The narrative operative report represents the traditional means by which breast cancer surgery has been documented. Previous work has established that omissions occur in narrative operative reports produced in an academic setting. The goal of this study was to determine the completeness of breast cancer narrative operative reports produced in a community care setting and to explore the effect of a surgeon's case volume and years in practice on the completeness of these reports. A standardized retrospective review of operative reports produced over a consecutive 2 year period was performed using a set of procedure-specific elements identified through a review of the relevant literature and work done locally. 772 operative reports were reviewed. 45% of all elements were completely documented. A small positive trend was observed between case volume and completeness while a small negative trend was observed between years in practice and completeness. The dictated narrative report inadequately documents breast cancer surgery irrespective of the recording surgeon's volume or experience. An intervention, such as the implementation of synoptic reporting, should be considered in an effort to maximize the utility of the breast cancer operative report. Copyright © 2017. Published by Elsevier Ltd.

Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?

PubMed

Jindal, Manila; Zheng, Chaoyi; Quadri, Humair S; Ihemelandu, Chukwuemeka U; Hong, Young K; Smith, Andrew K; Dudeja, Vikas; Shara, Nawar M; Johnson, Lynt B; Al-Refaie, Waddah B

2017-08-01

Centralization of complex surgical care has led patients to travel longer distances. Emerging evidence suggested a negative association between increased travel distance and mortality after pancreatectomy. However, the reason for this association remains largely unknown. We sought to unravel the relationships among travel distance, receiving pancreatectomy at high-volume hospitals, delayed surgery, and operative outcomes. We identified 44,476 patients who underwent pancreatectomy for neoplasms between 2004 and 2013 at the reporting facility from the National Cancer Database. Multivariable analyses were performed to examine the independent relationships between increments in travel distance mortality (30-day and long-term survival) after adjusting for patient demographics, comorbidity, cancer stage, and time trend. We then examined how additional adjustment of procedure volume affected this relationship overall and among rural patients. Median travel distance to undergo pancreatectomy increased from 16.5 to 18.7 miles (p for trend < 0.001). Although longer travel distance was associated with delayed pancreatectomy, it was also related to higher odds of receiving pancreatectomy at a high-volume hospital and lower postoperative mortality. In multivariable analysis, difference in mortality among patients with varying travel distance was attenuated by adjustment for procedure volume. However, longest travel distance was still associated with a 77% lower 30-day mortality rate than shortest travel among rural patients, even when accounting for procedure volume. Our large national study found that the beneficial effect of longer travel distance on mortality after pancreatectomy is mainly attributable to increase in procedure volume. However, it can have additional benefits on rural patients that are not explained by volume. Distance can represent a surrogate for rural populations. Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

10 Years Later: Lessons Learned from an Academic Multidisciplinary Cosmetic Center

PubMed Central

Chen, Jenny T.; Nayar, Harry S.

2017-01-01

Background: In 2006, a Centers for Medicare and Medicaid Services-accredited multidisciplinary academic ambulatory surgery center was established with the goal of delivering high-quality, efficient reconstructive, and cosmetic services in an academic setting. We review our decade-long experience since its establishment. Methods: Clinical and financial data from 2006 to 2016 are reviewed. All cosmetic procedures, including both minimally invasive and operative cases, are included. Data are compared to nationally published reports. Results: Nearly 3,500 cosmetic surgeries and 10,000 minimally invasive procedures were performed. Compared with national averages, surgical volume in abdominoplasty is high, whereas rhinoplasty and breast augmentation is low. Regarding trend data, breast augmentation volume has decreased by 25%, whereas minimally invasive procedural volume continues to grow and is comparable with national reports. Similarly, where surgical revenue remains steady, minimally invasive revenue has increased significantly. The majority of surgical cases (70%) are reconstructive in nature and insurance-based. Payer mix is 71% private insurance, 18% Medicare and Medicaid, and 11% self-pay. Despite year-over-year revenue increases, net profit in 2015 was $6,120. Rent and anesthesia costs exceed national averages, and employee salary and wages are the highest expenditure. Conclusion: Although the creation of our academic cosmetic ambulatory surgery center has greatly increased the overall volume of cosmetic surgery performed at the University of Wisconsin, the majority of surgical volume and revenue is reconstructive. As is seen nationwide, minimally invasive cosmetic procedures represent our most rapidly expanding revenue stream. PMID:29062640

Skin and Soft Tissue Surgery in the Office Versus Operating Room Setting: An Analysis Based on Individual-Level Medicare Data.

PubMed

Kantor, Jonathan

2018-03-23

The relative volume of skin and soft tissue excision and reconstructive procedures performed in the outpatient office versus facility (ambulatory surgical center or hospital) differs by specialty, and has major implications for quality of care, outcomes, development of guidelines, resident education, health care economics, and patient perception. To assess the relative volume of surgical procedures performed in each setting (office vs ambulatory surgery center [ASC]/hospital) by dermatologists and nondermatologists. A cross-sectional analytical study was performed using the Medicare public use file (PUF) for 2014, which includes every patient seen in an office, ASC, or hospital in the United States billed to Medicare part B. Data were divided by physician specialty and setting. A total of 9,316,307 individual encounters were included in the Medicare PUF. Dermatologists account for 195,001 (2.1%) of the total. Dermatologists were more likely to perform surgical procedures in an office setting only (odds ratio 5.48 [95% confidence interval 5.05-5.95], p < .0001) than other specialists in aggregate. More than 90% of surgical procedures are performed in an office setting, and dermatologists are more than 5 times as likely as other specialists to operate in an office setting.

Occupational Radiation Exposure During Endovascular Aortic Repair

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

Sailer, Anna M., E-mail: anni.sailer@mumc.nl; Schurink, Geert Willem H., E-mail: gwh.schurink@mumc.nl; Bol, Martine E., E-mail: m.bol@maastrichtuniversity.nl

PurposeThe aim of the study was to evaluate the radiation exposure to operating room personnel and to assess determinants for high personal doses during endovascular aortic repair.Materials and MethodsOccupational radiation exposure was prospectively evaluated during 22 infra-renal aortic repair procedures (EVAR), 11 thoracic aortic repair procedures (TEVAR), and 11 fenestrated or branched aortic repair procedures (FEVAR). Real-time over-lead dosimeters attached to the left breast pocket measured personal doses for the first operators (FO) and second operators (SO), radiology technicians (RT), scrub nurses (SN), anesthesiologists (AN), and non-sterile nurses (NSN). Besides protective apron and thyroid collar, no additional radiation shielding wasmore » used. Procedural dose area product (DAP), iodinated contrast volume, fluoroscopy time, patient’s body weight, and C-arm angulation were documented.ResultsAverage procedural FO dose was significantly higher during FEVAR (0.34 ± 0.28 mSv) compared to EVAR (0.11 ± 0.21 mSv) and TEVAR (0.06 ± 0.05 mSv; p = 0.003). Average personnel doses were 0.17 ± 0.21 mSv (FO), 0.042 ± 0.045 mSv (SO), 0.019 ± 0.042 mSv (RT), 0.017 ± 0.031 mSv (SN), 0.006 ± 0.007 mSv (AN), and 0.004 ± 0.009 mSv (NSN). SO and AN doses were strongly correlated with FO dose (p = 0.003 and p < 0.001). There was a significant correlation between FO dose and procedural DAP (R = 0.69, p < 0.001), iodinated contrast volume (R = 0.67, p < 0.001) and left-anterior C-arm projections >60° (p = 0.02), and a weak correlation with fluoroscopy time (R = 0.40, p = 0.049).ConclusionAverage FO dose was a factor four higher than SO dose. Predictors for high personal doses are procedural DAP, iodinated contrast volume, and left-anterior C-arm projections greater than 60°.« less

Use of computed tomography to assess volume change after endoscopic orbital decompression for Graves' ophthalmopathy.

PubMed

Schiff, Bradley A; McMullen, Caitlin P; Farinhas, Joaquim; Jackman, Alexis H; Hagiwara, Mari; McKellop, Jason; Lui, Yvonne W

2015-01-01

Orbital decompression is frequently performed in the management of patients with sight-threatening and disfiguring Graves' ophthalmopathy. The quantitative measurements of the change in orbital volume after orbital decompression procedures are not definitively known. Furthermore, the quantitative effect of septal deviation on volume change has not been previously analyzed. To provide quantitative measurement of orbital volume change after medial and inferior endoscopic decompression and describe a straightforward method of measuring this change using open-source technologies. A secondary objective was to assess the effect of septal deviation on orbital volume change. A retrospective review was performed on all patients undergoing medial and inferior endoscopic orbital decompression for Graves' ophthalmopathy at a tertiary care academic medical center. Pre-operative and post-operative orbital volumes were calculated from computed tomography (CT) data using a semi-automated segmenting technique and Osirix™, an open-source DICOM reader. Data were collected for pre-operative and post-operative orbital volumes, degree of septal deviation, time to follow-up scan, and individual patient Hertel scores. Nine patients (12 orbits) were imaged before and after decompression. Mean pre-operative orbital volume was 26.99 cm(3) (SD=2.86 cm(3)). Mean post-operative volume was 33.07 cm(3) (SD=3.96 cm(3)). The mean change in volume was 6.08 cm(3) (SD=2.31 cm(3)). The mean change in Hertel score was 4.83 (SD=0.75). Regression analysis of change in volume versus follow-up time to imaging indicates that follow-up time to imaging has little effect on change in volume (R=-0.2), and overall mean maximal septal deviation toward the operative side was -0.5mm. Negative values were attributed to deviation away form the operative site. A significant correlation was demonstrated between change in orbital volume and septal deviation distance site (R=0.66), as well as between change in orbital volume and septal deviation angle (R=0.67). Greater volume changes were associated with greater degree of septal deviation away from the surgical site, whereas smaller volume changes were associated with greater degree of septal deviation toward the surgical site. A straightforward, semi-automated segmenting technique for measuring change in volume following endoscopic orbital decompression is described. This method proved useful in determining that a mean increase of approximately 6 cm in volume was achieved in this group of patients undergoing medial and inferior orbital decompression. Septal deviation appears to have an effect on the surgical outcome and should be considered during operative planning. Copyright © 2015 Elsevier Inc. All rights reserved.

Impact of backwashing procedures on deep bed filtration productivity in drinking water treatment.

PubMed

Slavik, Irene; Jehmlich, Alexander; Uhl, Wolfgang

2013-10-15

Backwash procedures for deep bed filters were evaluated and compared by means of a new integrated approach based on productivity. For this, different backwash procedures were experimentally evaluated by using a pilot plant for direct filtration. A standard backwash mode as applied in practice served as a reference and effluent turbidity was used as the criterion for filter run termination. The backwash water volumes needed, duration of the filter-to-waste period, time out of operation, total volume discharged and filter run-time were determined and used to calculate average filtration velocity and average productivity. Results for filter run-times, filter backwash volumes, and filter-to-waste volumes showed considerable differences between the backwash procedures. Thus, backwash procedures with additional clear flushing phases were characterised by an increased need for backwash water. However, this additional water consumption could not be compensated by savings during filter ripening. Compared to the reference backwash procedure, filter run-times were longer for both single-media and dual-media filters when air scour and air/water flush were optimised with respect to flow rates and the proportion of air and water. This means that drinking water production time is longer and less water is needed for filter bed cleaning. Also, backwashing with additional clear flushing phases resulted in longer filter run-times before turbidity breakthrough. However, regarding the productivity of the filtration process, it was shown that it was almost the same for all of the backwash procedures investigated in this study. Due to this unexpected finding, the relationships between filter bed cleaning, filter ripening and filtration performance were considered and important conclusions and new approaches for process optimisation and resource savings were derived. Copyright © 2013 Elsevier Ltd. All rights reserved.

Automation of Command and Data Entry in a Glovebox Work Volume: An Evaluation of Data Entry Devices

NASA Technical Reports Server (NTRS)

Steele, Marianne K.; Nakamura, Gail; Havens, Cindy; LeMay, Moira

1996-01-01

The present study was designed to examine the human-computer interface for data entry while performing experimental procedures within a glovebox work volume in order to make a recommendation to the Space Station Biological Research Project for a data entry system to be used within the Life Sciences Glovebox. Test subjects entered data using either a manual keypad, similar to a standard computer numerical keypad located within the glovebox work volume, or a voice input system using a speech recognition program with a microphone headset. Numerical input and commands were programmed in an identical manner between the two systems. With both electronic systems, a small trackball was available within the work volume for cursor control. Data, such as sample vial identification numbers, sample tissue weights, and health check parameters of the specimen, were entered directly into procedures that were electronically displayed on a video monitor within the glovebox. A pen and paper system with a 'flip-chart' format for procedure display, similar to that currently in use on the Space Shuttle, was used as a baseline data entry condition. Procedures were performed by a single operator; eight test subjects were used in the study. The electronic systems were tested under both a 'nominal' or 'anomalous' condition. The anomalous condition was introduced into the experimental procedure to increase the probability of finding limitations or problems with human interactions with the electronic systems. Each subject performed five test runs during a test day: two procedures each with voice and keypad, one with and one without anomalies, and one pen and paper procedure. The data collected were both quantitative (times, errors) and qualitative (subjective ratings of the subjects).

The Small Aircraft Transportation System Higher Volume Operations (SATS HVO) Flight Experiment

NASA Technical Reports Server (NTRS)

Williams, Daniel M.; Murdoch, Jennifer L.; Adams, Catherine H.

2005-01-01

This paper provides a summary of conclusions from the Small Aircraft Transportation System (SATS) Higher Volume Operations (HVO) Flight Experiment which NASA conducted to determine pilot acceptability of the HVO concept for normal conditions. The SATS HVO concept improves efficiency at non-towered, non-radar airports in Instrument Meteorological Conditions (IMC) while achieving a level of safety equal to today s system. Reported are results from flight experiment data that indicate that the SATS HVO concept is viable. The success of the SATS HVO concept is based on acceptable pilot workload, performance, and subjective criteria when compared to the procedural control operations in use today at non-towered, non-radar controlled airfields in IMC. The HVO Flight Experiment, flown on NASA's Cirrus SR22, used a subset of the HVO Simulation Experiment scenarios and evaluation pilots in order to validate the simulation experiment results. HVO and Baseline (today s system) scenarios flown included: single aircraft arriving for a GPS non-precision approach; aircraft arriving for the approach with multiple traffic aircraft; and aircraft arriving for the approach with multiple traffic aircraft and then conducting a missed approach. Results reveal that all twelve low-time instrument-rated pilots preferred SATS HVO when compared to current procedural separation operations. These pilots also flew the HVO procedures safely and proficiently without additional workload in comparison to today s system (Baseline). Detailed results of pilot flight technical error, and their subjective assessments of workload and situation awareness are presented in this paper.

A comparative study of female sterilization via modified Uchida and silver clip techniques in rural China.

PubMed

Qiu, Hongyan; Li, Li; Wu, Shangchun; Liang, Hong; Yuan, Wei; He, Yingqin

2011-03-01

To compare the specific effects of 2 female sterilization methods: the modified Uchida technique and the application of silver clips. A total of 2198 women living in rural areas who were still of reproductive age but opting for sterilization were enrolled. The participants were randomly divided into 2 groups, and underwent sterilization by either modified Uchida technique or silver clips. Information on acceptability, operation conditions, effectiveness, adverse effects, and complaints was collected 3, 6, and 12 months after the procedure. No significant difference in effectiveness, adverse effects or chief complaints between the 2 procedures was found. Differences in operative outcome, bleeding volume during the procedure, and operation time were found. A shorter operation time and less bleeding for the silver clip method indicated that female sterilization by this technique was as safe as that by modified Uchida technique. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Systems Analysis Directorate Activities Summary - September 1977. Volume 1

DTIC Science & Technology

1977-10-01

Identify by block number) Chemical agent Censor criteria Purity of the agent Statistical samples 20. ABSTRACT (Continue on reverse side U... chemical agent lots. Volume II (CONF) contains an analysis fo the operational capability as the 105rom MIOIAI and M102 Hpwltzej^g, DD , FORM JAN 73...Data Entered) CONTENTS Page Procedure for Determining the Serviceability Category of Chemical Agent Lots •• 5 User’s Guide to the Computer

Orbiter multiplexer-demultiplexer (MDM)/Space Lab Bus Interface Unit (SL/BIU) serial data interface evaluation, volume 2

NASA Technical Reports Server (NTRS)

Tobey, G. L.

1978-01-01

Tests were performed to evaluate the operating characteristics of the interface between the Space Lab Bus Interface Unit (SL/BIU) and the Orbiter Multiplexer-Demultiplexer (MDM) serial data input-output (SIO) module. This volume contains the test equipment preparation procedures and a detailed description of the Nova/Input Output Processor Simulator (IOPS) software used during the data transfer tests to determine word error rates (WER).

GEODYN operations description, volume 3. [computer program for estimation of orbit and geodetic parameters

NASA Technical Reports Server (NTRS)

Martin, T. V.; Mullins, N. E.

1972-01-01

The operating and set-up procedures for the multi-satellite, multi-arc GEODYN- Orbit Determination program are described. All system output is analyzed. The GEODYN Program is the nucleus of the entire GEODYN system. It is a definitive orbit and geodetic parameter estimation program capable of simultaneously processing observations from multiple arcs of multiple satellites. GEODYN has two modes of operation: (1) the data reduction mode and (2) the orbit generation mode.

Aquablation Procedural Outcomes for BPH in Large Prostates (80-150cc): Initial Experience.

PubMed

Desai, Mihir; Bidair, Mo; Bhojani, Naeem; Trainer, Andrew; Arther, Andrew; Kramolowsky, Eugene; Doumanian, Leo; Elterman, Dean; Kaufman, Ronald P; Lingeman, James; Krambeck, Amy; Eure, Gregg; Badlani, Gopal; Plante, Mark; Uchio, Edward; Gin, Greg; Goldenberg, Larry; Paterson, Ryan; So, Alan; Humphreys, Mitch; Roehrborn, Claus; Kaplan, Steven; Motola, Jay; Zorn, Kevin C

2018-04-25

To present early safety and feasibility data from a multicenter prospective study of Aquablation in treatment of symptomatic men with large volume BPH. Between September and December 2017, 101 men with moderate-to-severe BPH symptoms and prostate volume of 80-150cc underwent Aquablation in a prospective multicenter international clinical trial. Baseline demographics and standardized postoperative management parameters were carefully recorded in a central independently monitored database. Surgeons answered analog scale questionnaires on intraoperative technical factors and postoperative management. Adverse events through 1 month were adjudicated by an independent clinical events committee. Mean prostate volume was 107cc (range 80 to 150). Mean operative time was 37 minutes (range 15-97) and mean Aquablation resection time was 8 minutes (range 3-15). Adequate adenoma resection was achieved with a single pass in 34 patients and additional passes in 67 patients (mean 1.8 treatment passes), all in a single operative session. Hemostasis was achieved using either a Foley balloon catheter placed in the bladder under traction (N=98, mean duration 18 hours) or direct tamponade using a balloon inflated in the prostate fossa (N=3, mean duration 15 hours). No subject required electrocautery for hemostasis at the time of primary procedure. The average length of stay following the procedure was 1.6 days (range same day-6 days). The observed Clavien-Dindo (CD) grade 2 or higher event rate at 1 month was 29.7%. Bleeding complications were recorded in 10 (9.9%) patients during the index procedure hospitalization prior to discharge and included six (5.9%) peri-operative transfusions. Aquablation is feasible and safe in treating men with men with large prostates (80-150cc). The six month efficacy data are being accrued and will be presented in future publications (number, NCT03123250). This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

A MATHEMATICAL MODEL OF ELECTROSTATIC PRECIPITATION. (REVISION 1): VOLUME I. MODELING AND PROGRAMMING

EPA Science Inventory

The report briefly describes the fundamental mechanisms and limiting factors involved in the electrostatic precipitation process. It discusses theories and procedures used in the computer model to describe the physical mechanisms, and generally describes the major operations perf...

QUALITY ASSURANCE HANDBOOK FOR AIR POLLUTION MEASUREMENT SYSTEMS: VOLUME IV - METEOROLOGICAL MEASUREMENTS (REVISED - AUGUST 1994)

EPA Science Inventory

Procedures on installing, acceptance testing, operating, maintaining and quality assuring three types of ground-based, upper air meteorological measurement systems are described. he limitations and uncertainties in precision and accuracy measurements associated with these systems...

We still need to operate at night!

PubMed Central

Faiz, Omar; Banerjee, Saswata; Tekkis, Paris; Papagrigoriadis, Savvas; Rennie, John; Leather, Andrew

2007-01-01

Introduction In the past the National Confidential Enquiry into Peri-operative deaths (NCEPOD) have advocated a reduction in non-essential night-time operating in NHS hospitals. In this study a retrospective analysis of the emergency general surgical operative workload at a London Teaching centre was performed. Methods All general surgical and vascular emergency operations recorded prospectively on the theatre database between 1997 and 2004 were included in the study. Operations were categorised according to whether they commenced during the daytime(08:01–18:00 hours), evening(18:01–00:00 hours) or night-time(00:01–08:00 hours). The procedure type and grade of the participating surgical personnel were also recorded. Bivariate correlation was used to analyse changing trends in the emergency workload. Results In total 5,316 emergency operations were performed over the study period. The numbers of daytime, evening and night-time emergency procedures performed were 2,963(55.7%), 1,832(34.5%), and 521(9.8%) respectively. Laparotomies and complex vascular procedures collectively accounted for half of all cases performed after midnight whereas they represented only 30% of the combined daytime and evening emergency workload. Thirty-two percent (n = 166) of all night-time operations were supervised or performed by a consultant surgeon. The annual volume of emergency cases performed increased significantly throughout the study period. Enhanced daytime (r = 0.741, p < 0.01) and evening (r = 0.548, p < 0.01) operating absorbed this increase in workload. There was no significant change in the absolute number of cases performed at night but the proportion of the emergency workload that took place after midnight decreased significantly throughout the study (r = -0.742, p < 0.01). Conclusion A small but consistent volume of complex cases require emergency surgery after midnight. Provision of an emergency general surgical service must incorporate this need. PMID:17973987

Shuttle user analysis (study 2.2). Volume 3: Business risk and value of operations in space (BRAVO). Part 2: User's manual

NASA Technical Reports Server (NTRS)

1974-01-01

The purpose of the BRAVO User's Manual is to describe the BRAVO methodology in terms of step-by-step procedures. The BRAVO methodology then becomes a tool which a team of analysts can utilize to perform cost effectiveness analyses on potential future space applications with a relatively general set of input information and a relatively small expenditure of resources. An overview of the BRAVO procedure is given by describing the complete procedure in a general form.

Automated 3D renal segmentation based on image partitioning

NASA Astrophysics Data System (ADS)

Yeghiazaryan, Varduhi; Voiculescu, Irina D.

2016-03-01

Despite several decades of research into segmentation techniques, automated medical image segmentation is barely usable in a clinical context, and still at vast user time expense. This paper illustrates unsupervised organ segmentation through the use of a novel automated labelling approximation algorithm followed by a hypersurface front propagation method. The approximation stage relies on a pre-computed image partition forest obtained directly from CT scan data. We have implemented all procedures to operate directly on 3D volumes, rather than slice-by-slice, because our algorithms are dimensionality-independent. The results picture segmentations which identify kidneys, but can easily be extrapolated to other body parts. Quantitative analysis of our automated segmentation compared against hand-segmented gold standards indicates an average Dice similarity coefficient of 90%. Results were obtained over volumes of CT data with 9 kidneys, computing both volume-based similarity measures (such as the Dice and Jaccard coefficients, true positive volume fraction) and size-based measures (such as the relative volume difference). The analysis considered both healthy and diseased kidneys, although extreme pathological cases were excluded from the overall count. Such cases are difficult to segment both manually and automatically due to the large amplitude of Hounsfield unit distribution in the scan, and the wide spread of the tumorous tissue inside the abdomen. In the case of kidneys that have maintained their shape, the similarity range lies around the values obtained for inter-operator variability. Whilst the procedure is fully automated, our tools also provide a light level of manual editing.

Evaluation of effects of anterior palatoplasty operation on upper airway parameters in computed tomography in patients with pure snoring and obstructive sleep apnea syndrome.

PubMed

Selcuk, Adin; Ozer, Tulay; Esen, Erkan; Ozdogan, Fatih; Ozel, Halil Erdem; Yuce, Turgut; Caliskan, Sebla; Dasli, Sinem; Bilal, Nagihan; Genc, Gulden; Genc, Selahattin

2017-05-01

To investigate changes in upper airway volume parameters measured by computerized tomography scans in patients with surgically treated by anterior palatoplasty of whom having pure snoring and mild-moderate obstructive sleep apnea. A prospective study on consecutively anterior palatoplasty performed pure snoring and obstructive sleep apnea patients. Computerized tomography scans were obtained preoperatively and following anterior palatoplasty procedure to measure changes in upper airway volume. Patients underwent diagnostic drug induced sleep endoscopy to assess the site of obstruction. Preoperative and postoperative measurements were compared using student's t test and Chi-square test. Twenty-two patients (16 men and 6 women, age 48.22 ± 9.23, body mass index 25.85 ± 2.57) completed the trial. Anterior palatoplasty was associated with an increase in total upper airway volume from 4.81 ± 1.73 cm 3 before treatment to 6.57 ± 2.03 cm 3 after treatment (p < 0.005). Change in soft palate thickness did not vary significantly (p < 0.039). The mean soft palate length has changed from 4.13 ± 0.41 to 3.93 ± 0.51 cm (p < 0.001). The preoperative and postoperative measurements of cross-sectional areas and volumes all showed significant difference except velopharynx minimal lateral airway dimension. The operational procedure increased the total upper airway volume much more in men than in women (p < 0.05). Results of this study indicate that anterior palatoplasty operation appears to produce significant increase in upper airway volume and cross sectional area. It does not seem to have an effect on lateral airway dimension. Computerized tomography is a quick and noninvasive imaging technique that allows for quantitative assessment of the velopharyngeal patency changes.

Changing trends in abdominal surgical complications following cardiac surgery in an era of advanced procedures. A retrospective cohort study.

PubMed

Ashfaq, Awais; Johnson, Daniel J; Chapital, Alyssa B; Lanza, Louis A; DeValeria, Patrick A; Arabia, Francisco A

2015-03-01

Abdominal complications following cardiopulmonary bypass (CPB) procedures may have mortality rates as high as 25%. Advanced procedures such as ventricular assist devices, artificial hearts and cardiac transplantation are being increasingly employed, changing the complexity of interventions. This study was undertaken to examine the changing trends in complications and the impact of cardiac surgery on emergency general surgery (EGS) coverage. A retrospective review was conducted of all CPB procedures admitted to our ICU between Jan. 2007 and Mar. 2010. The procedures included coronary bypass (CABG), valve, combination (including adult congenital) and advanced heart failure (AHF) procedures. The records were reviewed to obtain demographics, need for EGS consult/procedure and outcomes. Mean age of the patients was 66 ± 8.5 years, 71% were male. There were 945 CPB procedures performed on 914 patients during this study period. Over 39 months, 23 EGS consults were obtained, resulting in 10 operations and one hospital death (10% operative mortality). CABG and valve procedures had minimal impact on EGS workload while complex cardiac and AHF procedures accounted for significantly more EGS consultations (p < 0.005) and operations (p < 0.005). The majority of consultations were for small bowel obstruction/ileus (n = 4, 17%), cholecystitis (n = 3, 13%) and to rule out ischemia (n = 2, 9%) In the era of modern critical care and cardiac surgery, advanced technology has increased the volume of complex CPB procedures increasing the EGS workload. Emergency general surgeons working in institutions that perform advanced procedures should be aware of the potential for general surgical complications perioperatively and the resultant nuances that are associated with operative management in this patient population. Copyright © 2015 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Best Practices During Hip Arthroscopy: Aggregate Recommendations of High-Volume Surgeons.

PubMed

Gupta, Asheesh; Suarez-Ahedo, Carlos; Redmond, John M; Gerhardt, Michael B; Hanypsiak, Bryan; Stake, Christine E; Finch, Nathan A; Domb, Benjamin G

2015-09-01

To survey surgeons who perform a high volume of hip arthroscopy procedures regarding their operative technique, type of procedure, and postoperative management. We conducted a cross-sectional survey of 27 high-volume orthopaedic surgeons specializing in hip arthroscopy to report their preferences and practices related to their operative practice and postoperative rehabilitation protocol. All participants completed the survey in person in an anonymous fashion during a meeting of the American Hip Institute. All surgeons perform hip arthroscopy with the patient in the supine position, accessing the central compartment of the hip initially, using intraoperative fluoroscopy. All surgeons perform labral repair (100%), with the majority performing labral reconstructions (77.8%) and gluteus medius repairs (81.5%). There is variability in the type of anchors used during labral repair. Most surgeons perform capsular closure in most cases (88.9%), inject either intra-articular cortisone or platelet-rich plasma at the conclusion of the procedure (59%), and prescribe a postoperative hip brace for some or all patients (59%). There is considerable variability in rehabilitation protocols. All surgeons routinely prescribe postoperative heterotopic ossification prophylaxis to their patients, with most surgeons (88.9%) prescribing a nonsteroidal anti-inflammatory medication for 3 weeks. Forty percent of the respondents use the modified Harris Hip Score as the most important outcome measure. Consistent practices such as use of intraoperative fluoroscopy, heterotopic ossification prophylaxis, and labral repair skills were identified by surveying 27 hip arthroscopy surgeons at high-volume centers. Most of the surgeons performed routine capsular closure unless underlying conditions precluded capsular release or plication. The survey identified higher variability between surgeons regarding postoperative rehabilitation protocols and use of intra-articular pharmacologic injections at the end of the procedure. These data may provide surgeons with a set of aggregate trends that may help guide training, clinical practice, and research in the evolving field of hip arthroscopy. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

40 CFR 60.285a - Test methods and procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... performance test. (b) The owner or operator must determine compliance with the filterable particulate matter... used to determine the filterable particulate matter concentration. The sampling time and sample volume... repeat performance tests for filterable particulate matter at intervals no longer than 5 years following...

NASA TLA workload analysis support. Volume 1: Detailed task scenarios for general aviation and metering and spacing studies

NASA Technical Reports Server (NTRS)

Sundstrom, J. L.

1980-01-01

The techniques required to produce and validate six detailed task timeline scenarios for crew workload studies are described. Specific emphasis is given to: general aviation single pilot instrument flight rules operations in a high density traffic area; fixed path metering and spacing operations; and comparative workload operation between the forward and aft-flight decks of the NASA terminal control vehicle. The validation efforts also provide a cursory examination of the resultant demand workload based on the operating procedures depicted in the detailed task scenarios.

Evaluation of Bridges Subjected to Military Loading and Dynamic Hydraulic Effects: Review of Design Regulations, Selection Criteria, and Inspection Procedures for Bridge Railing Systems

DTIC Science & Technology

2011-08-01

Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington VA 22202-4302. Respondents should be aware that notwithstanding any...may be required by the United States Customs and Immigration Services, in connection with the operation of an international bridge or tunnel. ERDC...significant effect on the operation , service quality, and safety of road networks by restricting the traffic volume and vehicle weight that can be

Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial.

PubMed

Tabbutt, Sarah; Ghanayem, Nancy; Ravishankar, Chitra; Sleeper, Lynn A; Cooper, David S; Frank, Deborah U; Lu, Minmin; Pizarro, Christian; Frommelt, Peter; Goldberg, Caren S; Graham, Eric M; Krawczeski, Catherine Dent; Lai, Wyman W; Lewis, Alan; Kirsh, Joel A; Mahony, Lynn; Ohye, Richard G; Simsic, Janet; Lodge, Andrew J; Spurrier, Ellen; Stylianou, Mario; Laussen, Peter

2012-10-01

We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial. Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality. Analysis included 549 subjects prospectively enrolled from 15 centers; 30-day and hospital mortality were 11.5% (63/549) and 16.0% (88/549), respectively. Independent risk factors for both 30-day and hospital mortality included lower birth weight, genetic abnormality, extracorporeal membrane oxygenation (ECMO) and open sternum on the day of the Norwood procedure. In addition, longer duration of deep hypothermic circulatory arrest was a risk factor for 30-day mortality. Shunt type at the end of the Norwood procedure was not a significant risk factor for 30-day or hospital mortality. Independent risk factors for postoperative renal failure (n = 46), sepsis (n = 93), increased length of ventilation, and hospital length of stay among survivors included genetic abnormality, lower center/surgeon volume, open sternum, and post-Norwood operations. Innate patient factors, ECMO, open sternum, and lower center/surgeon volume are important risk factors for postoperative mortality and/or morbidity during the Norwood hospitalization. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Natural Resource Information System. Volume 2: System operating procedures and instructions

NASA Technical Reports Server (NTRS)

1972-01-01

A total computer software system description is provided for the prototype Natural Resource Information System designed to store, process, and display data of maximum usefulness to land management decision making. Program modules are described, as are the computer file design, file updating methods, digitizing process, and paper tape conversion to magnetic tape. Operating instructions for the system, data output, printed output, and graphic output are also discussed.

The Shock and Vibration Digest. Volume 12, Number 7,

DTIC Science & Technology

1980-07-01

clearance of the pump [14]. This external damper controls passage of the and the journal bearing have an effect on the stability shaft through...initial Analytical and experimental investigation with the operation of large Deriaz pumps have been studied squeeze- film damper [15, 16] showed the...existence (251; a procedure for satisfactory operation is de- of an intershaft viscous damper instability. The scribed. squeeze- film damper was explored

Engineering Guide for Fire Protection and Detection Systems at Army Ammunition Plants. Volume 1. Selection and Design

DTIC Science & Technology

1980-12-01

type of personnel likely to he using them, (3) the physical environment , (4) health and operational safety considerations. Carefully selected portable...operated apparatus must have the battery and energy-limiting components located outside the hazardous environment , and be so constructed that a direct...designate effect on equipment or personnel), based upon the most severe result of personnel error, procedural deficiencies, environment , design

Does ITV vaginal procedure ensure dosimetric coverage during IMRT of post-operative gynaecological tumours without instructions concerning rectal filling?

PubMed

Verges, Ramona; Giraldo, Alexandra; Seoane, Alejandro; Toral, Elisabet; Ruiz, M Carmen; Pons, Ariadna; Giralt, Jordi

2018-01-01

To find out whether the internal target volume (ITV) vaginal procedure ensures dosimetric coverage during intensity-modulated radiation therapy (IMRT) of post-operative gynaecological tumours without instructions on rectal filling. The ITV vaginal procedure does not necessarily include all movements of the bladder, and does not include changes in the rectal volume. We should know if the vaginal ITV is a useful tool in maintaining CTV coverage during treatment. A retrospective analysis of 24 patients treated between July 2012 and July 2014 with adjuvant IMRT for gynaecological cancer. All patients underwent empty and full bladder CT on simulation (CT-planning) and three weeks later (CT-control). ITV displacement was measured and the 3D vector was calculated. ITV coverage was then evaluated by comparing the volume covered by the prescription isodose on both CT's. Patients were asked to have full bladder but they did not follow recommendations for the rectum. The mean 3D vector was 0.64 ± 0.32 cm (0.09-1.30). The mean ITV coverage loss was 5.8 ± 5.7% (0-20.2). We found a significant positive correlation between the 3D vector and the loss of coverage (Pearson correlation, r  = 0.493, 95% CI: 0.111-0.748, p  = 0.0144). We did not find any significant correlation between the bladder and rectal parameters with the 3D vector and loss of dosimetric coverage. We found a trend between the maximum rectal diameter in CT-planning and 3D vector ( r  = 0.400, 95% CI: -0.004 to 0.692, p  = 0.0529). ITV vaginal procedure contributed to ensuring a good dose coverage without instructions on rectal filling.

40 CFR 86.1838-01 - Small volume manufacturer certification procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... miles, a manufacturer may demonstrate to the satisfaction of the Agency that, based on owner survey data... means of support of economic value from any related manufacturers for purposes of vehicle design, vehicle parts procurement, research and development, and production facilities and operation. Any...

Prediction of sonic boom from experimental near-field overpressure data. Volume 1: Method and results

NASA Technical Reports Server (NTRS)

Glatt, C. R.; Hague, D. S.; Reiners, S. J.

1975-01-01

A computerized procedure for predicting sonic boom from experimental near-field overpressure data has been developed. The procedure extrapolates near-field pressure signatures for a specified flight condition to the ground by the Thomas method. Near-field pressure signatures are interpolated from a data base of experimental pressure signatures. The program is an independently operated ODIN (Optimal Design Integration) program which obtains flight path information from other ODIN programs or from input.

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

NONE

The study was conducted to determine the pollutants of concern in the Istanbul metropolitan area, monitoring equipment specifications and monitoring and data analysis procedures for an air quality and meteorological monitoring program. This volume consists of: (1) Introduction; (2) Selection of Pollutants of Concern; (3) Selection of Monitoring Locations; (4) Equipment Specifications; (5) Site Preparation and Security; (6) Standard Operating Procedures; (7) Data Reduction and Analysis; (8) Future Phases; (9) References. Also included are Attachments A through G and List of Tables and List of Figures.

Evaluation of potential severe accidents during low power and shutdown operations at Surry, Unit 1: Analysis of core damage frequency from internal events during mid-loop operations, Appendices A--D. Volume 2, Part 2

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

Chu, T.L.; Musicki, Z.; Kohut, P.

1994-06-01

During 1989, the Nuclear Regulatory Commission (NRC) initiated an extensive program to carefully examine the Potential risks during low Power and shutdown operations. The program includes two parallel projects being performed by Brookhaven National Laboratory (BNL) and Sandia National Laboratories (SNL). Two plants, Surry (pressurized water reactor) and Grand Gulf (boiling water reactor), were selected as the Plants to be studied. The objectives of the program are to assess the risks of severe accidents initiated during plant operational states other than full power operation and to compare the estimated core damage frequencies, important accident sequences and other qualitative and quantitativemore » results with those accidents initiated during full power operation as assessed in NUREG-1150. The objective of this report is to document the approach utilized in the Surry plant and discuss the results obtained. A parallel report for the Grand Gulf plant is prepared by SNL. This study shows that the core-damage frequency during mid-loop operation at the Surry plant is comparable to that of power operation. We recognize that there is very large uncertainty in the human error probabilities in this study. This study identified that only a few procedures are available for mitigating accidents that may occur during shutdown. Procedures written specifically for shutdown accidents would be useful. This document, Volume 2, Pt. 2 provides appendices A through D of this report.« less

Low rates of complications for carotid artery stenting are associated with a high clinician volume of carotid artery stenting and aortic endografting but not with a high volume of percutaneous coronary interventions.

PubMed

Modrall, J Gregory; Chung, Jayer; Kirkwood, Melissa L; Baig, M Shadman; Tsai, Shirling X; Timaran, Carlos H; Valentine, R James; Rosero, Eric B

2014-07-01

Prior studies have demonstrated improved clinical outcomes for surgeons with a high-volume experience with certain open vascular operations. A high-volume experience with carotid artery stenting (CAS) improves clinical outcomes. Moreover, it is not known whether experience with other endovascular procedures, including percutaneous coronary interventions (PCIs), is an adequate substitute for experience with CAS. The goal of this study was to quantify the effect of increasing clinician volume of CAS, endovascular aneurysm repair (EVAR), and thoracic endovascular aortic aneurysm repair (TEVAR), and PCI on the outcomes for CAS. The Nationwide Inpatient Sample was analyzed to identify patients undergoing CAS for the years 2005 to 2009. Clinicians were stratified into tertiles of low-volume, medium-volume, and high-volume groups by annual volume of CAS, EVAR/TEVAR, and PCI. Multiple logistic regression analyses were used to examine the relationship between clinician volume and a composite outcome of the in-hospital stroke and death rate after CAS. Between 2005 and 2009, 56,374 elective CAS procedures were performed nationwide, with a crude in-hospital stroke and death rate of 3.22%. A median of nine CAS procedures (interquartile range, 3-20) were performed annually per clinician. As expected, stroke and death rates for CAS decreased with increasing volume of CAS performed by a clinician (low-volume vs medium-volume vs high-volume: 4.43% vs 2.89% vs 2.27%; P = .0001). Similar patterns were noted between clinicians' volume of EVAR/TEVAR (low-volume vs medium-volume vs high-volume: 4.58% vs 3.18% vs 2.16%; P = .0023). In contrast, increasing PCI volume was not associated with decreased stroke and death rates after CAS (low-volume vs medium-volume vs high-volume: 2.99% vs 3.18% vs 3.55%; P = .35). After adjusting for patient and hospital characteristics, clinician volume of CAS (odds ratio [OR], 0.84; 95% confidence interval [CI], 0.74-0.94; P = .003) and EVAR/TEVAR (OR, 0.85; 95% CI, 0.75-0.97; P = .020) remained significant predictors of stroke and death after CAS, whereas increasing clinician volume of PCI was associated with significantly increasing likelihood of stroke or death after CAS (OR, 1.025; 95% CI, 1.004-1.047; P = .019). The stroke and death rate for CAS to treat carotid stenosis is inversely affected by the number of CAS and EVAR/TEVAR procedures performed by a clinician. In contrast, a high-volume experience with PCI is not associated with improved outcomes after CAS. Copyright © 2014 Society for Vascular Surgery. All rights reserved.

Understanding Skill in EVA Mass Handling. Volume 2; Empirical Investigation

NASA Technical Reports Server (NTRS)

Riccio, Gary; McDonald, Vernon; Peters, Brian; Layne, Charles; Bloomberg, Jacob

1997-01-01

In this report we describe the details of our empirical protocol effort investigating skill in extravehicular mass handling using NASA's principal mass handling simulator, the precision air bearing floor. Contents of this report include a description of the necessary modifications to the mass handling simulator; choice of task, and the description of an operationally relevant protocol. Our independent variables are presented in the context of the specific operational issues they were designed to simulate. The explanation of our dependent variables focuses on the specific data processing procedures used to transform data from common laboratory instruments into measures that are relevant to a special class of nested control systems (discussed in Volume 1): manual interactions between an individual and the substantial environment. The data reduction is explained in the context of the theoretical foundation described in Volume 1. Finally as a preface to the presentation of the empirical data in Volume 3 of this report series, a set of detailed hypotheses is presented.

Software Engineering Laboratory (SEL) data base reporting software user's guide and system description. Volume 1: Introduction and user's guide

NASA Technical Reports Server (NTRS)

1983-01-01

Reporting software programs provide formatted listings and summary reports of the Software Engineering Laboratory (SEL) data base contents. The operating procedures and system information for 18 different reporting software programs are described. Sample output reports from each program are provided.

Space Station Human Factors Research Review. Volume 4: Inhouse Advanced Development and Research

NASA Technical Reports Server (NTRS)

Tanner, Trieve (Editor); Clearwater, Yvonne A. (Editor); Cohen, Marc M. (Editor)

1988-01-01

A variety of human factors studies related to space station design are presented. Subjects include proximity operations and window design, spatial perceptual issues regarding displays, image management, workload research, spatial cognition, virtual interface, fault diagnosis in orbital refueling, and error tolerance and procedure aids.

Graphic Arts: Book Three. The Press and Related Processes.

ERIC Educational Resources Information Center

Farajollahi, Karim; And Others

The third of a three-volume set of instructional materials for a graphic arts course, this manual consists of nine instructional units dealing with presses and related processes. Covered in the units are basic press fundamentals, offset press systems, offset press operating procedures, offset inks and dampening chemistry, preventive maintenance…

Standard Procedures for Air Force Operational Test and Evaluation. Volume I. Appendices

DTIC Science & Technology

1974-10-01

Participates in selected tests data for assessment of suitability Participates in the intepretation of and effectiveness, as practicable tet results...selected tests Interprels test results Inteprets test resultst ReplRorts to CNO the results of the "eports independent operational TI’ECIIEVAL assessment" v... films , lists, tapes, drawings, specifications. parts breakdowns, ctc. RAW DATA; ’The original form of data at the time it was recorded. DATA

Design Guidelines and Criteria for User/Operator Transactions with Battlefield Automated Systems. Volume 2. Technical Discussion

DTIC Science & Technology

1981-02-01

Continue on tevetee «Id* If necemtery mid Identify br black number) Battlefield automated systems Human- computer interaction. Design criteria System...Report (this report) In-Depth Analyses of Individual Systems A. Tactical Fire Direction System (TACFIRE) (RP 81-26) B. Tactical Computer Terminal...select the design features and operating procedures of the human- computer Interface which best match the require- ments and capabilities of anticipated

Space Transportation System Cargo projects: inertial stage/spacecraft integration plan. Volume 1: Management plan

NASA Technical Reports Server (NTRS)

1981-01-01

The Kennedy Space Center (KSC) Management System for the Inertial Upper Stage (IUS) - spacecraft processing from KSC arrival through launch is described. The roles and responsibilities of the agencies and test team organizations involved in IUS-S/C processing at KSC for non-Department of Defense missions are described. Working relationships are defined with respect to documentation preparation, coordination and approval, schedule development and maintenance, test conduct and control, configuration management, quality control and safety. The policy regarding the use of spacecraft contractor test procedures, IUS contractor detailed operating procedures and KSC operations and maintenance instructions is defined. Review and approval requirements for each documentation system are described.

Operative experience of surgery residents: trends and challenges.

PubMed

Malangoni, Mark A; Biester, Thomas W; Jones, Andrew T; Klingensmith, Mary E; Lewis, Frank R

2013-01-01

To evaluate trends in operative experience and to determine the effect of establishing the Surgical Council on Resident Education (SCORE) operative classification system on changes in operative volume among graduating surgery residents. The general surgery operative logs of graduating surgery residents from 2005 were retrospectively compared with residents who completed training in 2010 and 2011. Nonparametric statistical analyses were used (Mann-Whitney and median test) with significance set at p<0.01. A total of 1022 residents completing residency in 2005 were compared with 1923 residents completing training in 2010-2011. Total operations reported increased from a median of 1023 to 1238 (21%) between 2005 and 2010-2011 (p<0.001). Cases increased in most SCORE categories. The median numbers of total, basic, and complex laparoscopic operations increased by 49%, 37%, and 82%, respectively, over the 5-year interval (p<0.001). Open cavitary (thoracic + abdominal) operations decreased by 5%, whereas other major operations increased by 35% (both p<0.001). The frequency of discrete operations done at least 10 times during residency did not change. The median number of SCORE essential-common operations performed ranged from 1 to 107, whereas essential-uncommon operations ranged from 0 to 4. Twenty-three of 67 SCORE essential-common operations (34%) had a median of less than 5 and 4 had a median of 0. The operative volume of graduating surgical residents has increased by 21% since 2005; however, the number of operations done 10 times or greater has not changed. Although open cavitary procedures continue to decline, there has been a large increase in endoscopy, complex laparoscopic, and other major operations. Some essential-common operations continue to be performed infrequently. These results suggest that education in the operating room must improve and alternate methods for teaching infrequently performed procedures are needed. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

Otoplasty: the case for skin incision by higher volume operators.

PubMed

Arkoulis, Nikolaos; Reid, Jenny; Neill, Conor O '; Stewart, Kenneth J

2015-02-01

Prominent ear correction in the paediatric population is a common and popular procedure, with demonstrable benefit in alleviating psychological distress. Posterior cartilage-sparing techniques for otoplasty have been shown to be consistently safer and better than cartilage-scoring alternatives, however excision of the posterior auricular skin during otoplasty, although a common first step, has not been shown to have any benefits over skin incision alone. In this study, we examined the association between skin excision and recurrence of ear prominence, by examining the collective surgical outcomes of five plastic surgeons, performing 118 otoplasties at the Royal Hospital for Sick Children Edinburgh, between January 2011 and December 2013. Recurrence of prominence at the first follow-up appointment (mean follow-up 3.4 months) was 10.2%. Surgeons with low case volumes had significantly higher recurrence rates than high volume operators. There was no statistically significant association between skin excision and recurrence of prominence. We still favour posterior, cartilage-sparing otoplasties, but based on our findings we do not advocate any skin excision at any stage of the procedure. Surgeons should not include paediatric otoplasty in their portfolio unless they are undertaking significant number of cases each year. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Procedural Portfolio Planning in Plastic Surgery, Part 2: Collaboration Between Surgeons and Hospital Administrators to Develop a Funds Flow Model for Procedures Performed at an Academic Medical Center.

PubMed

Hultman, Charles Scott

2016-06-01

Although plastic surgeons make important contributions to the clinical, educational, and research missions of academic medical centers (AMCs), determining the financial value of a plastic surgery service can be difficult, due to complex cost accounting systems. We analyzed the financial impact of plastic surgery on an AMC, by examining the contribution margins and operating income of surgical procedures. We collaborated with hospital administrators to implement 3 types of strategic changes: (1) growth of areas with high contribution margin, (2) curtailment of high-risk procedures with negative contribution margin, (3) improved efficiency of mission-critical services with high resource consumption. Outcome measures included: facility charges, hospital collections, contribution margin, operating margin, and operating room times. We also studied the top 50 Current Procedural Terminology codes (total case number × charge/case), ranking procedures for profitability, as determined by operating margin. During the 2-year study period, we had no turnover in faculty; did not pursue any formal marketing; did not change our surgical fees, billing system, or payer mix; and maintained our commitment to indigent care. After rebalancing our case mix, through procedural portfolio planning, average hospital operating income/procedure increased from $-79 to $+816. Volume and diversity of cases increased, with no change in payer mix. Although charges/case decreased, both contribution margin and operating margin increased, due to improved throughput and decreased operating room times. The 5 most profitable procedures for the hospital were hernia repair, mandibular osteotomy, hand skin graft, free fibula flap, and head and neck flap, whereas the 5 least profitable were latissimus breast reconstruction, craniosynostosis repair, free-flap breast reconstruction, trunk skin graft, and cutaneous free flap. Total operating income for the hospital, from plastic surgery procedures, increased from $-115,103 to $+1,277,040, of which $350,000 (25%) was returned to the practice plan as enterprise funds to support program development. Through focused strategic initiatives, plastic surgeons and hospital administrators can work together to unlock the latent value of a plastic surgery service to an AMC. Specific financial benefits to the hospital include increased contribution margin and operating income, the latter of which can be reinvested in the plastic surgery service through a gain-sharing model.

[MINIMALLY INVASIVE PROCEDURE FOR CORRECTION OF PECTUS CARINATUM].

PubMed

Xu, Bing; Liu, Wenying

2015-04-01

To explore the method and experience in correction of pectus carinatum with minimally invasive procedure. Between June 2010 and January 2014, 30 patients with pectus carinatum were corrected by minimally invasive procedure. There were 21 boys and 9 girls whose average age was 13 years and 2 months (range, from 8 years and 10 months to 18 years and 9 months), including 24 cases of first operation, 2 recurrence after traditional pectus carinatum correction, and 4 cases secondary to median thoracotomy. Thirty patients had symmetric and asymmetric mild pectus carinatum. The operation was performed successfully in all patients, and no severe complication occurred. The operation time was 42-95 minutes (mean, 70 minutes). The bleeding volume during operation was 4-30 mL (mean, 10 mL). The time from operation to discharge was 6-10 days (mean, 7 days). The average time of follow-up was 25 months (range, 9-54 months). All surgical wound healed primarily with no infection. The X-ray films showed slight pneumothorax in 7 cases, and it was absorbed after 1 month without treatment. Loosening of internal fixation was found in 1 patient because of trauma at 6 months, and operation was performed again. The bar was removed at 2 years in 21 patients. The patients had good thoracic contour and normal activity. Minimally invasive procedure for correction of pectus carinatum is safe and will get satisfactory effect in maintaining thoracic contour. It has also less trauma and shorter operation time.

High-speed two-dimensional laser scanner based on Bragg gratings stored in photothermorefractive glass.

PubMed

Yaqoob, Zahid; Arain, Muzammil A; Riza, Nabeel A

2003-09-10

A high-speed free-space wavelength-multiplexed optical scanner with high-speed wavelength selection coupled with narrowband volume Bragg gratings stored in photothermorefractive (PTR) glass is reported. The proposed scanner with no moving parts has a modular design with a wide angular scan range, accurate beam pointing, low scanner insertion loss, and two-dimensional beam scan capabilities. We present a complete analysis and design procedure for storing multiple tilted Bragg-grating structures in a single PTR glass volume (for normal incidence) in an optimal fashion. Because the scanner design is modular, many PTR glass volumes (each having multiple tilted Bragg-grating structures) can be stacked together, providing an efficient throughput with operations in both the visible and the infrared (IR) regions. A proof-of-concept experimental study is conducted with four Bragg gratings in independent PTR glass plates, and both visible and IR region scanner operations are demonstrated.

Accurate assessment of breast volume: a study comparing the volumetric gold standard (direct water displacement measurement of mastectomy specimen) with a 3D laser scanning technique.

PubMed

Yip, Jia Miin; Mouratova, Naila; Jeffery, Rebecca M; Veitch, Daisy E; Woodman, Richard J; Dean, Nicola R

2012-02-01

Preoperative assessment of breast volume could contribute significantly to the planning of breast-related procedures. The availability of 3D scanning technology provides us with an innovative method for doing this. We performed this study to compare measurements by this technology with breast volume measurement by water displacement. A total of 30 patients undergoing 39 mastectomies were recruited from our center. The volume of each patient's breast(s) was determined with a preoperative 3D laser scan. The volume of the mastectomy specimen was then measured in the operating theater by water displacement. There was a strong linear association between breast volumes measured using the 2 different methods when using a Pearson correlation (r = 0.95, P < 0.001). The mastectomy mean volume was defined by the equation: mastectomy mean volume = (scan mean volume × 1.03) -70.6. This close correlation validates the Cyberware WBX Scanner as a tool for assessment of breast volume.

Asleep Deep Brain Stimulation Reduces Incidence of Intracranial Air during Electrode Implantation.

PubMed

Ko, Andrew L; Magown, Philippe; Ozpinar, Alp; Hamzaoglu, Vural; Burchiel, Kim J

2018-05-30

Asleep deep brain stimulation (aDBS) implantation replaces microelectrode recording for image-guided implantation, shortening the operative time and reducing cerebrospinal fluid egress. This may decrease pneumocephalus, thus decreasing brain shift during implantation. To compare the incidence and volume of pneumocephalus during awake (wkDBS) and aDBS procedures. A retrospective review of bilateral DBS cases performed at Oregon Health & Science University from 2009 to 2017 was undertaken. Postimplantation imaging was reviewed to determine the presence and volume of intracranial air and measure cortical brain shift. Among 371 patients, pneumocephalus was noted in 66% of wkDBS and 15.6% of aDBS. The average volume of air was significantly higher in wkDBS than aDBS (8.0 vs. 1.8 mL). Volumes of air greater than 7 mL, which have previously been linked to brain shift, occurred significantly more frequently in wkDBS than aDBS (34 vs 5.6%). wkDBS resulted in significantly larger cortical brain shifts (5.8 vs. 1.2 mm). We show that aDBS reduces the incidence of intracranial air, larger air volumes, and cortical brain shift. Large volumes of intracranial air have been correlated to shifting of brain structures during DBS procedures, a variable that could impact accuracy of electrode placement. © 2018 S. Karger AG, Basel.

[Implementation of a robotic video-assisted thoracic surgical program].

PubMed

Baste, J-M; Riviera, C; Nouhaud, F-X; Rinieri, P; Melki, J; Peillon, C

2016-03-01

Recent publications from North America have shown the benefits of robot-assisted thoracic surgery. We report here the process of setting up such a program in a French university centre and early results in a unit with an average treatment volume. Retrospective review of a single institution database. The program was launched after a 6-month preparation period. From January 2012 to January 2013, totally endoscopic, full robot-assisted procedures were performed on 30 patients (17 males). Median age was 54 [Q1-Q3, 48-63] years and ASA score 2 [1,2]. Operative procedures included thymectomy (9 ; 30%), lobectomy with nodes resection (11 ; 38%), segmentectomy (4 ; 14%), lymphadenectomy (3 ; 10%), Bronchogenic cyst (2, 5%) and posterior mediastinal mass resection (1 ; 3%). No conversion was required. Median blood loss was 50mL [10-100]. Median operating time was 135 min (105-165) including 30 min [20-40] for docking, 90min for robot-assisted operating [70-120] and 15 min [10-15] for lesion extraction. CO2 insufflation was used in 28 cases (93%). Hospital stay was 4 days [4-6] with 6 minor complications (20%) (Grade 1 according to the Clavien-Dindo classification). After a median 4 months follow-up [2-7], all patients were alive and demonstrated a good quality of life. This series suggests that full robotic thoracic procedures are safe and effective treatment for various pathologies, with low morbidity and without a significant learning curve, even in a lower volume centre. This technology should accompany the development of minimally invasive thoracic surgery. The importance of robotic training should be emphasized to optimize procedures and costs. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Use of Lean methodology to improve operating room efficiency in hospitals across the Kingdom of Saudi Arabia.

PubMed

Hassanain, Mazen; Zamakhshary, Mohammed; Farhat, Ghada; Al-Badr, Ahmed

2017-04-01

The objective of this study was to assess whether an intervention on process efficiency using the Lean methodology leads to improved utilization of the operating room (OR), as measured by key performance metrics of OR efficiency. A quasi-experimental design was used to test the impact of the intervention by comparing pre-intervention and post-intervention data on five key performance indicators. The ORs of 12 hospitals were selected across regions of the Kingdom of Saudi Arabia (KSA). The participants were patients treated at these hospitals during the study period. The intervention comprised the following: (i) creation of visual dashboards that enable starting the first case on time; (ii) use of computerized surgical list management; (iii) optimization of time allocation; (iv) development of an operating model with policies and procedures for the pre-anesthesia clinic; and (iv) creation of a governance structure with policies and procedures for day surgeries. The following were the main outcome measures: on-time start for the first case, room turnover times, percent of overrun cases, average weekly procedure volume and OR utilization. The hospital exhibited statistically significant improvements in the following performance metrics: on-time start for the first case, room turnover times and percent of overrun cases. A statistically significant difference in OR utilization or average weekly procedure volumes was not detected. The implementation of a Lean-based intervention targeting process efficiency applied in ORs across various KSA hospitals resulted in encouraging results on some metrics at some sites, suggesting that the approach has the potential to produce significant benefit in the future. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Limiting excessive postoperative blood transfusion after cardiac procedures. A review.

PubMed Central

Ferraris, V A; Ferraris, S P

1995-01-01

Analysis of blood product use after cardiac operations reveals that a few patients (< or = 20%) consume the majority of blood products (> 80%). The risk factors that predispose a minority of patients to excessive blood use include patient-related factors, transfusion practices, drug-related causes, and procedure-related factors. Multivariate studies suggest that patient age and red blood cell volume are independent patient-related variables that predict excessive blood product transfusion after cardiac procedures. Other factors include preoperative aspirin ingestion, type of operation, over- or underutilization of heparin during cardiopulmonary bypass, failure to correct hypothermia after cardiopulmonary bypass, and physician overtransfusion. A survey of the currently available blood conservation techniques reveals 5 that stand out as reliable methods: 1) high-dose aprotinin therapy, 2) preoperative erythropoietin therapy when time permits adequate dosage before operation, 3) hemodilution by harvest of whole blood immediately before cardiopulmonary bypass, 4) autologous predonation of blood, and 5) salvage of oxygenator blood after cardiopulmonary bypass. Other methods, such as the use of epsilon-aminocaproic acid or desmopressin, cell saving devices, reinfusion of shed mediastinal blood, and hemofiltration have been reported to be less reliable and may even be harmful in some high-risk patients. Consideration of the available data allows formulation of a 4-pronged plan for limiting excessive blood transfusion after surgery: 1) recognize the causes of excessive transfusion, including the importance of red blood cell volume, type of procedure being performed, preoperative aspirin ingestion, etc.; 2) establish a quality management program, including a survey of transfusion practices that emphasizes physician education and availability of real-time laboratory testing to guide transfusion therapy; 3) adopt a multimodal approach using institution-proven techniques; and 4) continually reassess blood product use and analyze the cost-benefits of blood conservation interventions. PMID:7580359

Feasibility study of modern airships, phase 1. Volume 3: Historical overview (task 1)

NASA Technical Reports Server (NTRS)

Faurote, G. L.

1975-01-01

The history of lighter-than-air vehicles is reviewed in terms of providing a background for the mission analysis and parametric analysis tasks. Data from past airships and airship operations are presented in the following areas: (1) parameterization of design characteristics; (2) markets, missions, costs, and operating procedures, (3) indices of efficiency for comparison; (4) identification of critical design and operational characteristics; and (5) definition of the 1930 state-of-the-art and the 1974 state-of-the-art from a technical and economic standpoint.

Orbital transfer vehicle concept definition and system analysis study. Volume 4, Appendix A: Space station accommodations. Revision 1

NASA Technical Reports Server (NTRS)

Randall, Roger M.

1987-01-01

Orbit Transfer Vehicle (OTV) processing at the space station is divided into two major categories: OTV processing and assembly operations, and support operations. These categories are further subdivided into major functional areas to allow development of detailed OTV processing procedures and timelines. These procedures and timelines are used to derive the specific space station accommodations necessary to support OTV activities. The overall objective is to limit impact on OTV processing requirements on space station operations, involvement of crew, and associated crew training and skill requirements. The operational concept maximizes use of automated and robotic systems to perform all required OTV servicing and maintenance tasks. Only potentially critical activities would require direct crew involvement or supervision. EVA operations are considered to be strictly contingency back-up to failure of the automated and robotic systems, with the exception of the initial assembly of Space-Based OTV accommodations at the space station, which will require manned involvement.

Emergency general surgery in geriatric patients: A statewide analysis of surgeon and hospital volume with outcomes.

PubMed

Mehta, Ambar; Dultz, Linda A; Joseph, Bellal; Canner, Joseph K; Stevens, Kent; Jones, Christian; Haut, Elliott R; Efron, David T; Sakran, Joseph V

2018-06-01

Geriatric patients undergoing emergency general surgery (EGS) face significant morbidity and mortality. We assessed how surgeon and hospital volumes affected these outcomes. We identified patients at least 65 years old in Maryland's Health Services Cost Review Commission database from 2012 to 2014 who underwent one of 12 EGS procedures, as defined by the American Association for the Surgery of Trauma, and then calculated four outcomes: mortality rate, the incidence of at least one of eight common in-hospital EGS complications, failure-to-rescue (death after experiencing a postoperative complication), and the 30-day readmission rate. Median annual volumes of geriatric-EGS procedures divided both surgeons and hospitals into two groups (low volume and high volume). Multivariable logistic regressions calculated associations between the volume groups and outcomes after adjusting for patient, surgeon, and hospital factors, and hospital clusters. We identified 3,832 patients who had an EGS procedure by 302 surgeons (median: 8 geriatric-EGS/year, IQR: 3-18) at 44 hospitals (median: 82 geriatric-EGS/year, IQR: 35-132). While operating on 16.5% of all geriatric-EGS patients, low-volume surgeons had higher risk-adjusted adverse outcomes: mortality (7.0% vs. 4.0%, p = 0.005), in-hospital complications (22.1% vs. 19.7%, p = 0.13), failure-to-rescue (17.3% vs. 12.1%, p = 0.021), and 30-day readmissions (11.2% vs. 10.0%, p = 0.55). After adjustment, low-volume surgeons were associated with higher mortality (adjusted odds ratio [aOR] 1.86, 95% CI [1.21-2.86]) and failure-to-rescue rates (aOR 1.74 [1.09-2.80]) but not in-hospital complications (aOR 1.20 [0.95-1.51]) or 30-day readmissions (aOR 1.07 [0.85-1.34]). In contrast, low-volume hospitals relative to high-volume hospitals, and hospitals serving lower proportions of geriatric-EGS patients, were not associated with adverse outcomes. Relative to their higher-volume counterparts, surgeons performing eight or fewer geriatric-EGS procedures annually were associated with an 86% higher odds of death and 74% higher odds of failure-to-rescue in this elderly EGS patient population. These findings underscore the need for focused care of elderly surgical patients. Prognostic and epidemiological, level IV.

Cost/benefit tradeoffs for reducing the energy consumption of the commercial air transportation system. Volume 1: Technical analysis

NASA Technical Reports Server (NTRS)

Kraus, E. F.

1976-01-01

The effectiveness and associated costs of operational and technical options for reduced fuel consumption by Douglas aircraft in the domestic airline fleet are assessed. Areas explored include alternative procedures for airline and flight operations, advanced and state of the art technology, modification and derivative configurations, new near-term aircraft, turboprop configuration studies, and optimum aircraft geometry. Data for each aircraft studied is presented in tables and graphs.

Common Ada (tradename) Missile Package (CAMP) Project. Missile Software Parts. Volume 8. Detail Design Document

DTIC Science & Technology

1988-03-01

PACKAGE BODY ) TLCSC P661 (CATALOG #P106-0) This package contains the CAMP parts required to do the vaypoint steering portion of navigation. The...3.3.4.1.6 PROCESSING The following describes the processing performed by this part: package body WaypointSteering is package body ...Steering_Vector_Operations is separate; package body Steering_Vector_Operations_with_Arcsin is separate; procedure Compute Turn_Angle_and Direction (UnitNormal C

Surgical Burn Care by Médecins Sans Frontières-Operations Center Brussels: 2008 to 2014.

PubMed

Stewart, Barclay T; Trelles, Miguel; Dominguez, Lynette; Wong, Evan; Fiozounam, Hervé Tribunal; Hassani, Ghulam Hiadar; Akemani, Clemence; Naseer, Aemer; Ntawukiruwabo, Innocent Bagura; Kushner, Adam L

Humanitarian organizations care for burns during crisis and while supporting healthcare facilities in low-income and middle-income countries. This study aimed to define the epidemiology of burn-related procedures to aid humanitarian response. In addition, operational data collected from humanitarian organizations are useful for describing surgical need otherwise unmet by national health systems. Procedures performed in operating theatres run by Médecins Sans Frontières-Operations Centre Brussels (MSF-OCB) from July 2008 through June 2014 were reviewed. Surgical specialist missions were excluded. Burn procedures were quantified, related to demographics and reason for humanitarian response, and described. A total of 96,239 operations were performed at 27 MSF-OCB projects in 15 countries between 2008 and 2014. Of the 33,947 general surgical operations, 4,280 (11%) were for burns. This proportion steadily increased from 3% in 2008 to 24% in 2014. People receiving surgical care from conflict relief missions had nearly twice the odds of having a burn operation compared with people requiring surgery in communities affected by natural disaster (adjusted odds ratio, 1.94; 95% confidence interval, 1.46-2.58). Nearly 70% of burn procedures were planned serial visits to the theatre. A diverse skill set was required. Unmet humanitarian assistance needs increased US$400 million dollars in 2013 in the face of an increasing number of individuals affected by crisis and a growing surgical burden. Given the high volume of burn procedures performed at MSF-OCB projects and the resource intensive nature of burn management, requisite planning and reliable funding are necessary to ensure quality for burn care in humanitarian settings.

Operational considerations in monitoring oxygen levels at the National Transonic Facility

NASA Technical Reports Server (NTRS)

Zalenski, M. A.; Rowe, E. L.; Mcphee, J. R.

1985-01-01

Laboratory monitoring of the level of oxygen in sample gas mixtures is a process which can be performed with accurate and repeatable results. Operations at the National Transonic Facility require the storage and pumping of large volumes of liquid nitrogen. To protect against the possibility of a fault resulting in a localized oxygen deficient atmosphere, the facility is equipped with a monitoring system with an array of sensors. During the early operational stages, the system produced recurrent alarms, none of which could be traced to a true oxygen deficiency. A thorough analysis of the system was undertaken with primary emphasis placed on the sensor units. These units sense the partial pressure of oxygen which, after signal conditioning, is presented as a % by volume indication at the system output. It was determined that many of the problems experienced were due to a lack of proper accounting for the partial pressure/% by volume relationship, with a secondary cause being premature sensor failure. Procedures were established to consider atmospherically induced partial pressure variations. Sensor rebuilding techniques were examined, and those elements contributing to premature sensor failure were identified. The system now operates with a high degree of confidence and reliability.

Surgical team turnover and operative time: An evaluation of operating room efficiency during pulmonary resection.

PubMed

Azzi, Alain Joe; Shah, Karan; Seely, Andrew; Villeneuve, James Patrick; Sundaresan, Sudhir R; Shamji, Farid M; Maziak, Donna E; Gilbert, Sebastien

2016-05-01

Health care resources are costly and should be used judiciously and efficiently. Predicting the duration of surgical procedures is key to optimizing operating room resources. Our objective was to identify factors influencing operative time, particularly surgical team turnover. We performed a single-institution, retrospective review of lobectomy operations. Univariate and multivariate analyses were performed to evaluate the impact of different factors on surgical time (skin-to-skin) and total procedure time. Staff turnover within the nursing component of the surgical team was defined as the number of instances any nurse had to leave the operating room over the total number of nurses involved in the operation. A total of 235 lobectomies were performed by 5 surgeons, most commonly for lung cancer (95%). On multivariate analysis, percent forced expiratory volume in 1 second, surgical approach, and lesion size had a significant effect on surgical time. Nursing turnover was associated with a significant increase in surgical time (53.7 minutes; 95% confidence interval, 6.4-101; P = .026) and total procedure time (83.2 minutes; 95% confidence interval, 30.1-136.2; P = .002). Active management of surgical team turnover may be an opportunity to improve operating room efficiency when the surgical team is engaged in a major pulmonary resection. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Use of a Modern Polymerization Pilot-Plant for Undergraduate Control Projects.

ERIC Educational Resources Information Center

Mendoza-Bustos, S. A.; And Others

1991-01-01

Described is a project where students gain experience in handling large volumes of hazardous materials, process start up and shut down, equipment failures, operational variations, scaling up, equipment cleaning, and run-time scheduling while working in a modern pilot plant. Included are the system design, experimental procedures, and results. (KR)

Design, fabrication and testing of a 5-Hz acoustic exciter system

NASA Technical Reports Server (NTRS)

Lundy, D. H.; Robinson, G. D.

1973-01-01

A 5-Hz acoustic excitation system was designed, fabricated and checked out for use in the modulation of a stagnant gas volume contained in an absorption cell. A detailed system description of the test equipment, both mechanical and electronic, and an operating procedure are included. Conclusions are also presented.

40 CFR 60.266 - Test methods and procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... effluent gas from exhaust stream “i”, dscm/hr (dscf/hr). P=average furnace power input, MW. K=conversion....8, the owner or operator shall not allow gaseous diluents to be added to the effluent gas stream after the fabric in an open pressurized fabric filter collector unless the total gas volume flow from...

Design/Use of the Remotely Operated Bakeout Box Shutter (ROBBS)

NASA Technical Reports Server (NTRS)

Ottens, Brian P.

1999-01-01

A thermal vacuum box bakeout and certification allows orbital payloads to be cleaned and certified when the background TQCM measurements (a measure of how much molecular contamination is on a payload or chamber) are unacceptable or unmanageable in the standard thermal vacuum chamber. The box bakeout procedure is usually performed in 4 steps: bakeout the box, certify the box, bake out the payload, and finally certify the payload. In the procedure's current setup, the contaminant conduction hole ("lid") is initially open and a vacuum chamber break must occur between the bakeout and certification phases to close the box from the vacuum chamber. This exposure is necessary to allow the outgassed contaminants to escape the box's volume rapidly during bakeout phase, but payload certification isn't usually performed while the lid is still open, because it exposes the payload, TQCM, and box volume to chamber contaminants. The Remotely Operated Bakeout Box Shutter (ROBBS) is a new facility design and will allow the remote closure of the contamination hole while the chamber is still under vacuum, and with little or no time to do so.

Transverse uterine fundal incision for placenta praevia with accreta, involving the entire anterior uterine wall: a case series.

PubMed

Kotsuji, F; Nishijima, K; Kurokawa, T; Yoshida, Y; Sekiya, T; Banzai, M; Minakami, H; Udagawa, Y

2013-08-01

To determine the feasibility and safety of transverse fundal incision with manual placental removal in women with placenta praevia and possible placenta accreta. Case series. Four level-three Japanese obstetric centres. Thirty-four women with prior caesarean section and placenta praevia that widely covers the anterior uterine wall, in whom placenta accreta cannot be ruled out. A transverse fundal incision was performed at the time of caesarean section and manual placental removal was attempted under direct observation. Operative fluid loss. The total volume of fluid lost during our operative procedure compares favourably with the volume lost during our routine transverse lower-segment caesarean sections performed in patients without placenta praevia or accreta. The average fluid loss was 1370 g. No patients required transfer to intensive care, and there were no cases of fetal anaemia. This procedure has the potential to reduce the heavy bleeding that arises from caesarean deliveries in women with placenta praevia and placenta accreta. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

Preoperative Mechanical Bowel Evacuation Reduces Intraoperative Bleeding and Operation Time in Spinal Surgery.

PubMed

Rezvani, Majid; Abbasi, Reza; Tabesh, Homayoon; Dehghani, Leila; Dolatkhah, Shahab; Nasri, Maryam; Kolahdouzan, Mohsen; Meamar, Rokhsareh

2018-06-01

Randomized clinical trial. In this study, we evaluated the effect of mechanical evacuation of the bowels prior to operation on intraoperative bleeding. Bleeding is the most significant complication in patients undergoing spinal surgery. We randomly divided 108 individuals planned to undergo spinal surgery into two age-, sex-, and co-morbidity (especially preoperative hemoglobin [Hb])-matched groups of 54. The treatment group was administered polyethylene glycol (PEG) before the operation, whereas the control group was not. The exact amount (mL) of bleeding during operation, operative time, and approximate amount of blood transfused were recorded. The volume of bleeding and Hb level were also recorded 24 and 48 hours postoperatively. T -tests revealed that intraoperative bleeding, the volume of transfusion, and operative time were significantly lower in the treatment group than in the control group. Statistically significant correlations of intraoperative bleeding with age, body mass index (BMI), preoperative Hb levels, operative time, the volume of transfusion, hospitalization time, and 24- and 48-hour postoperative bleeding were observed ( p =0.001, all). Repeated measures analysis of covariance after adjusting the covariate variables revealed that the volume of bleeding showed a near-significant trend in the treatment group compared with that in the control group ( p =0.056). Diabetic females had the highest bleeding amount between the groups ( p =0.03). Bleeding was higher in patients with higher BMI ( p =0.02) and was related to operative time ( p =0.001) in both the groups. Preoperative gastrointestinal tract evacuation by PEG administration can decrease intraoperative bleeding in spinal surgeries; however, more research is imperative regarding PEG administration in surgical procedures for this purpose.

Regional variability in fecal microbiota transplantation practices: a survey of the Southern Ontario Fecal Microbiota Transplantation Movement.

PubMed

Hota, Susy S; Surangiwala, Salman; Paterson, Aimee S; Coburn, Bryan; Poutanen, Susan M

2018-04-18

There is growing evidence that fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection, but little guidance exists for implementation of FMT programs. The objective of this study is to describe the program characteristics and protocols of 9 planned or operating FMT programs in the Southern Ontario Fecal Microbiota Transplantation (SOFT) Movement, to help guide future FMT program implementation. A 59-item survey was administered electronically to clinical leads of the SOFT Movement on June 2, 2016. The survey evaluated 7 domains: FMT program characteristics, FMT recipients, donor screening/selection, transplant manufacturing, FMT administration, good manufacturing procedures/biosafety procedures and infection-control procedures. We used descriptive statistics to analyze quantitative data. All 9 programs responded to the survey: 6 were active, 1 had FMT standard operating procedures developed but did not have clinical experience, and 2 were in the process of forming FMT programs. All 6 active programs performed FMT in adult patients with C. difficile infection. About 1300 FMT procedures were performed between 2003 and 2016. Five of the 6 operating programs administered the preparation via enema. Programs were driven primarily by physicians. All programs used universal FMT donors and followed Health Canada's screening guidelines, with considerable variability in screening frequency (every 3-6 mo) and modality. Locations for transplant preparation and manufacturing protocols varied across programs. Stool mass for FMT ranged from 20 g to 150 g, and transplant volume ranged from 25 mL to 300 mL. The experience of this high-volume regional FMT network highlights current challenges in FMT program development, including a high reliance on physicians and the costly nature of donor screening. Standardization and optimization through development of regional centres of excellence for FMT donor recruitment and administration should be explored. Copyright 2018, Joule Inc. or its licensors.

A novel atrial volume reduction technique to enhance the Cox maze procedure: initial results.

PubMed

Marui, Akira; Nishina, Takeshi; Tambara, Keiichi; Saji, Yoshiaki; Shimamoto, Takeshi; Nishioka, Masahiko; Ikeda, Tadashi; Komeda, Masashi

2006-11-01

Large left atrial diameter is reported to be a predictor for recurrent atrial fibrillation after the Cox maze procedure, and left atrial diameter by itself influences the chance of sinus rhythm recovery, as well as maintenance of sinus rhythm. However, additional cut-and-sew procedures to decrease left atrial diameter extend operative time and can cause bleeding. Thus we developed a no-bleeding, faster, and therefore less invasive left atrial volume reduction technique to enhance the Cox maze procedure. The modified Cox maze III procedure with cryoablation or the left atrial maze procedure in association with mitral valve surgery was performed in 80 patients with atrial fibrillation and enlarged left atria (> or =60 mm). Among them, 44 patients had the concomitant volume reduction technique (VR group); continuous horizontal mattress sutures for left atrial plication were placed on the left atrial wall along the pulmonary vein isolation line. Cryoablation was applied to the suture line so that the plicated left atrium is anatomically and electrically isolated. Another 36 patients did not have the volume reduction technique (control group). The VR group had preoperative left atrial diameters similar to those of the control group (67.1 +/- 7.8 vs 64.5 +/- 6.7 mm) and a longer preoperative duration of atrial fibrillation (14.1 +/- 5.4 vs 9.5 +/- 5.1 years, P < .05) but had smaller postoperative left atrial diameters (47.6 +/- 6.3 vs 62.1 +/- 7.9 mm, P < .01). There were no differences in mean crossclamp/bypass time and chest tube drainage for 12 hours between the groups. Twelve months after surgical intervention, the sinus rhythm recovery rate of the VR group was better than that of the control group (90% vs 69%, P < .05). Even in patients with long-standing atrial fibrillation and an enlarged left atrium, maze procedures concomitant with the novel left atrial volume reduction technique improved the sinus rhythm recovery rate without increasing complications. Although further study with a larger number of patients and a longer follow-up period is needed, this safe and thus far potent technique that catheter-based ablation cannot copy might extend indication of the Cox maze procedure for patients with tough atrial fibrillation.

Surgical Strategy Based on Indocyanine Green Test for Chemotherapy-Associated Liver Injury and Long-Term Outcome in Colorectal Liver Metastases.

PubMed

Takamoto, Takeshi; Hashimoto, Takuya; Ichida, Akihiko; Shimada, Kei; Maruyama, Yoshikazu; Makuuchi, Masatoshi

2018-06-01

It remains unclear whether the presence of chemotherapy-induced liver injury (CALI) or impaired liver functional reserve affects the long-term outcome. This study assessed the applicability and long-term effects of using criteria based on the indocyanine green (ICG) test results in selecting the operative procedure among patients with colorectal liver metastases (CRLM) who had a risk of CALI. CRLM patients who received preoperative chemotherapy including oxaliplatin and/or irinotecan prior to a curative hepatectomy between 2007 and 2017 were included. For each case, the minimum required future remnant liver volume and operative procedure were decided based on the ICG retention rate at 15 min (ICG R15). Patients with an ICG R15 > 10% and who had undergone a major hepatectomy were categorized in a marginal liver functional reserve (MHML) group. Overall, 161 patients were included; 77 of them had an ICG R15 > 10%, and 57 had pathological liver injury (PLI). After the median follow-up time of 30.9 months, the 5-year overall survival rate was 36.1%. The presence of an impaired ICG test result or CALI did not negatively impact the overall and recurrence-free survival outcomes. A multivariate analysis revealed that the presence of four or more nodules of liver metastases was the only independent predictor of a poor overall survival. A significantly larger proportion of patients in the MHML group (n = 37) had a 25% or larger increase in splenic volume (30 vs. 13%; P = 0.024). The presence of an impaired ICG test result or PLI did not affect the long-term outcome after individually selected operative procedure. However, patients undergoing MHML had a higher possibility of developing a > 25% splenic volume increase after hepatectomy.

Synfuel program analysis. Volume 2: VENVAL users manual

NASA Astrophysics Data System (ADS)

Muddiman, J. B.; Whelan, J. W.

1980-07-01

This volume is intended for program analysts and is a users manual for the VENVAL model. It contains specific explanations as to input data requirements and programming procedures for the use of this model. VENVAL is a generalized computer program to aid in evaluation of prospective private sector production ventures. The program can project interrelated values of installed capacity, production, sales revenue, operating costs, depreciation, investment, dent, earnings, taxes, return on investment, depletion, and cash flow measures. It can also compute related public sector and other external costs and revenues if unit costs are furnished.

TBC costing. [test bed concentrator

NASA Technical Reports Server (NTRS)

Kaminski, H. L.

1980-01-01

Procedures to be used in determining the cost of producing and installing a parabolic dish collector in annual production volumes of 10,000, 50,000, 100,000, and 1,000,000 units include (1) evaluating each individual part for material cost and for the type and number of operations required to work the raw material into the finished part; (2) costing labor, burden, tooling, gaging, machinery, and equipment; (3) estimating facilities requirements for each production volume; and (4) considering suggestions for design and material alterations that could result in cost reduction.

Extractive procedure for uranium determination in water samples by liquid scintillation counting.

PubMed

Gomez Escobar, V; Vera Tomé, F; Lozano, J C; Martín Sánchez, A

1998-07-01

An extractive procedure for uranium determination using liquid scintillation counting with the URAEX cocktail is described. Interference from radon and a strong influence of nitrate ion were detected in this procedure. Interference from radium, thorium and polonium emissions were very low when optimal operating conditions were reached. Quenching effects were considered and the minimum detectable activity was evaluated for different sample volumes. Isotopic analysis of samples can be performed using the proposed method. Comparisons with the results obtained with the general procedure used in alpha spectrometry with passivated implanted planar silicon detectors showed good agreement. The proposed procedure is thus suitable for uranium determination in water samples and can be considered as an alternative to the laborious conventional chemical preparations needed for alpha spectrometry methods using semiconductor detectors.

Spacecraft crew procedures from paper to computers

NASA Technical Reports Server (NTRS)

Oneal, Michael; Manahan, Meera

1993-01-01

Large volumes of paper are launched with each Space Shuttle Mission that contain step-by-step instructions for various activities that are to be performed by the crew during the mission. These instructions include normal operational procedures and malfunction or contingency procedures and are collectively known as the Flight Data File (FDF). An example of nominal procedures would be those used in the deployment of a satellite from the Space Shuttle; a malfunction procedure would describe actions to be taken if a specific problem developed during the deployment. A new FDF and associated system is being created for Space Station Freedom. The system will be called the Space Station Flight Data File (SFDF). NASA has determined that the SFDF will be computer-based rather than paper-based. Various aspects of the SFDF are discussed.

Improving observational study estimates of treatment effects using joint modeling of selection effects and outcomes: the case of AAA repair.

PubMed

O'Malley, A James; Cotterill, Philip; Schermerhorn, Marc L; Landon, Bruce E

2011-12-01

When 2 treatment approaches are available, there are likely to be unmeasured confounders that influence choice of procedure, which complicates estimation of the causal effect of treatment on outcomes using observational data. To estimate the effect of endovascular (endo) versus open surgical (open) repair, including possible modification by institutional volume, on survival after treatment for abdominal aortic aneurysm, accounting for observed and unobserved confounding variables. Observational study of data from the Medicare program using a joint model of treatment selection and survival given treatment to estimate the effects of type of surgery and institutional volume on survival. We studied 61,414 eligible repairs of intact abdominal aortic aneurysms during 2001 to 2004. The outcome, perioperative death, is defined as in-hospital death or death within 30 days of operation. The key predictors are use of endo, transformed endo and open volume, and endo-volume interactions. There is strong evidence of nonrandom selection of treatment with potential confounding variables including institutional volume and procedure date, variables not typically adjusted for in clinical trials. The best fitting model included heterogeneous transformations of endo volume for endo cases and open volume for open cases as predictors. Consistent with our hypothesis, accounting for unmeasured selection reduced the mortality benefit of endo. The effect of endo versus open surgery varies nonlinearly with endo and open volume. Accounting for institutional experience and unmeasured selection enables better decision-making by physicians making treatment referrals, investigators evaluating treatments, and policy makers.

RVUs poorly correlate with measures of surgical effort and complexity

PubMed Central

Shah, Dhruvil R.; Bold, Richard J.; Yang, Anthony D.; Khatri, Vijay P.; Martinez, Steve R.; Canter, Robert J.

2014-01-01

Background The relationship between procedural relative value units (RVUs) for surgical procedures and other measures of surgeon effort are poorly characterized. We hypothesized that RVUs would poorly correlate with quantifiable metrics of surgeon effort. Methods Using the 2010 ACS-NSQIP database, we selected 11 primary CPT codes associated with high volume surgical procedures. We then identified all patients with a single reported procedural RVU who underwent non-emergent, inpatient general surgical operations. We used linear regression to correlate length of stay, operative time, overall morbidity, frequency of serious adverse events (SAEs), and mortality with RVUs. We used multivariable logistic regression using all pre-operative NSQIP variables to determine other significant predictors of our outcome measures. Results Among 14,481 patients, RVUs poorly correlated with individual length of stay (R2=0.05), operative time (R2=0.10), and mortality (R2=0.35). There was a moderate correlation between RVUs and SAEs (R2 =0.79), and RVUs and overall morbidity (R2=0.75). However, among low to mid-level RVU procedures (11 to 35) there was a poor correlation between SAEs (R2=0.15), overall morbidity (R2=0.05), and RVUs. On multivariable analysis, RVUs were significant predictors of operative time, length of stay, and SAEs (OR 1.06, 95%CI: 1.05–1.07), but RVUs were not a significant predictor of mortality (OR 1.02, 95%CI: 0.99–1.05) Conclusion For common, index general surgery procedures, the current RVU assignments poorly correlate with certain metrics of surgeon work, while moderately correlating with others. Given the increasing emphasis on measuring and tracking surgeon productivity, more objective measures of surgeon work and productivity should be developed. PMID:24953983

Time-motion analysis of clinical nursing documentation during implementation of an electronic operating room management system for ophthalmic surgery.

PubMed

Read-Brown, Sarah; Sanders, David S; Brown, Anna S; Yackel, Thomas R; Choi, Dongseok; Tu, Daniel C; Chiang, Michael F

2013-01-01

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design.

Time-Motion Analysis of Clinical Nursing Documentation During Implementation of an Electronic Operating Room Management System for Ophthalmic Surgery

PubMed Central

Read-Brown, Sarah; Sanders, David S.; Brown, Anna S.; Yackel, Thomas R.; Choi, Dongseok; Tu, Daniel C.; Chiang, Michael F.

2013-01-01

Efficiency and quality of documentation are critical in surgical settings because operating rooms are a major source of revenue, and because adverse events may have enormous consequences. Electronic health records (EHRs) have potential to impact surgical volume, quality, and documentation time. Ophthalmology is an ideal domain to examine these issues because procedures are high-throughput and demand efficient documentation. This time-motion study examines nursing documentation during implementation of an EHR operating room management system in an ophthalmology department. Key findings are: (1) EHR nursing documentation time was significantly worse during early implementation, but improved to a level near but slightly worse than paper baseline, (2) Mean documentation time varied significantly among nurses during early implementation, and (3) There was no decrease in operating room turnover time or surgical volume after implementation. These findings have important implications for ambulatory surgery departments planning EHR implementation, and for research in system design. PMID:24551402

Forceps Delivery Volumes in Teaching and Nonteaching Hospitals: Are Volumes Sufficient for Physicians to Acquire and Maintain Competence?

PubMed Central

Kyser, Kathy L.; Lu, Xin; Santillan, Donna; Santillan, Mark; Caughey, Aaron B.; Wilson, Mark C.; Cram, Peter

2015-01-01

Purpose The decline in the use of forceps in operative deliveries over the last two decades raises questions about teaching hospitals' ability to provide trainees with adequate experience in the use of forceps. The authors examined: (1) the number of operative deliveries performed in teaching and nonteaching hospitals, and (2) whether teaching hospitals performed a sufficient number of forceps deliveries for physicians to acquire and maintain competence. Method The authors used State Inpatient Data from nine states to identify all women hospitalized for childbirth in 2008. They divided hospitals into three categories: major teaching, minor teaching, and nonteaching. They calculated delivery volumes (total operative, cesarean, vacuum, forceps, two or more methods) for each hospital and compared data across hospital categories. Results The sample included 1,344,305 childbirths in 835 hospitals. The mean cesarean volumes for major teaching, minor teaching, and nonteaching hospitals were 969.8, 757.8, and 406.9. The mean vacuum volumes were 301.0, 304.2, and 190.4, and the mean forceps volumes were 25.2, 15.3, and 8.9. In 2008, 31 hospitals (3.7% of all hospitals) performed no vacuum extractions, and 320 (38.3%) performed no forceps deliveries. In 2008, 13 (23%) major teaching and 44 (44%) minor teaching hospitals performed five or fewer forceps deliveries. Conclusions Low forceps delivery volumes may preclude many trainees from acquiring adequate experience and proficiency. These findings highlighted broader challenges, faced by many specialties, in ensuring that trainees and practicing physicians acquire and maintain competence in infrequently performed, highly technical procedures. PMID:24280847

Specialization and utilization after hepatectomy in academic medical centers.

PubMed

Shaw, Joshua J; Santry, Heena P; Shah, Shimul A

2013-11-01

Specialized procedures such as hepatectomy are performed by a variety of specialties in surgery. We aimed to determine whether variation exists among utilization of resources, cost, and patient outcomes by specialty, surgeon case volume, and center case volume for hepatectomy. We queried centers (n = 50) in the University Health Consortium database from 2007-2010 for patients who underwent elective hepatectomy in which specialty was designated general surgeon (n = 2685; 30%) or specialist surgeon (n = 6277; 70%), surgeon volume was designated high volume (>38 cases annually) and center volume was designated high volume (>100 cases annually). We then stratified our cohort by primary diagnosis, defined as primary tumor (n = 2241; 25%), secondary tumor (n = 5466; 61%), and benign (n = 1255; 14%). Specialist surgeons performed more cases for primary malignancy (primary 26% versus 15%) while general surgeons operated more for secondary malignancies (67% versus 61%) and benign disease (18% versus 13%). Specialists were associated with a shorter total length of stay (LOS) (5 d versus 6 d; P < 0.01) and lower in-hospital morbidity (7% versus 11%; P < 0.01). Patients treated by high volume surgeons or at high volume centers were less likely to die than those treated by low volume surgeons or at low volume centers, (OR 0.55; 95% CI 0.33-0.89) and (OR 0.44; 95% CI 0.13-0.56). Surgical specialization, surgeon volume and center volume may be important metrics for quality and utilization in complex procedures like hepatectomy. Further studies are necessary to link direct factors related to hospital performance in the changing healthcare environment. Copyright © 2013 Elsevier Inc. All rights reserved.

Standard Procedures for Air Force Operational Test and Evaluation. Volume I.

DTIC Science & Technology

1974-10-01

of the foregoing, and assuming the successful advocacy of the prcposed OT&E a Test Directive is drafted by AFTEC, reviewed by HQ USAF, and upon...design purposes. A successful approach to this problem used by both Air Force and Army OT&E agencies is to conduct an analysis of the operational mission...conduct an analysis of the mission structure involved in the OT&E. This constitutes a top level structure of the scenario with identification of the players

Operation and maintenance, fire rescue air-pack. Volume 2: Communications

NASA Technical Reports Server (NTRS)

1972-01-01

The operation and maintenance procedures are described for the development model of the fire rescue air pack (FRAP) voice amplifier assembly, including the battery charger. Operational instructions include a general description of the assembly, specifications, and installation and operation. Maintenance instructions include theory of operation, preventive maintenance, repair, adjustment, and a parts list. The FRAP is intended to permit fire rescue personnel to enter a smoke-filled, toxic or oxygen depleted environment carrying their own source of breathing air. The voice amplifier assembly permits the wearer to communicate by voice with other persons in the vicinity. The battery charger assembly provides a means of keeping the amplifier batteries fully charged.

Joint Department of Defense/Department of Energy/Federal Emergency Management Agency Nuclear Weapon Accident Exercise (NUWAX 83) After Action Report. Volume 2

DTIC Science & Technology

1983-12-30

support among the scientific community. In the absence of some agreed criteria, the economic impact and legal aspects could be overwhelming. _ 17 The...processing large numbers of people. Guidance on CCS operations needs to incl]ue release limits and procedures for receiptinq for articles held for...contaminated articles and the re-clothiny of personreJ. 5P ""N ~ ’aEMNON Better procedures and equipment with which to rapidly process large numbers of

An analysis of fuel conserving operational procedures and design modifications for bomber/transport aircraft. Volume I. Executive summary. Final report, 7 June 1976-7 July 1978

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

Aggarwal, R.

1978-07-01

Various proposed improvements in the design and operational procedures for bomber/transport aircraft are evaluated. The evaluation is performed in terms of the estimated savings in fuel consumption and in Direct Operating Cost (DOC). As an aid in the evaluation of design modifications, graphs of fuel and DOC savings as a function of the design parameters are developed. These graphs are based on actual mission trajectory data rather than some type trajectory profile. The actual mission data is presented in terms of histograms which provide statistical information concerning altitude, air speed, take-off weight, landing weights, and mission time. Separate analyses aremore » performed on the following aircraft: the B-52G, the B-52H, the KC-135, the C-141, the C-130, and the C-5A.« less

An analysis of fuel conserving operational procedures and design modifications for bomber/transport aircraft. volume ii. Final report, 7 June 1976-7 July 1978

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

Aggarwal, R.K.

1978-07-01

Various proposed improvements in the design and operational procedures for bomber/transport aircraft are evaluated. The evaluation is performed in terms of the estimated savings in fuel consumption and in Direct Operating Cost (DOC). As an aid in the evaluation of design modifications, graphs of fuel and DOC savings as a function of the design parameters are developed. These graphs are based on actual mission trajectory data rather than some typical trajectory profile. The actual mission data is presented in terms of histograms which provide statistical information concerning altitude, air speed, take-off weight, landing weight, and mission time. Separate analyses aremore » performed on the following aircraft: the B-52G, the B-52H, the KC-135, the C-141, the C-130, and the C-5A. (Author)« less

[Correlation analysis of cement leakage with volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence in percutaneous vertebroplasty for osteoporotic vertebral compression fractures].

PubMed

Liang, De; Ye, Linqiang; Jiang, Xiaobing; Huang, Weiquan; Yao, Zhensong; Tang, Yongchao; Zhang, Shuncong; Jin, Daxiang

2014-11-01

To investigate the risk factors of cement leakage in percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fracture (OVCF). Between March 2011 and March 2012, 98 patients with single level OVCF were treated by PVP, and the clinical data were analyzed retrospectively. There were 13 males and 85 females, with a mean age of 77.2 years (range, 54-95 years). The mean disease duration was 43 days (range, 15-120 days), and the mean T score of bone mineral density (BMD) was -3.8 (range, -6.7- -2.5). Bilateral transpedicular approach was used in all the patients. The patients were divided into cement leakage group and no cement leakage group by occurrence of cement leakage based on postoperative CT. Single factor analysis was used to analyze the difference between 2 groups in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, preoperative vertebral body wall incompetence, cement volume, and volume ratio of intravertebral bone cement to vertebral body. All relevant factors were introduced to logistic regression analysis to analyze the risk factors of cement leakage. All procedures were performed successfully. The mean operation time was 40 minutes (range, 30-50 minutes), and the mean volume ratio of intravertebral bone cement to vertebral body was 24.88% (range, 7.84%-38.99%). Back pain was alleviated significantly in all the patients postoperatively. All patients were followed up with a mean time of 8 months (range, 6-12 months). Cement leakage occurred in 49 patients. Single factor analysis showed that there were significant differences in the volume ratio of intravertebral bone cement to vertebral body and preoperative vertebral body wall incompetence between 2 groups (P < 0.05), while no significant difference in T score of BMD, operative level, preoperative anterior compression degree of operative vertebrae, preoperative middle compression degree of operative vertebrae, preoperative sagittal Cobb angle of operative vertebrae, and cement volume (P > 0.05). The logistic regression analysis showed that the volume ratio of intravertebral bone cement to vertebral body (P < 0.05) and vertebral body wall incompetence (P < 0.05) were the risk factors for occurrence of cement leakage. The volume ratio of intravertebral bone cement to vertebral body and vertebral body wall incompetence are risk factors of cement leakage in PVP for OVCF. Cement leakage is easy to occur in operative level with vertebral body wall incompetence and high volume ratio of intravertebral bone cement to vertebral body.

Application of Shuttle EVA Systems to Payloads. Volume 2: Payload EVA Task Completion Plans

NASA Technical Reports Server (NTRS)

1976-01-01

Candidate payload tasks for EVA application were identified and selected, based on an analysis of four representative space shuttle payloads, and typical EVA scenarios with supporting crew timelines and procedures were developed. The EVA preparations and post EVA operations, as well as the timelines emphasizing concurrent payload support functions, were also summarized.

Birch management on industry lands

Treesearch

Kendall S. Norcott

1969-01-01

I have no revolutionary ideas to offer concerning the management of white and yellow birch. The most I can hope to accomplish is to acquaint you with Brown Company's current and past operating procedures in northern hardwoods, and to relate some of my observations of the results we are getting from harvesting substantial volumes of birch and other commercial...

Saturn S-2 production operations techniques: Production welding. Volume 1: Bulkhead welding

NASA Technical Reports Server (NTRS)

Abel, O. G.

1970-01-01

The complex Saturn S-2 welding processes and procedures required considerable development and refinement to establish a production capability that could consistently produce aluminum alloy welds within specified requirements. The special processes and techniques are defined that were established for the welding of gore-to-gore and manhole- or closeout-to-gore.

40 CFR Appendix F to Part 75 - Conversion Procedures

Code of Federal Regulations, 2012 CFR

2012-07-01

... pollutant concentration during unit operation, ppm. 3.3.4%O2, %CO2 = Oxygen or carbon dioxide volume during....6.1H, C, S, N, and O are content by weight of hydrogen, carbon, sulfur, nitrogen, and oxygen... section 2.4 of appendix D of this part. If a daily coal consumption value is not available, substitute the...

40 CFR Appendix F to Part 75 - Conversion Procedures

Code of Federal Regulations, 2014 CFR

2014-07-01

... pollutant concentration during unit operation, ppm. 3.3.4%O2, %CO2 = Oxygen or carbon dioxide volume during....6.1H, C, S, N, and O are content by weight of hydrogen, carbon, sulfur, nitrogen, and oxygen... section 2.4 of appendix D of this part. If a daily coal consumption value is not available, substitute the...

40 CFR Appendix F to Part 75 - Conversion Procedures

Code of Federal Regulations, 2013 CFR

2013-07-01

... pollutant concentration during unit operation, ppm. 3.3.4%O2, %CO2 = Oxygen or carbon dioxide volume during....6.1H, C, S, N, and O are content by weight of hydrogen, carbon, sulfur, nitrogen, and oxygen... section 2.4 of appendix D of this part. If a daily coal consumption value is not available, substitute the...

Automatic control of a negative ion source

NASA Astrophysics Data System (ADS)

Saadatmand, K.; Sredniawski, J.; Solensten, L.

1989-04-01

A CAMAC based control architecture is devised for a Berkeley-type H - volume ion source [1]. The architecture employs three 80386 TM PCs. One PC is dedicated to control and monitoring of source operation. The other PC functions with digitizers to provide data acquisition of waveforms. The third PC is used for off-line analysis. Initially, operation of the source was put under remote computer control (supervisory). This was followed by development of an automated startup procedure. Finally, a study of the physics of operation is now underway to establish a data base from which automatic beam optimization can be derived.

Flight Experiment Investigation of General Aviation Self-Separation and Sequencing Tasks

NASA Technical Reports Server (NTRS)

Murdoch, Jennifer L.; Ramiscal, Ermin R.; McNabb, Jennifer L.; Bussink, Frank J. L.

2005-01-01

A new flight operations concept called Small Aircraft Transportation System (SATS) Higher Volume Operations (HVO) was developed to increase capacity during Instrument Meteorological Conditions (IMC) at non-towered, non-radar airports by enabling concurrent operations of multiple aircraft. One aspect of this concept involves having pilots safely self-separate from other aircraft during approaches into these airports using appropriate SATS HVO procedures. A flight experiment was conducted to determine if instrument-rated general aviation (GA) pilots could self-separate and sequence their ownship aircraft, while following a simulated aircraft, into a non-towered, non-radar airport during simulated IMC. Six GA pilots' workload levels and abilities to perform self-separation and sequencing procedures while flying a global positioning system (GPS) instrument approach procedure were examined. The results showed that the evaluation pilots maintained at least the minimum specified separation between their ownship aircraft and simulated traffic and maintained their assigned landing sequence 100-percent of the time. Neither flight path deviations nor subjective workload assessments were negatively impacted by the additional tasks of self-separating and sequencing during these instrument approaches.

How much tumor surgery do early-career orthopaedic oncologists perform?

PubMed

Miller, Benjamin J; Rajani, Rajiv; Leddy, Lee; Carmody Soni, Emily E; White, Jeremy R

2015-02-01

There are few data on the types of procedures orthopaedic oncologists perform in their first years of practice. Because fellowships are graduating fellows each year and the number of tumor patients is limited, defining the practice patterns of early-career orthopaedic oncologists may help diminish early employment discontent and enhance workforce discussions. The aim of the study was to use the objective case log volumes of a cross-section of early career orthopaedic oncologists to describe (1) the number of operations performed annually; (2) the proportion of tumor, trauma, adult reconstruction, and other operations for individual participants, (3) individual practice characteristics that were associated with the number of tumor procedures; and (4) the sources of satisfaction and challenges in each individual's career and surgical practice. Fifteen fellowship-trained orthopaedic oncologists out of a potential pool of 33 (45%) in their first 4 years of practice responded to a survey by submitting complete operative case lists for a 2-year period. We recorded the type of procedure and determined associations between the annual number of tumor operations and total operative caseload, years in practice, and some details of individual practice patterns. Each participant completed a survey regarding practice-related sources of stress and satisfaction. A total of 5611 surgical cases were available for review. For the entire cohort, there were 3303 (59%) tumor procedures, 973 (17%) trauma, 890 (16%) adult reconstruction, and 445 (8%) other. The median annual number of total operations was 214 (range, 63-356) and median annual number of tumor operations was 135 (range, 47-216). The median proportion of tumor operations in an individual practice was 56% (range, 43%-94%). The annual number of tumor operations correlated with the total annual number of operations (r = 0.73, p < 0.001). Sources of stress and satisfaction were similar to the general membership of the Musculoskeletal Tumor Society (MSTS), apart from more early-career surgeons regarding case volume as important (29 of 104 [28%] of MSTS versus 11 of 15 [73%] of early-career, p < 0.001). The typical early-career orthopaedic tumor surgeon had fewer than 60% of his or her operative procedures directly related to the subject of his or her fellowship training in orthopaedic oncology. Overall, the challenges and rewards of clinical practice are similar to oncologic surgeons later in their career. This study is a first step in assessing early practice characteristics and may be of value to the prospective orthopaedic oncologist, fellowship educators, and the society in workforce discussions. Early-career practice patterns have not been previously presented, to our knowledge, for any subspecialty of orthopaedic surgery, and we hope that this study will stimulate similar efforts throughout the field. Level IV, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.

Surgery for advanced epithelial ovarian cancer.

PubMed

Hacker, Neville F; Rao, Archana

2017-05-01

Cytoreductive surgery for patients with advanced epithelial ovarian cancer has been practised since the pioneering work of Tom Griffiths in 1975. Further research has demonstrated the prognostic significance of the extent of metastatic disease pre-operatively, and of complete cytoreduction post-operatively. Patients with advanced epithelial ovarian cancer should be referred to high volume cancer units, and managed by multidisciplinary teams. The role of thoracoscopy and resection of intrathoracic disease is presently investigational. In recent years, there has been increasing use of neoadjuvant chemotherapy and interval cytoreductive surgery in patients with poor performance status, which is usually due to large volume ascites and/or large pleural effusions. Neoadjuvant chemotherapy reduces the post-operative morbidity, but if the tumour responds well to the chemotherapy, the inflammatory response makes the surgery more difficult. Post-operative morbidity is generally tolerable, but increases in older patients, and in those having multiple, aggressive surgical procedures, such as bowel resection or diaphragmatic stripping. Primary cytoreductive surgery should be regarded as the gold standard for most patients until a test is developed which would allow the prediction of platinum resistance pre-operatively. Copyright © 2016. Published by Elsevier Ltd.

Point-to-Point! Validation of the Small Aircraft Transportation System Higher Volume Operations Concept

NASA Technical Reports Server (NTRS)

Williams, Daniel M.

2006-01-01

Described is the research process that NASA researchers used to validate the Small Aircraft Transportation System (SATS) Higher Volume Operations (HVO) concept. The four phase building-block validation and verification process included multiple elements ranging from formal analysis of HVO procedures to flight test, to full-system architecture prototype that was successfully shown to the public at the June 2005 SATS Technical Demonstration in Danville, VA. Presented are significant results of each of the four research phases that extend early results presented at ICAS 2004. HVO study results have been incorporated into the development of the Next Generation Air Transportation System (NGATS) vision and offer a validated concept to provide a significant portion of the 3X capacity improvement sought after in the United States National Airspace System (NAS).

Using Concentration Curves to Assess Organization-Specific Relationships between Surgeon Volumes and Outcomes.

PubMed

Kanter, Michael H; Huang, Yii-Chieh; Kally, Zina; Gordon, Margo A; Meltzer, Charles

2018-06-01

A well-documented association exists between higher surgeon volumes and better outcomes for many procedures, but surgeons may be reluctant to change practice patterns without objective, credible, and near real-time data on their performance. In addition, published thresholds for procedure volumes may be biased or perceived as arbitrary; typical reports compare surgeons grouped into discrete procedure volume categories, even though the volume-outcomes relationship is likely continuous. The concentration curves methodology, which has been used to analyze whether health outcomes vary with socioeconomic status, was adapted to explore the association between procedure volume and outcomes as a continuous relationship so that data for all surgeons within a health care organization could be included. Using widely available software and requiring minimal analytic expertise, this approach plots cumulative percentages of two variables of interest against each other and assesses the characteristics of the resulting curve. Organization-specific relationships between surgeon volumes and outcomes were examined for three example types of procedures: uncomplicated hysterectomies, infant circumcisions, and total thyroidectomies. The concentration index was used to assess whether outcomes were equally distributed unrelated to volumes. For all three procedures, the concentration curve methodology identified associations between surgeon procedure volumes and selected outcomes that were specific to the organization. The concentration indices confirmed the higher prevalence of examined outcomes among low-volume surgeons. The curves supported organizational discussions about surgical quality. Concentration curves require minimal resources to identify organization- and procedure-specific relationships between surgeon procedure volumes and outcomes and can support quality improvement. Copyright © 2018 The Joint Commission. Published by Elsevier Inc. All rights reserved.

3D printed renal cancer models derived from MRI data: application in pre-surgical planning.

PubMed

Wake, Nicole; Rude, Temitope; Kang, Stella K; Stifelman, Michael D; Borin, James F; Sodickson, Daniel K; Huang, William C; Chandarana, Hersh

2017-05-01

To determine whether patient-specific 3D printed renal tumor models change pre-operative planning decisions made by urological surgeons in preparation for complex renal mass surgical procedures. From our ongoing IRB approved study on renal neoplasms, ten renal mass cases were retrospectively selected based on Nephrometry Score greater than 5 (range 6-10). A 3D post-contrast fat-suppressed gradient-echo T1-weighted sequence was used to generate 3D printed models. The cases were evaluated by three experienced urologic oncology surgeons in a randomized fashion using (1) imaging data on PACS alone and (2) 3D printed model in addition to the imaging data. A questionnaire regarding surgical approach and planning was administered. The presumed pre-operative approaches with and without the model were compared. Any change between the presumed approaches and the actual surgical intervention was recorded. There was a change in planned approach with the 3D printed model for all ten cases with the largest impact seen regarding decisions on transperitoneal or retroperitoneal approach and clamping, with changes seen in 30%-50% of cases. Mean parenchymal volume loss for the operated kidney was 21.4%. Volume losses >20% were associated with increased ischemia times and surgeons tended to report a different approach with the use of the 3D model compared to that with imaging alone in these cases. The 3D printed models helped increase confidence regarding the chosen operative procedure in all cases. Pre-operative physical 3D models created from MRI data may influence surgical planning for complex kidney cancer.

Development of a surgical site infection (SSI) surveillance system, calculation of SSI rates and specification of important factors affecting SSI in a digestive organ surgical department.

PubMed

Kimura, Koji; Sawa, Akihiro; Akagi, Shinji; Kihira, Kenji

2007-06-01

We have developed an original system to conduct surgical site infection (SSI) surveillance. This system accumulates SSI surveillance information based on the National Nosocomial Infections Surveillance (NNIS) System and the Japanese Nosocomial Infections Surveillance (JNIS) System. The features of this system are as follows: easy input of data, high generality, data accuracy, SSI rate by operative procedure and risk index category (RIC) can be promptly calculated and compared with the current NNIS SSI rate, and the SSI rates and accumulated data can be exported electronically. Using this system, we monitored 798 patients in 24 operative procedure categories in the Digestive Organs Surgery Department of Mazda Hospital, Mazda Motor Corporation, from January 2004 through December 2005. The total number and rate of SSI were 47 and 5.89%, respectively. The SSI rates of 777 patients were calculated based on 15 operative procedure categories and Risk Index Categories (RIC). The highest SSI rate was observed in the rectum surgery of RIC 1 (30%), followed by the colon surgery of RIC3 (28.57%). About 30% of the isolated infecting bacteria were Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. Using quantification theory type 2, the American Society of Anesthesiology score (4.531), volume of hemorrhage under operation (3.075), wound classification (1.76), operation time (1.352), and history of diabetes (0.989) increased to higher ranks as factors for SSI. Therefore, we evaluated this system as a useful tool in safety control for operative procedures.

77 FR 59039 - Proposed Collection; Comment Request for Revenue Procedure 2011-49

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-25

... comments concerning Revenue Procedure 2011-49, Master and Prototype and Volume Submitter Plans. DATES... [email protected] . SUPPLEMENTARY INFORMATION: Title: Master and Prototype and Volume Submitter... and prototype and volume submitter revenue procedure sets forth the procedures for sponsors of master...

National Trends in Prostate Biopsy and Radical Prostatectomy Volumes Following the US Preventive Services Task Force Guidelines Against Prostate-Specific Antigen Screening.

PubMed

Halpern, Joshua A; Shoag, Jonathan E; Artis, Amanda S; Ballman, Karla V; Sedrakyan, Art; Hershman, Dawn L; Wright, Jason D; Shih, Ya Chen Tina; Hu, Jim C

2017-02-01

Studies demonstrate that use of prostate-specific antigen screening decreased significantly following the US Preventive Services Task Force (USPSTF) recommendation against prostate-specific antigen screening in 2012. To determine downstream effects on practice patterns in prostate cancer diagnosis and treatment following the 2012 USPSTF recommendation. Procedural volumes of certifying and recertifying urologists from 2009 through 2016 were evaluated for variation in prostate biopsy and radical prostatectomy (RP) volume. Trends were confirmed using the New York Statewide Planning and Research Cooperative System and Nationwide Inpatient Sample. The study included a representative sample of urologists across practice settings and nationally representative sample of all RP discharges. We obtained operative case logs from the American Board of Urology and identified urologists performing at least 1 prostate biopsy (n = 5173) or RP (n = 3748), respectively. The 2012 USPSTF recommendation against routine population-wide prostate-specific antigen screening. Change in median biopsy and RP volume per urologist and national procedural volume. Following the USPSTF recommendation, median biopsy volume per urologist decreased from 29 to 21 (interquartile range [IQR}, 12-34; P < .001). After adjusting for physician and practice characteristics, biopsy volume decreased by 28.7% following 2012 (parameter estimate, -0.25; SE, 0.03; P < .001). Similarly, following the USPSTF recommendation, median RP volume per urologist decreased from 7 (IQR, 3-15) to 6 (IQR, 2-12) (P < .001), and in adjusted analyses, RP volume decreased 16.2% (parameter estimate, -0.15; SE, 0.05; P = .003). Following the 2012 USPSTF recommendation, prostate biopsy and RP volumes decreased significantly. A panoramic vantage point is needed to evaluate the long-term consequences of the 2012 USPSTF recommendation.

Estimating the Cost of Neurosurgical Procedures in a Low-Income Setting: An Observational Economic Analysis.

PubMed

Abdelgadir, Jihad; Tran, Tu; Muhindo, Alex; Obiga, Doomwin; Mukasa, John; Ssenyonjo, Hussein; Muhumza, Michael; Kiryabwire, Joel; Haglund, Michael M; Sloan, Frank A

2017-05-01

There are no data on cost of neurosurgery in low-income and middle-income countries. The objective of this study was to estimate the cost of neurosurgical procedures in a low-resource setting to better inform resource allocation and health sector planning. In this observational economic analysis, microcosting was used to estimate the direct and indirect costs of neurosurgical procedures at Mulago National Referral Hospital (Kampala, Uganda). During the study period, October 2014 to September 2015, 1440 charts were reviewed. Of these patients, 434 had surgery, whereas the other 1006 were treated nonsurgically. Thirteen types of procedures were performed at the hospital. The estimated mean cost of a neurosurgical procedure was $542.14 (standard deviation [SD], $253.62). The mean cost of different procedures ranged from $291 (SD, $101) for burr hole evacuations to $1,221 (SD, $473) for excision of brain tumors. For most surgeries, overhead costs represented the largest proportion of the total cost (29%-41%). This is the first study using primary data to determine the cost of neurosurgery in a low-resource setting. Operating theater capacity is likely the binding constraint on operative volume, and thus, investing in operating theaters should achieve a higher level of efficiency. Findings from this study could be used by stakeholders and policy makers for resource allocation and to perform economic analyses to establish the value of neurosurgery in achieving global health goals. Copyright © 2017 Elsevier Inc. All rights reserved.

Army Communicator. Volume 34, Number 2

DTIC Science & Technology

2009-01-01

tunneled into the NIPRNet traffic. The encryption hides the contents of the SIPRNet data through a process that randomizes the bit patterns...and technologies such as desktop applications, Virtual Private Network, Blackberry support, and the training and troubleshoot- ing of complex computer...to your own Standing Operating Procedure and then contract for services off the backside to a local Strategic Entry Point or tunnel through

Feasibility study of modern airships, phase 2. Volume 2: Airport feeder vehicle

NASA Technical Reports Server (NTRS)

1976-01-01

The Airport Feeder vehicle is a VTOL, semi-buoyant ellipsoidal airship capable of transporting passengers or cargo to major CTOL hub terminals from suburban and downtown depots. Six tasks were reviewed: (1) vehicle design definition, (2) operational procedures analysis, (3) cost analysis, (4) comparison with alternate transportation modes, (5) mission/vehicle feasibility assessment, and (6) technology assessment.

Small-Item Vapor Test Method, FY11 Release

DTIC Science & Technology

2012-07-01

to this test procedure is provided alphabetically in the following list: absorption: The uptake of a contaminant INTO the volume of a material. The... powders , wipes), or gas-phase (fumigants, including aerosols). decontamination process: The process of making any person, object, or area safe by...with another contaminant. Generally, bare metals and glass are nonsorptive materials for some agents. operational decontamination: Decontamination

CTEPP STANDARD OPERATING PROCEDURE FOR COLLECTION OF FLOOR DUST SAMPLES FOR PERSISTENT ORGANIC POLLUTANTS (SOP-2.19)

EPA Science Inventory

This SOP describes the method for collecting a floor dust sample from carpet. Dust samples will be collected in the room that the child uses most at home and/or at day care using a High Volume Small Surface Sampler (HVS3). In addition, participants will also be asked to donate a ...

Pharmacokinetic analysis of cloxacillin loss in children undergoing major surgery with massive bleeding.

PubMed Central

Levy, M; Egersegi, P; Strong, A; Tessoro, A; Spino, M; Bannatyne, R; Fear, D; Posnick, J C; Koren, G

1990-01-01

To determine the magnitude of cloxacillin loss during surgical procedures involving significant blood loss and high fluid replacement, we compared the pharmacokinetics of cloxacillin in children during craniomaxillofacial surgery with the disposition of the drug in healthy young adult volunteers with intact circulation. Blood loss during craniofacial operations may exceed blood volume, in some cases by as much as three times. Hemodynamic replacement with electrolyte solutions and blood products, which do not contain the drug, further dilute cloxacillin concentrations. In the patients that we studied, mean drug loss was estimated at 71%. Cloxacillin concentrations in serum fell below the lower range of the MIC for Staphylococcus aureus during significant portions of the surgical procedures. Thus, the traditional dosing of cloxacillin during prolonged operations with massive blood loss is inadequate. A more frequent dosing interval or priming of all replacement fluids with the drug may be required to maintain therapeutic levels. Our findings suggest that massive blood loss is likely to have a dramatic effect on the level of any drug with a small distribution volume. If such a drug is essential to the patient's well-being (e.g., antibiotics, antiarrhythmics, and anticonvulsants), it must be replaced promptly. PMID:2393274

Does surgeon volume matter in the outcome of endoscopic inguinal hernia repair?

PubMed

Köckerling, F; Bittner, R; Kraft, B; Hukauf, M; Kuthe, A; Schug-Pass, C

2017-02-01

For open and endoscopic inguinal hernia surgery, it has been demonstrated that low-volume surgeons with fewer than 25 and 30 procedures, respectively, per year are associated with significantly more recurrences than high-volume surgeons with 25 and 30 or more procedures, respectively, per year. This paper now explores the relationship between the caseload and the outcome based on the data from the Herniamed Registry. The prospective data of patients in the Herniamed Registry were analyzed using the inclusion criteria minimum age of 16 years, male patient, primary unilateral inguinal hernia, TEP or TAPP techniques and availability of data on 1-year follow-up. In total, 16,290 patients were enrolled between September 1, 2009, and February 1, 2014. Of the participating surgeons, 466 (87.6 %) had carried out fewer than 25 endoscopic/laparoscopic operations (low-volume surgeons) and 66 (12.4 %) surgeons 25 or more operations (high-volume surgeons) per year. Univariable (1.03 vs. 0.73 %; p = 0.047) and multivariable analysis [OR 1.494 (1.065-2.115); p = 0.023] revealed that low-volume surgeons had a significantly higher recurrence rate compared with the high-volume surgeons, although that difference was small. Multivariable analysis also showed that pain on exertion was negatively affected by a lower caseload <25 [OR 1.191 (1.062-1.337); p = 0.003]. While here, too, the difference was small, the fact that in that group there was a greater proportion of patients with small hernia defect sizes may have also played a role since the risk in that group was higher. In this analysis, no evidence was found that pain at rest [OR 1.052 (0.903-1.226); p = 0.516] or chronic pain requiring treatment [OR 1.108 (0.903-1.361); p = 0.326] were influenced by the surgeon volume. As confirmed by previously published studies, the data in the Herniamed Registry also demonstrated that the endoscopic/laparoscopic inguinal hernia surgery caseload impacted the outcome. However, given the overall high-quality level the differences between a "low-volume" surgeon and a "high-volume" surgeon were small. That was due to the use of a standardized technique, structured training as well as continuous supervision of trainees and surgeons with low annual caseload.

Survey of fish impingement at power plants in the United States. Volume II. Inland waters

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

Freeman, III, Richard F.; Sharma, Rajendra K.

1977-03-01

Impingement of fish at cooling-water intakes of 33 power plants located on inland waters other than the Great Lakes has been surveyed and data are presented. Descriptions of site, plant, and intake design and operation are provided. Reports in this volume summarize impingement data for individual plants in tabular and histogram formats. Information was available from differing sources such as the utilities themselves, public documents, regulatory agencies, and others. Thus, the extent of detail in the reports varies greatly from plant to plant. Histogram preparation involved an extrapolation procedure that has inadequacies. The reader is cautioned in the use ofmore » information presented in this volume to determine intake-design acceptability or intensity of impacts on ecosystems. No conclusions are presented herein; data comparisons are made in Volume IV.« less

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

Stupka, Richard C.; Sharma, Rajendra K.

Impingement of fish at cooling-water intakes of 32 power plants, located on estuaries and coastal waters has been surveyed and data are presented. Descriptions of site, plant, and intake design and operation are provided. Reports in this volume summarize impingement data for individual plants in tabular and histogram formats. Information was available from differing sources such as the utilities themselves, public documents, regulatory agencies, and others. Thus, the extent of detail in the reports varies greatly from plant to plant. Histogram preparation involved an extrapolation procedure that has inadequacies. The reader is cautioned in the use of information presented inmore » this volume to determine intake-design acceptability or intensity of impacts on ecosystems. No conclusions are presented herein; data comparisons are made in Volume IV.« less

VOFTools - A software package of calculation tools for volume of fluid methods using general convex grids

NASA Astrophysics Data System (ADS)

López, J.; Hernández, J.; Gómez, P.; Faura, F.

2018-02-01

The VOFTools library includes efficient analytical and geometrical routines for (1) area/volume computation, (2) truncation operations that typically arise in VOF (volume of fluid) methods, (3) area/volume conservation enforcement (VCE) in PLIC (piecewise linear interface calculation) reconstruction and(4) computation of the distance from a given point to the reconstructed interface. The computation of a polyhedron volume uses an efficient formula based on a quadrilateral decomposition and a 2D projection of each polyhedron face. The analytical VCE method is based on coupling an interpolation procedure to bracket the solution with an improved final calculation step based on the above volume computation formula. Although the library was originally created to help develop highly accurate advection and reconstruction schemes in the context of VOF methods, it may have more general applications. To assess the performance of the supplied routines, different tests, which are provided in FORTRAN and C, were implemented for several 2D and 3D geometries.

Architecture and data processing alternatives for the tse computer. Volume 4: Image rotation using tse operations

NASA Technical Reports Server (NTRS)

Kao, M. H.; Bodenheimer, R. E.

1976-01-01

The tse computer's capability of achieving image congruence between temporal and multiple images with misregistration due to rotational differences is reported. The coordinate transformations are obtained and a general algorithms is devised to perform image rotation using tse operations very efficiently. The details of this algorithm as well as its theoretical implications are presented. Step by step procedures of image registration are described in detail. Numerous examples are also employed to demonstrate the correctness and the effectiveness of the algorithms and conclusions and recommendations are made.

Is mammary reconstruction with the anatomical Becker expander a simple procedure? Complications and hidden problems leading to secondary surgical procedures: a follow-up study.

PubMed

Farace, Francesco; Faenza, Mario; Bulla, Antonio; Rubino, Corrado; Campus, Gian Vittorio

2013-06-01

Debate over the role of Becker expander implants (BEIs) in breast reconstruction is still ongoing. There are no clear indications for BEI use. The main indications for BEI use are one-stage breast reconstruction procedure and congenital breast deformities correction, due to the postoperative ability to vary BEI volume. Recent studies showed that BEIs were removed 5 years after mammary reconstruction in 68% of operated patients. This entails a further surgical procedure. BEIs should not, therefore, be regarded as one-stage prostheses. We performed a case-series study of breast reconstructions with anatomically shaped Becker-35™ implants, in order to highlight complications and to flag unseen problems, which might entail a second surgical procedure. A total of 229 patients, reconstructed from 2005 to 2010, were enrolled in this study. Data relating to implant type, volume, mean operative time and complications were recorded. All the patients underwent the same surgical procedure. The minimum follow-up period was 18 months. During a 5-year follow-up, 99 patients required secondary surgery to correct their complications or sequelae; 46 of them underwent BEI removal within 2 years of implantation, 56 within 3 years, 65 within 4 years and 74 within 5 years. Our findings show that two different sorts of complications can arise with these devices, leading to premature implant removal, one common to any breast implant and one peculiar to BEIs. The Becker implant is a permanent expander. Surgeons must, therefore, be aware that, once positioned, the Becker expander cannot be adjusted at a later date, as in two-stage expander/prosthesis reconstructions for instance. Surgeons must have a clear understanding of possible BEI complications in order to be able to discuss these with their patients. Therefore, only surgeons experienced in breast reconstruction should use BEIs. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

USAF Environmental Noise Data Handbook. Volume 150: C-140 in-flight crew noise

NASA Astrophysics Data System (ADS)

Hille, H. K.

1982-09-01

The C-140 is a USAF transport aircraft used for operational support. This report provides measured data defining the bioacoustic environments at flight crew/passenger locations inside this aircraft during normal flight operations. Date are reported for seven locations in a wide variety of physical and psychoacoustic measures: overall and band sound pressure levels, C-weighted and A-weighted sound levels, preferred speech interference level, perceived noise level, and limiting times for total daily exposure of personnel with and without standard Air Force ear protectors. Refer to Volume 1 of this handbook, USAF Bioenvironmental Noise Data Handbook, Vol. 1: Organization, Content and Application, AMRL-TR-75-50(1) 1975, for discussion of the objective and design of the handbook, the types of data presented, measurement procedures, instrumentation, data processing, definitions of quantities, symbols, equations, applications, limitations, etc.

An avionics sensitivity study. Volume 1: Operational considerations

NASA Technical Reports Server (NTRS)

Scott, R. W.; Mcconkey, E. D.

1976-01-01

Equipment and operational concepts affecting aircraft in the terminal area are reported. Curved approach applications and modified climb and descent procedures for minimum fuel consumption are considered. The curved approach study involves the application of MLS guidance to enable execution of the current visual approach to Washington National Airport under instrument flight conditions. The operational significance and the flight path control requirements involved in the application of curved approach paths to this situation are considered. Alternative flight path control regimes are considered to achieve minimum fuel consumption subject to constraints related to air traffic control requirements, flight crew and passenger reactions, and airframe and powerplant limitations.

Minimal invasive treatment of ureteropelvic junction obstruction in low volume pelvis: A comparative study of endopyelotomy and laparoscopic nondismembered pyeloplasty

PubMed Central

Singh, Pratipal; Jain, Paresh; Dharaskar, Anand; Mandhani, Anil; Dubey, Deepak; Kapoor, Rakesh; Kumar, Anant; Srivastava, Aneesh

2009-01-01

Objective: To evaluate the role of nondismembered laparoscopic pyeloplasty and percutaneous endopyelotomy for ureteropelvic junction obstruction (UPJO) with low volume renal pelvis. Material and Methods: Retrospective acquired data of 34 patients of laparoscopic nondismembered pyeloplasty was compared with 26 patients of UPJO with pelvic volume less than 50 ml undergoing antegrade endopyelotomy and analyzed for clinical parameters, operative outcomes and success of procedures. All patients were followed up clinically and with diuretic renogram at regular intervals. Results: Mean age, renal pelvic volume and preoperative glomerular filtration rate (GFR) was 25 years, 43.6 ml and 42.5 ml/min, respectively in endopyelotomy group and 21 years, 34.4 ml and 39.9 ml/min, respectively in laparoscopic pyeloplasty group. Mean operative time, postoperative analgesic requirement and mean hospital stay was 100min, 250 mg and 4 days, respectively in endopyelotomy group and 210 min, 300 mg and 4 days, respectively in laparoscopic pyeloplasty group. Only operative time was significantly different between two groups (P < 0.05). Mean follow-up was 36 and 39 months and success rates were 91.2% and 88.8% in laparoscopy and endopyelotomy group, respectively (P < 0.05). No significant complication was seen in endopyelotomy group while two patients had hematuria (one requiring blood transfusion) and three had increased drain output for more than 3 days in laparoscopy group. Conclusion: Percutaneous endopyelotomy is associated with significantly less operative time and postoperative complication rate and provides equivalent success in comparison to nondismembered laparoscopic pyeloplasty in patients with UPJO and low volume pelvis. It can be a preferred minimally invasive treatment modality for such patients. PMID:19468432

Influence of hospital-level practice patterns on variation in the application of minimally invasive surgery in United States pediatric patients.

PubMed

Train, Arianne T; Harmon, Carroll M; Rothstein, David H

2017-10-01

Although disparities in access to minimally invasive surgery are thought to exist in pediatric surgical patients in the United States, hospital-level practice patterns have not been evaluated as a possible contributing factor. Retrospective cohort study using the Kids' Inpatient Database, 2012. Odds ratios of undergoing a minimally invasive compared to open operation were calculated for six typical pediatric surgical operations after adjustment for multiple patient demographic and hospital-level variables. Further adjustment to the regression model was made by incorporating hospital practice patterns, defined as operation-specific minimally invasive frequency and volume. Age was the most significant patient demographic factor affecting application of minimally invasive surgery for all procedures. For several procedures, adjusting for individual hospital practice patterns removed race- and income-based disparities seen in performance of minimally invasive operations. Disparities related to insurance status were not affected by the same adjustment. Variation in the application of minimally invasive surgery in pediatric surgical patients is primarily influenced by patient age and the type of procedure performed. Perceived disparities in access related to some socioeconomic factors are decreased but not eliminated by accounting for individual hospital practice patterns, suggesting that complex underlying factors influence application of advanced surgical techniques. II. Copyright © 2017 Elsevier Inc. All rights reserved.

Preliminary Validation of the Small Aircraft Transportation System Higher Volume Operations (SATS HVO) Concept

NASA Technical Reports Server (NTRS)

Williams, Daniel; Consiglio, Maria; Murdoch, Jennifer; Adams, Catherine

2004-01-01

This document provides a preliminary validation of the Small Aircraft Transportation System (SATS) Higher Volume Operations (HVO) concept for normal conditions. Initial results reveal that the concept provides reduced air traffic delays when compared to current operations without increasing pilot workload. Characteristic to the SATS HVO concept is the establishment of a newly defined area of flight operations called a Self-Controlled Area (SCA) which would be activated by air traffic control (ATC) around designated non-towered, non-radar airports. During periods of poor visibility, SATS pilots would take responsibility for separation assurance between their aircraft and other similarly equipped aircraft in the SCA. Using onboard equipment and simple instrument flight procedures, they would then be better able to approach and land at the airport or depart from it. This concept would also require a new, ground-based automation system, typically located at the airport that would provide appropriate sequencing information to the arriving aircraft. Further validation of the SATS HVO concept is required and is the subject of ongoing research and subsequent publications.

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

NASA Astrophysics Data System (ADS)

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

2007-03-01

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

The Operative Burden of General Surgical Disease and Non-Battle Injury in a Deployed Military Treatment Facility in Afghanistan.

PubMed

Hollingsworth, Andrew C; Bowley, Douglas M; Lundy, Jonathan B

2016-09-01

Contemporary medical operations support a mobile, nonconventional force involved in nation building, counterinsurgency, and humanitarian operations. Prior reports have described surgical care for disease and nonbattle injuries (DNBI). The purpose of this report is to describe the prevalence and scope of DNBI managed by general surgeons in a contemporary, deployed medical facility. A 2-year retrospective review of the operative logbook from the U.K. Role 3 Multinational Hospital, Camp Bastion, Afghanistan, was performed to determine the prevalence and makeup of procedures performed for DNBI by general surgeons. Nontrauma general surgical procedures accounted for 7.7% (n = 279 of 3,607 cases) of cases; appendectomy (n = 146) was the most common, followed by drainage of soft tissue (n = 55) and oral abscesses (n = 5), scrotal exploration (n = 12), and hernia repair (n = 7). A total of 7.2% (n = 20 of 279) of cases fell outside the standard scope of practice of an urban, civilian general surgeon. Although the prevalence of operative procedures for DNBI was low, the spectrum of cases included those not typically managed in the civilian setting of the United Kingdom. With an evolving decline in case volume performed in multiple anatomic locations due to subspecialization during surgical training, this gap in expertise is likely to increase. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

Thulium laser enucleation (ThuLEP) versus transurethral resection of the prostate in saline (TURis): A randomized prospective trial to compare intra and early postoperative outcomes.

PubMed

Bozzini, G; Seveso, M; Melegari, S; de Francesco, O; Buffi, N M; Guazzoni, G; Provenzano, M; Mandressi, A; Taverna, G

2017-06-01

To compare clinical intra and early postoperative outcomes between thulium laser transurethral enucleation of the prostate (ThuLEP) and transurethral bipolar resection of the prostate (TURis) for treating benign prostatic hyperplasia (BPH) in a prospective randomized trial. The study randomized 208 consecutive patients with BPH to ThuLEP (n=102) or TURis (n=106). For all patients were evaluated preoperatively with regards to blood loss, catheterization time, irrigation volume, hospital stay and operative time. At 3 months after surgery they were also evaluated by International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), and postvoid residual urine volume (PVR). The patients in each study arm each showed no significant difference in preoperative parameters. Compared with TURIS, ThuLEP had same operative time (53.69±31.44 vs 61.66±18.70minutes, P=.123) but resulted in less hemoglobin decrease (0.45 vs 2.83g/dL, P=.005). ThuLEP also needed less catheterization time (1.3 vs 4.8 days, P=.011), irrigation volume (29.4 vs 69.2 L, P=.002), and hospital stay (1.7 vs 5.2 days, P=.016). During the 3 months of follow-up, the procedures did not demonstrate a significant difference in Qmax, IPSS, PVR, and QOLS. ThuLEP and TURis both relieve lower urinary tract symptoms equally, with high efficacy and safety. ThuLEP was statistically superior to TURis in blood loss, catheterization time, irrigation volume, and hospital stay. However, procedures did not differ significantly in Qmax, IPSS, PVR, and QOLS through 3 months of follow-up. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Demonstration of Four Operating Capabilities to Enable a Small Aircraft Transportation System

NASA Technical Reports Server (NTRS)

Viken, Sally A.; Brooks, Frederick M.

2005-01-01

The Small Aircraft Transportation System (SATS) project has been a five-year effort fostering research and development that could lead to the transformation of our country s air transportation system. It has become evident that our commercial air transportation system is reaching its peak in terms of capacity, with numerous delays in the system and the demand keeps steadily increasing. The SATS vision is to increase mobility in our nation s transportation system by expanding access to more than 3400 small community airports that are currently under-utilized. The SATS project has focused its efforts on four key operating capabilities that have addressed new emerging technologies and procedures to pave the way for a new way of air travel. The four key operating capabilities are: Higher Volume Operations at Non-Towered/Non-Radar Airports, En Route Procedures and Systems for Integrated Fleet Operations, Lower Landing Minimums at Minimally Equipped Landing Facilities, and Increased Single Pilot Performance. These four capabilities are key to enabling low-cost, on-demand, point-to-point transportation of goods and passengers utilizing small aircraft operating from small airports. The focus of this paper is to discuss the technical and operational feasibility of the four operating capabilities and demonstrate how they can enable a small aircraft transportation system.

Comparison of 7.2% hypertonic saline - 6% hydroxyethyl starch solution and 6% hydroxyethyl starch solution after the induction of anesthesia in patients undergoing elective neurosurgical procedures.

PubMed

Shao, Liujiazi; Wang, Baoguo; Wang, Shuangyan; Mu, Feng; Gu, Ke

2013-01-01

The ideal solution for fluid management during neurosurgical procedures remains controversial. The aim of this study was to compare the effects of a 7.2% hypertonic saline - 6% hydroxyethyl starch (HS-HES) solution and a 6% hydroxyethyl starch (HES) solution on clinical, hemodynamic and laboratory variables during elective neurosurgical procedures. Forty patients scheduled for elective neurosurgical procedures were randomly assigned to the HS-HES group orthe HES group. Afterthe induction of anesthesia, patients in the HS-HES group received 250 mL of HS-HES (500 mL/h), whereas the patients in the HES group received 1,000 mL of HES (1000 mL/h). The monitored variables included clinical, hemodynamic and laboratory parameters. Chictr.org: ChiCTR-TRC-12002357 The patients who received the HS-HES solution had a significant decrease in the intraoperative total fluid input (p<0.01), the volume of Ringer's solution required (p<0.05), the fluid balance (p<0.01) and their dural tension scores (p<0.05). The total urine output, blood loss, bleeding severity scores, operation duration and hemodynamic variables were similar in both groups (p>0.05). Moreover, compared with the HES group, the HS-HES group had significantly higher plasma concentrations of sodium and chloride, increasing the osmolality (p<0.01). Our results suggest that HS-HES reduced the volume of intraoperative fluid required to maintain the patients undergoing surgery and led to a decrease in the intraoperative fluid balance. Moreover, HS-HES improved the dural tension scores and provided satisfactory brain relaxation. Our results indicate that HS-HES may represent a new avenue for volume therapy during elective neurosurgical procedures.

Comparison of 7.2% hypertonic saline - 6% hydroxyethyl starch solution and 6% hydroxyethyl starch solution after the induction of anesthesia in patients undergoing elective neurosurgical procedures

PubMed Central

Shao, Liujiazi; Wang, Baoguo; Wang, Shuangyan; Mu, Feng; Gu, Ke

2013-01-01

OBJECTIVE: The ideal solution for fluid management during neurosurgical procedures remains controversial. The aim of this study was to compare the effects of a 7.2% hypertonic saline - 6% hydroxyethyl starch (HS-HES) solution and a 6% hydroxyethyl starch (HES) solution on clinical, hemodynamic and laboratory variables during elective neurosurgical procedures. METHODS: Forty patients scheduled for elective neurosurgical procedures were randomly assigned to the HS-HES group or the HES group. After the induction of anesthesia, patients in the HS-HES group received 250 mL of HS-HES (500 mL/h), whereas the patients in the HES group received 1,000 mL of HES (1000 mL/h). The monitored variables included clinical, hemodynamic and laboratory parameters. Chictr.org: ChiCTR-TRC-12002357 RESULTS: The patients who received the HS-HES solution had a significant decrease in the intraoperative total fluid input (p<0.01), the volume of Ringer's solution required (p<0.05), the fluid balance (p<0.01) and their dural tension scores (p<0.05). The total urine output, blood loss, bleeding severity scores, operation duration and hemodynamic variables were similar in both groups (p>0.05). Moreover, compared with the HES group, the HS-HES group had significantly higher plasma concentrations of sodium and chloride, increasing the osmolality (p<0.01). CONCLUSION: Our results suggest that HS-HES reduced the volume of intraoperative fluid required to maintain the patients undergoing surgery and led to a decrease in the intraoperative fluid balance. Moreover, HS-HES improved the dural tension scores and provided satisfactory brain relaxation. Our results indicate that HS-HES may represent a new avenue for volume therapy during elective neurosurgical procedures. PMID:23644851

A comparison of case volumes among urologic surgeons identified on an industry-sponsored website to an all provider peer group.

PubMed

See, William A; Jacobson, Kenneth; Derus, Sue; Langenstroer, Peter

2014-11-01

Industry-sponsored websites for robotic surgery direct to surgeons listed as performing specific robotic surgical procedures. The purpose of this study was to compare average annual, surgeon-specific, case volumes for those procedures for which they were listed as performing on the commercial website with the volumes of all providers performing these same procedures across a defined geographic region. A list of providers within the state of Wisconsin cited as performing specific urologic procedures was obtained through the Intuitive Surgical website 〈http://www.davincisurgery.com/da-vinci-urology/〉. Surgeon-specific annual case volumes from 2009 to 2013 for these same cases were obtained for all Wisconsin providers through DataBay Resources (Warrendale, PA) based on International classification of diseases-9 codes. Procedural activity was rank ordered, and surgeons were placed in "volume deciles" derived from the total annual number of cases performed by all surgeons. The distribution of commercially listed surgeon volumes, both 5-year average and most recent year, was compared with the average and 2013 volumes of all surgeons performing a specific procedure. A total of 35 individual urologic surgeons listed as performing robotic surgery in Wisconsin were identified through a "search" using the Intuitive Surgical website. Specific procedure analysis returned 5, 12, 9, and 15 surgeon names for cystectomy, partial nephrectomy, radical nephrectomy, and prostatectomy, respectively. This compared with the total number of surgeons who had performed the listed procedure in Wisconsin at least 1 time during the prior 5 years of 123, 153, 242, and 165, respectively. When distributed by surgeon-volume deciles, surgeons listed on industry-sponsored sites varied widely in their respective volume decile. More than half of site-listed, procedure-specific surgeons fell below the fifth decile for surgeon volume. Data analysis based solely on 2013 case volumes had no effect on the number of website-listed surgeons whose volumes fell below the fifth decile. Surgeons listed on an industry-sponsored website demonstrate wide variation in the actual volume of specific procedures performed. The inferred endorsement of competence by commercial sites has the potential to mislead patients seeking surgical expertise. Providers should consider the ethical and legal implications of these commercial advertising that do not have volume or outcome data. Published by Elsevier Inc.

Higher surgeon annual volume, but not years of experience, is associated with reduced rates of postoperative complications and reoperations after open abdominal aortic aneurysm repair.

PubMed

Dubois, Luc; Allen, Britney; Bray-Jenkyn, Krista; Power, Adam H; DeRose, Guy; Forbes, Thomas L; Duncan, Audra; Shariff, Salimah Z

2018-06-01

Volume-outcome relationships for open abdominal aortic aneurysm (AAA) repair have received less attention in publicly funded health systems. Furthermore, the roles of surgeon seniority (years of experience) and composite volume (encompassing all major arterial cases) on outcomes after open AAA repair are less well known. We sought to determine the effects of surgeon volume, surgeon years of experience, and composite volume on outcomes after elective open AAA repairs performed in Ontario, Canada. Using a population-based, prospectively collected health administrative database, all elective open AAA repairs occurring in the province of Ontario from 2005 to 2014 were identified. Surgeon annual volume was classified by quintiles, with the highest volume quintile acting as the reference category. Multivariable logistic regression modeling was used, adjusting for patient factors (age, sex, comorbidities, year of procedure, income) to investigate the relationship between surgeon annual volume and 30-day mortality, 30-day major complications, 30-day reoperations, 1-year mortality, and 1-year reoperations (related to index procedure). The potential effects of annual surgeon composite volume and surgeon years of experience on postoperative outcomes were also explored. A total of 7211 elective open AAA repairs performed by 101 surgeons were identified between 2005 and 2014. Most of the operations were performed by vascular surgeons (81.5%), followed by cardiac (12.1%) and general surgeons (6.1%). Median number of procedures in the lowest quintile group was 3 repairs/y, whereas the highest quintile group performed 54 repairs/y. Overall 30-day mortality was 3%. No difference in mortality was detected in comparing the lowest with the highest volume groups (1.89% vs 3.01%; adjusted odds ratio [OR], 0.60; 95% confidence interval [CI], 0.27-1.33). The lowest volume group exhibited a higher 30-day complication rate (28.0% vs 20.4%; OR, 1.54; 95% CI, 1.15-2.06) and 30-day reoperation rate (10.53% vs 6.73%; OR, 1.64; 95% CI, 1.13-2.38) compared with the highest volume group. No effect of surgeon volume on 1-year mortality or 1-year reoperation was observed. Similarly, composite volume and surgeon years of experience were not associated with postoperative outcomes. In a single-payer system with a relatively high number of open AAA repairs/surgeon per year, surgeon annual volume had no effect on postoperative mortality but was associated with lower postoperative complication and reoperation rates. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

High performance concentration method for viruses in drinking water.

PubMed

Kunze, Andreas; Pei, Lu; Elsässer, Dennis; Niessner, Reinhard; Seidel, Michael

2015-09-15

According to the risk assessment of the WHO, highly infectious pathogenic viruses like rotaviruses should not be present in large-volume drinking water samples of up to 90 m(3). On the other hand, quantification methods for viruses are only operable in small volumes, and presently no concentration procedure for processing such large volumes has been reported. Therefore, the aim of this study was to demonstrate a procedure for processing viruses in-line of a drinking water pipeline by ultrafiltration (UF) and consecutive further concentration by monolithic filtration (MF) and centrifugal ultrafiltration (CeUF) of viruses to a final 1-mL sample. For testing this concept, the model virus bacteriophage MS2 was spiked continuously in UF instrumentation. Tap water was processed in volumes between 32.4 m(3) (22 h) and 97.7 m(3) (72 h) continuously either in dead-end (DE) or cross-flow (CF) mode. Best results were found by DE-UF over 22 h. The concentration of MS2 was increased from 4.2×10(4) GU/mL (genomic units per milliliter) to 3.2×10(10) GU/mL and from 71 PFU/mL to 2×10(8) PFU/mL as determined by qRT-PCR and plaque assay, respectively. Copyright © 2015 Elsevier B.V. All rights reserved.

US Army Medical Bioengineering Research and Development Laboratory Annual Progress Report for FY 84. Volume 1

DTIC Science & Technology

1984-10-01

develop pollution abatement procedures for Army munition plants and military installations.n, t ftr Laboratory is also actively engaged in the...FACILITIES The physical plant provides over 100,000 square feet for research, development, testing, and administrative activities . Space is...protection of industrial workers and thq surrounding community at Army-controlled, industry-operated munition plants . G Environmental Quality program

Journal of Special Operations Medicine. Volume 2, Edition 1, Winter 2002

DTIC Science & Technology

2002-01-01

regarding clean surgi- cal procedures that an antibiotic treatment regime must be based upon the expected pathogens, appro- priate pharmacokinetic properties...conduction apparatus toDiagram of ear Auricle Epitympanic recess Malleus (head) Incus Crura of stapes Tegmen tympani Cochlear nerve Vesibular nerve Facial...Prominence of lateral semicircular canal Scala vestibuli Cochlear duct containing spiral organ (of Corti) Scala tympaniAuditory (Eustachian) tube Round

Are critical pathways and implant standardization programs effective in reducing costs in total knee replacement operations?

PubMed

Ho, David M; Huo, Michael H

2007-07-01

Total knee replacement (TKR) operation is one of the most effective procedures, both clinically and in terms of cost. Because of increased volume and cost for this procedure during the past 3 decades, TKRs are often targeted for cost reduction. The purpose of this study was to evaluate the efficacy of two cost reducing methodologies, establishment of critical clinical pathways, and standardization of implant costs. Ninety patients (90 knees) were randomly selected from a population undergoing primary TKR during a 2-year period at a tertiary teaching hospital. Patients were assigned to three groups that corresponded to different strategies implemented during the evolution of the joint-replacement program. Medical records were reviewed for type of anesthesia, operative time, length of stay, and any perioperative complications. Financial information for each patient was compared among the three groups. Data analysis demonstrated that the institution of a critical pathway significantly shortened length of hospital stay and was effective in reducing the hospital costs by 18% (p < 0.05). In addition, standardization of surgical techniques under the care of a single surgeon substantially reduced the operative time. Selection of implants from a single vendor did not have any substantial effect in additionally reducing the costs. Standardized postoperative management protocols and critical clinical pathways can reduce costs and operative time. Future efforts must focus on lowering the costs of the prostheses, particularly with competitive bidding or capitation of prostheses costs. Although a single-vendor approach was not effective in this study, it is possible that a cost reduction could have been realized if more TKRs were performed, because the pricing contract was based on projected volume of TKRs to be done by the hospital.

Measurement of pressure and flow rates during irrigation of a root canal ex vivo with three endodontic needles.

PubMed

Boutsioukis, C; Lambrianidis, T; Kastrinakis, E; Bekiaroglou, P

2007-07-01

To monitor ex vivo intra-canal irrigation with three endodontic needles (25, 27 and 30 gauge) and compare them in terms of irrigant flow rate, intra-barrel pressure, duration of irrigation and volume of irrigant delivered. A testing system was constructed to allow measurement of selected variables with pressure and displacement transducers during ex vivo intra-canal irrigation with a syringe and three different needles (groups A, B, C) into a prepared root canal. Ten specialist endodontists performed the irrigation procedure. Each operator performed ten procedures with each needle. Data recorded by the transducers were analysed using Friedman's test, Wilcoxon Signed Rank test, Mann-Whitney U-test and Kendall's T(b) test. The level of significance was set to 95%. Significant differences were detected among the three needles for most variables. Duration of delivery and flow rates significantly decreased as the needle diameter increased, whilst pressure increased up to 400-550 kPa. Gender of the operator had a significant impact on the results. Experience of the operators (years) were negatively correlated to volume of irrigant (all groups), to the duration of delivery (groups A, B) and to the average flow rate (group A). Finer diameter needles require increased effort to deliver the irrigant and result in higher intra-barrel pressure. The syringe and needles used tolerated the pressure developed. Irrigant flow rate should be considered as a factor directly influencing flow beyond the needle. Wide variations of flow rate were observed among operators. Syringe irrigation appears difficult to standardize and control.

Application of Information Technology Solution for Early Warning Systems at Water Utilities

NASA Astrophysics Data System (ADS)

Bałut, Alicja

2018-02-01

Deployment of IT solutions in water utilities in Poland concerns nowadays lots beyond GIS implementation projects [1]. The scope of modern IT platforms is truly advanced software for complete management of water treatment processes and involved objects, including ranges of various types of equipment. There are multiply factors that disrupt required volumes of supplied water. They are normally classified as natural, accidental and intentional. This paper addresses potential residing in already deployed IT solutions of water utilities in and also in new ones being now developed. Primarily- from the perspective of intentional, terrorist threats. This document depicts operating procedures that are called in case of spotted contamination in a water supply (damage of key elements of the network infrastructure) or in case of an introduction factors. This paper also discusses relevant IT tools with access provided to network operators or water plant owners that are extremely useful in accurate pinpointing the treat and in following relevant operating procedures and related actions.

Alignment of training curriculum and surgical practice: implications for competency, manpower, and practice modeling.

PubMed

Sømme, S; Bronsert, M; Kempe, A; Morrato, E H; Ziegler, M

2012-02-01

The attractiveness of pediatric surgery (PS) as a specialty includes its primary role in the care of multisystemic disease. We were interested in identifying changes in operative case quality and quantity when comparing PS residents to PS practitioners. The 2006 Accreditation Council for Graduate Medical Education PS resident current procedural terminology (CPT) code database (26,077 resident cases) was merged with the 2006 Kids' Inpatient Database of International Classification of Diseases (ICD)-9 procedure codes (230,504 practitioner cases) and categorized by case type and volumes according to a resident CPT reference file. Cases were categorized into 84 procedure types. A recent estimate of 691 practicing pediatric surgeons was used as denominator to calculate case volume per surgeon. Our analysis focused on the PS index cases and we compared PS residents to subspecialty board certified general pediatric surgeons in practice. We excluded cases that may be performed by general surgeons without PS training. Our data indicate that, on average, 501 cases are performed annually by each PS resident. We identified significant differences in case volume per surgeon between training and practice for most PS index cases.CONCLUSIONS The PS index case quantity declined significantly from training to practice. If a volume to outcome relationship applies to these complex and infrequent PS cases, then to sustain and improve clinical quality post-training will require a new paradigm of continued learning. Additionally, a relook at the optimal manpower and more focused regionalization is warranted. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

When is rotational angiography superior to conventional single-plane angiography for planning coronary angioplasty?

PubMed

Morris, Paul D; Taylor, Jane; Boutong, Sara; Brett, Sarah; Louis, Amal; Heppenstall, James; Morton, Allison C; Gunn, Julian P

2016-03-01

To investigate the value of rotational coronary angiography (RoCA) in the context of percutaneous coronary intervention (PCI) planning. As a diagnostic tool, RoCA is associated with decreased patient irradiation and contrast use compared with conventional coronary angiography (CA) and provides superior appreciation of three-dimensional anatomy. However, its value in PCI remains unknown. We studied stable coronary artery disease assessment and PCI planning by interventional cardiologists. Patients underwent either RoCA or conventional CA pre-PCI for planning. These were compared with the referral CA (all conventional) in terms of quantitative lesion assessment and operator confidence. An independent panel reanalyzed all parameters. Six operators performed 127 procedures (60 RoCA, 60 conventional CA, and 7 crossed-over) and assessed 212 lesions. RoCA was associated with a reduction in the number of lesions judged to involve a bifurcation (23 vs. 30 lesions, P < 0.05) and a reduction in the assessment of vessel caliber (2.8 vs. 3.0 mm, P < 0.05). RoCA improved confidence assessing lesion length (P = 0.01), percentage stenosis (P = 0.02), tortuosity (P < 0.04), and proximity to a bifurcation (P = 0.03), particularly in left coronary artery cases. X-ray dose, contrast agent volume, and procedure duration were not significantly different. Compared with conventional CA, RoCA augments quantitative lesion assessment, enhances confidence in the assessment of coronary artery disease and the precise details of the proposed procedure, but does not affect X-ray dose, contrast agent volume, or procedure duration. © 2015 The Authors. Catheterization and Cardiovascular Interventions. Published by Wiley Periodicals, Inc.

Fresh-Frozen Plasma: Ordering Patterns and Utilization in the Operating Rooms of a Tertiary Referral Hospital.

PubMed

Meyer, Matthew J; Dzik, Walter H; Levine, Wilton C

2017-02-01

Blood product transfusion is the most commonly performed hospital procedure. Intraoperative blood product utilization varies between institutions and anesthesiologists. In the United States in 2011, nearly 4 million plasma units were transfused. A retrospective analysis of intraoperative plasma ordering patterns and utilization (thawing and transfusing) was performed at a tertiary, academic hospital between January 2015 and March 2016. Over 15 months, 46,002 operative procedures were performed. In 1540 of them, plasma was thawed or transfused: 8297 plasma units were thawed and 3306 of those units were transfused. These 3306 plasma units were transfused in 749 cases with a median of 2 plasma units (interquartile range, 2-4) transfused. The percentage of average monthly procedures with plasma thawed and none transfused was 51.3% (confidence interval, 49.0%-53.6%). The cardiac surgery service requested the greatest number of plasma units to be thawed (2143) but only transfused 712 (33.2%) of them. Of all plasma units not transfused, 45% were generated by procedures with 1 to 4 units of plasma thawed; 95.7% of these units were thawed as even integers (ie, 2, 4). For operative procedures, far more plasma was thawed than was transfused and this practice occurred across surgical specialties and anesthesiologists. Considering the plasma that was not transfused, 45% occurred in procedures with 4 or fewer units of plasma requested suggesting these low-volume requests were a primary source of potential waste. Further studies are needed to examine associations between plasma utilization and clinical outcomes.

Procedural volume and structure of interventional pulmonary fellowships: a survey of fellows and fellowship program directors.

PubMed

Yarmus, Lonny; Feller-Kopman, David; Imad, Melhem; Kim, Stephanie; Lee, Hans J

2013-09-01

Current interventional pulmonary (IP) procedural guidelines for competency are based on expert opinion. There are few objective data to support competency metrics for IP procedures. This survey reports procedural volume during IP fellowships to help define new standards in training and curriculum development. A web-based survey was developed to evaluate IP training procedural volume. The survey was administered to all US and Canadian IP fellowship directors and graduates in training from 2006 to 2011. The survey inquired about all diagnostic and therapeutic procedures performed during the specialized year of IP training. Questions regarding the training program structure were collected and analyzed. There was a 92.5% fellow response rate (37 of 40) and 77% fellowship director response rate (10 of 13) from programs in existence at the time of the survey. Procedural volume was consistent between fellowship directors and graduates (P = .64). Although there was a wide range of procedural volume and types of procedures between different programs, the procedural mean volumes were all significantly higher than the American College of Chest Physicians (ACCP) and American Thoracic Society/European Respiratory Society (ATS/ERS) guideline recommendations (P < .005). US and Canadian IP fellowships produce fellows with variable procedural volumes; however, these are significantly higher than ACCP and ATS/ERS guidelines for most programs and procedures. With a uniform training curriculum being adopted by the majority of IP fellowship programs in the United States and Canada, as well as data showing improved core knowledge in IP fellows undergoing a dedicated year of additional training, further metrics examining the impact of advanced IP training on patient outcomes are needed.

Implementation of transcatheter aortic valve replacement in California: Influence on aortic valve surgery.

PubMed

Maximus, Steven; Milliken, Jeffrey C; Danielsen, Beate; Shemin, Richard; Khan, Junaid; Carey, Joseph S

2018-04-01

Transcatheter aortic valve replacement (TAVR) procedures were introduced in 2011. Initially, procedures were limited to patients who were not surgical candidates, but subsequently high-risk surgical candidates were considered for TAVR. The influence on aortic valve surgery in California is unknown. The California Office of Statewide Health Planning and Development hospitalized patient discharge database was queried for the years 2009 through 2014. isolated surgical aortic valve and aortic valve/coronary artery bypass graft (SAVR) and TAVR procedures were identified by International Classification of Diseases-9th revision clinical modification procedure codes. Seven TAVR programs were introduced in 2011, 12 in 2012, 3 in 2013, and 6 in 2014. SAVR procedure volumes were compared from the 2 years before institution with SAVR volumes during the year(s) after institution of the TAVR program in these 28 hospitals. Overall, surgical volumes increased during the first, second, and third years after implementation of TAVR procedures. Among 7 hospitals with 4-year programs, surgical volumes increased to a maximum of 15.5% during the third year, then began to decrease. The hospital performing the largest number of TAVR procedures showed a marked decrease in SAVR volume by the fourth year, suggesting a shift of SAVR candidates to TAVR. Among all hospitals with 4-year programs, TAVR exceeded SAVR procedures by the fourth year. In California overall, SAVR increased during 2011 through 2013, due primarily to increasing volume of isolated SAVR procedures. Statewide, isolated SAVR increased from a yearly average of 3111 procedures during 2009-2010 to 3592 (+15.5%) in 2013, then decreased slightly in 2014. SAVR plus coronary artery bypass graft procedures decreased during the same time period. After implementation of TAVR, hospital SAVR volumes increased moderately, then began to decrease by the fourth year, when TAVR volume exceeded SAVR. Surgical candidates may be identified during evaluation for TAVR, resulting in increased SAVR volume. Increasing SAVR volume may also be related to improved patient and provider awareness of aortic valve disease. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Patient-specific geometrical modeling of orthopedic structures with high efficiency and accuracy for finite element modeling and 3D printing.

PubMed

Huang, Huajun; Xiang, Chunling; Zeng, Canjun; Ouyang, Hanbin; Wong, Kelvin Kian Loong; Huang, Wenhua

2015-12-01

We improved the geometrical modeling procedure for fast and accurate reconstruction of orthopedic structures. This procedure consists of medical image segmentation, three-dimensional geometrical reconstruction, and assignment of material properties. The patient-specific orthopedic structures reconstructed by this improved procedure can be used in the virtual surgical planning, 3D printing of real orthopedic structures and finite element analysis. A conventional modeling consists of: image segmentation, geometrical reconstruction, mesh generation, and assignment of material properties. The present study modified the conventional method to enhance software operating procedures. Patient's CT images of different bones were acquired and subsequently reconstructed to give models. The reconstruction procedures were three-dimensional image segmentation, modification of the edge length and quantity of meshes, and the assignment of material properties according to the intensity of gravy value. We compared the performance of our procedures to the conventional procedures modeling in terms of software operating time, success rate and mesh quality. Our proposed framework has the following improvements in the geometrical modeling: (1) processing time: (femur: 87.16 ± 5.90 %; pelvis: 80.16 ± 7.67 %; thoracic vertebra: 17.81 ± 4.36 %; P < 0.05); (2) least volume reduction (femur: 0.26 ± 0.06 %; pelvis: 0.70 ± 0.47, thoracic vertebra: 3.70 ± 1.75 %; P < 0.01) and (3) mesh quality in terms of aspect ratio (femur: 8.00 ± 7.38 %; pelvis: 17.70 ± 9.82 %; thoracic vertebra: 13.93 ± 9.79 %; P < 0.05) and maximum angle (femur: 4.90 ± 5.28 %; pelvis: 17.20 ± 19.29 %; thoracic vertebra: 3.86 ± 3.82 %; P < 0.05). Our proposed patient-specific geometrical modeling requires less operating time and workload, but the orthopedic structures were generated at a higher rate of success as compared with the conventional method. It is expected to benefit the surgical planning of orthopedic structures with less operating time and high accuracy of modeling.

Evaluation of Right Ventricular Myocardial Mechanics Using Velocity Vector Imaging of Cardiac MRI Cine Images in Transposition of the Great Arteries Following Atrial and Arterial Switch Operations.

PubMed

Thattaliyath, Bijoy D; Forsha, Daniel E; Stewart, Chad; Barker, Piers C A; Campbell, Michael J

2015-01-01

The aim of the study was to determine right and left ventricle deformation parameters in patients with transposition of the great arteries who had undergone atrial or arterial switch procedures. Patients with transposition are born with a systemic right ventricle. Historically, the atrial switch operation, in which the right ventricle remains the systemic ventricle, was performed. These patients have increased rates of morbidity and mortality. We used cardiac MRI with Velocity Vector Imaging analysis to characterize and compare ventricular myocardial deformation in patients who had an atrial switch or arterial switch operation. Patients with a history of these procedures, who had a clinically ordered cardiac MRI were included in the study. Consecutive 20 patients (75% male, 28.7 ± 1.8 years) who underwent atrial switch operation and 20 patients (60% male, 17.7 ± 1.9 years) who underwent arterial switch operation were included in the study. Four chamber and short-axis cine images were used to determine longitudinal and circumferential strain and strain rate using Vector Velocity Imaging software. Compared with the arterial switch group, the atrial switch group had decreased right ventricular ejection fraction and increased end-diastolic and end-systolic volumes, and no difference in left ventricular ejection fraction and volumes. The atrial switch group had decreased longitudinal and circumferential strain and strain rate. When compared with normal controls multiple strain parameters in the atrial switch group were reduced. Myocardial deformation analysis of transposition patients reveals a reduction of right ventricular function and decreased longitudinal and circumferential strain parameters in patients with an atrial switch operation compared with those with arterial switch operation. A better understanding of the mechanisms of right ventricle failure in transposition of great arteries may lead to improved therapies and adaptation. © 2015 Wiley Periodicals, Inc.

On-site flow calibration of turbine meters for natural gas custody transfer

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

Ting, V.C.; Schexnayder, L.L.; Conkling, D.B.

1991-05-01

This paper presents the design criteria, performance characteristics, and calibration procedures relating to a turbine-meter flow-calibration facility used in the high-volume custody transfer of natural gas. The facility, located in Venice, LA, is owned and operated by Chevron U.S.A. Inc. and is used to meter sales volumes of up to 500 MMscf/D (14.16 {times} 10 std m{sup 3}/d) at a nominal operating pressure of 1,000 psig (6.9 MPa). The system includes three 12-in. (30.48 cm) turbine meters used for sales-volume measurement, a bank of sonic nozzles, and a master turbine meter connected in series with the sales meters. The sonicmore » nozzles and master meter serve as flow-proving and -calibration devices. sonic nozzles are recommended by the turbine-meter standard for meter calibration. This paper examines the performance of on-site calibration of gas turbine meters. The Venice facility successfully demonstrated that on-site calibration of gas-metering devices can ensure accurate gas-flow measurement under field conditions.« less

Final safety analysis report for the Ground Test Accelerator (GTA), Phase 2

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

NONE

1994-10-01

This document is the second volume of a 3 volume safety analysis report on the Ground Test Accelerator (GTA). The GTA program at the Los Alamos National Laboratory (LANL) is the major element of the national Neutral Particle Beam (NPB) program, which is supported by the Strategic Defense Initiative Office (SDIO). A principal goal of the national NPB program is to assess the feasibility of using hydrogen and deuterium neutral particle beams outside the Earth`s atmosphere. The main effort of the NPB program at Los Alamos concentrates on developing the GTA. The GTA is classified as a low-hazard facility, exceptmore » for the cryogenic-cooling system, which is classified as a moderate-hazard facility. This volume consists of failure modes and effects analysis; accident analysis; operational safety requirements; quality assurance program; ES&H management program; environmental, safety, and health systems critical to safety; summary of waste-management program; environmental monitoring program; facility expansion, decontamination, and decommissioning; summary of emergency response plan; summary plan for employee training; summary plan for operating procedures; glossary; and appendices A and B.« less

Virtual reality system for planning minimally invasive neurosurgery. Technical note.

PubMed

Stadie, Axel Thomas; Kockro, Ralf Alfons; Reisch, Robert; Tropine, Andrei; Boor, Stephan; Stoeter, Peter; Perneczky, Axel

2008-02-01

The authors report on their experience with a 3D virtual reality system for planning minimally invasive neurosurgical procedures. Between October 2002 and April 2006, the authors used the Dextroscope (Volume Interactions, Ltd.) to plan neurosurgical procedures in 106 patients, including 100 with intracranial and 6 with spinal lesions. The planning was performed 1 to 3 days preoperatively, and in 12 cases, 3D prints of the planning procedure were taken into the operating room. A questionnaire was completed by the neurosurgeon after the planning procedure. After a short period of acclimatization, the system proved easy to operate and is currently used routinely for preoperative planning of difficult cases at the authors' institution. It was felt that working with a virtual reality multimodal model of the patient significantly improved surgical planning. The pathoanatomy in individual patients could easily be understood in great detail, enabling the authors to determine the surgical trajectory precisely and in the most minimally invasive way. The authors found the preoperative 3D model to be in high concordance with intraoperative conditions; the resulting intraoperative "déjà-vu" feeling enhanced surgical confidence. In all procedures planned with the Dextroscope, the chosen surgical strategy proved to be the correct choice. Three-dimensional virtual reality models of a patient allow quick and easy understanding of complex intracranial lesions.

ATLAS, an integrated structural analysis and design system. Volume 2: System design document

NASA Technical Reports Server (NTRS)

Erickson, W. J. (Editor)

1979-01-01

ATLAS is a structural analysis and design system, operational on the Control Data Corporation 6600/CYBER computers. The overall system design, the design of the individual program modules, and the routines in the ATLAS system library are described. The overall design is discussed in terms of system architecture, executive function, data base structure, user program interfaces and operational procedures. The program module sections include detailed code description, common block usage and random access file usage. The description of the ATLAS program library includes all information needed to use these general purpose routines.

High Frontier: The Journal for Space and Cyberspace Professionals. Volume 6, Number 4, August 2010

DTIC Science & Technology

2010-08-01

information that warfighters rely on is likely to be useless (a three-way disaster is, anyway, logically impossible; if the global information grid...processing, exploitation, and dissemination (TCPED) of information . Space and cyber systems collectively provide the core functionality of the TCPED...rather than crisis management procedures. Space and cyber operations have several similarities dur- ing and can be extremely useful for informing Phase

Instruments for the nondestructive testing of materials and products: Handbook. Volumes 1 & 2 (2nd revised and enlarged edition)

NASA Astrophysics Data System (ADS)

Kliuev, V. V.

Data on the general design and principles of operation of various instruments and systems for the nondestructive testing of materials and products of various kinds are presented, and test procedures are described. Methods discussed include optical, thermal, capillary, RF, and X-ray testing techniques. The discussion also covers magnetic, electromagnetic, eddy-current, acoustic, and combined nondestructive testing methods.

Feasibility of mining lunar resources for earth use: Circa 2000 AD. Volume 1: Summary

NASA Technical Reports Server (NTRS)

Nishioka, K.; Arno, R. D.; Alexander, A. D.; Slye, R. E.

1973-01-01

The feasibility of obtaining lunar minerals for terrestrial uses is examined. Preliminary results gave indications that it will not be economically feasible to mine, refine, and transport lunar materials to Earth for consumption. A broad systems approach was used to analyze the problem. It was determined that even though the procedure was not economically advisable, the concept for the operations is technically sound.

Space Station crew safety alternatives study. Volume 5: Space Station safety plan

NASA Technical Reports Server (NTRS)

Mead, G. H.; Peercy, R. L., Jr.; Raasch, R. F.

1985-01-01

The Space Station Safety Plan has been prepared as an adjunct to the subject contract final report, suggesting the tasks and implementation procedures to ensure that threats are addressed and resolution strategy options identified and incorporated into the space station program. The safety program's approach is to realize minimum risk exposure without levying undue design and operational constraints. Safety objectives and risk acceptances are discussed.

Armored Family of Vehicles (AFV). Phase 1 Report. Book 7. Volume 11

DTIC Science & Technology

1987-08-31

Armored Family of Vehicles. Specific requirements and products are described which initiate the training development process and a training management ...approach for the TRADOC and proponent schools to plan, develop, manage and integrate the training subsystem(s) for the Armored Family of Vehicles...Procedures. q. Charter, Armored Family of Vehicles. r. Operational and Organizational (O&W) Plan for AFV. s. System MANPRINT Management Plan for AFV

[Cost analysis for navigation in knee endoprosthetics].

PubMed

Cerha, O; Kirschner, S; Günther, K-P; Lützner, J

2009-12-01

Total knee arthroplasty (TKA) is one of the most frequent procedures in orthopaedic surgery. The outcome depends on a range of factors including alignment of the leg and the positioning of the implant in addition to patient-associated factors. Computer-assisted navigation systems can improve the restoration of a neutral leg alignment. This procedure has been established especially in Europe and North America. The additional expenses are not reimbursed in the German DRG system (Diagnosis Related Groups). In the present study a cost analysis of computer-assisted TKA compared to the conventional technique was performed. The acquisition expenses of various navigation systems (5 and 10 year depreciation), annual costs for maintenance and software updates as well as the accompanying costs per operation (consumables, additional operating time) were considered. The additional operating time was determined on the basis of a meta-analysis according to the current literature. Situations with 25, 50, 100, 200 and 500 computer-assisted TKAs per year were simulated. The amount of the incremental costs of the computer-assisted TKA depends mainly on the annual volume and the additional operating time. A relevant decrease of the incremental costs was detected between 50 and 100 procedures per year. In a model with 100 computer-assisted TKAs per year an additional operating time of 14 mins and a 10 year depreciation of the investment costs, the incremental expenses amount to 300-395 depending on the navigation system. Computer-assisted TKA is associated with additional costs. From an economical point of view an amount of more than 50 procedures per year appears to be favourable. The cost-effectiveness could be estimated if long-term results will show a reduction of revisions or a better clinical outcome.

A personal experience of 2-year general thoracic surgery training programs in Japan and the United States.

PubMed

Hamaji, Masatsugu; Tanaka, Toru

2013-03-01

The objective of the study is to review and compare two countries' thoracic surgery training programs. Retrospective review of the first author's prospectively maintained operative case logs in two countries was performed. Each training program was established in a teaching hospital for its country's board requirement. Preoperative diagnosis, operative procedures and postoperative diagnosis were reviewed. The case volume (overall and in each category) was also reviewed. The ratio of each category and overall case volume was compared between the two programs by Chi-square test. p value was considered significant if it is <0.05. The overall case volumes were 169 cases in the Japanese institution and 456 cases in the United States' institution. The number ratio of each category's procedures and overall procedures was as follows: pleural cases, Japan 19.2 % versus the Unites States 20.6 % (p = 0.782), pulmonary cases, Japan 72.7 % versus the United States 36.8 % (p < 0.0001), mediastinal cases, Japan 8.1 % versus the United States 8.6 % (p = 0.678), diaphragm cases, Japan 0.62 % versus the United States 13.2 % (p = 0.0001), chest wall cases, Japan 1.2 % versus the United States 3.5 % (p = 0.0858), tracheobronchial cases, Japan 1.2 % versus the United States 1.8 % (p = 0.583). Regarding the approach, the ratios of each approach and overall cases are as follows: minimally invasive approach, Japan 78.3 % versus the United States 45.8 % (p < 0.0001), reoperative cases, Japan 0.62 % versus the United States 3.1 % (p = 0.0411). Case variety is different between the two countries. Our findings suggest that thoracic surgery training in the United States may be beneficial for Japanese medical graduates.

HYDRA-II: A hydrothermal analysis computer code: Volume 3, Verification/validation assessments

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

McCann, R.A.; Lowery, P.S.

1987-10-01

HYDRA-II is a hydrothermal computer code capable of three-dimensional analysis of coupled conduction, convection, and thermal radiation problems. This code is especially appropriate for simulating the steady-state performance of spent fuel storage systems. The code has been evaluated for this application for the US Department of Energy's Commercial Spent Fuel Management Program. HYDRA-II provides a finite difference solution in cartesian coordinates to the equations governing the conservation of mass, momentum, and energy. A cylindrical coordinate system may also be used to enclose the cartesian coordinate system. This exterior coordinate system is useful for modeling cylindrical cask bodies. The difference equationsmore » for conservation of momentum are enhanced by the incorporation of directional porosities and permeabilities that aid in modeling solid structures whose dimensions may be smaller than the computational mesh. The equation for conservation of energy permits modeling of orthotropic physical properties and film resistances. Several automated procedures are available to model radiation transfer within enclosures and from fuel rod to fuel rod. The documentation of HYDRA-II is presented in three separate volumes. Volume I - Equations and Numerics describes the basic differential equations, illustrates how the difference equations are formulated, and gives the solution procedures employed. Volume II - User's Manual contains code flow charts, discusses the code structure, provides detailed instructions for preparing an input file, and illustrates the operation of the code by means of a model problem. This volume, Volume III - Verification/Validation Assessments, provides a comparison between the analytical solution and the numerical simulation for problems with a known solution. This volume also documents comparisons between the results of simulations of single- and multiassembly storage systems and actual experimental data. 11 refs., 55 figs., 13 tabs.« less

Stone Attenuation Values Measured by Average Hounsfield Units and Stone Volume as Predictors of Total Laser Energy Required During Ureteroscopic Lithotripsy Using Holmium:Yttrium-Aluminum-Garnet Lasers.

PubMed

Ofude, Mitsuo; Shima, Takashi; Yotsuyanagi, Satoshi; Ikeda, Daisuke

2017-04-01

To evaluate the predictors of the total laser energy (TLE) required during ureteroscopic lithotripsy (URS) using the holmium:yttrium-aluminum-garnet (Ho:YAG) laser for a single ureteral stone. We retrospectively analyzed the data of 93 URS procedures performed for a single ureteral stone in our institution from November 2011 to September 2015. We evaluated the association between TLE and preoperative clinical data, such as age, sex, body mass index, and noncontrast computed tomographic findings, including stone laterality, location, maximum diameter, volume, stone attenuation values measured using average Hounsfield units (HUs), and presence of secondary signs (severe hydronephrosis, tissue rim sign, and perinephric stranding). The mean maximum stone diameter, volume, and average HUs were 9.2 ± 3.8 mm, 283.2 ± 341.4 mm 3 , and 863 ± 297, respectively. The mean TLE and operative time were 2.93 ± 3.27 kJ and 59.1 ± 28.1 minutes, respectively. Maximum stone diameter, volume, average HUs, severe hydronephrosis, and tissue rim sign were significantly correlated with TLE (Spearman's rho analysis). Stepwise multiple linear regression analysis defining stone volume, average HUs, severe hydronephrosis, and tissue rim sign as explanatory variables showed that stone volume and average HUs were significant predictors of TLE (standardized coefficients of 0.565 and 0.320, respectively; adjusted R 2  = 0.55, F = 54.7, P <.001). Stone attenuation values measured by average HUs and stone volume were strong predictors of TLE during URS using Ho:YAG laser procedures. Copyright © 2016 Elsevier Inc. All rights reserved.

Minimally invasive video-assisted thyroidectomy: Ascending the learning curve

PubMed Central

Capponi, Michela Giulii; Bellotti, Carlo; Lotti, Marco; Ansaloni, Luca

2015-01-01

BACKGROUND: Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. The aim of this report is to point out some aspects of the learning curve of the video-assisted thyroid surgery, through the analysis of our preliminary series of procedures. PATIENTS AND METHODS: Over a period of 8 months, we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35 mm and total thyroid volume <20 ml; presence of biochemical and ultrasound signs of thyroiditis and pre-operative diagnosis of cancer were exclusion criteria. We analysed surgical results, conversion rate, operating time, post-operative complications, hospital stay and cosmetic outcomes of the series. RESULTS: We performed 36 total thyroidectomy and in one case we performed a consensual parathyroidectomy. The procedure was successfully carried out in 33 out of 36 cases (conversion rate 8.3%). The mean operating time was 109 min (range: 80-241 min) and reached a plateau after 29 MIVAT. Post-operative complications included three transient recurrent nerve palsies and two transient hypocalcemias; no definitive hypoparathyroidism was registered. The cosmetic result was considered excellent by most patients. CONCLUSIONS: Advances in skills and technology allow surgeons to easily reproduce the standard open total thyroidectomy with video-assistance. Although the learning curve represents a time-consuming step, training remains a crucial point in gaining a reasonable confidence with video-assisted surgical technique. PMID:25883451

[Usefulness of Laparoscopic Stoma Creation for Unresectable Colorectal Cancer].

PubMed

Ishimoto, Takeshi; Nishida, Tatsurou; Suzuki, Tomoyuki; Osawa, Rumi; Sai, Sojin; Kin, Shuichi; Fujita, Yoshifumi; Suganuma, Yasushi; Shirakata, Shuji; Nomi, Shinhachiro

2018-01-01

Laparoscopic stoma creation enables good visualization of viscera within the abdominal cavity to ensure adequate mobilization of the large intestine. Laparoscopic stoma creation/construction was indicated and performed at our hospital in 7 patients who were diagnosed with unresectable colorectal cancer between July 2015 and May 2017. Duringthe ileostomy procedure, we made a skin incision at the stoma site and performed a single-incision(3-port)laparoscopic surgery. For the colostomy procedure, we made a small incision at the umbilicus and mobilized the large intestine with laparoscopic dissection of any interveningadhesions. Operation time ranged between 34 and 127 minutes, and the volume of intraoperative blood loss was low in all cases. There were no fatal complications related to the operation. Laparoscopic stoma creation can be performed safely and may be useful for staging of malignant colorectal tumors and reducing the risk of complications.

Minimally invasive video-assisted thyroid surgery: how can we improve the learning curve?

PubMed

Castagnola, G; Giulii Cappone, M; Tierno, S M; Mezzetti, G; Centanini, F; Vetrone, I; Bellotti, C

2012-10-01

Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. A time consuming learning and training period is mandatory at the beginning of the experience. The aim of our report is to focus some aspects of the learning curve of the surgeon who practices video-assisted thyroid procedures for the first time, through the analysis of our preliminary series of 36 cases. From September 2004 to April 2005 we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35 mm in maximum diameter; total thyroid volume within normal range; absence of biochemical and echographic signs of thyroiditis. We analyzed surgical results, conversion rate, operating time, post-operative complications, hospital stay, cosmetic outcome of the series. We performed 36 total thyroidectomy. The procedure was successfully carried out in 33/36 cases. Post-operative complications included 3 transient recurrent nerve palsies and 2 transient hypocalcemias; no definitive hypoparathyroidism was registered. All patients were discharged 2 days after operation. The cosmetic result was considered excellent by most patients. Advances in skills and technology have enabled surgeons to reproduce most open surgical techniques with video-assistance or laparoscopically. Training is essential to acquire any new surgical technique and it should be organized in detail to exploit it completely.

Retroperitoneal Laparoscopic Ureterolithotomy for Proximal Ureteral Calculi in Selected Patients

PubMed Central

Hu, Qingfeng; Ding, Weihong; Gou, Yuancheng; Ho, Yatfaat; Xu, Ke; Gu, Bin; Sun, Chuanyu; Xia, Guowei; Ding, Qiang

2014-01-01

Objectives. To summarize our experience of retroperitoneal laparoscopic ureterolithotomy for ureteral calculi and evaluate the safety and efficiency of this procedure. Methods. We conducted a retrospective analysis of 197 patients with proximal ureteral calculi who accepted retroperitoneal laparoscopic ureterolithotomy from June 2005 to June 2014. Results. All procedures were performed successfully and the mean operating time and estimated blood loss were 87 min and 64 mL. The clearance rate was 98.5% and the rates of urine leak and ureteral stricture were 2.5% and 1.0%. Conclusions. Retroperitoneal laparoscopic ureterolithotomy is a safe and effective procedure for patients with complex stones or anatomic abnormalities, and, with experience of high volume series, it is also a reasonable choice as the primary treatment for such selected patients. PMID:25548791

Tank atmosphere perturbation: a procedure for assessing flashing losses from oil storage tanks.

PubMed

Littlejohn, David; Lucas, Donald

2003-03-01

A new procedure to measure the total volume of emissions from heavy crude oil storage tanks is described. Tank flashing losses, which are difficult to measure, can be determined by correcting this value for working and breathing losses. The procedure uses a fan or blower to vent the headspace of the storage tank, with subsequent monitoring of the change in concentrations of oxygen or other gases. Combined with a separate determination of the reactive organic carbon (ROC) fraction in the gas, this method allows the evaluation of the total amount of ROC emitted. The operation of the system is described, and results from measurement of several storage tanks in California oil fields are presented. Our measurements are compared with those obtained using the California Air Resources Board (CARB) 150 method.

Parry-Romberg reconstruction: optimal timing for hard and soft tissue procedures.

PubMed

Slack, Ginger C; Tabit, Christina J; Allam, Karam A; Kawamoto, Henry K; Bradley, James P

2012-11-01

For the treatment of Parry-Romberg syndrome or progressive hemifacial atrophy, we studied 3 controversial issues: (1) optimal timing, (2) need for skeletal reconstruction, and (3) need for soft tissue (medial canthus/lacrimal duct) reconstruction. Patients with Parry-Romberg syndrome (>5 y follow-up) were divided into 2 groups: (1) younger than 14 years and (2) 14 years or older (n = 43). Sex, age, severity of deformity, number of procedures, operative times, and augmentation fat volumes were recorded. Physician and patient satisfaction surveys (5-point scale) were obtained, preoperative and postoperative three-dimensional computed tomographic scans were reviewed, and a digital three-dimensional photogrammetry system was used to determine volume retention. Our results indicate that the younger patient group required more procedures compared with the older patient group (4.3 versus 2.8); however, the younger group had higher patient/family satisfaction scores (3.8 versus 3.0). Skeletal and soft tissue reconstruction resulted in improved symmetry score (60% preoperatively to 93% final) and satisfaction scores (3.4 preoperatively to 3.8 final). Patients with Parry-Romberg syndrome required multiple corrective surgeries but showed improvements even when beginning before puberty. Soft and hard tissue reconstruction was beneficial.

The Ross Procedure in Pediatric Patients: A 20-Year Experience of Ross Procedure in a Single Institution

PubMed Central

Yoon, Dong Woog; Yang, Ji-Hyuk; Jun, Tae-Gook; Park, Pyo Won

2017-01-01

Background The Ross/Ross-Konno procedure is considered a good option for irreparable aortic valve disease in pediatric patients because of its hemodynamic performance and potential for growth of the pulmonary autograft. This study is a review of the long-term results of our 20-year experience with the Ross and Ross-Konno operations in a single institution. Methods Between June 1995 and January 2016, 16 consecutive patients (mean age, 6.0±5.9 years; range, 16 days to 17.4 years) underwent either a Ross operation (n=9) or a Ross-Konno operation (n=7). The study included 12 males and 4 females, with a median follow-up period of 47 months (range, 6 to 256 months). Results There were no cases of in-hospital or late mortality. Six reoperations were performed in 5 patients. Four patients underwent right ventricular-pulmonary artery (RV-PA) conduit replacement. Two patients underwent concomitant replacement of the pulmonary autograft and RV-PA conduit 10 years and 8 years after the Ross operation, respectively. The rate of freedom from adverse outcomes of the pulmonary autograft was 88% and 70% at 5 and 10 years, respectively. The rate of freedom from valve-related reoperations was 79% and 63% at 5 and 10 years, respectively. Conclusion Pulmonary autografts demonstrated good durability with low mortality. The Ross/Ross-Konno procedure is a good option that can be performed safely in pediatric patients with aortic valve disease, even in a small-volume center. PMID:28795027

Tear cytokine profile as a noninvasive biomarker of inflammation for ocular surface diseases: standard operating procedures.

PubMed

Wei, Yi; Gadaria-Rathod, Neha; Epstein, Seth; Asbell, Penny

2013-12-23

To provide standard operating procedures (SOPs) for measuring tear inflammatory cytokine concentrations and to validate the resulting profile as a minimally invasive objective metric and biomarker of ocular surface inflammation for use in multicenter clinical trials on dry eye disease (DED). Standard operating procedures were established and then validated with cytokine standards, quality controls, and masked tear samples collected from local and distant clinical sites. The concentrations of the inflammatory cytokines in tears were quantified using a high-sensitivity human cytokine multiplex kit. A panel of inflammatory cytokines was initially investigated, from which four key inflammatory cytokines (IL-1β, IL-6, INF-γ, and TNF-α) were chosen. Results with cytokine standards statistically satisfied the manufacturer's quality control criteria. Results with pooled tear samples were highly reproducible and reliable with tear volumes ranging from 4 to 10 μL. Incorporation of the SOPs into clinical trials was subsequently validated. Tear samples were collected at a distant clinical site, stored, and shipped to our Biomarker Laboratory, where a masked analysis of the four tear cytokines was successfully performed. Tear samples were also collected from a feasibility study on DED. Inflammatory cytokine concentrations were decreased in tears of subjects who received anti-inflammatory treatment. Standard operating procedures for human tear cytokine assessment suitable for multicenter clinical trials were established. Tear cytokine profiling using these SOPs may provide objective metrics useful for diagnosing, classifying, and analyzing treatment efficacy in inflammatory conditions of the ocular surface, which may further elucidate the mechanisms involved in the pathogenesis of ocular surface disease.

A Quantitative Analysis of the Relationship between Medicare Payment and Service Volume for Glaucoma Procedures from 2005 through 2009.

PubMed

Gong, Dan; Jun, Lin; Tsai, James C

2015-05-01

To calculate the association between Medicare payment and service volume for 6 commonly performed glaucoma procedures. Retrospective, longitudinal database study. A 100% dataset of all glaucoma procedures performed on Medicare Part B beneficiaries within the United States from 2005 to 2009. Fixed-effects regression model using Medicare Part B carrier data for all 50 states and the District of Columbia, controlling for time-invariant carrier-specific characteristics, national trends in glaucoma service volume, Medicare beneficiary population, number of ophthalmologists, and income per capita. Payment-volume elasticities, defined as the percent change in service volume per 1% change in Medicare payment, for laser trabeculoplasty (Current Procedural Terminology [CPT] code 65855), trabeculectomy without previous surgery (CPT code 66170), trabeculectomy with previous surgery (CPT code 66172), aqueous shunt to reservoir (CPT code 66180), laser iridotomy (CPT code 66761), and scleral reinforcement with graft (CPT code 67255). The payment-volume elasticity was nonsignificant for 4 of 6 procedures studied: laser trabeculoplasty (elasticity, -0.27; 95% confidence interval [CI], -1.31 to 0.77; P = 0.61), trabeculectomy without previous surgery (elasticity, -0.42; 95% CI, -0.85 to 0.01; P = 0.053), trabeculectomy with previous surgery (elasticity, -0.28; 95% CI, -0.83 to 0.28; P = 0.32), and aqueous shunt to reservoir (elasticity, -0.47; 95% CI, -3.32 to 2.37; P = 0.74). Two procedures yielded significant associations between Medicare payment and service volume. For laser iridotomy, the payment-volume elasticity was -1.06 (95% CI, -1.39 to -0.72; P < 0.001): for every 1% decrease in CPT code 66761 payment, laser iridotomy service volume increased by 1.06%. For scleral reinforcement with graft, the payment-volume elasticity was -2.92 (95% CI, -5.72 to -0.12; P = 0.041): for every 1% decrease in CPT code 67255 payment, scleral reinforcement with graft service volume increased by 2.92%. This study calculated the association between Medicare payment and service volume for 6 commonly performed glaucoma procedures and found varying magnitudes of payment-volume elasticities, suggesting that the volume response to changes in Medicare payments, if present, is not uniform across all Medicare procedures. Copyright © 2015 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Southern forest inventory and analysis volume equation user’s guide

Treesearch

Christopher M. Oswalt; Roger C. Conner

2011-01-01

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

Earth Observations Division version of the Laboratory for Applications of Remote Sensing System (EOD-LARSYS) user guide for the IBM 370/148. Volume 2: User reference manual

NASA Technical Reports Server (NTRS)

Aucoin, P. J.; Stewart, J.; Mckay, M. F. (Principal Investigator)

1980-01-01

This document presents instructions for analysts who use the EOD-LARSYS as programmed on the Purdue University IBM 370/148 (recently replaced by the IBM 3031) computer. It presents sample applications, control cards, and error messages for all processors in the system and gives detailed descriptions of the mathematical procedures and information needed to execute the system and obtain the desired output. EOD-LARSYS is the JSC version of an integrated batch system for analysis of multispectral scanner imagery data. The data included is designed for use with the as built documentation (volume 3) and the program listings (volume 4). The system is operational from remote terminals at Johnson Space Center under the virtual machine/conversational monitor system environment.

Cost drivers in total hip arthroplasty: effects of procedure volume and implant selling price.

PubMed

Kelly, Michael P; Bozic, Kevin J

2009-01-01

Total hip arthroplasty (THA), though a highly effective procedure for patients with end-stage hip disease, has become increasingly costly, both because of increasing procedure volume and because of the introduction and widespread use of new technologies. Data regarding procedure volume and procedure costs for THA were obtained from the National Inpatient Sample and other published sources for the years 1995 through 2005. Procedure volume increased 61% over the period studied. When adjusted for inflation, using the medical consumer price index, the average selling price of THA implants increased 24%. The selling price of THA implants as a percentage of total procedure costs increased from 29% to 60% during the period under study. The increasing cost of THA in the United States is a result of both increased procedure volume and increased cost of THA implants. No long-term outcome studies related to use of new implant technologies are available, and short-term results have been similar to those obtained with previous generations of THA implants. This study reinforces the need for a US total joint arthroplasty registry and for careful clinical and economic analyses of new technologies in orthopedics.

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

NASA Astrophysics Data System (ADS)

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

2011-03-01

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

[Current status and changes of metabolic and bariatric surgery in China].

PubMed

Liu, Jingang

2017-04-25

Through continuous development, metabolic and bariatric surgery (MBS) has become widely recognized in academic and medical circles. In China, the volume of MBS operations has increased year by year. Therapeutic goals of MBS have evolved from treating obesity to treating Type 2 diabetes mellitus, and further to treating a series of obesity-associated metabolic diseases (including conditions in the endocrine system, circulatory system, respiratory system, reproductive system, and etc). Surgical approach of MBS has also been evolving continuously. Currently the common surgical procedures include laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic sleeve gastrectomy (LSG), laparoscopic adjustable gastric banding (LAGB) and bilio-pancreatic diversion with duodenal switch (BPD-DS). All surgical procedures have pros and cons, and the choice of surgical procedures should be based on the conditions of patients, the surgeon's technical ability, and benefits and operative risks. With the development of MBS, the proportions of different surgical procedures also changed in China. In recent five years, the proportion of AGB has decreased continuously and LAGB is no longer a common procedure. The proportion of LSG has increased rapidly, rising from 9% in 2010 to 55% in 2015. The proportion of RYGB has increased from 57% to 64% between 2010 and 2013, and remained at 45% afterwards. Since 2010, most MBS operations are laparoscopic surgery. 3D Laparoscopic surgery, laparoendoscopic single-site surgery and da Vinci Robotic Surgery have also been introduced in MBS. This review discusses the status quo and changes of MBS in china, as well as the new technology in MBS, aiming to strengthen the information and comprehension of MBS in china.

The German registry for natural orifice translumenal endoscopic surgery: report of the first 551 patients.

PubMed

Lehmann, Kai S; Ritz, Jörg P; Wibmer, Andreas; Gellert, Klaus; Zornig, Carsten; Burghardt, Jens; Büsing, Martin; Runkel, Norbert; Kohlhaw, Kay; Albrecht, Roland; Kirchner, Tom G; Arlt, Georg; Mall, Julian W; Butters, Michael; Bulian, Dirk R; Bretschneider, Jörgen; Holmer, Christoph; Buhr, Heinz J

2010-08-01

To analyze patient outcome in the first 14 months of the German natural orifice translumenal endoscopic surgery (NOTES) registry (GNR). NOTES is a new surgical concept, which permits scarless intra-abdominal operations through natural orifices, such as the mouth, vagina, rectum, or urethra. The GNR was established as a nationwide outcome database to allow the monitoring and safe introduction of this technique in Germany. The GNR was designed as a voluntary database with online access. All surgeons in Germany who performed NOTES procedures were requested to participate in the registry. The GNR recorded demographical and therapy data as well as data on the postoperative course. A total of 572 target organs were operated in 551 patients. Cholecystectomies accounted for 85.3% of all NOTES procedures. All procedures were performed in female patients using transvaginal hybrid technique. Complications occurred in 3.1% of all patients, conversions to laparoscopy or open surgery in 4.9%. In cholecystectomies, institutional case volume, obesity, and age had substantial effect on conversion rate, operation length, and length of hospital stay, but no effect on complications. Despite the fact that NOTES has just recently been introduced, the technique has already gained considerable clinical application. Transvaginal hybrid NOTES cholecystectomy is a practicable and safe alternative to laparoscopic resection even in obese or older patients.

Shuttle vehicle and mission simulation requirements report, volume 1

NASA Technical Reports Server (NTRS)

Burke, J. F.

1972-01-01

The requirements for the space shuttle vehicle and mission simulation are developed to analyze the systems, mission, operations, and interfaces. The requirements are developed according to the following subject areas: (1) mission envelope, (2) orbit flight dynamics, (3) shuttle vehicle systems, (4) external interfaces, (5) crew procedures, (6) crew station, (7) visual cues, and (8) aural cues. Line drawings and diagrams of the space shuttle are included to explain the various systems and components.

Executive overview and introduction to the SMAP information system life-cycle and documentation standards

NASA Technical Reports Server (NTRS)

1989-01-01

An overview of the five volume set of Information System Life-Cycle and Documentation Standards is provided with information on its use. The overview covers description, objectives, key definitions, structure and application of the standards, and document structure decisions. These standards were created to provide consistent NASA-wide structures for coordinating, controlling, and documenting the engineering of an information system (hardware, software, and operational procedures components) phase by phase.

An experimental investigation of (UF-235)6 fission nuclear-pumped lasers

NASA Technical Reports Server (NTRS)

Miley, G. H.

1979-01-01

A UF6 handling system was designed for use in conjunction with the existing nuclear-pumped laser vacuum system at a nuclear reactor laboratory to perform the experiments described above. A modification to separate the gas fill system from the vacuum system and thus greatly reduce its volume is described as well as operating procedures for the first controlled nuclear pumping experiments with UF6 vapor contained in the laser cell.

Financial Management Regulation. Volume 15. Security Assistance Policy and Procedures

DTIC Science & Technology

1993-03-01

Definitions DEFINITIONS case level, i.e., commitments, obligations and 1. Above-the-line-Cost. Cost identified as disbursements resulting from contract award...of the asset or was a direct result of O ment is made when SAAC determines it does negligence, simple or gross. not have the accounting capability to... resulting from ments leaving the DoD system, contracts with operation of the FMS program: commercial firms, General Services Administra- tion

Journal of Special Operations Medicine. Volume 9, Edition 4, Fall 2009

DTIC Science & Technology

2009-01-01

Other concepts to be reconsidered are the use of nerve blocks for extremity injuries, fracture care, procedures, and wound care. Fracture reduction and...balanced proteins, carbohydrates, and fats is justified. Several thousand calories per day di- vided into small feedings every four to six hours would be...confidence information. In non-emergent situa- tions, US can also provide previously unknown capa- bilities as well such as confirming fractures without X

Library Operations Policies and Procedures, Volume 2. Central Archive for Reusable Defense Software (CARDS)

DTIC Science & Technology

1994-02-28

improvements. Pare 10 ka•- V •DkI U Release Manager The Release Manager provides franchisees with media copies of existing libraries, as needed. Security...implementors, and potential library franchisees . Security Team The Security Team assists the Security Officer with security analysis. Team members are...and Franchisees . A Potential User is an individual who requests a Library Account. A User Recruit has been sent a CARDS Library Account Registration

Journal of Special Operations Medicine, Volume 3, Edition 1

DTIC Science & Technology

2003-01-01

manufacturing processes. They can also require special in- plant test- ing procedures before the item or system is finally turned over to the military for further...trials of aspirin for treatment or of ibuprofen for prevention; naproxen ineffective Aspirin Ibuprofen Prevention of headache 400 or 600 mg orally once...and is the Installation Medical Authority for the McAlester Army Ammunition Plant , McAlester, Oklahoma. 1) Vedder, James A., Combat Surgeon: Up

Harvests from bone marrow donors who weigh less than their recipients are associated with a significantly increased probability of a suboptimal harvest yield.

PubMed

Anthias, Chloe; Billen, Annelies; Arkwright, Rebecca; Szydlo, Richard M; Madrigal, J Alejandro; Shaw, Bronwen E

2016-05-01

Previous studies have demonstrated the importance of bone marrow (BM) harvest yield in determining transplant outcomes, but little is known regarding donor and procedure variables associated with achievement of an optimal yield. We hypothesized that donor demographics and variables relating to the procedure were likely to impact the yield (total nucleated cells [TNCs]/kg recipient weight) and quality (TNCs/mL) of the harvest. To test our hypothesis, BM harvests of 110 consecutive unrelated donors were evaluated. The relationship between donor or procedure characteristics and the BM harvest yield was examined. The relationship between donor and recipient weight significantly influenced the harvest yield; only 14% of BM harvests from donors who weighed less than their recipient achieved a TNC count of more than 4 × 10(8) /kg compared to 56% of harvests from donors heavier than their recipient (p = 0.001). Higher-volume harvests were significantly less likely to achieve an optimal yield than lower-volume harvests (32% vs. 78%; p = 0.007), and higher-volume harvests contained significantly fewer TNCs/mL, indicating peripheral blood contamination. BM harvest quality also varied significantly between collection centers adding to recent concerns regarding maintenance of BM harvest expertise within the transplant community. Since the relationship between donor and recipient weight has a critical influence yield, we recommend prioritizing this secondary donor characteristic when selecting from multiple well-matched donors. Given the declining number of requests for BM harvests, it is crucial that systems are developed to train operators and ensure expertise in this procedure is retained. © 2016 AABB.

Hip Arthroscopy Surgical Volume Trends and 30-Day Postoperative Complications.

PubMed

Cvetanovich, Gregory L; Chalmers, Peter N; Levy, David M; Mather, Richard C; Harris, Joshua D; Bush-Joseph, Charles A; Nho, Shane J

2016-07-01

To determine hip arthroscopy surgical volume trends from 2006 to 2013 using the National Surgical Quality Improvement Program (NSQIP) database, the incidence of 30-day complications of hip arthroscopy, and patient and surgical risk factors for complications. Patients who underwent hip arthroscopy from 2006 to 2013 were identified in the NSQIP database for the over 400 NSQIP participating hospitals from the United States using Current Procedural Terminology and International Classification of Diseases, Ninth Revision codes. Trends in number of hip arthroscopy procedures per year were analyzed. Complications in the 30-day period after hip arthroscopy were identified. Univariate and multivariate regression analyses were performed to identify risk factors for complications. We identified 1,338 patients who underwent hip arthroscopy, with a mean age of 39.5 ± 13.0 years. Female patients comprised 59.6%. Hip arthroscopy procedures became 25 times more common in 2013 than 2006 (P < .001). Major complications occurred in 8 patients (0.6%), and minor complications occurred in 11 patients (0.8%); overall complications occurred in 18 patients (1.3%) (1 patient had 2 complications). The most common complications were bleeding requiring a transfusion (5, 0.4%), return to the operating room (4, 0.3%), superficial infection not requiring return to the operating room (3, 0.2%), deep venous thrombosis (2, 0.1%), and death (2, 0.1%). Multivariate analysis showed that regional/monitored anesthesia care as opposed to general anesthesia (P = .005; odds ratio, 0.102) and a history of patient steroid use (P = .05; odds ratio, 8.346) were independent predictors of minor complications in the 30 days after hip arthroscopy. Hip arthroscopy is an increasingly common procedure, with a 25-fold increase from 2006 to 2013. There is a low incidence of 30-day postoperative complications (1.3%), most commonly bleeding requiring a transfusion, return to the operating room, and superficial infection. Regional/monitored anesthesia care and steroid use were independent risk factors for minor complications. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Ambulatory patient classifications and the regressive nature of Medicare reform: is the reduction in outpatient health care reimbursement worth the price?

PubMed

Borgelt, B B; Stone, C

1999-10-01

To evaluate the impact of the proposed Ambulatory Patient Classification (APC) system on reimbursement for hospital outpatient Medicare procedures at the Massachusetts General Hospital (MGH) Department of Radiation Oncology. Treatment and cost data for the MGH Department of Radiation Oncology for the fiscal year 1997 were analyzed. This represented 66,981 technical procedures and 41 CPT-4 codes. The cost of each procedure was calculated by allocating departmental costs to the relative value units (RVUs) for each procedure according to accepted accounting principles. Net reimbursement for each CPT-4 procedure was then calculated by subtracting its cost from the allowed 1998 Boston area Medicare reimbursement or from the proposed Boston area APC reimbursement. The impact of the proposed APC reimbursement system on changes in reimbursement per procedure and on volume-adjusted changes in overall net reimbursements per procedure was determined. Although the overall effect of APCs on volume-adjusted net reimbursements for Medicare patients was projected to be budget-neutral, treatment planning revenues would have decreased by 514% and treatment delivery revenues would have increased by 151%. Net reimbursements for less complicated courses of treatment would have increased while those for treatment courses requiring more complicated or more frequent treatment planning would have decreased. Net reimbursements for a typical prostate interstitial implant and a three-treatment high-dose-rate intracavitary application would have decreased by 481% and 632%, respectively. The financial incentives designed into the proposed APC reimbursement structure could lead to compromises in currently accepted standards of care, and may make it increasingly difficult for academic institutions to continue to fulfill their missions of research and service to their communities. The ability of many smaller, low patient volume, high Medicare mix hospital-based radiation oncology departments to continue to deliver their current level of care could be compromised. APC reform may carry monetary and opportunity costs which far outweigh its apparent savings. As payment systems continue to place pressure on operating margins, it becomes even more critical that both academic and community radiation oncology practices know the cost of providing services.

Providing surgery in a war-torn context: the Médecins Sans Frontières experience in Syria.

PubMed

Trelles, Miguel; Dominguez, Lynette; Tayler-Smith, Katie; Kisswani, Katrin; Zerboni, Alberto; Vandenborre, Thierry; Dallatomasina, Silvia; Rahmoun, Alaa; Ferir, Marie-Christine

2015-01-01

Since 2011, civil war has crippled Syria leaving much of the population without access to healthcare. Various field hospitals have been clandestinely set up to provide basic healthcare but few have been able to provide quality surgical care. In 2012, Medecins Sans Frontieres (MSF) began providing surgical care in the Jabal al-Akrad region of north-western Syria. Based on the MSF experience, we describe, for the period 5th September 2012 to 1st January 2014: a) the volume and profile of surgical cases, b) the volume and type of anaesthetic and surgical procedures performed, and c) the intraoperative mortality rate. A descriptive study using routinely collected MSF programme data. Quality surgical care was assured through strict adherence to the following minimum standards: adequate infrastructure, adequate water and sanitation provisions, availability of all essential disposables, drugs and equipment, strict adherence to hygiene requirements and universal precautions, mandatory use of sterile equipment for surgical and anaesthesia procedures, capability for blood transfusion and adequate human resources. During the study period, MSF operated on 578 new patients, of whom 57 % were male and median age was 25 years (Interquartile range: 21-32 years). Violent trauma was the most common surgical indication (n-254, 44 %), followed by obstetric emergencies (n-191, 33 %) and accidental trauma (n-59, 10 %). In total, 712 anaesthetic procedures were performed. General anaesthesia without intubation was the most common type of anaesthesia (47 % of all anaesthetics) followed by spinal anaesthesia (25 %). A total of 831 surgical procedures were performed, just over half being minor/wound care procedures and nearly one fifth, caesarean sections. There were four intra-operative deaths, giving an intra-operative mortality rate of 0.7 %. Surgical needs in a conflict-afflicted setting like Syria are high and include both combat and non-combat indications, particularly obstetric emergencies. Provision of quality surgical care in a complex and volatile setting like this is possible providing appropriate measures, supported by highly experienced staff, can be implemented that allow a specific set of minimum standards of care to be adhered to. This is particularly important when patient outcomes - as a reflection of quality of care - are difficult to assess.

[Clinical research of minimal extracorporeal circulation in perioperative blood conservation of coronary artery bypass graft].

PubMed

Liu, Yan; Cui, Hu-jun; Tao, Liang; Chen, Xu-fa

2011-04-01

To analyze the clinical effect of minimal extracorporeal circulation (MECC) in blood conservation perioperatively coronary artery bypass graft (CABG). The data of 120 cases received simple CABG since August 2006 to October 2009 was analyzed retrospectively. All the patients were divided to three groups according to the mode of circulation support in-operation: MECC, conventional extracorporeal circulation (cECC) or off-pump, 40 cases in each group. Jostra MECC system with normal temperature was used in MECC group, and common membrane oxygenator with moderate hypo-temperature was used in cECC group. Collect the data of coagulation and the blood cytological examination perioperatively, the draining volume during the first 24 h after operation, and consumption of blood products perioperatively. Standard and logistic EuroSCORE were higher in MECC group than the others (P < 0.01). The operative time and the number of distal anastomosis of off-pump group were less than MECC and cECC groups (P < 0.05), while no difference between MECC group and cECC group. Intrinsic coagulation (activated partial thromboplastin time) were much more prolonged early postoperatively in cECC group, and higher than in MECC group and off-pump group at 2 h, 6 h and 12 h postoperatively (P < 0.05), but no difference in extrinsic coagulation (prothrombin time) among three group. Adjusted by hematocrit of the same sample, free hemoglobin level rose up during the ECC procedure and reached the maximum at the end of ECC in cECC group and MECC group, but the levels were more higher in cECC group than in MECC group (P < 0.05). The draining volume during the first 24 h after operation of cECC group was larger than MECC group and off-pump group (P < 0.05). Although the decreased platelet count perioperatively and more consumed of the blood products in cECC group, but no difference among the three groups. MECC could reduce the ruin to blood cell and interfere to coagulation function during the conventional ECC procedure, decrease the postoperative draining volume and requirement of blood products.

The feasibility of introducing advanced minimally invasive surgery into surgical practice

PubMed Central

Birch, Daniel W.; Misra, Monali; Farrokhyar, Forough

2007-01-01

Background This study investigates the feasibility of performing advanced minimally invasive surgery (MIS) in a nonspecialized practice environment. Methods We conducted a cross-sectional survey of all community general surgeons currently practising in Ontario. Results Few community surgeons perform a high volume (> 10 procedures per yr) of advanced MIS. Most (70%) believe it is important to acquire additional skills in advanced MIS. The most appropriate methods for learning advanced MIS are believed to be expert mentoring (79.7%), courses (77.2%) and a colleague mentor (63.9%). A total of 57.6% of respondents have attended a course in MIS while in practice, and most have access to a reasonable variety of instrumentation. Respondents believe that 57.6% of assistants, 54.8% of nurses and 43.4% of anaesthetists are relatively inexperienced with advanced MIS. Barriers to establishing advanced MIS include limited operating room access (50%), resources or equipment (45.2%) and limited expert mentoring (43.6%). Surgeons with less than 10 years of practice found lack of trained nursing staff (7.9% v. 4.2%, p = 0.01) and experienced assistants (12% v. 6.2%, p = 0.008) to be more important barriers than did those with over 10 years of practice, respectively. Conclusion Most general surgeons working in Ontario are self-taught with respect to MIS skills, and few perform a high volume of advanced MIS. Only one-half of all respondents have access to skilled MIS operating room nurses, surgical assistants or anesthesiology. Despite this, general surgeons perceive the greatest barriers to introducing advanced MIS procedures to be limited access to operating rooms, resources or equipment and limited mentoring. This study has shown that the role of the surgical team in advanced MIS may be underestimated by many general surgeons. These data have important implications in training general surgeons and in incorporating additional advanced MIS procedures into the armamentarium of general surgeons. PMID:17897513

The clinical application of laparoscope-assisted peritoneal vaginoplasty for the treatment of congenital absence of vagina.

PubMed

Qin, Chenglu; Luo, Guangnan; Du, Min; Liao, Shi; Wang, Chunping; Xu, Keke; Tang, Jie; Li, Baoyan; Zhang, Juanjuan; Pan, Hongxin; Ball, Tyler W; Fang, Yujiang

2016-06-01

To evaluate the outcomes of laparoscope-assisted peritoneal vaginoplasty for the treatment of congenital vaginal atresia. A retrospective study enrolled patients diagnosed with congenital vaginal atresia who were treated with one of two different laparoscope-assisted peritoneal vaginoplasty techniques (named Luohu-one and Luohu-two) between October 31, 2001 and December 31, 2014. Operative time, intraoperative bleeding volume, surgical difficulty, complications, and post-procedure sexual satisfaction were reported. Data were collected for 620 patients. The Luohu-one procedure was used in the treatment of 145 patients, while 475 patients were treated with the Luohu-two procedure. In 5 (0.8%) patients, it was necessary to perform a sigmoid colon vaginoplasty. During surgery, 16 patients experienced a rectal injury, among whom, 9 patients experienced a rectal-vaginal fistula. Follow-up data extending to 7years were available for 285 patients. Of these 285 patients, 231 agreed to report details of their sexual experiences. In total, 222 (96.1%) patients reported being very satisfied with their vaginal conditions and sex life. The Luohu-two procedure demonstrated shorter operative and recovery time, and reduced intraoperative bleeding. However, both procedures demonstrated satisfactory results. Laparoscope-assisted peritoneal vaginoplasty demonstrated good safety and effectiveness in the treatment of patients with congenital vaginal atresia. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

[Comparative effects of Roux-en-Y gastric bypass procedures preserving different gastric volume on blood glucose in Goto-Kakizaki rats].

PubMed

Zou, Zhong-dong; Jiao, Ya-bin; Wang, Yi-bo; Wang, Chang; Liu, Bin; Wang, Yu; Huang, Sheng

2012-01-01

To compare the effects of Roux-en-Y gastric bypass (RYGBP)procedures preserving different gastric volume on blood glucose of rats with non-obese type 2 diabetes. A total of 36 Goto-Kakizaki rats randomly underwent one of the following procedures: gastric bypass with different types of anastomosis including the Roux-en-Y of total stomach excision(n=12), the Roux-en-Y of partial stomach excision(n=12) and the Roux-en-Y of stomach preservation(n=12). Rats were observed for 24 weeks after surgery. Body weight, food intake and fasting blood glucose level were tested at 0(preoperative), 1, 3, 6, 12, 24 weeks. Hemoglobin A1c(HbA1c) level was measured at 0, 12, 24 weeks and glucose tolerance test (OGTT) was performed in conscious rats before (baseline) and then 30, 60, 120, and 180 minutes. Change of blood glucose over time was depicted. Area under curve(AUC) of glucose tolerance were calculated. Compared with preoperative levels, the weight and food intake of all the rats were significantly decreased at 1 week after surgery(P<0.01). At 3 weeks after operation, the weight and food intake were significantly increased compared with 1 week after operation in the Roux-en-Y of partial stomach excision and the Roux-en-Y of stomach retention(P<0.01). In the Roux-en-Y of total stomach excision, the weight and food intake were significantly lower compared with other two groups(P<0.05). At 24 weeks after operation, the levels of fasting blood glucose were (7.3 ± 1.5), (7.5 ± 2.0) and (8.3 ± 1.3) mmol/L, which were lower than the preoperative levels [(13.2 ± 1.6), (13.6 ± 2.5) and (12.9 ± 2.0) mmol/L, P<0.01] in the three groups. There were no significant differences among the three groups(P>0.05). At 24 weeks after operation, the HbA1c levels were(6.3 ± 1.3)%, (6.4 ± 2.0)% and (7.0 ± 1.3)%, which were lower than the preoperative level[(10.2 ± 2.6)%, (9.6 ± 2.5) and (9.9 ± 2.0)%, P<0.01]. There were no significant differences among the three groups(P>0.05). The trend of the glucose tolerance test and AUC were similar in the three groups after operation. Roux-en-Y gastric bypass in non-obese diabetic rats is effective in terms of glucose control and the efficacy of gastric bypass has no obvious association with the stomach volume.

Increased risk environment for emergency general surgery in the context of regionalization and specialization.

PubMed

Beecher, S; O'Leary, D P; McLaughlin, R

2015-09-01

The pressures on tertiary hospitals with increased volume and complexity related to regionalization and specialization has impacted upon availability of operating theatres with consequent displacement of emergencies to high risk out of hours settings. A retrospective review of an electronic emergency theatre list prospectively maintained database was performed over a two year period. Data gathered included type of operation performed, Time to Theatre (TTT), operation start time and length of stay (LOS). Of 7041 emergency operations 25% were performed out of hours. 2949 patient had general surgical emergency procedures with 910 (30%) performed out of hours. 53% of all emergency laparotomies and 54% of appendicectomies were out of hours. 57% of cases operated on out of hours had been awaiting surgery during the day. Mean TTT was shorter for those admitted at the weekend compared to those admitted during the week (15.6 vs 24.9 h) (p < 0.0001). The majority of major emergency surgery is performed out of hours in a way unfavorable to good clinical outcomes. It is of concern that more than half of the most life threating procedures involving laparotomy, take place out of hours. Regionalization needs to be accompanied by infrastructure planning to accommodate emergency surgery. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

Development of techniques for advanced optical contamination measurement with internal reflection spectroscopy, phase 1, volume 1

NASA Technical Reports Server (NTRS)

Hayes, J. D.

1972-01-01

The feasibility of monitoring volatile contaminants in a large space simulation chamber using techniques of internal reflection spectroscopy was demonstrated analytically and experimentally. The infrared spectral region was selected as the operational spectral range in order to provide unique identification of the contaminants along with sufficient sensitivity to detect trace contaminant concentrations. It was determined theoretically that a monolayer of the contaminants could be detected and identified using optimized experimental procedures. This ability was verified experimentally. Procedures were developed to correct the attenuated total reflectance spectra for thick sample distortion. However, by using two different element designs the need for such correction can be avoided.

National practice patterns for management of adult congenital heart disease: operation by pediatric heart surgeons decreases in-hospital death.

PubMed

Karamlou, Tara; Diggs, Brian S; Person, Thomas; Ungerleider, Ross M; Welke, Karl F

2008-12-02

Surgery for grown-up (age > or = 18 years) patients with congenital heart disease (GUCH) is frequently performed by surgeons without specialization in pediatric heart surgery. We sought to define national practice patterns and to determine whether outcomes for GUCH patients are improved if they are treated by specialized pediatric heart surgeons (PHSs) compared with non-PHSs. We identified index cardiac procedures in patients with 12 congenital heart disease diagnostic groups using the Nationwide Inpatient Sample 1988 to 2003. PHSs were defined as surgeons whose annual practice volumes were made of >75% annual pediatric heart cases. GUCH operations were defined as operations within these 12 diagnoses occurring in patients > or =18 years of age. We identified 30,250 operations, yielding a national estimate of 152,277 +/- 7,875 operations. Of these, 111,816 +/- 7,456 (73%) were pediatric operations, and 40,461 +/- 1,365 (27%) were GUCH operations. PHSs performed 68% of pediatric operations in all diagnostic groups, whereas non-PHSs performed 95% of GUCH operations within the same diagnostic groups (P<0.0001). In-hospital death rates for GUCH patients operated on by PHSs were lower than death rates for GUCH patients operated on by non-PHSs (1.87% [95% CI, 0.62 to 3.13] versus 4.84% [95% CI, 4.30 to 5.38%]; P<0.0001). Survival advantage increased with increasing surgeon annual pediatric volume (P=0.0031). Pediatric patients within specific diagnostic groups are more likely to undergo operation by PHSs, whereas GUCH patients within the same diagnostic groups are more likely to undergo operation by non-PHSs. In-hospital death rates are lower for GUCH patients operated on by PHSs. GUCH patients should be encouraged to obtain surgical operation by PHS.

Introduction to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infections.

PubMed

Solomkin, Joseph S; Mazuski, John; Blanchard, Joan C; Itani, Kamal M F; Ricks, Philip; Dellinger, E Patchen; Allen, George; Kelz, Rachel; Reinke, Caroline E; Berríos-Torres, Sandra I

Surgical site infection (SSI) is a common type of health-care-associated infection (HAI) and adds considerably to the individual, social, and economic costs of surgical treatment. This document serves to introduce the updated Guideline for the Prevention of SSI from the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). The Core section of the guideline addresses issues relevant to multiple surgical specialties and procedures. The second procedure-specific section focuses on a high-volume, high-burden procedure: Prosthetic joint arthroplasty. While many elements of the 1999 guideline remain current, others warrant updating to incorporate new knowledge and changes in the patient population, operative techniques, emerging pathogens, and guideline development methodology.

Optimizing efficiency and operations at a California safety-net endoscopy center: a modeling and simulation approach.

PubMed

Day, Lukejohn W; Belson, David; Dessouky, Maged; Hawkins, Caitlin; Hogan, Michael

2014-11-01

Improvements in endoscopy center efficiency are needed, but scant data are available. To identify opportunities to improve patient throughput while balancing resource use and patient wait times in a safety-net endoscopy center. Safety-net endoscopy center. Outpatients undergoing endoscopy. A time and motion study was performed and a discrete event simulation model constructed to evaluate multiple scenarios aimed at improving endoscopy center efficiency. Procedure volume and patient wait time. Data were collected on 278 patients. Time and motion study revealed that 53.8 procedures were performed per week, with patients spending 2.3 hours at the endoscopy center. By using discrete event simulation modeling, a number of proposed changes to the endoscopy center were assessed. Decreasing scheduled endoscopy appointment times from 60 to 45 minutes led to a 26.4% increase in the number of procedures performed per week, but also increased patient wait time. Increasing the number of endoscopists by 1 each half day resulted in increased procedure volume, but there was a concomitant increase in patient wait time and nurse utilization exceeding capacity. By combining several proposed scenarios together in the simulation model, the greatest improvement in performance metrics was created by moving patient endoscopy appointments from the afternoon to the morning. In this simulation at 45- and 40-minute appointment times, procedure volume increased by 30.5% and 52.0% and patient time spent in the endoscopy center decreased by 17.4% and 13.0%, respectively. The predictions of the simulation model were found to be accurate when compared with actual changes implemented in the endoscopy center. Findings may not be generalizable to non-safety-net endoscopy centers. The combination of minor, cost-effective changes such as reducing appointment times, minimizing and standardizing recovery time, and making small increases in preprocedure ancillary staff maximized endoscopy center efficiency across a number of performance metrics. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Economic analysis of the future growth of cosmetic surgery procedures.

PubMed

Liu, Tom S; Miller, Timothy A

2008-06-01

The economic growth of cosmetic surgical and nonsurgical procedures has been tremendous. Between 1992 and 2005, annual U.S. cosmetic surgery volume increased by 725 percent, with over $10 billion spent in 2005. It is unknown whether this growth will continue for the next decade and, if so, what impact it will it have on the plastic surgeon workforce. The authors analyzed annual U.S. cosmetic surgery procedure volume reported by the American Society of Plastic Surgeons (ASPS) National Clearinghouse of Plastic Surgery Statistics between 1992 and 2005. Reconstructive plastic surgery volume was not included in the analysis. The authors analyzed the ability of economic and noneconomic variables to predict annual cosmetic surgery volume. The authors also used growth rate analyses to construct models with which to predict the future growth of cosmetic surgery. None of the economic and noneconomic variables were a significant predictor of annual cosmetic surgery volume. Instead, based on current compound annual growth rates, the authors predict that total cosmetic surgery volume (surgical and nonsurgical) will exceed 55 million annual procedures by 2015. ASPS members are projected to perform 299 surgical and 2165 nonsurgical annual procedures. Non-ASPS members are projected to perform 39 surgical and 1448 nonsurgical annual procedures. If current growth rates continue into the next decade, the future demand in cosmetic surgery will be driven largely by nonsurgical procedures. The growth of surgical procedures will be met by ASPS members. However, meeting the projected growth in nonsurgical procedures could be a potential challenge and a potential area for increased competition.

Effect of fluid countermeasures of varying osmolarity on cardiovascular responses to orthostatic stress

NASA Technical Reports Server (NTRS)

Davis, John E.

1989-01-01

Current operational procedures for shuttle crewmembers include the ingestion of a fluid countermeasure approximately 2 hours before reentry into the earth's gravitational field. The ingestion of the fluid countermeasure is thought to restore plasma volume and improve orthostatic responses upon reentry. The present countermeasure consists of ingesting salt tablets and water to achieve an isotonic solution. It has yet to be determined whether this is the optimal drink to restore orthostatic tolerance. It is also not known whether the drink solution is effective in increasing plasma volume. The purpose here is to evaluate the effectiveness of drink solutions of different osmolarity on restoring plasma volume and orthostatic responses. A hypertonic drink solution was more effective in restoring plasma volume after dehydration than an isotonic solution. However, there were no differences in their effects on an orthostatic challenge. These data suggest that the plasma volume differences produced in this study were not sufficient to produce differences in the cardiovascular responses to an orthostatic challenge, or there are other changes that occur during space flight that are more important in determining orthostatic intolerance.

Learning by Doing, Scale Effects, or Neither? Cardiac Surgeons after Residency

PubMed Central

Huesch, Marco D

2009-01-01

Objective To examine impacts of operating surgeon scale and cumulative experience on postoperative outcomes for patients treated with coronary artery bypass grafts (CABG) by “new” surgeons. Pooled linear, fixed effects panel, and instrumented regressions were estimated. Data Sources The administrative data included comorbidities, procedures, and outcomes for 19,978 adult CABG patients in Florida in 1998–2006, and public data on 57 cardiac surgeons who completed residencies after 1997. Study Design Analysis was at the patient level. Controls for risk, hospital scale and scope, and operating surgeon characteristics were made. Patient choice model instruments were constructed. Experience was estimated allowing for “forgetting” effects. Principal Findings Panel regressions with surgeon fixed effects showed neither surgeon scale nor cumulative volumes significantly impacted mortality nor consistently impacted morbidity. Estimation of “forgetting” suggests that almost all prior experience is depreciated from one quarter to the next. Instruments were strong, but exogeneity of volume was not rejected. Conclusions In postresidency surgeons, no persuasive evidence is found for learning by doing, scale, or selection effects. More research is needed to support the cautious view that, for these “new” cardiac surgeons, patient volume could be redistributed based on realized outcomes without disruption. PMID:19732169

Training our Future Endocrine Surgeons: A Look at the Endocrine Surgery Operative Experience of U.S. Surgical Residents

PubMed Central

Zarebczan, Barbara; Rajamanickam, Victoria; Leverson, Glen; Chen, Herbert; Sippel, Rebecca S

2010-01-01

Background Over the last 10 years the number of endocrine procedures performed in the US has increased significantly. We sought to determine if this has translated into an increase in operative volume for general surgery and otolaryngology residents. Method We evaluated records from the Resident Statistic Summaries of the RRC for US general surgery and otolaryngology residents for the years 2004-2008, specifically examining data on thyroidectomies and parathyroidectomies. Results Between 2004 and 2008, the average endocrine case volume of US general surgery and otolaryngology residents increased by approximately 15%, but otolaryngology residents performed over twice as many operations as US general surgery residents. The growth in case volume was mostly due to increases in the number of thyroidectomies performed by US general surgery and otolaryngology residents (17.9 to 21.8, p=0.007 and 46.5 to 54.4, p=0.04). Overall, otolaryngology residents also performed more parathyroidectomies than their general surgery counterparts (11.6 vs. 8.8, p=0.007). Conclusion Although there has been an increase in the number of endocrine cases performed by graduating US general surgery residents, this is significantly smaller than that of otolaryngology residents. In order to remain competitive, general surgery residents wishing to practice endocrine surgery may need to pursue additional fellowship training. PMID:21134536

Training our future endocrine surgeons: a look at the endocrine surgery operative experience of U.S. surgical residents.

PubMed

Zarebczan, Barbara; McDonald, Robert; Rajamanickam, Victoria; Leverson, Glen; Chen, Herbert; Sippel, Rebecca S

2010-12-01

During the last 10 years, the number of endocrine procedures performed in the United States has increased significantly. We sought to determine whether this has translated into an increase in operative volume for general surgery and otolaryngology residents. We evaluated records from the Resident Statistic Summaries of the Residency Review Committee (RRC) for U.S. general surgery and otolaryngology residents for the years 2004-2008, specifically examining data on thyroidectomies and parathyroidectomies. Between 2004 and 2008, the average endocrine case volume of U.S. general surgery and otolaryngology residents increased by approximately 15%, but otolaryngology residents performed more than twice as many operations as U.S. general surgery residents. The growth in case volume was mostly from increases in the number of thyroidectomies performed by U.S. general surgery and otolaryngology residents (17.9 to 21.8, P = .007 and 46.5 to 54.4, P = .04). Overall, otolaryngology residents also performed more parathyroidectomies than their general surgery counterparts (11.6 vs 8.8, P = .007). Although there has been an increase in the number of endocrine cases performed by graduating U.S. general surgery residents, this is significantly smaller than that of otolaryngology residents. To remain competitive, general surgery residents wishing to practice endocrine surgery may need to pursue additional fellowship training. Copyright © 2010 Mosby, Inc. All rights reserved.

Composite Failure Analysis Handbook. Volume 2: Technical Handbook. Part 1 - Procedures and Techniques

DTIC Science & Technology

1992-02-01

If abrasive cutting equipment is not available or coolant contamination is a concern, hand operated toothed blades or saws such as hack or coping saws...325 F) CE-345 7781 387 9.0 (15 PSI/250 F) CE-aSS 7781 35.1 8.1 (15 PS1/250 F) CE-339 120 A9.4 19.3 (15 PS4 /250 F) CE-324 7781 37 * 3 10.__5 I10 MIN/15

Benchmarking surgical incident reports using a database and a triage system to reduce adverse outcomes.

PubMed

Antonacci, Anthony C; Lam, Steven; Lavarias, Valentina; Homel, Peter; Eavey, Roland D

2008-12-01

To study the profile of incidents affecting quality outcomes after surgery by developing a usable operating room and perioperative clinical incident report database and a functional electronic classification, triage, and reporting system. Previously, incident reports after surgery were handled on an individual, episodic basis, which limited the ability to perceive actuarial patterns and meaningfully improve outcomes. Clinical incident reports were experientially generated in the second largest health care system in New York City. Data were entered into a functional classification system organized into 16 categories, and weekly triage meetings were held to electronically review and report summaries on 40 to 60 incident reports per week. System development and deployment reviewed 1041 reports after 19,693 operative procedures. During the next 4 years, 3819 additional reports were generated from 83,988 operative procedures and were reported electronically to the appropriate departments. Number of incident reports generated annually. A significant decrease in volume-adjusted clinical incident reports occurred (from 53 to 39 reports per 1000 procedures) from 2001 to 2005 (P < .001). Reductions in incident reports were observed for ambulatory conversions (74% reduction), wasted implants (65%), skin breakdown (64%), complications in the operating room (42%), laparoscopic conversions (32%), and cancellations (23%) as a result of data-focused process and clinical interventions. Six of 16 categories of incident reports accounted for more than 88% of all incident reports. These data suggest that effective review, communication, and summary feedback of clinical incident reports can produce a statistically significant decrease in adverse outcomes.

Minimally invasive evacuation of intraventricular hemorrhage with the Apollo vibration/suction device.

PubMed

Tan, Lee A; Lopes, Demetrius K; Munoz, Lorenzo F; Shah, Yojan; Bhabad, Sudeep; Jhaveri, Miral; Moftakhar, Roham

2016-05-01

Intraventricular hemorrhages (IVH) can occur as a consequence of spontaneous intracerebral hemorrhage, aneurysm rupture, arteriovenous malformation hemorrhage, trauma, or coagulopathy. IVH is a known risk factor for poor clinical outcome with up to 80% mortality. The current standard treatment strategy for IVH consists of the placement of an external ventricular drain. We report our early experience with using the Apollo suction/vibration aspiration system (Penumbra, Alameda, CA, USA) for minimally invasive evacuation of IVH with a review of the pertinent literature. Medical records of patients with IVH who were admitted to Rush University Medical Center, USA, from July to November 2014 were queried from the electronic database. Patients with Graeb Scores (GS) >6 were selected for minimally invasive IVH evacuation with the Apollo aspiration system. Patient demographics, pre- and post-operative GS, pre- and post-operative modified Graeb Score (mGS), as well procedure related complications were analyzed and recorded. A total of eight patients (five men) were identified during the study period. The average age was 55.5years. The mean GS was 9.6 pre-operatively and decreased to 4.9 post-operatively (p=0.0002). The mean mGS was 22.9 pre-operatively and decreased to 11.4 post-operatively (p=0.0001). Most of the IVH reduction occurred in the frontal horn and atrium of the lateral ventricle, as well the third ventricle. One (1/8) procedure-related complication occurred consisted of a tract hemorrhage. The Apollo system can be used for minimally invasive IVH evacuation to achieve significant blood clot volume reduction with minimal procedure-related complication. Copyright © 2016. Published by Elsevier Ltd.

In-hospital mortality for children with hypoplastic left heart syndrome after stage I surgical palliation: teaching versus nonteaching hospitals.

PubMed

Berry, Jay G; Cowley, Collin G; Hoff, Charles J; Srivastava, Rajendu

2006-04-01

Teaching hospitals are perceived to provide a higher quality of care for the treatment of rare disease and complex patients. A substantial proportion of stage I palliation for hypoplastic left heart syndrome (HLHS) may be performed in nonteaching hospitals. This study compares the in-hospital mortality of stage I palliation between teaching and nonteaching hospitals. The authors conducted a retrospective cohort study using the Kids' Inpatient Database 1997 and 2000. Patients with HLHS undergoing stage I palliation were identified using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. Seven hundred fifty-four and 880 discharges of children with HLHS undergoing stage I palliation in 1997 and 2000, respectively, were identified. The in-hospital mortality for the study population was 28% in 1997 and 24% in 2000. Twenty percent of stage I palliation operations were performed in nonteaching hospitals in 1997. Two percent of operations were performed in nonteaching hospitals in 2000. In 1997 only, in-hospital mortality remained higher in nonteaching hospitals after controlling for stage I palliation hospital volume and condition-severity diagnoses. Low-volume hospitals performing stage I palliation were associated with increased in-hospital mortality in 1997 and 2000. Patients with HLHS undergoing stage I palliation in nonteaching hospitals experienced increased in-hospital mortality in 1997. A significant reduction in the number of stage I palliation procedures performed in nonteaching hospitals occurred between 1997 and 2000. This centralization of stage I palliation into teaching hospitals, along with advances in postoperative medical and surgical care for these children, was associated with a decrease in mortality. Patients in low-volume hospitals performing stage I palliation continued to experience increased mortality in 2000.

Evaluation of mitigation measures to reduce hydropeaking impacts on river ecosystems - a case study from the Swiss Alps.

PubMed

Tonolla, Diego; Bruder, Andreas; Schweizer, Steffen

2017-01-01

New Swiss legislation obligates hydropower plant owners to reduce detrimental impacts on rivers ecosystems caused by hydropeaking. We used a case study in the Swiss Alps (hydropower company Kraftwerke Oberhasli AG) to develop an efficient and successful procedure for the ecological evaluation of such impacts, and to predict the effects of possible mitigation measures. We evaluated the following scenarios using 12 biotic and abiotic indicators: the pre-mitigation scenario (i.e. current state), the future scenario with increased turbine capacity but without mitigation measures, and future scenarios with increased turbine capacity and four alternative mitigation measures. The evaluation was based on representative hydrographs and quantitative or qualitative prediction of the indicators. Despite uncertainties in the ecological responses and the future operation mode of the hydropower plant, the procedure allowed the most appropriate mitigation measure to be identified. This measure combines a basin and a cavern at a total retention volume of 80,000m 3 , allowing for substantial dampening in the flow falling and ramping rates and in turn considerable reduction in stranding risk for juvenile trout and in macroinvertebrate drift. In general, this retention volume had the greatest predicted ecological benefit and can also, to some extent, compensate for possible modifications in the hydropower operation regime in the future, e.g. due to climate change, changes in the energy market, and changes in river morphology. Furthermore, it also allows for more specific seasonal regulations of retention volume during ecologically sensitive periods (e.g. fish spawning seasons). Overall experience gained from our case study is expected to support other hydropeaking mitigation projects. Copyright © 2016 Elsevier B.V. All rights reserved.

Evaluation of potential severe accidents during low power and shutdown operations at Surry, Unit 1: Analysis of core damage frequency from internal events during mid-loop operations, Appendices E (Sections E.1--E.8). Volume 2, Part 3A

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

Chu, T.L.; Musicki, Z.; Kohut, P.

1994-06-01

During 1989, the Nuclear Regulatory Commission (NRC) initiated an extensive program to carefully examine the potential risks during low power and shutdown operations. The program includes two parallel projects being performed by Brookhaven National Laboratory (BNL) and Sandia National Laboratories (SNL). Two plants, Surry (pressurized water reactor) and Grand Gulf (boiling water reactor), were selected as the plants to be studied. The objectives of the program are to assess the risks of severe accidents initiated during plant operational states other than full power operation and to compare the estimated core damage frequencies, important accident sequences and other qualitative and quantitativemore » results with those accidents initiated during full power operation as assessed in NUREG-1150. The objective of this report is to document the approach utilized in the Surry plant and discuss the results obtained. A parallel report for the Grand Gulf plant is prepared by SNL. This study shows that the core-damage frequency during mid-loop operation at the Surry plant is comparable to that of power operation. The authors recognize that there is very large uncertainty in the human error probabilities in this study. This study identified that only a few procedures are available for mitigating accidents that may occur during shutdown. Procedures written specifically for shutdown accidents would be useful.« less

Hospital volume and the risk of revision in Oxford unicompartmental knee arthroplasty in the Nordic countries -an observational study of 14,496 cases.

PubMed

Badawy, Mona; Fenstad, Anne M; Bartz-Johannessen, Christoffer A; Indrekvam, Kari; Havelin, Leif I; Robertsson, Otto; W-Dahl, Annette; Eskelinen, Antti; Mäkelä, Keijo; Pedersen, Alma B; Schrøder, Henrik M; Furnes, Ove

2017-09-07

High procedure volume and dedication to unicompartmental knee arthroplasty (UKA) has been suggested to improve revision rates. This study aimed to quantify the annual hospital volume effect on revision risk in Oxfordu nicompartmental knee arthroplasty in the Nordic countries. 14,496 cases of cemented medial Oxford III UKA were identified in 126 hospitals in the four countries included in the Nordic Arthroplasty Register Association (NARA) database from 2000 to 2012. Hospitals were divided by quartiles into 4 annual procedure volume groups (≤11, 12-23, 24-43 and ≥44). The outcome was revision risk after 2 and 10 years calculated using Kaplan Meier method. Multivariate Cox regression analysis was used to assess the Hazard Ratio (HR) of any revision due to specific reasons with 95% confidence intervals (CI). The implant survival was 80% at 10 years in the volume group ≤11 procedures per year compared to 83% in other volume groups. The HR adjusted for age category, sex, year of surgery and nation was 0.87 (95% CI: 0.76-0.99, p = 0.036) for the group 12-23 procedures per year, 0.78 (95% CI: 0.68-0.91, p = 0.002) for the group 24-43 procedures per year and 0.82 (95% CI: 0.70-0.94, p = 0.006) for the group ≥44 procedures per year compared to the low volume group. Log-rank test was p = 0.003. The risk of revision for unexplained pain was 40-50% higher in the low compared with other volume groups. Low volume hospitals performing ≤11 Oxford III UKAs per year were associated with an increased risk of revision compared to higher volume hospitals, and unexplained pain as revision cause was more common in low volume hospitals.

Development of an improved overlay procedure for Oregon : volume III, field manual.

DOT National Transportation Integrated Search

1987-12-01

This report is the third in a three-volume series dealing with the development of an improved overlay design procedure for Oregon. This report presents technical guidelines for using the proposed overlay design procedure. Four areas are described, in...

Ethical considerations of transparency, informed consent, and nudging in a patient with paediatric aortic stenosis and symptomatic left ventricular endocardial fibroelastosis.

PubMed

Mavroudis, Constantine D; Cook, Thomas; Jacobs, Jeffrey P; Mavroudis, Constantine

2016-12-01

A 9-year-old boy who was born with bicuspid aortic stenosis underwent two unsuccessful aortic valvuloplasty interventions, and by 2 years of age he developed restrictive cardiomyopathy caused by left ventricular endocardial fibroelastosis and diastolic dysfunction. The attending cardiologist referred the patient to a high-volume, high-profile congenital cardiac surgical programme 1000 miles away that has a team with considerable experience with left ventricular endocardial fibroelastosis resection and a reputation of achieving good results. Owing to problems with insurance coverage, the parents sought other options for the care of their child in their home state. Dr George Miller is a well-respected local congenital and paediatric cardiac surgeon with considerable experience with the Ross operation as well as with right ventricular endocardial fibroelastosis resection. When talking with Dr Miller, he implied that there is little difference between right ventricular endocardial fibroelastosis and left ventricular endocardial fibroelastosis resection, and stated that he would perform the operation with low mortality based on his overall experience. Dr Miller stated that the local institution could provide an equivalent surgical procedure with comparable outcomes, without the patient and family having to travel out of state. A fundamental dilemma that often arises in clinical surgical practice concerns the conduct of assessing and performing new procedures, especially in rare cases, for which the collective global experience is scant. Although Dr Miller has performed right ventricular endocardial fibroelastosis resection, this procedure differs from left ventricular endocardial fibroelastosis resection, and he cannot be sure that he will indeed be able to perform the procedure better than the high-volume surgeon. This ethical situation is best understood in terms of the principles of respect for patient autonomy, beneficence, non-maleficence, and justice. The tension between the imperatives of beneficence and the obligation to respect the autonomy of the patient by acting only with the patient's best interest in mind is discussed.

Radiology operations: what you don't know could be costing you millions.

PubMed

Joffe, Sam; Drew, Donna; Bansal, Manju; Hase, Michael

2007-01-01

Rapid growth in advanced imaging procedures has left hospital radiology departments struggling to keep up with demand, resulting in loss of patients to facilities that can offer service more quickly. While the departments appear to be working at full capacity, an operational analysis of over 400 hospital radiology departments in the US by GE Healthcare has determined that, paradoxically, many departments are in fact underutilized and operating for below their potential capacity. While CT cycle time in hospitals that were studied averaged 35 minutes, top performing hospitals operated the same equipment at a cycle time of 15 minutes, yielding approximately double the throughput volume. Factors leading to suboptimal performance include accounting metrics that mask true performance, leadership focus on capital investment rather than operations, under staffing, under scheduling, poorly aligned incentives, a fragmented view of operations, lack of awareness of latent opportunities, and lack of sufficient skills and processes to implement improvements. The study showed how modest investments in radiology operations can dramatically improve access to services and profitability.

Epidemiology of Operative Procedures in an NCAA Division I Football Team Over 10 Seasons

PubMed Central

Mehran, Nima; Photopoulos, Christos D.; Narvy, Steven J.; Romano, Russ; Gamradt, Seth C.; Tibone, James E.

2016-01-01

Background: Injury rates are high for collegiate football players. Few studies have evaluated the epidemiology of surgical procedures in National Collegiate Athletic Association (NCAA) Division I collegiate football players. Purpose: To determine the most common surgical procedures performed in collegiate football players over a 10-year period. Study Design: Descriptive epidemiological study. Methods: From the 2004-2005 season through the 2013-2014 season, all surgical procedures performed on athletes from a single NCAA Division I college football team during athletic participation were reviewed. Surgeries were categorized by anatomic location, and operative reports were used to obtain further surgical details. Data collected over this 10-season span included type of injury, primary procedures, reoperations, and cause of reoperation, all categorized by specific anatomic locations and position played. Results: From the 2004-2005 through the 2013-2014 seasons, 254 operations were performed on 207 players, averaging 25.4 surgical procedures per year. The majority of surgeries performed were orthopaedic procedures (92.1%, n = 234). However, there were multiple nonorthopaedic procedures (7.9%, n = 20). The most common procedure performed was arthroscopic shoulder labral repair (12.2%, n = 31). Partial meniscectomy (11.8%, n = 30), arthroscopic anterior cruciate ligament (ACL) reconstruction (9.4% n = 24), and arthroscopic hip labral repair (5.9% n = 15) were the other commonly performed procedures. There were a total of 29 reoperations performed; thus, 12.9% of primary procedures had a reoperation. The most common revision procedure was a revision open reduction internal fixation of stress fractures in the foot as a result of a symptomatic nonunion (33.33%, n = 4) and revision ACL reconstruction (12.5%, n = 3). By position, relative to the number of athletes at each position, linebackers (30.5%) and defensive linemen (29.1%) were the most likely to undergo surgery while kickers (6%) were the least likely. Conclusion: In NCAA Division I college football players, the most commonly performed surgeries conducted for injuries were orthopaedic in nature. Of these, arthroscopic shoulder labral repair was the most common, followed closely by partial meniscectomy. Nonorthopaedic procedures nonetheless accounted for a sizable portion of surgical volume. Familiarity with this injury and surgical spectrum is of utmost importance for the team physician treating these high-level contact athletes. PMID:27504464

Atrial Fibrillation Radiofrequency Ablation: Safety Using Contact Force Catheter In A Low-Volume Centre.

PubMed

Vaccari Md, Diego; Giacopelli MSc, Daniele; Rocchetto MSc, Eros; Vittadello Md, Sabina; Mantovan Md, Roberto; Neri Md, Gianfilippo

2014-01-01

The tip-to-tissue contact force (CF) has been identified as a potential determinant of lesion quality during radiofrequency (RF) ablation. The aim of this paper is to report the experience of a single low-volume centre in the atrial fibrillation (AF) ablation procedure with an RF catheter capable of measuring this parameter. CF data and their possible implications on patient safety are presented. Thirty-nine consecutive patients suffering of paroxysmal or permanent AF received percutaneous ablation with the novel catheter studied. Procedural characteristics, CF applied and safety events related to the procedure were reported. During RF application the mean CF value was 17 ± 3 g, with a maximum mean value of 37 ± 8 g. CF value never exceeded 62 g and in the 74% of the RF applications ranged between 10 g and 30 g. No complication related to the catheter manipulation or to the energy delivered was observed. This study of a single centre with a low level of experience in AF ablation suggests that the ability to measure CF may provide additional useful information to the operator. It ensures uniform ablations, with little variability in the catheter manipulations, and it avoids excessive contact forces increasing the patient safety.

[Study on the peritoneal dissemination of endometrial cells during hysteroscopy].

PubMed

Duan, Hua; Li, Wei; Zhang, Ying; Zhao, Xia; Xia, En-Lan

2007-02-01

To study prospectively the likelihood and the affecting factors of endometrial cell dissemination into the peritoneal cavity during hysteroscopic procedures. A total of 121 patients with benign endometrial pathology underwent hysteroscopy combined with laparoscopy. All the patients had pelvic washings performed just before and after the procedure of hysteroscopy. We collected the peritoneal washings and analyzed the peritoneal cytology changes in both groups pre- and post-hysteroscopy, as well as the dissemination rate related to the time of hysteroscopy, the intrauterine distention pressure, the volume of distention media, and the feature of endometrial conditions. The ratio of positive endometrial cells in the peritoneal washings of post-hysteroscopy group was 51.2% (62/121), which was significantly higher than pre-hysteroscopy group, 38.0% (46/121) (P < 0.01). The mean operation time in the group of positive peritoneal cytology was (38 +/- 16) min, longer than the negative group (P < 0.05). However, there was no significant difference between the two groups with regard to the total volume of distention media, the distention pressure, and the endometrial feature (P > 0.05). Hysteroscopic procedures may have a risk of disseminating the endometrial cells into peritoneal cavity. Under a certain uterine distention pressure, the rate of dissemination is correlated with hysteroscopic duration.

Improved environmental impact with diversion of perfusion bypass circuit to municipal solid waste.

PubMed

Debois, William; Prata, Jessica; Elmer, Barbara; Liu, Junli; Fominyam, Edward; Salemi, Arash

2013-06-01

The project goal was to reduce waste disposal volume, costs and minimize the negative impact that regulated waste treatment and disposal has on the environment. This was accomplished by diverting bypass circuits from the traditional regulated medical waste (RMW) to clear bag waste, or municipal solid waste (MSW). To qualify circuits to be disposed of through MSW stream, the circuits needed to be void of any free-flowing blood and be "responsibly clear." Traditionally the perfusion bypass circuit was emptied through the cardioplegia pump starting shortly after decannulation and heparin reversal. Up to 2000 mL of additional prime solution was added until the bypass circuit was rinsed clear. Three hundred sixty of 400 procedures (90%) had a complete circuit rinse and successful diversion to MSW. An additional 240 mL of processed cell salvage blood was available for transfusion. No additional time was spent in the operating room as a result of this procedure. Based on our procedure case volume and circuit weight of 15 pounds, almost 15,000 pounds (7.5 tons) of trash will be diverted from RMW. This technique represents another way for perfusionists to participate in sustainability efforts. Diverting the bypass circuit to clear bag waste results in a reduced environmental impact and annual cost savings. The treatment of RMW is associated with various environmental implications. MSW, or clear bag waste, on the other hand can now be disposed of in waste-to-energy facilities. This process not only releases a significantly less amount of carbon dioxide into the environment, but also helps generate renewable energy. Therefore, the bypass circuit diversion pilot project effectively demonstrates decreases in the carbon footprint of our organization and overall operating costs.

Optimized Standard Operating Procedures for the Analysis of Cerebrospinal Fluid Aβ42 and the Ratios of Aβ Isoforms Using Low Protein Binding Tubes.

PubMed

Vanderstichele, Hugo Marcel Johan; Janelidze, Shorena; Demeyer, Leentje; Coart, Els; Stoops, Erik; Herbst, Victor; Mauroo, Kimberley; Brix, Britta; Hansson, Oskar

2016-05-31

Reduced cerebrospinal fluid (CSF) concentration of amyloid-β1-42 (Aβ1-42) reflects the presence of amyloidopathy in brains of subjects with Alzheimer's disease (AD). To qualify the use of Aβ1-42/Aβ1-40 for improvement of standard operating procedures (SOP) for measurement of CSF Aβ with a focus on CSF collection, storage, and analysis. Euroimmun ELISAs for CSF Aβ isoforms were used to set up a SOP with respect to recipient properties (low binding, polypropylene), volume of tubes, freeze/thaw cycles, addition of detergents (Triton X-100, Tween-20) in collection or storage tubes or during CSF analysis. Data were analyzed with linear repeated measures and mixed effects models. Optimization of CSF analysis included a pre-wash of recipients (e.g., tubes, 96-well plates) before sample analysis. Using the Aβ1-42/Aβ1-40 ratio, in contrast to Aβ1-42, eliminated effects of tube type, additional freeze/thaw cycles, or effect of CSF volumes for polypropylene storage tubes. 'Low binding' tubes reduced the loss of Aβ when aliquoting CSF or in function of additional freeze/thaw cycles. Addition of detergent in CSF collection tubes resulted in an almost complete absence of variation in function of collection procedures, but affected the concentration of Aβ isoforms in the immunoassay. The ratio of Aβ1-42/Aβ1-40 is a more robust biomarker than Aβ1-42 toward (pre-) analytical interfering factors. Further, 'low binding' recipients and addition of detergent in collection tubes are able to remove effects of SOP-related confounding factors. Integration of the Aβ1-42/Aβ1-40 ratio and 'low-binding tubes' into guidance criteria may speed up worldwide standardization of CSF biomarker analysis.

Space station data system analysis/architecture study. Task 3: Trade studies, DR-5, volume 1

NASA Technical Reports Server (NTRS)

1985-01-01

The primary objective of Task 3 is to provide additional analysis and insight necessary to support key design/programmatic decision for options quantification and selection for system definition. This includes: (1) the identification of key trade study topics; (2) the definition of a trade study procedure for each topic (issues to be resolved, key inputs, criteria/weighting, methodology); (3) conduct tradeoff and sensitivity analysis; and (4) the review/verification of results within the context of evolving system design and definition. The trade study topics addressed in this volume include space autonomy and function automation, software transportability, system network topology, communications standardization, onboard local area networking, distributed operating system, software configuration management, and the software development environment facility.

The cost of obesity for nonbariatric inpatient operative procedures in the United States: national cost estimates obese versus nonobese patients.

PubMed

Mason, Rodney J; Moroney, Jolene R; Berne, Thomas V

2013-10-01

To evaluate the economic impact of obesity on hospital costs associated with the commonest nonbariatric, nonobstetrical surgical procedures. Health care costs and obesity are both rising. Nonsurgical costs associated with obesity are well documented but surgical costs are not. National cost estimates were calculated from the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database, 2005-2009, for the highest volume nonbariatric nonobstetric procedures. Obesity was identified from the HCUP-NIS severity data file comorbidity index. Costs for obese patients were compared with those for nonobese patients. To control for medical complexity, each obese patient was matched one-to-one with a nonobese patient using age, sex, race, and 28 comorbid defined elements. Of 2,309,699 procedures, 439,8129 (19%) were successfully matched into 2 medically equal groups (obese vs nonobese). Adjusted total hospital costs incurred by obese patients were 3.7% higher with a significantly (P < 0.0001) higher per capita cost of $648 (95% confidence interval [CI]: $556-$736) compared with nonobese patients. Of the 2 major components of hospital costs, length of stay was significantly increased in obese patients (mean difference = 0.0253 days, 95% CI: 0.0225-0.0282) and resource utilization determined by costs per day were greater in obese patients due to an increased number of diagnostic and therapeutic procedures needed postoperatively (odds ratio [OR] = 0.94, 95% CI: 0.93-0.96). Postoperative complications were equivalent in both groups (OR = 0.97, 95% CI: 0.93-1.02). Annual national hospital expenditures for the largest volume surgical procedures is an estimated $160 million higher in obese than in a comparative group of nonobese patients.

Determination of the thermal stability of fluids by tensimetry - Instrumentation and procedure

NASA Technical Reports Server (NTRS)

Helmick, Larry S.; Jones, William R., Jr.

1990-01-01

A computerized tensimeter and experimental procedure for determination of the thermal decomposition temperature (T sub d) of perfluoro alkylethers were developed and tested. Both the apparatus and the procedure are described in detail. Results of testing with bis(2-ethylhexyl) phthalate and trimethylolpropane triheptanoate demonstrate that the reciprocal of the decomposition temperature is a linear function of the logarithm of the gas volume/heated liquid volume ratio. The T sub d obtained for each compound at a gas volume/heated liquid volume ration of one was similar to the value previously reported using an isoteniscope technique. Results of testing with a polymer of hexafluoropropylene oxide demonstrate that this instrument and procedure can be used to determine the T sub d of perfluoro alkylethers.

Determination of the thermal stability of perfluoroalkylethers by tensimetry: Instrumentation and Procedure

NASA Technical Reports Server (NTRS)

Helmick, Larry S.; Jones, William R., Jr.

1989-01-01

A computerized tensimeter and experimental procedure for determination of the thermal decomposition temperature (T sub d) of perfluoro alkylethers were developed and tested. Both the apparatus and the procedure are described in detail. Results of testing with bis(2-ethylhexyl) phthalate and trimethylolpropane triheptanoate demonstrate that the reciprocal of the decomposition temperature is a linear function of the logarithm of the gas volume/heated liquid volume ratio. The T sub d obtained for each compound at a gas volume/heated liquid volume ration of one was similar to the value previously reported using an isoteniscope technique. Results of testing with a polymer of hexafluoropropylene oxide demonstrate that this instrument and procedure can be used to determine the T sub d of perfluoroalkylethers.

Simulated procedure rehearsal is more effective than a preoperative generic warm-up for endovascular procedures.

PubMed

Willaert, Willem I M; Aggarwal, Rajesh; Daruwalla, Farhad; Van Herzeele, Isabelle; Darzi, Ara W; Vermassen, Frank E; Cheshire, Nicholas J

2012-06-01

Patient-specific simulated rehearsal (PsR) of a carotid artery stenting procedure (CAS) enables the interventionalist to rehearse the case before performing the procedure on the actual patient by incorporating patient-specific computed tomographic data into the simulation software. This study aimed to evaluate whether PsR of a CAS procedure can enhance the operative performance versus a virtual reality (VR) generic CAS warm-up procedure or no preparation at all. During a 10-session cognitive/technical VR course, medical residents were trained in CAS. Thereafter, in a randomized crossover study, each participant performed a patient-specific CAS case 3 times on the simulator, preceded by 3 different tasks: a PsR, a generic case, or no preparation. Technical performances were assessed using simulator-based metrics and expert-based ratings. Twenty medical residents (surgery, cardiology, radiology) were recruited. Training plateaus were observed after 10 sessions for all participants. Performances were significantly better after PsR than after a generic warm-up or no warm-up for total procedure time (16.3 ± 0.6 vs 19.7 ± 1.0 vs 20.9 ± 1.1 minutes, P = 0.001) and fluoroscopy time (9.3 ± 0.1 vs 11.2 ± 0.6 vs 11.2 ± 0.5 minutes, P = 0.022) but did not influence contrast volume or number of roadmaps used during the "real" case. PsR significantly improved the quality of performance as measured by the expert-based ratings (scores 28 vs 25 vs 25, P = 0.020). Patient-specific simulated rehearsal of a CAS procedure significantly improves operative performance, compared to a generic VR warm-up or no warm-up. This technology requires further investigation with respect to improved outcomes on patients in the clinical setting.

US Fish and Wildlife Service lands biomonitoring operations manual

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

Rope, R.C.; Breckenridge, R.P.

1993-08-01

This is Volume 1 of an operations manual designed to facilitate the development of biomonitoring strategies for U.S. Fish and Wildlife Service Lands. It is one component of the U.S. Fish and Wildlife Service Lands Biomonitoring Operations Manual. The Volume contains the Introduction to the Manual, background information on monitoring, and procedures for developing a biomonitoring strategy for Service lands. The purpose of the Biomonitoring Operations Manual is to provide an approach to develop and implement biomonitoring activities to assess the status and trends of U.S. Fish and Wildlife Service trust resources. It also provides field sampline methods and documentationmore » protocols for contaminant monitoring activities. The strategy described in the Manual has been designed as a stand alone process to characterize the presence of contaminants on lands managed by the Service. This process can be sued to develop a monitoring program for any tract of real estate with potential threats from on- or off-site contaminants. Because the process was designed to address concerns for Service lands that span the United States from Alaska to the Tropical Islands, it has a generic format that can be used in al types of ecosystems, however, significant site specific informtion is required to complete the Workbook and make the process work successfully.« less

Logistics of building a laser practice for the treatment of hypertrophic burn scars.

PubMed

Hultman, Charles Scott; Edkins, Renee E; Cairns, Bruce A; Meyer, Anthony A

2013-05-01

Although lasers can improve burn scars, such treatment has not been adopted universally, due to operational challenges starting a practice and the perception that such a program is not financially viable. We report the logistics of building a laser practice for the treatment of hypertrophic burn scars. We analyzed the clinical, operational, and financial components of our laser practice, focusing on treatment of hypertrophic burn scars, using pulsed dye laser, fractional CO2 laser, and intense pulsed light. Cases were performed in an operating room, with anesthesia, after preauthorization. We examined professional charges and collections, case time, variable and indirect expenses, and breakeven volumes. Our practice grew as follows: 2008, 1 case; 2009, 44 cases; 2010, 169 cases; and 2011, 415 cases. Overall collection rate was 32.1%. Expenses incurred by the provider, per 8-hour session, included laser rental/lease ($2375), personnel salaries ($1900), and physician overhead ($808), for a total cost of $5083. Mean charge was $1642 per case; mean collection was $527 per case. Median case time (procedure plus turnover) was 40 minutes. In this model, breakeven volume is 9.7 cases per day; breakeven time is 49.7 minutes. Provider profit margin for 10 cases per day, or 83% capacity utilization, is $187 per day (income - expenses = $5270 - $5083). Despite high costs associated with starting and operating a laser practice for the treatment of hypertrophic burn scars, a sustainable enterprise can be achieved when the provider has accrued enough volume to batch cases over an entire day. Critical to achieving breakeven is preauthorization, controlling overhead, and efficient throughput.

3D tumor measurement in cone-beam CT breast imaging

NASA Astrophysics Data System (ADS)

Chen, Zikuan; Ning, Ruola

2004-05-01

Cone-beam CT breast imaging provides a digital volume representation of a breast. With a digital breast volume, the immediate task is to extract the breast tissue information, especially for suspicious tumors, preferably in an automatic manner or with minimal user interaction. This paper reports a program for three-dimensional breast tissue analysis. It consists of volumetric segmentation (by globally thresholding), subsegmentation (connection-based separation), and volumetric component measurement (volume, surface, shape, and other geometrical specifications). A combination scheme of multi-thresholding and binary volume morphology is proposed to fast determine the surface gradients, which may be interpreted as the surface evolution (outward growth or inward shrinkage) for a tumor volume. This scheme is also used to optimize the volumetric segmentation. With a binary volume, we decompose the foreground into components according to spatial connectedness. Since this decomposition procedure is performed after volumetric segmentation, it is called subsegmentation. The subsegmentation brings the convenience for component visualization and measurement, in the whole support space, without interference from others. Upon the tumor component identification, we measure the following specifications: volume, surface area, roundness, elongation, aspect, star-shapedness, and location (centroid). A 3D morphological operation is used to extract the cluster shell and, by delineating the corresponding volume from the grayscale volume, to measure the shell stiffness. This 3D tissue measurement is demonstrated with a tumor-borne breast specimen (a surgical part).

US Fish and Wildlife Service biomonitoring operations manual, Appendices A--K

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

Gianotto, D.F.; Rope, R.C.; Mondecar, M.

1993-04-01

Volume 2 contains Appendices and Summary Sheets for the following areas: A-Legislative Background and Key to Relevant Legislation, B- Biomonitoring Operations Workbook, C-Air Monitoring, D-Introduction to the Flora and Fauna for Biomonitoring, E-Decontamination Guidance Reference Field Methods, F-Documentation Guidance, Sample Handling, and Quality Assurance/Quality Control Standard Operating Procedures, G-Field Instrument Measurements Reference Field Methods, H-Ground Water Sampling Reference Field Methods, I-Sediment Sampling Reference Field Methods, J-Soil Sampling Reference Field Methods, K-Surface Water Reference Field Methods. Appendix B explains how to set up strategy to enter information on the ``disk workbook``. Appendix B is enhanced by DE97006389, an on-line workbook formore » users to be able to make revisions to their own biomonitoring data.« less

Variability of Arthroscopy Case Volume in Orthopaedic Surgery Residency.

PubMed

Gil, Joseph A; Waryasz, Gregory R; Owens, Brett D; Daniels, Alan H

2016-05-01

To examine orthopaedic surgery case logs for arthroscopy case volume during residency training and to evaluate trends in case volume and variability over time. Publicly available Accreditation Council for Graduate Medical Education surgical case logs from 2007 to 2013 for orthopaedic surgery residency were assessed for variability and case volume trends in shoulder, elbow, wrist, hip, knee, and ankle arthroscopy. The national average number of procedures performed in each arthroscopy category reported was directly compared from 2009 to 2013. The 10th and 90th percentile arthroscopy case volume was compared between 2007 and 2013 for shoulder and knee arthroscopy procedures. Subsequently, the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2007 was compared with the difference between the 10th and 90th percentile arthroscopy case volume in each category in 2013. From 2007 to 2013, shoulder arthroscopy procedures performed per resident increased by 43.1% (P = .0001); elbow arthroscopy procedures increased by 28.0% (P = .00612); wrist arthroscopy procedures increased by 8.6% (P = .05); hip arthroscopy procedures, which were first reported in 2012, increased by 588.9%; knee arthroscopy procedures increased by 8.5% (P = .0435); ankle arthroscopy increased by 27.6% (P = .00149). The difference in knee and shoulder arthroscopy volume between residents in the 10th and 90th percentile in 2007 and residents in the 10th and 90th percentile in 2013 was not significant (P > .05). There was a 3.66-fold difference in knee arthroscopy volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 3.36-fold in 2013 (P = .70). There was a 5.86-fold difference in shoulder arthroscopy case volume between residents in the 10th and 90th percentile in 2007, whereas the difference was 4.96-fold in 2013 (P = .29). The volume of arthroscopy cases performed by graduating orthopaedic surgery residents has significantly increased over time. There continues to be substantial variability in knee and shoulder arthroscopy case volume between residents in the 10th and 90th percentile. Variability in residency training is notable and may affect knowledge, skill, and practice patterns of surgeons. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Design of single-winding energy-storage reactors for dc-to-dc converters using air-gapped magnetic-core structures

NASA Technical Reports Server (NTRS)

Ohri, A. K.; Wilson, T. G.; Owen, H. A., Jr.

1977-01-01

A procedure is presented for designing air-gapped energy-storage reactors for nine different dc-to-dc converters resulting from combinations of three single-winding power stages for voltage stepup, current stepup and voltage stepup/current stepup and three controllers with control laws that impose constant-frequency, constant transistor on-time and constant transistor off-time operation. The analysis, based on the energy-transfer requirement of the reactor, leads to a simple relationship for the required minimum volume of the air gap. Determination of this minimum air gap volume then permits the selection of either an air gap or a cross-sectional core area. Having picked one parameter, the minimum value of the other immediately leads to selection of the physical magnetic structure. Other analytically derived equations are used to obtain values for the required turns, the inductance, and the maximum rms winding current. The design procedure is applicable to a wide range of magnetic material characteristics and physical configurations for the air-gapped magnetic structure.

High-Throughput 3-D Monitoring of Agricultural-Tree Plantations with Unmanned Aerial Vehicle (UAV) Technology

PubMed Central

Torres-Sánchez, Jorge; López-Granados, Francisca; Serrano, Nicolás; Arquero, Octavio; Peña, José M.

2015-01-01

The geometric features of agricultural trees such as canopy area, tree height and crown volume provide useful information about plantation status and crop production. However, these variables are mostly estimated after a time-consuming and hard field work and applying equations that treat the trees as geometric solids, which produce inconsistent results. As an alternative, this work presents an innovative procedure for computing the 3-dimensional geometric features of individual trees and tree-rows by applying two consecutive phases: 1) generation of Digital Surface Models with Unmanned Aerial Vehicle (UAV) technology and 2) use of object-based image analysis techniques. Our UAV-based procedure produced successful results both in single-tree and in tree-row plantations, reporting up to 97% accuracy on area quantification and minimal deviations compared to in-field estimations of tree heights and crown volumes. The maps generated could be used to understand the linkages between tree grown and field-related factors or to optimize crop management operations in the context of precision agriculture with relevant agro-environmental implications. PMID:26107174

High-Throughput 3-D Monitoring of Agricultural-Tree Plantations with Unmanned Aerial Vehicle (UAV) Technology.

PubMed

Torres-Sánchez, Jorge; López-Granados, Francisca; Serrano, Nicolás; Arquero, Octavio; Peña, José M

2015-01-01

The geometric features of agricultural trees such as canopy area, tree height and crown volume provide useful information about plantation status and crop production. However, these variables are mostly estimated after a time-consuming and hard field work and applying equations that treat the trees as geometric solids, which produce inconsistent results. As an alternative, this work presents an innovative procedure for computing the 3-dimensional geometric features of individual trees and tree-rows by applying two consecutive phases: 1) generation of Digital Surface Models with Unmanned Aerial Vehicle (UAV) technology and 2) use of object-based image analysis techniques. Our UAV-based procedure produced successful results both in single-tree and in tree-row plantations, reporting up to 97% accuracy on area quantification and minimal deviations compared to in-field estimations of tree heights and crown volumes. The maps generated could be used to understand the linkages between tree grown and field-related factors or to optimize crop management operations in the context of precision agriculture with relevant agro-environmental implications.

Development of an improved overlay design procedure for Oregon : volume II, evaluation of procedure.

DOT National Transportation Integrated Search

1987-12-01

This report is the second in a three-volume series dealing with the development of an improved overlay design procedure for Oregon. This report presents the results of the second-year findings. Data from five projects were collected and analyzed usin...

Journal of Special Operations Medicine. Training Supplement: Tactics, Techniques, and Procedures, Volume 8 Edition 4, Fall 2008

DTIC Science & Technology

2008-01-01

alimentary tract anaerobes (AI). Initial antibacterial activity should not be directed at multidrug-resistant pathogens such as Acinetobacter baumannii...plus 4 isolation beds Ancillary Lab, x-ray 5. LPH, AKA, APA, LST class ships are no longer in active service. 6. Hospital ships (T-AH) may provide...responsibilities and as the supported combatant commander for the Global War on Terrorism (GWOT). USSOCOM is actively engaged in the JLLP, where the goal

SEASAT economic assessment. Volume 7: Marine transporation case study

NASA Technical Reports Server (NTRS)

1975-01-01

The studies conducted of the potential use of SEASAT ocean condition data and resulting forecasts by dry cargo ships and tankers reached the following conclusions. The SEASAT ocean condition data and resulting forecasts could be usefully employed to route ships around storms, thereby resulting in reduced adverse weather damage, time loss and the related operating costs, and occasional catastrophic losses. These benefits are incremental benefits beyond those which present and future conventional ship routing procedures can supply. The values of the benefits are listed.

Impact of Aircraft Emissions on Air Quality in the Vicinity of Airports. Volume 4. Nitrogen Dioxide and Hydrocarbons.

DTIC Science & Technology

1984-04-01

PROCESSING 2.1.1 Siting, Instrumentation, and Measurement History The ANLIEES Air Resources Section Air Monitoring Laboratory (AM4L) was located at... supplied from an external cylinder in a blend containing 10% C2H4 reactant and 90% CO2 diluent. The instrument was operated in a fast-response mode...an alternative procedure was adopted for their determination and was utilized to determine time lags for several different periods of time scattered

Automated Data Aggregation for Time-Series Analysis: Study Case on Anaesthesia Data Warehouse.

PubMed

Lamer, Antoine; Jeanne, Mathieu; Ficheur, Grégoire; Marcilly, Romaric

2016-01-01

Data stored in operational databases are not reusable directly. Aggregation modules are necessary to facilitate secondary use. They decrease volume of data while increasing the number of available information. In this paper, we present four automated engines of aggregation, integrated into an anaesthesia data warehouse. Four instances of clinical questions illustrate the use of those engines for various improvements of quality of care: duration of procedure, drug administration, assessment of hypotension and its related treatment.

KC-46A Formal Training Unit (FTU) and First Main Operating Base (MOB 1) Beddown EIS. Volume 1

DTIC Science & Technology

2014-03-01

jamaicensis), northern harrier (Circus cyaneus), great horned owl (Bubo virginianus), ring -necked pheasant (Phasianus colchicus), and a variety of...vary from flight to flight based on winds and other factors, so flight procedures could be louder or quieter than the SEL values listed in Table 4-3...Suspend all soil disturbance activities when winds exceed 25 miles per hour or when visible dust plumes emanate from the site and stabilize all

An investigation into pilot and system response to critical in-flight events, volume 1

NASA Technical Reports Server (NTRS)

Rockwell, T. H.; Giffin, W. C.

1981-01-01

The scope of a critical in-flight event (CIFE) with emphasis on pilot management of available resources is described. Detailed scenarios for both full mission simulation and written testing of pilot responses to CIFE's, and statistical relationships among pilot characteristics and observed responses are developed. A model developed to described pilot response to CIFE and an analysis of professional fight crews compliance with specified operating procedures and the relationships with in-flight errors are included.

MIKON 94. International Microwave Conference (10th) Held in Ksiaz, Poland on May 30-June 2, 1994. Volume 3. Invited Papers

DTIC Science & Technology

1994-01-01

linear non -differential equations in series. This makes it easier to control the result, and an exact and accurate solution is obtained without...battery operated and controlled by an industry standard computer 1161. The HF unit contains a step-recovery diode transmitter and two quasi -TEM antennas...16]. All of these procedures can take advantage of exact non -linear analysis or experimental power characterization and are therefore "full non

Solid Waste from the Operation and Decommissioning of Power Plants

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

Brown, Marilyn Ann; D'Arcy, Daniel; Lapsa, Melissa Voss

This baseline report examines the solid waste generated by the U.S. electric power industry, including both waste streams resulting from electricity generation and wastes resulting from the decommissioning of power plants. Coal and nuclear plants produce large volumes of waste during electricity generation, and this report describes the policies and procedures for handling these materials. Natural gas and oil-fired power plants face similar waste challenges. Renewables considered in this baseline report include hydropower, wind and solar.

Journal of Special Operations Medicine, Volume 7, Edition 4. Training Supplement: Tactics, Techniques, and Procedures

DTIC Science & Technology

2007-01-01

fatigued. The majority of the OIL and TTP listed here are oriented to the Level I management of combat CAX or management at the point of injury (POI) or...carried into the field by medical personnel. Time to evacuation from the POI or other casualty evacuation point (CEP) to an MTF may vary considerably...must be avoided during this time. Care must be rendered once the mission has reached an anticipated evacuation point , without pursuit, awaiting CASEVAC

Journal of Special Operations Medicine Volume 1, Edition 2

DTIC Science & Technology

2001-01-01

news.... New Group Surgeons at ONE: LCDR Kevin Walters and CDR Scott Flin; at TWO: LT Jose Henao�, at DEVGRU: CDR Fenton , and at BUD/s: LT Ware. Look...be eligible for this surgery. A common belief is that refractive surgery is a � cosmetic � surgical procedure only designed to free one from wearing...corrective glasses, and that the mili- tary should not be in the � cosmetic � business. How- ever, this is a technique for enhancement of soldier readi

Apollo/Saturn 5 space vehicle countdown. Volume 2: Turnaround from scrub

NASA Technical Reports Server (NTRS)

1972-01-01

The procedures required to prepare a space vehicle for subsequent launch attempt after cancelling lift-off activities are presented. The cancellation must occur after the start of cryogenic loading, but prior to initiation of ignition sequences. The sequence of operations necessary to return the space vehicle to a predetermined configuration at which time the launch count can be resumed or rescheduled for following launch opportunities is developed. The considerations and constraints that are the basis for the scrub/turnaround times are described.

TERSSE: Definition of the Total Earth Resources System for the Shuttle Era. Volume 7: User Models: A System Assessment

NASA Technical Reports Server (NTRS)

1974-01-01

User models defined as any explicit process or procedure used to transform information extracted from remotely sensed data into a form useful as a resource management information input are discussed. The role of the user models as information, technological, and operations interfaces between the TERSSE and the resource managers is emphasized. It is recommended that guidelines and management strategies be developed for a systems approach to user model development.

Operation, Maintenance and Performance Evaluation of the Potomac Estuary Experimental Water Treatment Plant. Appendix. Volume 1.

DTIC Science & Technology

1983-09-01

Biochemical Screening A-i-12 Quantitative Determination of Viruses A-1-13 Virus Adsorption A-1-13 Elution A-1-13 Reconcentration A-1-13 Virus Assay A-I... VIRUSES VIRUS ADSORPTION " The virus concentration method was based on an adsorption/elution procedure described in the 14th edition of Standard...the replication process of one virus may be inhibited by another. If the inoculum contains few infective viruses , interference problems are of little

Space shuttle/payload interface analysis. (Study 2.4) Volume 4: Business Risk and Value of Operations in Space (BRAVO). Part 2: User's manual

NASA Technical Reports Server (NTRS)

1974-01-01

The BRAVO User's Manual is presented which describes the BRAVO methodology in terms of step-by-step procedures, so that it may be used as a tool for a team of analysts performing cost effectiveness analyses on potential future space applications. BRAVO requires a relatively general set of input information and a relatively small expenditure of resources. For Vol. 1, see N74-12493; for Vol. 2, see N74-14530.

Multiple IMU system test plan, volume 4. [subroutines for space shuttle requirements

NASA Technical Reports Server (NTRS)

Landey, M.; Vincent, K. T., Jr.; Whittredge, R. S.

1974-01-01

Operating procedures for this redundant system are described. A test plan is developed with two objectives. First, performance of the hardware and software delivered is demonstrated. Second, applicability of multiple IMU systems to the space shuttle mission is shown through detailed experiments with FDI algorithms and other multiple IMU software: gyrocompassing, calibration, and navigation. Gimbal flip is examined in light of its possible detrimental effects on FDI and navigation. For Vol. 3, see N74-10296.

Impact of the aspirated volume of fat tissue in the insulin resistance after liposuction.

PubMed

Oliveira, Sérgio de Souza; Cibantos, Jubert Sanches; Ripari, Wagner Targa; Aguilar-Nascimento, José Eduardo de

2013-01-01

To investigate insulin resistance imposed by liposuction, correlating its intensity with the extent of the operation. The sample consisted of 20 female patients without comorbidities, aged between 21 and 43 years, body mass index between 19 and 27 kg/m², undergoing liposuction alone or associated with breasts' prosthesis. We assessed insulin resistance at the beginning and end of the procedure by calculating the Homeostasis Model Assessment (HOMA-IR). The operative variables were length of liposuction, breast prosthesis time, body areas submitted to liposuction and total fat aspirated. The liposuction time was 94-278 min (mean = 174 min), duration of breast prosthesis 20-140 min (mean = 65 min) and total fat aspirated 680-4280 g (mean = 1778 g). Statistical analysis was performed by considering a division line of 1500 g of aspirated fat and there was a significantly increased insulin resistance by HOMA index greater in the group > 1500 g (123% increase) than in the group d" 1500 g (an increase of 53 %) from the baseline data (p = 0.02). Other operative variables showed no significant correlation. Insulin resistance shows significant increase in liposuction, and it is correlated to the volume of aspirated fat.

Hysteroscopic morcellator for removal of intrauterine polyps and myomas: a randomized controlled pilot study among residents in training.

PubMed

van Dongen, Heleen; Emanuel, Mark Hans; Wolterbeek, Ron; Trimbos, J Baptist; Jansen, Frank Willem

2008-01-01

The purpose of this randomized controlled study was to compare conventional resectoscopy and hysteroscopic morcellation among residents in training (Canadian Task Force classification I). Sixty women with an intrauterine polyp or myoma were randomized to either hysteroscopic removal by conventional resectoscopy or hysteroscopic morcellation performed by 6 residents in training for obstetrics and gynecology (10 procedures per resident). The mean operating time for resectosocpy and morcellation was 17.0 (95% confidence interval [95% CI] 14.1-17.9, standard deviation [SD] 8.4) and 10.6 (95% CI 7.3-14.0, SD 9.5) min, respectively (p = .008). Multiple linear regression analysis showed that operating time increased significantly, for both resectoscopy and morcellator, when volume of intrauterine disorder increased. The use of the hysteroscopic morcellator reduced operating time more than 8 min in comparison to conventional resectoscopy (p < .001) when correction for volume was applied. Subjective surgeon and trainer scores for convenience of technique on a visual analog scale were in favor of the morcellator. No learning curve was observed. In conclusion, the hysteroscopic morcellator for removal of intrauterine polyps and myomas offers a good alternative to conventional resectoscopy for residents in training.

Monitoring and evaluating surgical care: defining perioperative mortality rate and standardising data collection.

PubMed

Palmqvist, Charlotta L; Ariyaratnam, Roshan; Watters, David A; Laing, Grant L; Stupart, Douglas; Hider, Phil; Ng-Kamstra, Joshua S; Wilson, Leona; Clarke, Damian L; Hagander, Lars; Greenberg, Sarah L M; Gruen, Russell L

2015-04-27

Case volume per 100 000 population and perioperative mortality rate (POMR) are key indicators to monitor and strengthen surgical services. However, comparisons of POMR have been restricted by absence of standardised approaches to when it is measured, the ideal denominator, need for risk adjustment, and whether data are available. We aimed to address these issues and recommend a minimum dataset by analysing four large mixed surgical datasets, two from well-resourced settings with sophisticated electronic patient information systems and two from resource-limited settings where clinicians maintain locally developed databases. We obtained data from the New Zealand (NZ) National Minimum Dataset, the Geelong Hospital patient management system in Australia, and purpose-built surgical databases in Pietermaritzburg, South Africa (PMZ) and Port Moresby, Papua New Guinea (PNG). Information was sought on inclusion and exclusion criteria, coding criteria, and completeness of patient identifiers, admission, procedure, discharge and death dates, operation details, urgency of admission, and American Society of Anesthesiologists (ASA) score. Date-related errors were defined as missing dates and impossible discrepancies. For every site, we then calculated the POMR, the effect of admission episodes or procedures as denominator, and the difference between in-hospital POMR and 30-day POMR. To determine the need for risk adjustment, we used univariate and multivariate logistic regression to assess the effect on relative POMR for each site of age, admission urgency, ASA score, and procedure type. 1 365 773 patient admissions involving 1 514 242 procedures were included, among which 8655 deaths were recorded within 30 days. Database inclusion and exclusion criteria differed substantially. NZ and Geelong records had less than 0·1% date-related errors and greater than 99·9% completeness. PMZ databases had 99·9% or greater completeness of all data except date-related items (94·0%). PNG had 99·9% or greater completeness for date of birth or age and admission date and operative procedure, but 80-83% completeness of patient identifiers and date related items. Coding of procedures was not standardised, and only NZ recorded ASA status and complete post-discharge mortality. In-hospital POMR range was 0·38% in NZ to 3·44% in PMZ, and in NZ it underestimated 30-day POMR by roughly a third. The difference in POMR by procedures instead of admission episodes as denominator ranged from 10% to 70%. Age older than 65 years and emergency admission had large independent effects on POMR, but relatively little effect in multivariate analysis on the relative odds of in-hospital death at each site. Hospitals can collect and provide data for case volume and POMR without sophisticated electronic information systems. POMR should initially be defined by in-hospital mortality because post-discharge deaths are not usually recorded, and with procedures as denominator because details allowing linkage of several operations within one patient's admission are not always present. Although age and admission urgency are independently associated with POMR, and ASA and case mix were not included, risk adjustment might not be essential because the relative odds between sites persisted. Standardisation of inclusion criteria and definitions is needed, as is attention to accuracy and completeness of dates of procedures, discharge and death. A one-page, paper-based form, or alternatively a simple electronic data collection form, containing a minimum dataset commenced in the operating theatre could facilitate this process. None. Copyright © 2015 Elsevier Ltd. All rights reserved.

Aerospace technology and commercial nuclear power; Proceedings of the Workshop Conference, Williamsburg, VA, November 18-20, 1981

NASA Technical Reports Server (NTRS)

Grey, J. (Editor)

1982-01-01

An attempt has been made to compare the technologies, institutions and procedures of the aerospace and commercial nuclear power industries, in order to characterize similarities and contrasts as well as to identify the most fruitful means by which to transfer information, technology, and procedures between the two industries. The seven working groups involved in this study took as their topics powerplant design formulation and effectiveness, plant safety and operations, powerplant control technology and integration, economic and financial analyses, public relations, and the management of nuclear waste and spent fuel. Consequential differences are noted between the two industries in matters of certification and licencing procedures, assignment of responsibility for both safety and financial performance, and public viewpoint. Areas for beneficial interaction include systems management and control and safety system technology. No individual items are abstracted in this volume

The Interlibrary Loan Transaction

PubMed Central

Pings, Vern M.

1965-01-01

Although the number of items borrowed through interlibrary loan may not increase as dramatically as it has in the past ten years, the trend can be expected to continue because of the growing interdisciplinary nature of biomedical research and because of the anticipated improved bibliographic control of biomedical literature. To provide a framework for collecting data on volume of flow between institutions, on time requirements for processing operations, on cost of interlibrary transactions, on the efficiency of communication channels, and on alternative procedures for performing the transaction, block diagrams were prepared to show the flow of information and materials between individuals and institutions. These diagrams show the interinstitutional dependence; any alterations in procedures in one institution affect other institutions. Even though it can be clearly shown where alterations in the flow pattern can be effected, there are little quantitative data available to serve as a justification for maintaining or modifying existing procedures. PMID:14271114

Overview of the Small Aircraft Transportation System Project Four Enabling Operating Capabilities

NASA Technical Reports Server (NTRS)

Viken, Sally A.; Brooks, Frederick M.; Johnson, Sally C.

2005-01-01

It has become evident that our commercial air transportation system is reaching its peak in terms of capacity, with numerous delays in the system and the demand still steadily increasing. NASA, FAA, and the National Consortium for Aviation Mobility (NCAM) have partnered to aid in increasing the mobility throughout the United States through the Small Aircraft Transportation System (SATS) project. The SATS project has been a five-year effort to provide the technical and economic basis for further national investment and policy decisions to support a small aircraft transportation system. The SATS vision is to enable people and goods to have the convenience of on-demand point-to-point travel, anywhere, anytime for both personal and business travel. This vision can be obtained by expanding near all-weather access to more than 3,400 small community airports that are currently under-utilized throughout the United States. SATS has focused its efforts on four key operating capabilities that have addressed new emerging technologies, procedures, and concepts to pave the way for small aircraft to operate in nearly all weather conditions at virtually any runway in the United States. These four key operating capabilities are: Higher Volume Operations at Non-Towered/Non-Radar Airports, En Route Procedures and Systems for Integrated Fleet Operations, Lower Landing Minimums at Minimally Equipped Landing Facilities, and Increased Single Pilot Performance. The SATS project culminated with the 2005 SATS Public Demonstration in Danville, Virginia on June 5th-7th, by showcasing the accomplishments achieved throughout the project and demonstrating that a small aircraft transportation system could be viable. The technologies, procedures, and concepts were successfully demonstrated to show that they were safe, effective, and affordable for small aircraft in near all weather conditions. The focus of this paper is to provide an overview of the technical and operational feasibility of the four operating capabilities, and explain how they can enable a small aircraft transportation system.

Does Categorization Method Matter in Exploring Volume-Outcome Relation? A Multiple Categorization Methods Comparison in Coronary Artery Bypass Graft Surgery Surgical Site Infection.

PubMed

Yu, Tsung-Hsien; Tung, Yu-Chi; Chung, Kuo-Piao

2015-08-01

Volume-infection relation studies have been published for high-risk surgical procedures, although the conclusions remain controversial. Inconsistent results may be caused by inconsistent categorization methods, the definitions of service volume, and different statistical approaches. The purpose of this study was to examine whether a relation exists between provider volume and coronary artery bypass graft (CABG) surgical site infection (SSI) using different categorization methods. A population-based cross-sectional multi-level study was conducted. A total of 10,405 patients who received CABG surgery between 2006 and 2008 in Taiwan were recruited. The outcome of interest was surgical site infection for CABG surgery. The associations among several patient, surgeon, and hospital characteristics was examined. The definition of surgeons' and hospitals' service volume was the cumulative CABG service volumes in the previous year for each CABG operation and categorized by three types of approaches: Continuous, quartile, and k-means clustering. The results of multi-level mixed effects modeling showed that hospital volume had no association with SSI. Although the relation between surgeon volume and surgical site infection was negative, it was inconsistent among the different categorization methods. Categorization of service volume is an important issue in volume-infection study. The findings of the current study suggest that different categorization methods might influence the relation between volume and SSI. The selection of an optimal cutoff point should be taken into account for future research.

On volume-source representations based on the representation theorem

NASA Astrophysics Data System (ADS)

Ichihara, Mie; Kusakabe, Tetsuya; Kame, Nobuki; Kumagai, Hiroyuki

2016-01-01

We discuss different ways to characterize a moment tensor associated with an actual volume change of ΔV C , which has been represented in terms of either the stress glut or the corresponding stress-free volume change ΔV T . Eshelby's virtual operation provides a conceptual model relating ΔV C to ΔV T and the stress glut, where non-elastic processes such as phase transitions allow ΔV T to be introduced and subsequent elastic deformation of - ΔV T is assumed to produce the stress glut. While it is true that ΔV T correctly represents the moment tensor of an actual volume source with volume change ΔV C , an explanation as to why such an operation relating ΔV C to ΔV T exists has not previously been given. This study presents a comprehensive explanation of the relationship between ΔV C and ΔV T based on the representation theorem. The displacement field is represented using Green's function, which consists of two integrals over the source surface: one for displacement and the other for traction. Both integrals are necessary for representing volumetric sources, whereas the representation of seismic faults includes only the first term, as the second integral over the two adjacent fault surfaces, across which the traction balances, always vanishes. Therefore, in a seismological framework, the contribution from the second term should be included as an additional surface displacement. We show that the seismic moment tensor of a volume source is directly obtained from the actual state of the displacement and stress at the source without considering any virtual non-elastic operations. A purely mathematical procedure based on the representation theorem enables us to specify the additional imaginary displacement necessary for representing a volume source only by the displacement term, which links ΔV C to ΔV T . It also specifies the additional imaginary stress necessary for representing a moment tensor solely by the traction term, which gives the "stress glut." The imaginary displacement-stress approach clarifies the mathematical background to the classical theory.

Tissue ablation after 120W greenlight laser vaporization and bipolar plasma vaporization of the prostate: a comparison using transrectal three-dimensional ultrasound volumetry

NASA Astrophysics Data System (ADS)

Kranzbühler, Benedikt; Gross, Oliver; Fankhauser, Christian D.; Hefermehl, Lukas J.; Poyet, Cédric; Largo, Remo; Müntener, Michael; Seifert, Hans-Helge; Zimmermann, Matthias; Sulser, Tullio; Müller, Alexander; Hermanns, Thomas

2012-02-01

Introduction and objectives: Greenlight laser vaporization (LV) of the prostate is characterized by simultaneous vaporization and coagulation of prostatic tissue resulting in tissue ablation together with excellent hemostasis during the procedure. It has been reported that bipolar plasma vaporization (BPV) of the prostate might be an alternative for LV. So far, it has not been shown that BPV is as effective as LV in terms of tissue ablation or hemostasis. We performed transrectal three-dimensional ultrasound investigations to compare the efficiency of tissue ablation between LV and BPV. Methods: Between 11.2009 and 5.2011, 50 patients underwent pure BPV in our institution. These patients were matched with regard to the pre-operative prostate volume to 50 LV patients from our existing 3D-volumetry-database. Transrectal 3D ultrasound and planimetric volumetry of the prostate were performed pre-operatively, after catheter removal, 6 weeks and 6 months. Results: Median pre-operative prostate volume was not significantly different between the two groups (45.3ml vs. 45.4ml; p=1.0). After catheter removal, median absolute volume reduction (BPV 12.4ml, LV 6.55ml) as well as relative volume reduction (27.8% vs. 16.4%) were significantly higher in the BPV group (p<0.001). After six weeks (42.9% vs. 33.3%) and six months (47.2% vs. 39.7%), relative volume reduction remained significantly higher in the BPV group (p<0.001). Absolute volume reduction was non-significantly higher in the BPV group after six weeks (18.4ml, 13.8ml; p=0.051) and six months (20.8ml, 18ml; p=0.3). Clinical outcome parameters improved significantly in both groups without relevant differences between the groups. Conclusions: Both vaporization techniques result in efficient tissue ablation with initial prostatic swelling. BPV seems to be superior due to a higher relative volume reduction. This difference had no clinical impact after a follow-up of 6M.

Tree form quotients as variables in volume estimation.

Treesearch

Gerald E. Hoyer

1985-01-01

The study reviews Hohenadl's procedure for defining form quotients and tree volume from diameters measured at fixed proportions of total tree height. Modifications of Hohenadl's procedure were applied to two sets of data for western hemlock (Tsuga heterophylla (Raf.) Sarg.) from the Pacific Northwest. The procedure was used to define...

The Surgeon Volume-outcome Relationship: Not Yet Ready for Policy.

PubMed

Modrall, J Gregory; Minter, Rebecca M; Minhajuddin, Abu; Eslava-Schmalbach, Javier; Joshi, Girish P; Patel, Shivani; Rosero, Eric B

2018-05-01

Increasing surgeon volume may improve outcomes for index operations. We hypothesized that there may be surrogate operative experiences that yield similar outcomes for surgeons with a low-volume experience with a specific index operation, such as esophagectomy. The relationship between surgeon volume and outcomes has potential implications for credentialing of surgeons. Restrictions of privileges based on surgeon volume are only reasonable if there is no substitute for direct experience with the index operation. This study was aimed at determining whether there are valid surrogates for direct experience with a sample index operation-open esophagectomy. The Nationwide Inpatient Sample (2003-2009) was utilized. Surgeons were stratified into low and high-volume groups based on annual volume of esophagectomy. Surrogate volume was defined as the aggregate annual volume per surgeon of upper gastrointestinal operations including excision of esophageal diverticulum, gastrectomy, gastroduodenectomy, and repair of diaphragmatic hernia. In all, 26,795 esophagectomies were performed nationwide (2003-2009), with a crude inhospital mortality rate of 5.2%. Inhospital mortality decreased with increasing volume of esophagectomies performed annually: 7.7% and 3.8% for low and high-volume surgeons, respectively (P < 0.0001). Among surgeons with a low-volume esophagectomy experience, increasing volume of surrogate operations improved the outcomes observed for esophagectomy: 9.7%, 7.1%, and 4.3% for low, medium, and high-surrogate-volume surgeons, respectively (P = 0.016). Both operation-specific volume and surrogate volume are significant predictors of inhospital mortality for esophagectomy. Based on these observations, it would be premature to limit hospital privileges based solely on operation-specific surgeon volume criteria.

Adding the Human Element to Ship Manoeuvring Simulations

NASA Astrophysics Data System (ADS)

Aarsæther, Karl Gunnar; Moan, Torgeir

Time-domain simulation of ship manoeuvring has been utilized in risk analysis to assess the effect of changes to the ship-lane, development in traffic volume and the associated risk. The process of ship manoeuvring in a wider socio-technical context consists of the technical systems, operational procedures, the human operators and support functions. Automated manoeuvring simulations without human operators in the simulation loop have often been preferred in simulation studies due to the low time required for simulations. Automatic control has represented the human element with little effort devoted to explain the relationship between the guidance and control algorithms and the human operator which they replace. This paper describes the development and application of a model for the human element for autonomous time-domain manoeuvring simulations. The method is applicable in the time-domain, modular and found to be capable of reproducing observed manoeuvre patterns, but limited to represent the intended behaviour.

Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center.

PubMed

Onat, Serdar; Ulku, Refik; Avci, Alper; Ates, Gungor; Ozcelik, Cemal

2011-09-01

Penetrating injuries to the chest present a frequent and challenging problem, but the majority of these injuries can be managed non-\\operatively. The aim of this study was to describe the incidence of penetrating chest trauma and the ultimate techniques used for operative management, as well as the diagnosis, complications, morbidity and mortality. A retrospective 9-year review of patients who underwent an operative procedure following penetrating chest trauma was performed. The mechanism of injury, gender, age, physiological and outcome parameters, including injury severity score (ISS), chest abbreviated injury scale (AIS) score, lung injury scale score, concomitant injuries, time from admission to operating room, transfusion requirement, indications for thoracotomy, intra-operative findings, operative procedures, length of hospital stay (LOS) and rate of mortality were recorded. A total of 1123 patients who were admitted with penetrating thoracic trauma were investigated. Of these, 158 patients (93 stabbings, 65 gunshots) underwent a thoracotomy within 24 h after the penetrating trauma. There were 146 (92.4%) male and 12 (7.6%) female patients, and their mean age was 25.72 9.33 (range, 15–54) years. The mean LOS was 10.65 8.30 (range, 5–65) days. Patients admitted after a gunshot had a significantly longer LOS than those admitted with a stab wound (gunshot, 13.53 9.92 days; stab wound, 8.76 6.42 days, p < 0.001). Patients who died had a significantly lower systolic blood pressure (SBP) on presentation in the emergency room (42.94 36.702 mm Hg) compared with those who survived (83.96 27.842 mm Hg, p = 0.001). The overall mortality rate was 10.8% (n = 17). Mortality for patients with stab wounds was 8/93 (8.6%) compared with 9/65 (13.8%) for patients with gunshot wounds (p = 0.29). Concomitant abdominal injuries (p = 0.01), diaphragmatic injury (p = 0.01), ISS (p = 0.001), chest AIS score (p < 0.05), ongoing output (p = 0.001), blood transfusion volume (p < 0.01) and SBP (p = 0.001) were associated with mortality. Penetrating injuries to the chest requiring a thoracotomy are uncommon, and lung-sparing techniques have become the most frequently used procedures for lung injuries. The presence of associated abdominal injuries increased the mortality five-fold. Factors that affected mortality were ISS, chest AIS score, SBP, ongoing chest output, blood transfusion volume, diaphragmatic injury and associated abdominal injury.

A finite-volume module for all-scale Earth-system modelling at ECMWF

NASA Astrophysics Data System (ADS)

Kühnlein, Christian; Malardel, Sylvie; Smolarkiewicz, Piotr

2017-04-01

We highlight recent advancements in the development of the finite-volume module (FVM) (Smolarkiewicz et al., 2016) for the IFS at ECMWF. FVM represents an alternative dynamical core that complements the operational spectral dynamical core of the IFS with new capabilities. Most notably, these include a compact-stencil finite-volume discretisation, flexible meshes, conservative non-oscillatory transport and all-scale governing equations. As a default, FVM solves the compressible Euler equations in a geospherical framework (Szmelter and Smolarkiewicz, 2010). The formulation incorporates a generalised terrain-following vertical coordinate. A hybrid computational mesh, fully unstructured in the horizontal and structured in the vertical, enables efficient global atmospheric modelling. Moreover, a centred two-time-level semi-implicit integration scheme is employed with 3D implicit treatment of acoustic, buoyant, and rotational modes. The associated 3D elliptic Helmholtz problem is solved using a preconditioned Generalised Conjugate Residual approach. The solution procedure employs the non-oscillatory finite-volume MPDATA advection scheme that is bespoke for the compressible dynamics on the hybrid mesh (Kühnlein and Smolarkiewicz, 2017). The recent progress of FVM is illustrated with results of benchmark simulations of intermediate complexity, and comparison to the operational spectral dynamical core of the IFS. C. Kühnlein, P.K. Smolarkiewicz: An unstructured-mesh finite-volume MPDATA for compressible atmospheric dynamics, J. Comput. Phys. (2017), in press. P.K. Smolarkiewicz, W. Deconinck, M. Hamrud, C. Kühnlein, G. Mozdzynski, J. Szmelter, N.P. Wedi: A finite-volume module for simulating global all-scale atmospheric flows, J. Comput. Phys. 314 (2016) 287-304. J. Szmelter, P.K. Smolarkiewicz: An edge-based unstructured mesh discretisation in geospherical framework, J. Comput. Phys. 229 (2010) 4980-4995.

A hierarchical 3D segmentation method and the definition of vertebral body coordinate systems for QCT of the lumbar spine.

PubMed

Mastmeyer, André; Engelke, Klaus; Fuchs, Christina; Kalender, Willi A

2006-08-01

We have developed a new hierarchical 3D technique to segment the vertebral bodies in order to measure bone mineral density (BMD) with high trueness and precision in volumetric CT datasets. The hierarchical approach starts with a coarse separation of the individual vertebrae, applies a variety of techniques to segment the vertebral bodies with increasing detail and ends with the definition of an anatomic coordinate system for each vertebral body, relative to which up to 41 trabecular and cortical volumes of interest are positioned. In a pre-segmentation step constraints consisting of Boolean combinations of simple geometric shapes are determined that enclose each individual vertebral body. Bound by these constraints viscous deformable models are used to segment the main shape of the vertebral bodies. Volume growing and morphological operations then capture the fine details of the bone-soft tissue interface. In the volumes of interest bone mineral density and content are determined. In addition, in the segmented vertebral bodies geometric parameters such as volume or the length of the main axes of inertia can be measured. Intra- and inter-operator precision errors of the segmentation procedure were analyzed using existing clinical patient datasets. Results for segmented volume, BMD, and coordinate system position were below 2.0%, 0.6%, and 0.7%, respectively. Trueness was analyzed using phantom scans. The bias of the segmented volume was below 4%; for BMD it was below 1.5%. The long-term goal of this work is improved fracture prediction and patient monitoring in the field of osteoporosis. A true 3D segmentation also enables an accurate measurement of geometrical parameters that may augment the clinical value of a pure BMD analysis.

Reoperations within 48 hours following 7942 pediatric neurosurgery procedures.

PubMed

Roy, Anil K; Chu, Jason; Bozeman, Caroline; Sarda, Samir; Sawvel, Michael; Chern, Joshua J

2017-06-01

OBJECTIVE Various indicators are used to evaluate the quality of care delivered by surgical services, one of which is early reoperation rate. The indications and rate of reoperations within a 48-hour time period have not been previously reported for pediatric neurosurgery. METHODS Between May 1, 2009, and December 30, 2014, 7942 surgeries were performed by the pediatric neurosurgery service in the operating rooms at a single institution. Demographic, socioeconomic, and clinical characteristics associated with each of the operations were prospectively collected. The procedures were grouped into 31 categories based on the nature of the procedure and underlying diseases. Reoperations within 48 hours at the conclusion of the index surgery were reviewed to determine whether the reoperation was planned or unplanned. Multivariate logistic regression was employed to analyze risk factors associated with unplanned reoperations. RESULTS Cerebrospinal fluid shunt-and hydrocephalus-related surgeries accounted for 3245 (40.8%) of the 7942 procedures. Spinal procedures, craniotomy for tumor resections, craniotomy for traumatic injury, and craniofacial reconstructions accounted for an additional 8.7%, 6.8%, 4.5%, and 4.5% of surgical volume. There were 221 reoperations within 48 hours of the index surgery, yielding an overall incidence of 2.78%; 159 of the reoperation were unplanned. Of these 159 unplanned reoperations, 121 followed index operations involving shunt manipulations. Using unplanned reoperations as the dependent variable (n = 159), index operations with a starting time after 3 pm and admission through the emergency department (ED) were associated with a two- to threefold increase in the likelihood of reoperations (after-hour surgery, odds ratio [OR] 2.01 [95% CI 1.43-2.83, p < 0.001]; ED admission, OR 1.97 (95% CI 1.32-2.96, p < 0.05]). CONCLUSIONS Approximately 25% of the reoperations within 48 hours of a pediatric neurosurgical procedure were planned. When reoperations were unplanned, contributing factors could be both surgeon related and system related. Further study is required to determine the extent to which these reoperations are preventable. The utility of unplanned reoperation as a quality indicator is dependent on proper definition, analysis, and calculation.

Declining operative experience for junior level residents: Is this an unintended consequence of minimally invasive surgery?

PubMed Central

Mullen, Matthew G.; Salerno, Elise P.; Michaels, Alex D.; Hedrick, Traci L.; Sohn, Min-Woong; Smith, Philip W.; Schirmer, Bruce D.; Friel, Charles M.

2016-01-01

Introduction Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. Methods A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The ACS NSQIP Participant Use Files were queried for these procedures between 2005–2012. Cases were stratified by participating resident post-graduate year (PGY) with ‘junior resident’ defined as PGY1–3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. Results 185,335 cases were included in the study. For three of the operations we considered, the prevalence of laparoscopic surgery increased from 2005–2012 (all p<0.001). Cholecystectomy was an exception, which showed an unchanged proportion of cases performed laparoscopically across the study period (p=0.119). Junior resident participation decreased by 4.5%/year (p<0.001) for laparoscopic procedures and by 6.2%/year (p<0.001) for open procedures. The proportion of laparoscopic surgeries performed by junior level residents decreased for appendectomy by 2.6%/year (p<0.001) and cholecystectomy by 6.1%/year (p<0.001), whereas it was unchanged for inguinal herniorrhaphy (p=0.75) and increased for partial colectomy by 3.9%/year (p=0.003). A decline in junior resident participation was seen for all open surgeries, with appendectomy decreasing by 9.4%/year (p<0.001), cholecystectomy by 4.1%/year (p<0.002), inguinal herniorrhaphy by 10%/year (p<0.001) and partial colectomy by 2.9%/year (p<0.004). Conclusions Along with the proliferation of laparoscopy for common general surgical procedures there has been a concomitant reduction in the participation of junior level residents. As previously thought, familiarity with laparoscopy has not translated to redistribution of basic operations from senior to junior residents. This trend has significant implications for general surgery resident education. PMID:27066854

Large-volume injection of sample diluents not miscible with the mobile phase as an alternative approach in sample preparation for bioanalysis: an application for fenspiride bioequivalence.

PubMed

Medvedovici, Andrei; Udrescu, Stefan; Albu, Florin; Tache, Florentin; David, Victor

2011-09-01

Liquid-liquid extraction of target compounds from biological matrices followed by the injection of a large volume from the organic layer into the chromatographic column operated under reversed-phase (RP) conditions would successfully combine the selectivity and the straightforward character of the procedure in order to enhance sensitivity, compared with the usual approach of involving solvent evaporation and residue re-dissolution. Large-volume injection of samples in diluents that are not miscible with the mobile phase was recently introduced in chromatographic practice. The risk of random errors produced during the manipulation of samples is also substantially reduced. A bioanalytical method designed for the bioequivalence of fenspiride containing pharmaceutical formulations was based on a sample preparation procedure involving extraction of the target analyte and the internal standard (trimetazidine) from alkalinized plasma samples in 1-octanol. A volume of 75 µl from the octanol layer was directly injected on a Zorbax SB C18 Rapid Resolution, 50 mm length × 4.6 mm internal diameter × 1.8 µm particle size column, with the RP separation being carried out under gradient elution conditions. Detection was made through positive ESI and MS/MS. Aspects related to method development and validation are discussed. The bioanalytical method was successfully applied to assess bioequivalence of a modified release pharmaceutical formulation containing 80 mg fenspiride hydrochloride during two different studies carried out as single-dose administration under fasting and fed conditions (four arms), and multiple doses administration, respectively. The quality attributes assigned to the bioanalytical method, as resulting from its application to the bioequivalence studies, are highlighted and fully demonstrate that sample preparation based on large-volume injection of immiscible diluents has an increased potential for application in bioanalysis.

Cognitive Conflict, Peers, and Volume Conservation.

ERIC Educational Resources Information Center

Renshaw, Peter D.

This study investigates the effects of a training procedure on children's conservation. Volume conservation was induced in twenty-one 8-year-old non-conserving children by a procedure that combined two sources of conflict. First, the competing schemes used in making decisions on volumes were aroused; second, the non-conserver was made aware of a…

Percutaneous closure of patent foramen ovale and atrial septal defect in adults: the impact of clinical variables and hospital procedure volume on in-hospital adverse events.

PubMed

Opotowsky, Alexander R; Landzberg, Michael J; Kimmel, Stephen E; Webb, Gary D

2009-05-01

Percutaneous closure of patent foramen ovale/atrial septal defect (PFO/ASD) is an increasingly common procedure perceived as having minimal risk. There are no population-based estimates of in-hospital adverse event rates of percutaneous PFO/ASD closure. We used nationally representative data from the 2001-2005 Nationwide Inpatient Sample to identify patients >or-=20 years old admitted to an acute care hospital with an International Classification of Diseases, Ninth Revision code designating percutaneous PFO/ASD closure on the first or second hospital day. Variables analyzed included age, sex, number of comorbidities, year, same-day use of intracardiac or other echocardiography, same-day left heart catheterization, hospital size and teaching status, PFO/ASD procedural volume, and coronary intervention volume. Outcomes of interest included length of stay, charges, and adverse events. The study included 2,555 (weighted to United States population: 12,544 +/- 1,987) PFO/ASD closure procedures. Mean age was 52.0 +/- 0.4 years, and 57.3% +/- 1.0% were women. Annual hospital volume averaged 40.8 +/- 7.7 procedures (range, 1-114). Overall, 8.2 +/- 0.8% of admissions involved an adverse event. Older patients and those with comorbidities were more likely to sustain adverse events. Use of intracardiac echocardiography was associated with fewer adverse events. The risk of adverse events was inversely proportional to annual hospital volume (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.86-0.96, per 10 procedures), even after limiting the analysis to hospitals performing >or=10 procedures annually (OR 0.91, 95% CI 0.85-0.98). Adverse events were more frequent at hospitals in the lowest volume quintile as compared with the highest volume quintile (13.3% vs 5.4%, OR 2.42, 95% CI 1.55-3.78). The risk of adverse events of percutaneous PFO/ASD closure is inversely correlated with hospital volume. This relationship applies even to hospitals meeting the current guidelines, performing >or=10 procedures annually.

Reduction of Costs for Pelvic Exenteration Performed by High Volume Surgeons: Analysis of the Maryland Health Service Cost Review Commission Database.

PubMed

Althumairi, Azah A; Canner, Joseph K; Gorin, Michael A; Fang, Sandy H; Gearhart, Susan L; Wick, Elizabeth C; Safar, Bashar; Bivalacqua, Trinity J; Efron, Jonathan E

2016-01-01

High volume hospitals (HVHs) and high volume surgeons (HVSs) have better outcomes after complex procedures, but the association between surgeon and hospital volumes and patient outcomes is not completely understood. Our aim was to evaluate the impact of surgeon and hospital volumes, and their interaction, on postoperative outcomes and costs in patients undergoing pelvic exenteration (PE) in the state of Maryland. A review of the Maryland Health Services Cost Review Commission database between 2000 and 2011 was performed. Patients were compared for demographics and clinical variables. The differences in length of hospital stay , length of intensive care unit (ICU) stay, operating room (OR) cost, and total cost were compared for surgeon volume and hospital volume controlling for all other factors. Surgery performed by HVS at HVH had the shortest ICU stay and lowest OR cost. When PE was performed by a low volume surgeon at an HVH, the OR cost and total cost were the highest and increased by $2,683 (P < 0.0001) and $16,076 (P < 0.0001), respectively. OR costs reduced when surgery was performed by an HVS at an HVH ($-1632, P = 0.008). PE performed by HVS at HVH is significantly associated with lower OR costs and ICU stay. We feel this is indicative of lower complication rates and higher quality care.

Feature-based US to CT registration of the aortic root

NASA Astrophysics Data System (ADS)

Lang, Pencilla; Chen, Elvis C. S.; Guiraudon, Gerard M.; Jones, Doug L.; Bainbridge, Daniel; Chu, Michael W.; Drangova, Maria; Hata, Noby; Jain, Ameet; Peters, Terry M.

2011-03-01

A feature-based registration was developed to align biplane and tracked ultrasound images of the aortic root with a preoperative CT volume. In transcatheter aortic valve replacement, a prosthetic valve is inserted into the aortic annulus via a catheter. Poor anatomical visualization of the aortic root region can result in incorrect positioning, leading to significant morbidity and mortality. Registration of pre-operative CT to transesophageal ultrasound and fluoroscopy images is a major step towards providing augmented image guidance for this procedure. The proposed registration approach uses an iterative closest point algorithm to register a surface mesh generated from CT to 3D US points reconstructed from a single biplane US acquisition, or multiple tracked US images. The use of a single simultaneous acquisition biplane image eliminates reconstruction error introduced by cardiac gating and TEE probe tracking, creating potential for real-time intra-operative registration. A simple initialization procedure is used to minimize changes to operating room workflow. The algorithm is tested on images acquired from excised porcine hearts. Results demonstrate a clinically acceptable accuracy of 2.6mm and 5mm for tracked US to CT and biplane US to CT registration respectively.

Association between hospital procedure volume and early complications after pacemaker implantation: results from a large, unselected, contemporary cohort of the German nationwide obligatory external quality assurance programme.

PubMed

Nowak, Bernd; Tasche, Karl; Barnewold, Linda; Heller, Günther; Schmidt, Boris; Bordignon, Stefano; Chun, K R Julian; Fürnkranz, Alexander; Mehta, Rajendra H

2015-05-01

Several studies demonstrated an inverse relationship between cardioverter-defibrillator implantation volume and complication rates, suggesting better outcomes for higher volume centres. However, the association of institutional procedural volume with patient outcomes for permanent pacemaker (PPM) implantation remains less known, especially in decentralized implantation systems. We performed retrospective examination of data on patients undergoing PPM from the German obligatory quality assurance programme (2007-12) to evaluate the relationship of hospital PPM volume (categorized into quintiles of their mean annual volume) with risk-adjusted in-hospital surgical complications (composite of pneumothorax, haemothorax, pericardial effusion, or pocket haematoma, all requiring intervention, or device infection) and pacemaker lead dislocation. Overall 430 416 PPM implantations were documented in 1226 hospitals. Systems included dual (72.8%) and single (25.8%) chamber PPM and cardiac resynchronization therapy (CRT) devices (1.1%). Complications included surgical (0.92%), and ventricular (0.99%), and atrial (1.22%) lead dislocation. Despite an increase in relatively complex procedures (dual chamber, CRT), there was a significant decrease in the procedural and fluoroscopy times and complications from lowest to highest implantation volume quintiles (P for trend <0.0001). The greatest difference was observed between the lowest (1-50 implantations/year-reference group) and the second-lowest (51-90 implantations/year) quintile: surgical complications [odds ratio (OR) 0.69; confidence interval (CI) 0.60-0.78], atrial lead dislocations (OR 0.69; CI 0.59-0.80), and ventricular lead dislocations (OR 0.73; CI 0.63-0.84). Hospital annual PPM volume was directly related to indication-based implantation of relatively more complex PPM and yet inversely with procedural times and rates of early surgical complications and lead dislocations. Thus, our data suggest better performance and lower complications with increasing procedural volume. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Venous vascular malformations of the craniofacial region: pre-operative embolisation with direct percutaneous puncture and N-butyl cyanoacrylate.

PubMed

Cil, B E; Vargel, I; Geyik, S; Peynircioglu, B; Cavusoglu, T

2008-12-01

Craniofacial venous vascular malformations cause severe cosmetic problems and yet these lesions are not candidates for transcatheter embolisation owing to the lack of arterial feeders. The purpose of this study was to evaluate the effectiveness of pre-operative embolisation of these lesions with N-butyl 2-cyanoacrylate (NBCA) via direct puncture. Between September 2003 and April 2006, 13 patients (7 female; age range, 6-64 years; mean, 16.7 years) were embolised with direct puncture and injection of NBCA. All of the patients were referred from plastic surgery with an operational plan. Angiography performed in all patients showed no or little arterial staining. NBCA diluted with iodized oil at a ratio of 1:6 (18%) was injected via a percutaneously placed 21 gauge needle. Complete embolisation was achieved in 8 patients and partial embolisation in the remaining 5. A total of 18 sessions of embolisation were performed on 13 patients. Nine patients underwent only one embolisation session, three patients underwent two sessions and only one patient underwent three sessions. The mean volume of NBCA used per session was 5.8 ml, ranging from 1-12 ml. All patients underwent a successful surgical resection to improve cosmetic disfigurement within 10-15 days after the embolisation procedure. Mean follow-up time was 22 months. One patient experienced skin necrosis on her nose after embolisation. No other complications related to the procedure were observed. In conclusion, pre-operative NBCA embolisation with direct puncture is a safe and easy procedure. It can increase the success of the surgical treatment of these lesions.

Effects of hospital safety-net burden and hospital volume on failure to rescue after open abdominal aortic surgery.

PubMed

Rosero, Eric B; Joshi, Girish P; Minhajuddin, Abu; Timaran, Carlos H; Modrall, J Gregory

2017-08-01

Failure to rescue (FTR) is defined as the inability to rescue a patient from major perioperative complications, resulting in operative mortality. FTR is a known contributor to operative mortality after open abdominal aortic surgery. Understanding the causes of FTR is essential to designing interventions to improve perioperative outcomes. The objective of this study was to determine the relative contributions of hospital volume and safety-net burden (the proportion of uninsured and Medicaid-insured patients) to FTR. The Nationwide Inpatient Sample (2001-2011) was analyzed to investigate variables associated with FTR after elective open abdominal aortic operations in the United States. FTR was defined as in-hospital death following postoperative complications. Mixed multivariate regression models were used to assess independent predictors of FTR, taking into account the clustered structure of the data (patients nested into hospitals). A total of 47,233 elective open abdominal aortic operations were performed in 1777 hospitals during the study period. The overall incidences of postoperative complications, in-hospital mortality, and FTR in the whole cohort were 32.7%, 3.2%, and 8.6%, respectively. After adjusting for demographics, comorbidities, and hospital characteristics, safety-net burden was significantly associated with increased likelihood of FTR (highest vs lowest quartile of safety-net burden, odds ratio, 1.59; 95% confidence interval, 1.32-1.91; P < .0001). In contrast, after adjusting for safety-net burden, procedure-specific hospital volume was not significantly associated with FTR (P = .897). After adjusting for patient- and hospital-level variables, including hospital volume, safety-net burden was an independent predictor of FTR after open aortic surgery. Future investigations should be aimed at better understanding the relationship between safety-net hospital burden and FTR to design interventions to improve outcomes after open abdominal aortic surgery. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Financial impact of emergency department ultrasound.

PubMed

Soremekun, Olanrewaju A; Noble, Vicki E; Liteplo, Andrew S; Brown, David F M; Zane, Richard D

2009-07-01

There is limited information on the financial implications of an emergency department ultrasound (ED US) program. The authors sought to perform a fiscal analysis of an integrated ED US program. A retrospective review of billing data was performed for fiscal year (FY) 2007 for an urban academic ED with an ED US program. The ED had an annual census of 80,000 visits and 1,101 ED trauma activations. The ED is a core teaching site for a 4-year emergency medicine (EM) residency, has 35 faculty members, and has 24-hour availability of all radiology services including formal US. ED US is utilized as part of evaluation of all trauma activations and for ED procedures. As actual billing charges and reimbursement rates are institution-specific and proprietary information, relative value units (RVUs) and reimbursement based on the Centers for Medicare & Medicaid Services (CMS) 2007 fee schedule (adjusted for fixed diagnosis-related group [DRG] payments and bad debt) was used to determine revenue generated from ED US. To estimate potential volume, assumptions were made on improvement in documentation rate for diagnostic scans (current documentation rates based on billed volume versus diagnostic studies in diagnostic image database), with no improvements assumed for procedural ED US. Expenses consist of three components-capital costs, training costs, and ongoing operational costs-and were determined by institutional experience. Training costs were considered sunken expenses by this institution and were thus not included in the original return on investment (ROI) calculation, although for this article a second ROI calculation was done with training cost estimates included. For the purposes of analysis, certain key assumptions were made. We utilized a collection rate of 45% and hospitalization rates (used to adjust for fixed DRG payments) of 33% for all diagnostic scans, 100% for vascular access, and 10% for needle placement. An optimal documentation rate of 95% was used to estimate potential revenue. In FY 2007, 486 limited echo exams of abdomen (current procedural terminology [CPT] 76705) and 480 limited echo cardiac exams were performed (CPT 93308) while there were 78 exams for US-guided vascular access (CPT 76937) and 36 US-guided needle placements when performing paracentesis, thoracentesis, or location of abscess for drainage (CPT 76492). Applying the 2007 CMS fee schedule and above assumptions, the revenue generated was 578 RVUs and $35,541 ($12,934 in professional physician fees and $22,607 in facility fees). Assuming optimal documentation rates for diagnostic ED US scans, ED US could have generated 1,487 RVUs and $94,593 ($33,953 in professional physician fees and $60,640 in facility fees). Program expenses include an initial capital expense (estimated at $120,000 for two US machines) and ongoing operational costs ($68,640 per year to cover image quality assurance review, continuing education, and program maintenance). Based on current revenue, there would be an annual operating loss, and thus an ROI cannot be calculated. However, if potential revenue is achieved, the annual operating income will be $22,846 per year with an ROI of 4.9 years to break even with initial investment. Determining an ROI is a required procedure for any business plan for establishing an ED US program. Our analysis demonstrates that an ED US program that captures charges for trauma and procedural US and achieves the potential billing volume breaks even in less than 5 years, at which point it would generate a positive margin.

Medicare patients' use of overpriced procedures before and after the Omnibus Budget Reconciliation Act of 1987.

PubMed Central

Escarce, J J

1993-01-01

OBJECTIVES. Under the Omnibus Budget Reconciliation Act of 1987, Medicare reduced physician fees for 12 procedures identified as overprices. This paper describes trends in the use of these procedures and other physician services by Medicare patients during the 4-year period surrounding the implementation of the 1987 budget act. METHODS. Medicare physician claims files were used to develop trends in physician-services use from 1986 to 1989. Services were grouped into four categories: overpriced procedures, other surgery, medical care, and ancillary tests. RESULTS. Growth in the volume of overpriced procedures slowed substantially after the 1987 budget act was implemented. Moreover, the reduction in the rate of volume growth for these procedures differed little among specialities or areas. In comparison, the rate of volume growth fell modestly for other surgery, was unchanged for medical care, and increased for ancillary tests. CONCLUSIONS. Increases do not necessarily occur in the volume of surgical procedures whose Medicare fees are reduced. Although the conclusions that may be drawn from a descriptive analysis are limited, these findings suggest that concerns that the resource-based Medicare fee schedule will lead to higher surgery rates may be unwarranted. PMID:8438971

When high-volume PCI operators in high-volume hospitals move to lower volume hospitals-Do they still maintain high volume and quality of outcomes?

PubMed

Lu, Tsung-Hsueh; Li, Sheng-Tun; Liang, Fu-Wen; Lee, Jo-Chi; Yin, Wei-Hsian

2017-10-31

The aim of this quasi-experimental study was to examine whether high-volume percutaneous coronary intervention (PCI) operators still maintain high volume and quality of outcomes when they moved to lower volume hospitals. Systematic reviews have indicated that high-volume PCI operators and hospitals have higher quality outcomes. However, little is known on whether high PCI volume and high quality outcomes are mainly due to operator characteristics (i.e., skill and experience) and is portable across organizations or whether it is due to hospital characteristics (i.e., equipment, team, and management system) and is less portable. We used Taiwan National Health Insurance claims data 2000-2012 to identify 98 high-volume PCI operators, 10 of whom moved from one hospital to another during the study period. We compared the PCI volume, risk-adjusted mortality ratio, and major adverse cardiovascular event (MACE) ratio before and after moving. Of the 10 high-volume operators who moved, 6 moved from high- to moderate- or low-volume hospitals, with median annual PCI volumes (interquartile range) of 130 (117-165) in prior hospitals and 54 (46-84) in subsequent hospitals (the hospital the operator moved to), and the remaining 4 moved from high to high-volume hospitals, with median annual PCI volumes (interquartile range) of 151 (133-162) in prior hospitals and 193 (178-239) in subsequent hospitals. No significant differences were observed in the risk-adjusted mortality ratios and MACE ratios between high-volume operators and matched controls before and after moving. High-volume operators cannot maintain high volume when they moved from high to moderate or low-volume hospitals; however, the quality of care is maintained. High PCI volume and high-quality outcomes are less portable and more hospital bound. © 2017 Wiley Periodicals, Inc.

Design of a superconducting volume coil for magnetic resonance microscopy of the mouse brain

NASA Astrophysics Data System (ADS)

Nouls, John C.; Izenson, Michael G.; Greeley, Harold P.; Johnson, G. Allan

2008-04-01

We present the design process of a superconducting volume coil for magnetic resonance microscopy of the mouse brain at 9.4 T. The yttrium barium copper oxide coil has been designed through an iterative process of three-dimensional finite-element simulations and validation against room temperature copper coils. Compared to previous designs, the Helmholtz pair provides substantially higher B1 homogeneity over an extended volume of interest sufficiently large to image biologically relevant specimens. A custom-built cryogenic cooling system maintains the superconducting probe at 60 ± 0.1 K. Specimen loading and probe retuning can be carried out interactively with the coil at operating temperature, enabling much higher through-put. The operation of the probe is a routine, consistent procedure. Signal-to-noise ratio in a mouse brain increased by a factor ranging from 1.1 to 2.9 as compared to a room-temperature solenoid coil optimized for mouse brain microscopy. We demonstrate images encoded at 10 × 10 × 20 μm for an entire mouse brain specimen with signal-to-noise ratio of 18 and a total acquisition time of 16.5 h, revealing neuroanatomy unseen at lower resolution. Phantom measurements show an effective spatial resolution better than 20 μm.

Design of a superconducting volume coil for magnetic resonance microscopy of the mouse brain.

PubMed

Nouls, John C; Izenson, Michael G; Greeley, Harold P; Johnson, G Allan

2008-04-01

We present the design process of a superconducting volume coil for magnetic resonance microscopy of the mouse brain at 9.4T. The yttrium barium copper oxide coil has been designed through an iterative process of three-dimensional finite-element simulations and validation against room temperature copper coils. Compared to previous designs, the Helmholtz pair provides substantially higher B(1) homogeneity over an extended volume of interest sufficiently large to image biologically relevant specimens. A custom-built cryogenic cooling system maintains the superconducting probe at 60+/-0.1K. Specimen loading and probe retuning can be carried out interactively with the coil at operating temperature, enabling much higher through-put. The operation of the probe is a routine, consistent procedure. Signal-to-noise ratio in a mouse brain increased by a factor ranging from 1.1 to 2.9 as compared to a room-temperature solenoid coil optimized for mouse brain microscopy. We demonstrate images encoded at 10x10x20mum for an entire mouse brain specimen with signal-to-noise ratio of 18 and a total acquisition time of 16.5h, revealing neuroanatomy unseen at lower resolution. Phantom measurements show an effective spatial resolution better than 20mum.

Intravascular US-Guided Portal Vein Access: Improved Procedural Metrics during TIPS Creation.

PubMed

Gipson, Matthew G; Smith, Mitchell T; Durham, Janette D; Brown, Anthony; Johnson, Thor; Ray, Charles E; Gupta, Rajan K; Kondo, Kimi L; Rochon, Paul J; Ryu, Robert K

2016-08-01

To evaluate transjugular intrahepatic portosystemic shunt (TIPS) outcomes and procedure metrics with the use of three different image guidance techniques for portal vein (PV) access during TIPS creation. A retrospective review of consecutive patients who underwent TIPS procedures for a range of indications during a 28-month study period identified a population of 68 patients. This was stratified by PV access techniques: fluoroscopic guidance with or without portography (n = 26), PV marker wire guidance (n = 18), or intravascular ultrasound (US) guidance (n = 24). Procedural outcomes and procedural metrics, including radiation exposure, contrast agent volume used, procedure duration, and PV access time, were analyzed. No differences in demographic or procedural characteristics were found among the three groups. Technical success, technical success of the primary planned approach, hemodynamic success, portosystemic gradient, and procedure-related complications were not significantly different among groups. Fluoroscopy time (P = .003), air kerma (P = .01), contrast agent volume (P = .003), and total procedural time (P = .02) were reduced with intravascular US guidance compared with fluoroscopic guidance. Fluoroscopy time (P = .01) and contrast agent volume (P = .02) were reduced with intravascular US guidance compared with marker wire guidance. Intravascular US guidance of PV access during TIPS creation not only facilitates successful TIPS creation in patients with challenging anatomy, as suggested by previous investigations, but also reduces important procedure metrics including radiation exposure, contrast agent volume, and overall procedure duration compared with fluoroscopically guided TIPS creation. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

Calculation of hydrocarbon-in-place in gas and gas-condensate reservoirs - Carbon dioxide sequestration

USGS Publications Warehouse

Verma, Mahendra K.

2012-01-01

The Energy Independence and Security Act of 2007 (Public Law 110-140) authorized the U.S. Geological Survey (USGS) to conduct a national assessment of geologic storage resources for carbon dioxide (CO2), requiring estimation of hydrocarbon-in-place volumes and formation volume factors for all the oil, gas, and gas-condensate reservoirs within the U.S. sedimentary basins. The procedures to calculate in-place volumes for oil and gas reservoirs have already been presented by Verma and Bird (2005) to help with the USGS assessment of the undiscovered resources in the National Petroleum Reserve, Alaska, but there is no straightforward procedure available for calculating in-place volumes for gas-condensate reservoirs for the carbon sequestration project. The objective of the present study is to propose a simple procedure for calculating the hydrocarbon-in-place volume of a condensate reservoir to help estimate the hydrocarbon pore volume for potential CO2 sequestration.

Development and operations of the astrophysics data system

NASA Technical Reports Server (NTRS)

Murray, Stephen S.; Oliversen, Ronald (Technical Monitor)

2005-01-01

Abstract service - Continued regular updates of abstracts in the databases, both at SA0 and at all mirror sites. - Modified loading scripts to accommodate changes in data format (PhyS) - Discussed data deliveries with providers to clear up problems with format or other errors (EGU) - Continued inclusion of large numbers of historical literature volumes and physics conference volumes xeroxed from the library. - Performed systematic fixes on some data sets in the database to account for changes in article numbering (AGU journals) - Implemented linking of ADS bibliographic records with multimedia files - Debugged and fixed obscure connection problems with the ADS Korean mirror site which were preventing successful updates of the data holdings. - Wrote procedure to parse citation data and characterize an ADS record based on its citation ratios within each database.

Time efficient Gabor fused master slave optical coherence tomography

NASA Astrophysics Data System (ADS)

Cernat, Ramona; Bradu, Adrian; Rivet, Sylvain; Podoleanu, Adrian

2018-02-01

In this paper the benefits in terms of operation time that Master/Slave (MS) implementation of optical coherence tomography can bring in comparison to Gabor fused (GF) employing conventional fast Fourier transform based OCT are presented. The Gabor Fusion/Master Slave Optical Coherence Tomography architecture proposed here does not need any data stitching. Instead, a subset of en-face images is produced for each focus position inside the sample to be imaged, using a reduced number of theoretically inferred Master masks. These en-face images are then assembled into a final volume. When the channelled spectra are digitized into 1024 sampling points, and more than 4 focus positions are required to produce the final volume, the Master Slave implementation of the instrument is faster than the conventional fast Fourier transform based procedure.

The Epidemiology of Revision Anterior Cruciate Ligament Reconstruction in Adults from Ontario, Canada

PubMed Central

Leroux, Timothy; Wasserstein, David; Dwyer, Tim; Ogilvie-Harris, Darrell; Marks, Paul H.; Bach, Bernard R.; Townley, John; Mahomed, Nizar; Chahal, Jaskarndip

2015-01-01

Objectives: The morbidity associated with revision anterior cruciate ligament reconstruction (ACLR) is largely unknown. The objective of this study was to determine the rate of and risk factors for re-revision, re-operation, and re-admission following revision ACLR in the general population. Methods: All patients who underwent first revision ACLR in Ontario, Canada from January 2004 to December 2010 were identified and followed to December 2012. Exclusions included age (<16 years), previous osteotomy, or multi-ligament knee reconstruction. The main outcome was re-revision ACLR. Secondary outcomes included re-operation [irrigation and debridement (I&D), meniscectomy, manipulation under anesthesia (MUA), contralateral ACLR, and total knee arthroplasty (TKA)], and re-admission within 90 days of surgery. Survival to re-revision was determined using the Kaplan-Meier (KM) approach. A Cox proportional hazards model or logistic regression were used to determine the influence of patient factors (age, sex, neighborhood income quintile, and comorbidity), surgical factors (graft choice, concurrent meniscal procedure, and fixation method), and provider factors (surgeon volume, surgeon years in practice, and hospital status) on outcomes. A post-hoc analysis was performed to determine the influence of the aforementioned factors on overall post-operative infection risk, including both operative and non-operative cases. Results: Overall, 827 patients were included (median age: 30 years; 58.8% males). Single stage revisions comprised 92.9% of cases, and a meniscal procedure (repair or debridement) was performed in 45.3% of cases. The re-revision rate at a mean follow-up of 4.8±2.2 years was 4.4%, and the five-year survival rate was 95.4% (Figure 1). The rates of I&D, meniscectomy, contralateral ACLR, and re-admission were 0.8%, 3.1%, 3.4%, and 4.1%, respectively. MUA and TKA were rare. Young age significantly increased contralateral ACLR risk (risk decreased by 5.1% with each year of age above 16 years, p=0.02), but not re-revision ACLR risk. Low surgeon annual volume of revision ACLR [<4 revisions/year: odds ratio (OR) 1.2, p=0.02)] and male sex (OR 13.3, p=0.01) significantly increased overall infection risk, while male sex also influenced I&D risk. No other factors significantly influenced re-revision, re-operation, or re-admission risk. Conclusion: Re-revision, re-operation, and re-admission rates following revision ACLR are low. The risk of I&D, overall infection, and contralateral ACLR were influenced by male sex, low surgeon volume, and young age, respectively. This is the first study of this magnitude to determine rates of and risk factors for morbidity following revision ACLR, providing clinicians with reference data from the general population.

Trends and outcomes of valve surgery: 16-year results of Netherlands Cardiac Surgery National Database.

PubMed

Siregar, Sabrina; de Heer, Frederiek; Groenwold, Rolf H H; Versteegh, Michel I M; Bekkers, Jos A; Brinkman, Emile S; Bots, Michiel L; van der Graaf, Yolanda; van Herwerden, Lex A

2014-09-01

The aim was to describe procedural volumes, patient risk profile and outcomes of heart valve surgery in the past 16 years in Netherlands. The Dutch National Database for Cardio-Thoracic Surgery includes approximately 200 000 cardiac operations performed between 1995 and 2010. Information on all valve surgeries (56 397 operations) was extracted. We determined trends for changes in procedural volume, demographics, risk profile and in-hospital mortality of valve operations. Because of incomplete data in the first years of registration, the total number of operations in those years was estimated using Poisson regression. For a subset from 2007 to 2010, follow-up data were available. Survival status was obtained through linkage with the national Cause of Death Registry, and survival analysis was performed using Kaplan-Meier method. Information on discharge and readmissions was obtained from the National Hospital Discharge Registry. The annual volume of heart valve operations increased by more than 100% from an estimated 2431 in 1995 to 5906 in 2010. Adjusted for population size in Netherlands, the number of operations per 100 000 adults increased from 20 in 1995 to 43 in 2010. In 2010, frequently performed valve surgery included the following: 34.6% isolated aortic valve (AoV) replacement, 21.8% AoV replacement and coronary artery bypass grafting (CABG), 14.6% isolated mitral valve surgery (repair or replacement) and 9.1% mitral valve and CABG. In AoV surgery, an increasing use of bioprostheses in all age categories is observed. In mitral valve surgery, 75.4% was performed by repair rather than replacement in 2010. In-hospital mortality for all valve surgery decreased significantly from 4.6% in 2007 to 3.6% in 2010, whereas the mean logistic EuroSCORE remained stable (median 5.8, P = 1.000). Thirty-day mortality after all valve surgery was 3.9% and 120-day mortality was 6.5%. At 1 year, survival after all valve surgery was 91.6% and a reoperation had been performed in 1.6%. The median postoperative length of stay was 7 days (interquartile range (IQR) 5-11) in the primary hospital and 11 days (IQR 8-16), including subsequent stay, in the secondary hospital. The results of this study provide a comprehensive overview of valve surgery trends and outcomes in Netherlands. The number of heart valve operations performed in Netherlands has increased since 1995. The significant decrease in mortality and unchanged EuroSCORE between 2007 and 2010 might reflect a general improvement of the safety of valve surgery. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Beyond Volume: Hospital-Based Healthcare Technology for Better Outcomes in Cerebrovascular Surgical Patients Diagnosed With Ischemic Stroke: A Population-Based Nationwide Cohort Study From 2002 to 2013.

PubMed

Kim, Jae-Hyun; Park, Eun-Cheol; Lee, Sang Gyu; Lee, Tae-Hyun; Jang, Sung-In

2016-03-01

We examined whether the level of hospital-based healthcare technology was related to the 30-day postoperative mortality rates, after adjusting for hospital volume, of ischemic stroke patients who underwent a cerebrovascular surgical procedure. Using the National Health Insurance Service-Cohort Sample Database, we reviewed records from 2002 to 2013 for data on patients with ischemic stroke who underwent cerebrovascular surgical procedures. Statistical analysis was performed using Cox proportional hazard models to test our hypothesis. A total of 798 subjects were included in our study. After adjusting for hospital volume of cerebrovascular surgical procedures as well as all for other potential confounders, the hazard ratio (HR) of 30-day mortality in low healthcare technology hospitals as compared to high healthcare technology hospitals was 2.583 (P < 0.001). We also found that, although the HR of 30-day mortality in low healthcare technology hospitals with high volume as compared to high healthcare technology hospitals with high volume was the highest (10.014, P < 0.0001), cerebrovascular surgical procedure patients treated in low healthcare technology hospitals had the highest 30-day mortality rate, irrespective of hospital volume. Although results of our study provide scientific evidence for a hospital volume/30-day mortality rate relationship in ischemic stroke patients who underwent cerebrovascular surgical procedures, our results also suggest that the level of hospital-based healthcare technology is associated with mortality rates independent of hospital volume. Given these results, further research into what components of hospital-based healthcare technology significantly impact mortality is warranted.

An investigation of a low-variability tire treadwear test procedure and of treadwear adjustment for ambient temperature. Volume 3 : appendices F, G, H, I, J and K, analytical files

DOT National Transportation Integrated Search

1985-01-01

This volume is the second part of a two-part appendix to the report on a low variability : tire treadwear procedure and treadwear adjustment for ambient : temperature. This volume contains Appendices F through K, covering the fundamental : statistica...

Real-time Interpolation for True 3-Dimensional Ultrasound Image Volumes

PubMed Central

Ji, Songbai; Roberts, David W.; Hartov, Alex; Paulsen, Keith D.

2013-01-01

We compared trilinear interpolation to voxel nearest neighbor and distance-weighted algorithms for fast and accurate processing of true 3-dimensional ultrasound (3DUS) image volumes. In this study, the computational efficiency and interpolation accuracy of the 3 methods were compared on the basis of a simulated 3DUS image volume, 34 clinical 3DUS image volumes from 5 patients, and 2 experimental phantom image volumes. We show that trilinear interpolation improves interpolation accuracy over both the voxel nearest neighbor and distance-weighted algorithms yet achieves real-time computational performance that is comparable to the voxel nearest neighbor algrorithm (1–2 orders of magnitude faster than the distance-weighted algorithm) as well as the fastest pixel-based algorithms for processing tracked 2-dimensional ultrasound images (0.035 seconds per 2-dimesional cross-sectional image [76,800 pixels interpolated, or 0.46 ms/1000 pixels] and 1.05 seconds per full volume with a 1-mm3 voxel size [4.6 million voxels interpolated, or 0.23 ms/1000 voxels]). On the basis of these results, trilinear interpolation is recommended as a fast and accurate interpolation method for rectilinear sampling of 3DUS image acquisitions, which is required to facilitate subsequent processing and display during operating room procedures such as image-guided neurosurgery. PMID:21266563

Real-time interpolation for true 3-dimensional ultrasound image volumes.

PubMed

Ji, Songbai; Roberts, David W; Hartov, Alex; Paulsen, Keith D

2011-02-01

We compared trilinear interpolation to voxel nearest neighbor and distance-weighted algorithms for fast and accurate processing of true 3-dimensional ultrasound (3DUS) image volumes. In this study, the computational efficiency and interpolation accuracy of the 3 methods were compared on the basis of a simulated 3DUS image volume, 34 clinical 3DUS image volumes from 5 patients, and 2 experimental phantom image volumes. We show that trilinear interpolation improves interpolation accuracy over both the voxel nearest neighbor and distance-weighted algorithms yet achieves real-time computational performance that is comparable to the voxel nearest neighbor algrorithm (1-2 orders of magnitude faster than the distance-weighted algorithm) as well as the fastest pixel-based algorithms for processing tracked 2-dimensional ultrasound images (0.035 seconds per 2-dimesional cross-sectional image [76,800 pixels interpolated, or 0.46 ms/1000 pixels] and 1.05 seconds per full volume with a 1-mm(3) voxel size [4.6 million voxels interpolated, or 0.23 ms/1000 voxels]). On the basis of these results, trilinear interpolation is recommended as a fast and accurate interpolation method for rectilinear sampling of 3DUS image acquisitions, which is required to facilitate subsequent processing and display during operating room procedures such as image-guided neurosurgery.

Operationally Efficient Propulsion System Study (OEPSS) data book. Executive summary

NASA Technical Reports Server (NTRS)

Wong, George S.

1990-01-01

The study was initiated to identify operations problems and cost drivers for current propulsion systems and to identify technology and design approaches to increase the operational efficiency and reduce operations costs for future propulsion systems. To provide readily usable data for the Advanced Launch System (ALS) program, the results of the Operationally Efficient Propulsion System Study (OEPSS) were organized into a series of OEPSS Data Books as follows: Volume 1, Generic Ground Operations Data; Volume 2, Ground Operations Problems; Volume 3, Operations Technology; Volume 4, OEPSS Design Concepts; and Volume 5, OEPSS Final Review Briefing, which summarizes the activities and results of the study. Summarized here are the salient results of the first year. A synopsis of each volume listed above is presented.

Analysis of utilization patterns and associated costs of the breast imaging and diagnostic procedures after screening mammography.

PubMed

Vlahiotis, Anna; Griffin, Brian; Stavros, A Thomas; Margolis, Jay

2018-01-01

Little data exist on real-world patterns and associated costs of downstream breast diagnostic procedures following an abnormal screening mammography or clinical exam. To analyze the utilization patterns in real-world clinical settings for breast imaging and diagnostic procedures, including the frequency and volume of patients and procedures, procedure sequencing, and associated health care expenditures. Using medical claims from 2011 to 2015 MarketScan Commercial and Medicare Databases, adult females with breast imaging/diagnostic procedures (diagnostic mammography, ultrasound, molecular breast imaging, tomosynthesis, magnetic resonance imaging, or biopsy) other than screening mammography were selected. Continuous health plan coverage without breast diagnostic procedures was required for ≥13 months before the first found breast diagnostic procedure (index event), with a 13-month post-index follow-up period. Key outcomes included diagnostic procedure volumes, sequences, and payments. Results reported descriptively were projected to provide US national patient and procedure volumes. The final sample of 875,526 patients was nationally projected to 12,394,432 patients annually receiving 8,732,909 diagnostic mammograms (53.3% of patients), 6,987,399 breast ultrasounds (42.4% of patients), and 1,585,856 biopsies (10.3% of patients). Following initial diagnostic procedures, 49.4% had second procedures, 20.1% followed with third procedures, and 10.0% had a fourth procedure. Mean (SD) costs for diagnostic mammograms of US$349 ($493), ultrasounds US$132 ($134), and biopsies US$1,938 ($2,343) contributed US$3.05 billion, US$0.92 billion, and US$3.07 billion, respectively, to annual diagnostic breast expenditures estimated at US$7.91 billion. The volume and expense of additional breast diagnostic testing, estimated at US$7.91 billion annually, underscores the need for technological improvements in the breast diagnostic landscape.

Operationally Efficient Propulsion System Study (OEPSS) data book. Volume 1: Generic ground operations data

NASA Technical Reports Server (NTRS)

Byrd, Raymond J.

1990-01-01

This study was initiated to identify operations problems and cost drivers for current propulsion systems and to identify technology and design approaches to increase the operational efficiency and reduce operations costs for future propulsion systems. To provide readily usable data for the Advance Launch System (ALS) program, the results of the Operationally Efficient Propulsion System Study (OEPSS) were organized into a series of OEPSS Data Books as follows: Volume 1, Generic Ground Operations Data; Volume 2, Ground Operations Problems; Volume 3, Operations Technology; Volume 4, OEPSS Design Concepts; and Volume 5, OEPSS Final Review Briefing, which summarizes the activities and results of the study. This volume presents ground processing data for a generic LOX/LH2 booster and core propulsion system based on current STS experience. The data presented includes: top logic diagram, process flow, activities bar-chart, loaded timelines, manpower requirements in terms of duration, headcount and skill mix per operations and maintenance instruction (OMI), and critical path tasks and durations.

Large area 3-D optical coherence tomography imaging of lumpectomy specimens for radiation treatment planning

NASA Astrophysics Data System (ADS)

Wang, Cuihuan; Kim, Leonard; Barnard, Nicola; Khan, Atif; Pierce, Mark C.

2016-02-01

Our long term goal is to develop a high-resolution imaging method for comprehensive assessment of tissue removed during lumpectomy procedures. By identifying regions of high-grade disease within the excised specimen, we aim to develop patient-specific post-operative radiation treatment regimens. We have assembled a benchtop spectral-domain optical coherence tomography (SD-OCT) system with 1320 nm center wavelength. Automated beam scanning enables "sub-volumes" spanning 5 mm x 5 mm x 2 mm (500 A-lines x 500 B-scans x 2 mm in depth) to be collected in under 15 seconds. A motorized sample positioning stage enables multiple sub-volumes to be acquired across an entire tissue specimen. Sub-volumes are rendered from individual B-scans in 3D Slicer software and en face (XY) images are extracted at specific depths. These images are then tiled together using MosaicJ software to produce a large area en face view (up to 40 mm x 25 mm). After OCT imaging, specimens were sectioned and stained with HE, allowing comparison between OCT image features and disease markers on histopathology. This manuscript describes the technical aspects of image acquisition and reconstruction, and reports initial qualitative comparison between large area en face OCT images and HE stained tissue sections. Future goals include developing image reconstruction algorithms for mapping an entire sample, and registering OCT image volumes with clinical CT and MRI images for post-operative treatment planning.

Non invasive evaluation of cardiomechanics in patients undergoing MitrClip procedure

PubMed Central

2013-01-01

Background In the last recent years a new percutaneous procedure, the MitraClip, has been validated for the treatment of mitral regurgitation. MitraClip procedure is a promising alternative for patients unsuitable for surgery as it reduces the risk of death related to surgery ensuring a similar result. Few data are present in literature about the variation of hemodynamic parameters and ventricular coupling after Mitraclip implantation. Methods Hemodynamic data of 18 patients enrolled for MitraClip procedure were retrospectively reviewed and analyzed. Echocardiographic measurements were obtained the day before the procedure (T0) and 21 ± 3 days after the procedure (T1), including evaluation of Ejection Fraction, mitral valve regurgitation severity and mechanism, forward Stroke Volume, left atrial volume, estimated systolic pulmonary pressure, non invasive echocardiographic estimation of single beat ventricular elastance (Es(sb)), arterial elastance (Ea) measured as systolic pressure • 0.9/ Stroke Volume, ventricular arterial coupling (Ea/Es(sb) ratio). Data were expressed as median and interquartile range. Measures obtained before and after the procedure were compared using Wilcoxon non parametric test for paired samples. Results Mitraclip procedure was effective in reducing regurgitation. We observed an amelioration of echocardiographic parameters with a reduction of estimated systolic pulmonary pressure (45 to 37,5 p = 0,0002) and left atrial volume (110 to 93 p = 0,0001). Despite a few cases decreasing in ejection fraction (37 to 35 p = 0,035), the maintained ventricular arterial coupling after the procedure (P = 0,67) was associated with an increasing in forward stroke volume (60,3 to 78 p = 0,05). Conclusion MitraClip is effective in reducing mitral valve regurgitation and determines an amelioration of hemodynamic parameters with preservation of ventricular arterial coupling. PMID:23642140

Methodological Research on Knowledge Use and School Improvement. Volume III. Measuring Knowledge Use: A Procedural Inventory.

ERIC Educational Resources Information Center

Dunn, William N.; And Others

This volume presents in one collection a systematic inventory of research and analytic procedures appropriate for generating information on knowledge production, diffusion, and utilization, gathered by the University of Pittsburgh Program for the Study of Knowledge Use. The main concern is with those procedures that focus on the utilization of…

Contemporary bloodletting in cardiac surgical care.

PubMed

Koch, Colleen G; Reineks, Edmunds Z; Tang, Anne S; Hixson, Eric D; Phillips, Shannon; Sabik, Joseph F; Henderson, J Michael; Blackstone, Eugene H

2015-03-01

Health care providers are seldom aware of the frequency and volume of phlebotomy for laboratory testing, bloodletting that often leads to hospital-acquired anemia. Our objectives were to examine the frequency of laboratory testing in patients undergoing cardiac surgery, calculate cumulative phlebotomy volume from time of initial surgical consultation to hospital discharge, and propose strategies to reduce phlebotomy volume. From January 1, 2012 to June 30, 2012, 1,894 patients underwent cardiac surgery at Cleveland Clinic; 1,867 had 1 hospitalization and 27 had 2. Each laboratory test was associated with a test name and blood volume. Phlebotomy volume was estimated separately for the intensive care unit (ICU), hospital floors, and cumulatively. A total of 221,498 laboratory tests were performed, averaging 115 tests per patient. The most frequently performed tests were 88,068 blood gas analyses, 39,535 coagulation tests, 30,421 complete blood counts, and 29,374 metabolic panels. Phlebotomy volume differed between ICU and hospital floors, with median volumes of 332 mL and 118 mL, respectively. Cumulative median volume for the entire hospital stay was 454 mL. More complex procedures were associated with higher overall phlebotomy volume than isolated procedures; eg, combined coronary artery bypass grafting (CABG) and valve procedure median volume was 653 mL (25th/75th percentiles, 428 of 1,065 mL) versus 448 mL (284 of 658 mL) for isolated CABG and 338 mL (237 of 619) for isolated valve procedures. We were astonished by the extent of bloodletting, with total phlebotomy volumes approaching amounts equivalent to 1 to 2 red blood cell units. Implementation of process improvement initiatives can potentially reduce phlebotomy volumes and resource utilization. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Outcomes of Cryoballoon Ablation in High- and Low-Volume Atrial Fibrillation Ablation Centres: A Russian Pilot Survey

PubMed Central

Mikhaylov, Evgeny N.; Lebedev, Dmitry S.; Pokushalov, Evgeny A.; Davtyan, Karapet V.; Ivanitskii, Eduard A.; Nechepurenko, Anatoly A.; Kosonogov, Alexey Ya.; Kolunin, Grigory V.; Morozov, Igor A.; Termosesov, Sergey A.; Maykov, Evgeny B.; Khomutinin, Dmitry N.; Eremin, Sergey A.; Mayorov, Igor M.; Romanov, Alexander B.; Shabanov, Vitaliy V.; Shatakhtsyan, Victoria; Tsivkovskii, Viktor; Revishvili, Amiran Sh.; Shlyakhto, Evgeny V.

2015-01-01

Purpose. The results of cryoballoon ablation (CBA) procedure have been mainly derived from studies conducted in experienced atrial fibrillation (AF) ablation centres. Here, we report on CBA efficacy and complications resulting from real practice of this procedure at both high- and low-volume centres. Methods. Among 62 Russian centres performing AF ablation, 15 (24%) used CBA technology for pulmonary vein isolation. The centres were asked to provide a detailed description of all CBA procedures performed and complications, if encountered. Results. Thirteen sites completed interviews on all CBAs in their centres (>95% of CBAs in Russia). Six sites were high-volume AF ablation (>100 AF cases/year) centres, and 7 were low-volume AF ablation. There was no statistical difference in arrhythmia-free rates between high- and low-volume centres (64.6 versus 60.8% at 6 months). Major complications developed in 1.5% of patients and were equally distributed between high- and low-volume centres. Minor procedure-related events were encountered in 8% of patients and were more prevalent in high-volume centres. Total event and vascular access site event rates were higher in women than in men. Conclusions. CBA has an acceptable efficacy profile in real practice. In less experienced AF ablation centres, the major complication rate is equal to that in high-volume centres. PMID:26640789

Pre-procedural bioimpedance vectorial analysis of fluid status and prediction of contrast-induced acute kidney injury.

PubMed

Maioli, Mauro; Toso, Anna; Leoncini, Mario; Musilli, Nicola; Bellandi, Francesco; Rosner, Mitchell H; McCullough, Peter A; Ronco, Claudio

2014-04-15

The aim of this study was to evaluate the relationship between pre-procedural fluid status assessed by bioimpedance vector analysis (BIVA) and development of contrast-induced acute kidney injury (CI-AKI). Accurate fluid management in patients undergoing angiographic procedures is of critical importance in limiting the risk of CI-AKI. Therefore, establishing peri-procedural fluid volume related to increased risk of CI-AKI development is essential. We evaluated the fluid status by BIVA of 900 consecutive patients with stable coronary artery disease (CAD) immediately before coronary angiography, measuring the resistance/height (R/H) ratio and impedance/height (Z/H) vector. CI-AKI was defined as an increase in serum creatinine ≥0.5 mg/dl above baseline within 3 days after contrast administration (iodixanol). CI-AKI occurred in 54 patients (6.0%). Pre-procedural R/H ratios were significantly higher in patients with CI-AKI than without CI-AKI (395 ± 71 Ohm/m vs. 352 ± 58 Ohm/m, p = 0.001 for women; 303 ± 59 Ohm/m vs. 279 ± 45 Ohm/m, p = 0.009 for men), indicating lower fluid volume in the patients with CI-AKI. When patients were stratified according to R/H ratio, there was an almost 3-fold higher risk in patients with higher values (odds ratio [OR]: 2.9; 95% confidence interval [CI]: 1.5 to 5.5; p = 0.002). The optimal receiver-operating characteristic curve analysis threshold values of R/H ratio for predicting CI-AKI were 380 Ohm/m for women and 315 Ohm/m for men. R/H ratio above these thresholds was found to be a significant and independent predictor of CI-AKI (OR: 3.1; 95% CI: 1.8 to 5.5; p = 0.001). Lower fluid status evaluated by BIVA immediately before contrast medium administration resulted in a significant and independent predictor of CI-AKI in patients with stable CAD. This simple noninvasive analysis should be tested in guiding tailored volume repletion. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

[Pancreatoduodenectomy: results in a large volume center].

PubMed

Chan, Carlos; Franssen, Bernardo; Uscanga, Luis; Robles, Guillermo; Campuzano, Manuel

2006-01-01

Analyze the experience with pancreaticoduodenectomy (PD) at the INCMNSZ. PD has become a popular procedure in hospitals throughout the USA and Europe in the last 25 years, where mortality is < 5% y morbidity remains around 40%. Nonetheless there are very few reports on PD in Latin America. The data of all PD's performed at the INCMNSZ between 1999 and 2005 was gathered prospectively and analyzed retrospectively. 133 PDs where performed; 47.5% where men and 52.5% where women. Median of age was 57.7 years. 81.5% underwent classical resection and 18.5% a pylorus preserving procedure. Intraoperative variables include: blood loss: 940 mL. (1,000). transfusion requirements: 1.9 U, median operative time: 5:49 (+/- 1:02) and median hospital stay: 14 days. Most frequent diagnosis include ampulary adenocarcinoma and pancreatic cancer Mortality in the entire series was 9.2%, decreased to 2.7% in the 2002-2005 period and from April 2003 has remained in 0. A total of 14 portal-superior mesenteric vein resections where performed. To our knowledge this is the largest series of PD in Latin America. Popularity and indications for PD are expanding. Mortality is acceptable and morbidity remains high despite much effort. This procedure is performed with a satisfactory outcome in high volume centers. Involvement of the portal-superior mesenteric vein is not a contraindication of PD.

Perioperative strategies and technical modifications to the Nuss repair for pectus excavatum in pediatric patients: a large volume, single institution experience.

PubMed

Sacco Casamassima, Maria Grazia; Goldstein, Seth D; Salazar, Jose H; McIltrot, Kimberly H; Abdullah, Fizan; Colombani, Paul M

2014-04-01

The safety and efficacy of minimally invasive pectus excavatum repair have been demonstrated over the last twenty years. However, technical details and perioperative management strategies continue to be debated. The aim of the present study is to review a large single-institution experience with the modified Nuss procedure. A retrospective review was performed of patients who underwent primary pectus excavatum repair at a single tertiary hospital via a modified Nuss procedure that included: no thoracoscopy, retrosternal dissection achieved via a left-to-right thoracic approach, four-point stabilization of the bar, and no routine epidural analgesia. Data collected included demographics, preoperative symptoms, operative characteristics, hospital charges and postoperative outcomes. A total of 336 pediatric patients were identified. No cardiac perforations occurred and the rate of pericarditis was 0.6%. Contemporary rates of bar displacement have fallen to 1.2%. Routine use of chlorhexidine scrub reduced superficial site infections to 0.7%. Two patients (0.6%) with severe recurrence required reoperation. Bars were removed after an average period of 31.7(SD 13.2) months, with satisfactory cosmetic and functional results in 94.9% of cases. We report here a single-institution large volume experience, including modifications to the Nuss procedure that make the technique simpler and safer, improve results, and minimize hospital charges. Copyright © 2014 Elsevier Inc. All rights reserved.

Prediction of resource volumes at untested locations using simple local prediction models

USGS Publications Warehouse

Attanasi, E.D.; Coburn, T.C.; Freeman, P.A.

2006-01-01

This paper shows how local spatial nonparametric prediction models can be applied to estimate volumes of recoverable gas resources at individual undrilled sites, at multiple sites on a regional scale, and to compute confidence bounds for regional volumes based on the distribution of those estimates. An approach that combines cross-validation, the jackknife, and bootstrap procedures is used to accomplish this task. Simulation experiments show that cross-validation can be applied beneficially to select an appropriate prediction model. The cross-validation procedure worked well for a wide range of different states of nature and levels of information. Jackknife procedures are used to compute individual prediction estimation errors at undrilled locations. The jackknife replicates also are used with a bootstrap resampling procedure to compute confidence bounds for the total volume. The method was applied to data (partitioned into a training set and target set) from the Devonian Antrim Shale continuous-type gas play in the Michigan Basin in Otsego County, Michigan. The analysis showed that the model estimate of total recoverable volumes at prediction sites is within 4 percent of the total observed volume. The model predictions also provide frequency distributions of the cell volumes at the production unit scale. Such distributions are the basis for subsequent economic analyses. ?? Springer Science+Business Media, LLC 2007.

Metrological tests of a 200 L calibration source for HPGE detector systems for assay of radioactive waste drums.

PubMed

Boshkova, T; Mitev, K

2016-03-01

In this work we present test procedures, approval criteria and results from two metrological inspections of a certified large volume (152)Eu source (drum about 200L) intended for calibration of HPGe gamma assay systems used for activity measurement of radioactive waste drums. The aim of the inspections was to prove the stability of the calibration source during its working life. The large volume source was designed and produced in 2007. It consists of 448 identical sealed radioactive sources (modules) apportioned in 32 transparent plastic tubes which were placed in a wooden matrix which filled the drum. During the inspections the modules were subjected to tests for verification of their certified characteristics. The results show a perfect compliance with the NIST basic guidelines for the properties of a radioactive certified reference material (CRM) and demonstrate the stability of the large volume CRM-drum after 7 years of operation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Split Space-Marching Finite-Volume Method for Chemically Reacting Supersonic Flow

NASA Technical Reports Server (NTRS)

Rizzi, Arthur W.; Bailey, Harry E.

1976-01-01

A space-marching finite-volume method employing a nonorthogonal coordinate system and using a split differencing scheme for calculating steady supersonic flow over aerodynamic shapes is presented. It is a second-order-accurate mixed explicit-implicit procedure that solves the inviscid adiabatic and nondiffusive equations for chemically reacting flow in integral conservation-law form. The relationship between the finite-volume and differential forms of the equations is examined and the relative merits of each discussed. The method admits initial Cauchy data situated on any arbitrary surface and integrates them forward along a general curvilinear coordinate, distorting and deforming the surface as it advances. The chemical kinetics term is split from the convective terms which are themselves dimensionally split, thereby freeing the fluid operators from the restricted step size imposed by the chemical reactions and increasing the computational efficiency. The accuracy of this splitting technique is analyzed, a sufficient stability criterion is established, a representative flow computation is discussed, and some comparisons are made with another method.

Complications of Bilateral Neck Dissection in Thyroid Cancer From a Single High-Volume Center.

PubMed

McMullen, Caitlin; Rocke, Daniel; Freeman, Jeremy

2017-04-01

The morbidity of bilateral lateral neck dissection (BLND) for thyroid cancers has not been described in detail. This study delineates the specific complications arising from BLND for thyroid cancers at a single high-volume center. To determine the morbidity associated with BLNDs for differentiated thyroid cancers at our institution. This was a retrospective review of medical records performed to identify patients having undergone BLNDs for thyroid cancers by a single surgeon at an academic, tertiary medical center in Toronto, Ontario, Canada, from 1988 to 2015. Patients who underwent BLND for papillary, follicular, or medullary thyroid cancers were identified through operative procedure codes and review of operative and pathology reports. The indication for this procedure was suspicious bilateral lateral compartment on imaging and clinical examination. Sixty-two patients who underwent BLND for thyroid cancers, with or without total thyroidectomy and central compartment dissection, were identified. The main outcome measures for this study were unanticipated medical or surgical complications during the operation or in the postoperative period. Secondary measures were oncologic outcomes, including regional structural or biochemical recurrence. Of the 62 patients, 24 were male (39%), and 38 (61%) were female. Their mean age was 46 years (range, 17-80 years). The overall risk of permanent hypoparathyroidism was 37%. There was 1 case of unanticipated permanent recurrent nerve paralysis and 1 case of temporary nerve paresis. Postoperative chyle fistula occurred in 6 cases (10%). There were 3 readmissions within 30 days of surgery, 1 pulmonary embolism, and 1 perioperative mortality. Fifty percent of patients had pN0 contralateral necks despite preoperative clinical suspicion. Four patients were found to have anaplastic thyroid cancers intraoperatively. Five patients (8%) developed nodal recurrence in the neck. Four patients died of their disease within available follow-up (mean, 3.2 years). Bilateral lateral neck dissection for thyroid cancers confers a significant amount of morbidity, including a significant rate of hypoparathyroidism. Knowledge of the complications of this procedure, especially in the setting of questionable survival benefit, may assist in preoperative decision-making and patient counseling.

Thulium vapoenucleation of the prostate versus holmium laser enucleation of the prostate for the treatment of large volume prostates: preliminary 6-month safety and efficacy results of a prospective randomized trial.

PubMed

Becker, B; Herrmann, T R W; Gross, A J; Netsch, C

2018-05-05

We compared the perioperative and postoperative characteristics of thulium vapoenucleation and holmium laser enucleation of the prostate for the treatment of large volume benign prostatic hyperplasia. A total of 94 patients with benign prostatic hyperplasia and a median prostate size of 80 (IQR 46.75-100) cc were either randomized to thulium vapoenucleation or holmium laser enucleation of the prostate. Patients were assessed preoperatively, 1 and 6 months postoperatively. The median operative time was 60 (IQR 41-79) min without significant differences between the groups. There were no significant differences between the groups regarding catheter time [2 (IQR 2-2) days] and postoperative stay [2 (IQR 2-3) days]. Clavien 1 (13.8%), 2 (3.2%), 3a (2.1%), and Clavien 3b (4.3%) complications occurred without significant differences between the groups. At 6-month follow-up, median maximum flow rate (10.7 vs. 25.9 ml/s), post-void residual urine (100 vs. 6.5 ml), I-PSS (20 vs. 5), quality of life (4 vs. 1), PSA (4.14 vs. 0.71 µg/l), and prostate volume (80 vs. 16 ml) had improved significantly (p < 0.001) compared to baseline without significant differences between the groups. Median PSA decrease was 79.7% (58.8-90.6%) and prostate volume reduction was 74.5% (68.57-87.63%) without differences between the groups. The reoperation rate was zero at 6-month follow-up. Thulium vapoenucleation and holmium laser enucleation of the prostate are safe and effective procedures for the treatment of large volume benign prostatic hyperplasia. Both procedures give satisfactory micturition improvement with low morbidity and sufficient prostate volume reduction at 6-month follow-up.

[Morbidity and mortality rates in relation to the "surgeon factor" after duodenopancreatectomy].

PubMed

Targarona, Javier; Pando, Elizabeth; Garatea, Rafael; Vavoulis, Alexandra; Montoya, Eduardo

2007-10-01

The present study was designed to determine whether the surgeon factor has an independent effect on morbidity and mortality rates after duodenopancreatectomy. Between October 2002 and December 2006, we performed a study of 119 patients who underwent duodenopancreatectomy. The surgeons were divided into 3 groups according to the number of interventions they performed each year: a low volume group (three Whipple procedures per year), a medium volume group (four to 10 Whipple procedures per year) and a high volume group (> 10 Whipple procedures per year). The morbidity rate was higher in the low volume group (82%) than in the high volume group (35%). Length of hospital stay was clearly longer in the low and medium volume groups (27 days, and 21 days) than in the high volume group (17 days). Comparison of the results of the 3 groups revealed that the group performing three or less interventions per year (low volume) had the highest mortality rate (47%), while the group performing more than 10 interventions per year (high volume) had a very low mortality rate (4%). We found that the volume-to-surgeon ratio was inversely proportional to morbidity, length of hospital stay, return to oral intake, and mortality rates. Therefore, increasing surgical volume could improve morbidity and mortality rates.

A conformal truncation framework for infinite-volume dynamics

DOE PAGES

Katz, Emanuel; Khandker, Zuhair U.; Walters, Matthew T.

2016-07-28

Here, we present a new framework for studying conformal field theories deformed by one or more relevant operators. The original CFT is described in infinite volume using a basis of states with definite momentum, P, and conformal Casimir, C. The relevant deformation is then considered using lightcone quantization, with the resulting Hamiltonian expressed in terms of this CFT basis. Truncating to states with C ≤ C max, one can numerically find the resulting spectrum, as well as other dynamical quantities, such as spectral densities of operators. This method requires the introduction of an appropriate regulator, which can be chosen tomore » preserve the conformal structure of the basis. We check this framework in three dimensions for various perturbative deformations of a free scalar CFT, and for the case of a free O(N) CFT deformed by a mass term and a non-perturbative quartic interaction at large- N. In all cases, the truncation scheme correctly reproduces known analytic results. As a result, we also discuss a general procedure for generating a basis of Casimir eigenstates for a free CFT in any number of dimensions.« less

Sandia SWiFT Wind Turbine Manual.

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

White, Jonathan; LeBlanc, Bruce Philip; Berg, Jonathan Charles

The Scaled Wind Farm Technology (SWiFT) facility, operated by Sandia National Laboratories for the U.S. Department of Energy's Wind and Water Power Program, is a wind energy research site with multiple wind turbines scaled for the experimental study of wake dynamics, advanced rotor development, turbine control, and advanced sensing for production-scale wind farms. The SWiFT site currently includes three variable-speed, pitch-regulated, three-bladed wind turbines. The six volumes of this manual provide a detailed description of the SWiFT wind turbines, including their operation and user interfaces, electrical and mechanical systems, assembly and commissioning procedures, and safety systems. Further dissemination only asmore » authorized to U.S. Government agencies and their contractors; other requests shall be approved by the originating facility or higher DOE programmatic authority. 111 UNCLASSIFIED UNLIMITED RELEASE Sandia SWiFT Wind Turbine Manual (SAND2016-0746 ) approved by: Department Manager SWiFT Site Lead Dave Minster (6121) Date Jonathan White (6121) Date SWiFT Site Supervisor Dave Mitchell (6121) Date Note: Document revision logs are found after the title page of each volume of this manual. iv« less

An investigation of a low-variability tire treadwear test procedure and of treadwear adjustment for ambient temperature. Volume 2 : appendices A, B, C, D and E, test data files

DOT National Transportation Integrated Search

1985-01-01

This volume is the first part of a two-part appendix to the report on a low variability : tire treadwear procedure and treadwear adjustment for ambient : temperature. This volume contains Appendices A through E, covering data sheets : describing equi...

External validation of a forest inventory and analysis volume equation and comparisons with estimates from multiple stem-profile models

Treesearch

Christopher M. Oswalt; Adam M. Saunders

2009-01-01

Sound estimation procedures are desideratum for generating credible population estimates to evaluate the status and trends in resource conditions. As such, volume estimation is an integral component of the U.S. Department of Agriculture, Forest Service, Forest Inventory and Analysis (FIA) program's reporting. In effect, reliable volume estimation procedures are...

Higher surgical training opportunities in the general hospital setting; getting the balance right.

PubMed

Robertson, I; Traynor, O; Khan, W; Waldron, R; Barry, K

2013-12-01

The general hospital can play an important role in training of higher surgical trainees (HSTs) in Ireland and abroad. Training opportunities in such a setting have not been closely analysed to date. The aim of this study was to quantify operative exposure for HSTs over a 5-year period in a single institution. Analysis of electronic training logbooks (over a 5-year period, 2007-2012) was performed for general surgery trainees on the higher surgical training programme in Ireland. The most commonly performed adult and paediatric procedures per trainee, per year were analysed. Standard general surgery operations such as herniae (average 58, range 32-86) and cholecystectomy (average 60, range 49-72) ranked highly in each logbook. The most frequently performed emergency operations were appendicectomy (average 45, range 33-53) and laparotomy for acute abdomen (average 48, range 10-79). Paediatric surgical experience included appendicectomy, circumcision, orchidopexy and hernia/hydrocoele repair. Overall, the procedure most commonly performed in the adult setting was endoscopy, with each trainee recording an average of 116 (range 98-132) oesophagogastroduodenoscopies and 284 (range 227-354) colonoscopies. General hospitals continue to play a major role in the training of higher surgical trainees. Analysis of the electronic logbooks over a 5-year period reveals the high volume of procedures available to trainees in a non-specialist centre. Such training opportunities are invaluable in the context of changing work practices and limited resources.

Trends in Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery in Korea.

PubMed

Lee, Heeyoung; Lee, Kun Sei; Sim, Sung Bo; Jeong, Hyo Seon; Ahn, Hye Mi; Chee, Hyun Keun

2016-12-01

Coronary angioplasty has been replacing coronary artery bypass grafting (CABG) because of the relative advantage in terms of recovery time and noninvasiveness of the procedure. Compared to other Organization for Economic Cooperation and Development (OECD) countries, Korea has experienced a rapid increase in coronary angioplasty volumes. We analyzed changes in procedure volumes of CABG and of percutaneous coronary intervention (PCI) from three sources: the OECD Health Data, the National Health Insurance Service (NHIS) surgery statistics, and the National Health Insurance claims data. We found the ratio of procedure volume of PCI to that of CABG per 100,000 population was 19.12 in 2014, which was more than triple the OECD average of 5.92 for the same year. According to data from NHIS statistics, this ratio was an increase from 11.4 to 19.3 between 2006 and 2013. We found that Korea has a higher ratio of total procedure volumes of PCI with respect to CABG and also a more rapid increase of volumes of PCI than other countries. Prospective studies are required to determine whether this increase in absolute volumes of PCI is a natural response to a real medical need or representative of medical overuse.

Centralisation for resection of the pancreatic head: A comparison of operative factors and early outcomes during the evolving unit and tertiary unit phases at a UK institution.

PubMed

Kostalas, M; Nageswaran, H; Froghi, S; Riga, A; Kumar, R; Menezes, N; Worthington, T R; Karanjia, N D

2017-08-19

To assess impact of centralisation on patients undergoing pancreatic head resections at a tertiary hepatobiliary (HPB) centre in the UK. Data were analysed from a prospectively maintained database from 1998 to 2014 on all patients undergoing pancreatic head resections. Two specific time periods were defined; these were the evolving unit phase (EU) from 1998 to 2009 and finally the established tertiary unit phase (TU) from 2010 to 2014. Peri-operative factors and post-operative outcomes were analysed. 395 resections were undertaken during the study period. Following establishment of our tertiary HPB unit, the volume of resections undertaken increased greater than three-fold with an associated increase in case-complexity (p = 0.004). Operating time was found to increase in the TU phase compared with EU phase (p=>0.0005) whilst there was no significant difference in the rate of peri-operative transfusion, or in post-operative morbidity rates. There was a significant reduction in the post-operative length of stay in the TU phase (p = 0.003) with a significantly higher proportion of patients being discharged within 9 days of their procedure (p=<0.0005). There was also a significant reduction in 30-day post-operative mortality in the TU phase (0.5%) compared with the EU phase (3%) (p = 0.029). Data from our series of 395 cases suggests that centralisation of pancreatic cancer services to a tertiary centre does result in improved patient outcomes. The benefits of a multi-disciplinary and specialist HPB service results in a high volume, high quality unit with improved patient outcomes. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Federal Logistics Information System (FLIS) Procedures Manual. Volume 5: Data Bank Interrogations/Search.

DTIC Science & Technology

1995-04-01

NO. 5 DoD 4100.39-M D oD 4100.39-MN Volume 5 DLSC- VPH 1 January 1997 "N FEDERAL LOGISTICS INFORMATION SYSTEM (FLIS) PROCEDURES MANUAL I. Volume 5. DoD...LOGISTICS SERVICES CENTER 74 WASHINGTON AVE N BATTLE CREEK MI 49017-3084 CH 4 CHANGE NO. 4 DoD 4100.39-M DoD 4100.39-M Volume 5 DLSC- VPH 1 July 1996 "FEDERAL...CENTER Volume 5 74 WASHINGTON AVE N BATTLE CREEK, MI 49017-3084 DLSC- VPH 1 April 1995 FOREWORD This is one of the volumes (see backside of cover for

Space Operations Center, Shuttle Interaction Study. Volume 2: Appendices, Book 1 of 2

NASA Technical Reports Server (NTRS)

1981-01-01

The feasibility of shuttle orbiter docking to the Space Operations Center (SOC) is studied. The in-orbit relative motion of the free flying orbiter and SOC was simulated, accounting for the Orbiter RCS and digital autopilot (DAP) systems, orbital mechanics, center of gravity offset of the orbiter docking port, aero and gravity gradient effects, and other pertinent natural and man-made phenomena. Since there is no specified flight path and procedure for docking, terminal closure sensitivities were investigated. Orbiter approach direction, Orbiter approach attitude out of plane, DAP thruster compensation mode, final ballistic docking distance and time to dock, rate and excursion attitude deadbands, and selection of various thruster combinations (differing from nominal) for translational pulses are considered.

Study of the application of advanced technologies to long range transport aircraft. Volume 2: Advanced technology program recommendations

NASA Technical Reports Server (NTRS)

1972-01-01

The benefits of the application of advanced technology to future transport aircraft were investigated. The noise reduction goals established by the CARD (Civil Aviation Research and Development) study for the 1981-1985 time period can be satisfied. Reduced terminal area and airway congestion can result from use of advanced on-board systems and operating procedures. The use of advanced structural design concepts can result in greatly reduced gross weight and improved operating economics. The full potential of these benefits can be realized in a 1985 airplane by implementing a research and development program that is funded to an average level of approximately $55 million per year over a ten year period.

The endoventricular circular patch plasty ("Dor procedure") in ischemic akinetic dilated ventricles.

PubMed

Dor, V

2001-09-01

From 1984 to 2000, 950 Left Ventricular ischemic asynergy (dyskinetic or akinetic) were operated using the endoventricular circular patch plasty technique. This allows to exclude all asynergic areas of the left ventricular wall and reshape the remaining wall. Both morphology and hemodynamic of left ventricle, are improved. Hospital mortality was below 7%. Life expectancy at 10 years reaches 80% if pre-operative L.V.E.F. is above 30%, and end systolic volume index (E.S.V.I.) below 90[emsp4 ]ml, and 60% in L.V.E.F. is below 30% and E.S.V.I. above 90[emsp4 ]ml. L.V.R. by endoventricular plasty has to be considered in the treatment of ischemic congestive heart failure.

A novel approach to restore atrial function after the maze procedure in patients with an enlarged left atrium.

PubMed

Marui, Akira; Tambara, Keiichi; Tadamura, Eiji; Saji, Yoshiaki; Sasahashi, Nozomu; Ikeda, Tadashi; Nishina, Takeshi; Komeda, Masashi

2007-08-01

Left atrial (LA) volume reduction surgery concomitant with the maze procedure has been reported to facilitate sinus rhythm recovery even in patients with refractory atrial fibrillation (AF) with an enlarged LA. However, it is unknown whether the procedures can also restore effective atrial function of the enlarged LA with over-stretched myocardium. The maze procedures in association with mitral valve surgery were performed to 57 AF patients with an enlarged LA (LA diameter >or=60mm). Among them, 32 patients had concomitant LA volume reduction surgery (VR group). Another 25 patients did not have the volume reduction (control group). Three months postoperatively LA end-diastolic volume (LAEDV, ml) assessed by magnetic resonance (MR) imaging was larger in the VR group than that in the control group (291+/-117 vs 223+/-81 ml, p<0.05). Postoperatively, sinus rhythm recovery rate was better (84 vs 68%, p<0.05) and LAEDV was drastically smaller (118+/-48 vs 203+/-76 ml, p<0.001) in the VR group than those in the control group. Among the patients with sinus rhythm recovery in both groups, LA contraction ejection fraction (%) improved in the VR group but not in the control group (22.3+/-7.8 vs 10.3+/-4.7%, p<0.001). The LA volume reduction surgery concomitant with the maze procedure restored contraction of the enlarged LA; however, the maze procedure alone did not restore LA contraction in spite of successful sinus rhythm recovery. LA volume reduction surgery may be desirable to the patients with refractory AF with over-stretched LA.

Variability in Resident Operative Hand Experience by Specialty.

PubMed

Silvestre, Jason; Lin, Ines C; Levin, L Scott; Chang, Benjamin

2018-01-01

Recent attention has sought to standardize hand surgery training in the United States. This study analyzes the variability in operative hand experience for orthopedic and general surgery residents. Case logs for orthopedic and general surgery residency graduates were obtained from the American Council of Graduate Medical Education (2006-2007 to 2014-2015). Plastic surgery case logs were not available for comparison. Hand surgery case volumes were compared between specialties with parametric tests. Intraspecialty variation in orthopedic surgery was assessed between the bottom and top 10th percentiles in procedure categories. Case logs for 9605 general surgery residents and 5911 orthopedic surgery residents were analyzed. Orthopedic surgery residents performed a greater number of hand surgery cases than general surgery residents ( P < .001). Mean total hand experience ranged from 2.5 ± 4 to 2.8 ± 5 procedures for general surgery residents with no reported cases of soft tissue repairs, vascular repairs, and replants. Significant intraspecialty variation existed in orthopedic surgery for all hand procedure categories (range, 3.3-15.0). As the model for hand surgery training evolves, general surgeons may represent an underutilized talent pool to meet the critical demand for hand surgeon specialists. Future research is needed to determine acceptable levels of training variability in hand surgery.

Garrison Clinical Setting Inadequate for Maintenance of Procedural Skills for Emergency Medicine Physicians: A Cross-Sectional Study.

PubMed

Schauer, Steven G; Varney, Shawn M; Cox, Kristin L

2015-01-01

Emergency medicine physicians (EPs) are often placed in far-forward, isolated areas in theater. Maintenance of their emergency intervention skills is vital to keep the medical forces deployment ready. The US Army suggests that working at a Military Treatment Facility (MTF) is sufficient to keep emergency procedural skills at a deployment-ready level. We sought to compare the volume of emergency procedures that providers reported necessary to maintain their skills with the number available in the MTF setting. EPs were surveyed to quantify the number of procedures they reported they would need to perform yearly to stay deployment-ready. We obtained procedure data for their duty stations and compared the procedure volume with the survey responses to determine if working at an MTF is sufficient to keep providers' skills deployment ready. The reported necessary average numbers per year were as follows: tube thoracostomy (5.9), intubation (11.4), cricothyrotomy (4.2), lumbar puncture (5.2), central line (10.0), focused assessment with sonography for trauma (FAST) (21.3), reductions (10.6), splints (10.5), and sedations (11.7). None of the procedure volumes at MTFs met provider requirements with the exception of FAST examinations at the only trauma center. This suggests the garrison clinical environment is inadequate for maintaining procedure skills. Further research is needed to determine modalities that will provide adequate training volume. 2015.

Orthopaedic surgery in natural disaster and conflict settings: how can quality care be ensured?

PubMed

Alvarado, Oscar; Trelles, Miguel; Tayler-Smith, Katie; Joseph, Holdine; Gesline, Rodné; Wilna, Thélusma Eli; Mohammad Omar, Mohammad Karim; Faiz Mohammad, Niaz Mohammad; Muhima Mastaki, John; Chingumwa Buhu, Richard; Caluwaerts, An; Dominguez, Lynette

2015-10-01

Médecins sans Frontières (MSF) is one of the main providers of orthopaedic surgery in natural disaster and conflict settings and strictly imposes a minimum set of context-specific standards before any surgery can be performed. Based on MSF's experience of performing orthopaedic surgery in a number of such settings, we describe: (a) whether it was possible to implement the minimum standards for one of the more rigorous orthopaedic procedures--internal fixation--and when possible, the time frame, (b) the volume and type of interventions performed and (c) the intra-operative mortality rates and postoperative infection rates. We conducted a retrospective review of routine programme data collected between 2007 and 2014 from three MSF emergency surgical interventions in Haiti (following the 2010 earthquake) and three ongoing MSF projects in Kunduz (Afghanistan), Masisi (Democratic Republic of the Congo) and Tabarre (Haiti). The minimum standards for internal fixation were achieved in one emergency intervention site in Haiti, and in Kunduz and Tabarre, taking up to 18 months to implement in Kunduz. All sites achieved the minimum standards to perform amputations, reductions and external fixations, with a total of 9,409 orthopaedic procedures performed during the study period. Intraoperative mortality rates ranged from 0.6 to 1.9 % and postoperative infection rates from 2.4 to 3.5 %. In settings affected by natural disaster or conflict, a high volume and wide repertoire of orthopaedic surgical procedures can be performed with good outcomes when minimum standards are in place. More demanding procedures like internal fixation may not always be feasible.

Proceedings of Workshop on Atmospheric Density and Aerodynamic Drag Models for Air Force Operations Held at Air Force Geophysics Laboratory on 20-22 October 1987. Volume 1

DTIC Science & Technology

1990-02-13

considered with these production processes in a simple photochemical equilibrium calculation , we are able to determine the contribution each makes to the...Hessian matrix of second derivatives (which is required in the Newton-Raphson procedure) by the vector product of the gradient (VJ) and its transpose...was focused on the altitude region 80-250 Km. Papers were presented in the folowing areas: Air Force requirements , physics of density and drag

USAFA/8086 - A State of the Art Microprocessor System. Volume II. Software Documentation.

DTIC Science & Technology

1980-06-01

34 /* THE THREE FOLLOWING STRUCTU2RES APE NECESSARY TO MLLLO ThE OPERATING SYTEM TO HAVE INDIRECT ACCESS TL 41EMOP *. 13- ** _3_ -- - , -- K k"" , PijPL...FILLJ$ ERROR$ ONE IOPB CHECKER LINK$IN$ DIR$IN$ ABM $IN$ DATA$IN$ OUT OUT OUT OUT DisK86 MODUlE FiGuRE 8. DATA TRANSFER UTILITIE.S 62 In addition to...SUPPORT ROUTINES. Table 3 shows the functions of these routines. TABLE 3. SUPPORT PROCEDURES ROUTINE FUNCTION ABM $ZERO Makes a given sector on a

Investigation of Noise in Solids at Low Temperatures.

DTIC Science & Technology

1980-08-01

surroundinz liquid helium dewar. The procedure used has been to liquefy helium gas and fill the liquid helium dewar. The liquefier operation is then...cryostat is at room temperature and is 25’ diameter X 72" long. Inside this is the liquid nitrogen shield which is a shell formed by two co-axial...cylinders of 22" and 19" diameters X 68’ long. This liquid nitrogen tank has a volume of 108 k. Across the bottom of this tank is a 1/16" thick copper

Procedural trends, outcomes, and readmission rates pre-and post-FDA approval for MitraClip from the National Readmission Database (2013-14).

PubMed

Panaich, Sidakpal S; Arora, Shilpkumar; Badheka, Apurva; Kumar, Varun; Maor, Elad; Raphael, Claire; Deshmukh, Abhishek; Reeder, Guy; Eleid, Mackram; Rihal, Charanjit S

2018-05-01

There are sparse clinical data on the procedural trends, outcomes and readmission rates following FDA approval and expansion of Transcatheter mitral valve repair/MitraClip ® . Whether a complex new technology can be disseminated safely and quickly is controversial. The study cohort was derived from the National Readmission Data (NRD) 2013-14. MitraClip ® was identified using appropriate International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. The primary outcome was a composite of in-hospital mortality + procedural complications. Secondary outcome included 30-day readmissions. Hierarchical two level logistic models were used to evaluate study outcomes. Our analysis included 2003 MitraClip ® procedures. Overall in-hospital mortality was 3.9%. As expected, there was a significant increase in procedural volume post-FDA approval. Importantly, a corresponding downward trend in mortality and procedural complications was observed. Significant predictors of in-hospital mortality and procedural complications included the use of vasopressors (P <0.001) and hemodynamic support (P < 0.001). Higher hospital volume (≥10 MitraClips/year) was associated with lower in-hospital mortality and complications (P = 0.02). There were 304 (15.1%) 30-day readmissions, with heart failure being the most common cause of readmission. Elective procedures had lower in-hospital mortality (P < 0.001) and lower readmission rates (P = 0.011) compared with nonelective procedures. A significant increase in MitraClip ® procedural volumes occurred post-FDA approval. Overall morbidity and mortality were low and trended downwards. Hospital procedure volume ≥10 cases were associated with lower mortality and overall complication rates. These data suggest a successful roll out of a very complex novel structural heart procedure. © 2017 Wiley Periodicals, Inc.

Reliability of sensor-based real-time workflow recognition in laparoscopic cholecystectomy.

PubMed

Kranzfelder, Michael; Schneider, Armin; Fiolka, Adam; Koller, Sebastian; Reiser, Silvano; Vogel, Thomas; Wilhelm, Dirk; Feussner, Hubertus

2014-11-01

Laparoscopic cholecystectomy is a very common minimally invasive surgical procedure that may be improved by autonomous or cooperative assistance support systems. Model-based surgery with a precise definition of distinct procedural tasks (PT) of the operation was implemented and tested to depict and analyze the process of this procedure. Reliability of real-time workflow recognition in laparoscopic cholecystectomy ([Formula: see text] cases) was evaluated by continuous sensor-based data acquisition. Ten PTs were defined including begin/end preparation calots' triangle, clipping/cutting cystic artery and duct, begin/end gallbladder dissection, begin/end hemostasis, gallbladder removal, and end of operation. Data acquisition was achieved with continuous instrument detection, room/table light status, intra-abdominal pressure, table tilt, irrigation/aspiration volume and coagulation/cutting current application. Two independent observers recorded start and endpoint of each step by analysis of the sensor data. The data were cross-checked with laparoscopic video recordings serving as gold standard for PT identification. Bland-Altman analysis revealed for 95% of cases a difference of annotation results within the limits of agreement ranging from [Formula: see text]309 s (PT 7) to +368 s (PT 5). Laparoscopic video and sensor data matched to a greater or lesser extent within the different procedural tasks. In the majority of cases, the observer results exceeded those obtained from the laparoscopic video. Empirical knowledge was required to detect phase transit. A set of sensors used to monitor laparoscopic cholecystectomy procedures was sufficient to enable expert observers to reliably identify each PT. In the future, computer systems may automate the task identification process provided a more robust data inflow is available.

After-hour Versus Daytime Shifts in Non-Operating Room Anesthesia Environments: National Distribution of Case Volume, Patient Characteristics, and Procedures.

PubMed

Gabriel, Rodney A; Burton, Brittany N; Tsai, Mitchell H; Ehrenfeld, Jesse M; Dutton, Richard P; Urman, Richard D

2017-09-01

The objective of this study was to characterize workload during all hours of the day in the non-operating room anesthesia (NORA) environment and identify what type of patients and procedures were more likely to occur during after-hours. By investigating data from the National Anesthesia Clinical Outcomes Registry, we characterized the total number of ongoing NORA cases per hour of the day (0 - 23 h). Results were presented as the mean hour and standard error (SE). Multivariable logistic regression was applied to assess the association of various patient, procedural, and facility characteristics with time of day (after-hours = 17:01-06:59 local time versus day-time). Included in this analysis, there were a total of 4,948,634 cases performed on non-holiday weekdays. The mean hour for ongoing cases for gastroenterology, cardiac, radiology and "other" were: 10.8 with standard error (SE) of 0.002, 11.5 (SE of 0.005), 11.2 (SE of 0.005), and 10.8 (SE of 0.002), respectively. Pairwise differences between means for each NORA specialty were all statistically significant (p < 0.0001). During after-hour shifts (4.3% of cases), patients with higher American Society of Anesthesiologists physical status classification scores had increased odds for undergoing a NORA procedure, while procedures that were more physiologically complex had decreased odds. With the increasing demand for NORA services, it is prudent that we fully understand the challenges of providing safe and efficient anesthetic services particularly in locations where fewer resources are available.

Air-Gapped Structures as Magnetic Elements for Use in Power Processing Systems. Ph.D. Thesis

NASA Technical Reports Server (NTRS)

Ohri, A. K.

1977-01-01

Methodical approaches to the design of inductors for use in LC filters and dc-to-dc converters using air gapped magnetic structures are presented. Methods for the analysis and design of full wave rectifier LC filter circuits operating with the inductor current in both the continuous conduction and the discontinuous conduction modes are also described. In the continuous conduction mode, linear circuit analysis techniques are employed, while in the case of the discontinuous mode, the method of analysis requires computer solutions of the piecewise linear differential equations which describe the filter in the time domain. Procedures for designing filter inductors using air gapped cores are presented. The first procedure requires digital computation to yield a design which is optimized in the sense of minimum core volume and minimum number of turns. The second procedure does not yield an optimized design as defined above, but the design can be obtained by hand calculations or with a small calculator. The third procedure is based on the use of specially prepared magnetic core data and provides an easy way to quickly reach a workable design.

Total robotic pancreaticoduodenectomy: a systematic review of the literature.

PubMed

Kornaropoulos, Michail; Moris, Demetrios; Beal, Eliza W; Makris, Marinos C; Mitrousias, Apostolos; Petrou, Athanasios; Felekouras, Evangelos; Michalinos, Adamantios; Vailas, Michail; Schizas, Dimitrios; Papalampros, Alexandros

2017-11-01

Pancreaticoduodenectomy (PD) is a complex operation with high perioperative morbidity and mortality, even in the highest volume centers. Since the development of the robotic platform, the number of reports on robotic-assisted pancreatic surgery has been on the rise. This article reviews the current state of completely robotic PD. A systematic literature search was performed including studies published between January 2000 and July 2016 reporting PDs in which all procedural steps (dissection, resection and reconstruction) were performed robotically. Thirteen studies met the inclusion criteria, including a total of 738 patients. Data regarding perioperative outcomes such as operative time, blood loss, mortality, morbidity, conversion and oncologic outcomes were analyzed. No major differences were observed in mortality, morbidity and oncologic parameters, between robotic and non-robotic approaches. However, operative time was longer in robotic PD, whereas the estimated blood loss was lower. The conversion rate to laparotomy was 6.5-7.8%. Robotic PD is feasible and safe in high-volume institutions, where surgeons are experienced and medical staff are appropriately trained. Randomized controlled trials are required to further investigate outcomes of robotic PD. Additionally, cost analysis and data on long-term oncologic outcomes are needed to evaluate cost-effectiveness of the robotic approach in comparison with the open technique.

USAF bioenvironmental noise data handbook. Volume 172: Hush-noise suppressor (Aero Systems Engineering, Incorporated) far-field noise

NASA Astrophysics Data System (ADS)

Lee, R. A.; Rau, T. H.; Jones, C.

1982-07-01

The hush-house noise suppressor was made by Aero Systems Engineering of Texas, Inc. for acoustical suppression of various AF fighter/trainer aircraft during ground runup operations. This report provides measured and extrapolated data defining the bioacoustic environments produced by several aircraft/engines operating in the hush-house suppressor for various engine power configurations. Far-field data measured at 20 locations are normalized to standard meteorological conditions and extrapolated from 75-8000 meters to derive sets of equal-value contours for seven acoustic measures as function of angle and distance from the source. Refer to Volume 1 of this handbook, 'USAF Bioenvironmental Noise Data Handbook, Vol 1: Organization, Content and Application,' AMRL-TR-75(1) 1975, for discussion of the objective and design of the handbook, the types of data presented, measurement procedures, instrumentation, data processing, definitions of quantities, symbols, equations, applications, limitations, etc. Data are presented for the following aircraft/engines operating in the hush-house noise suppressor: F-4, F-15, F-16, F-105, F-106, F-111F and T-38 aircraft and the TF41-A-1, J79-GE-15, F100-PW-100, J75-P19, J-75-P-17 and TF30-P-100 engines.

Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center.

PubMed

Valsangkar, Nakul P; Eppstein, Andrew C; Lawson, Rick A; Taylor, Amber N

2017-01-01

There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center. All patients evaluated by the general surgery department through outpatient clinics, clinical video teleconferencing, and e-consultations from October 2011 through September 2014 were included. Patients evaluated through the emergency department or as inpatient consults were excluded. The surgery service and systems redesign service held a value stream analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013. Planned outcome measures included wait time, clinic and telehealth volume, number of no-shows, and operative volume. Paired t tests were used to identify differences in outcome measures after the institution of reforms. Following rapid process improvement workshop project rollouts, mean (SD) patient wait times for elective general surgical procedures decreased from 33.4 (8.3) days in FY 2012 to 26.0 (9.5) days in FY 2013 (P = .02). In FY 2014, mean (SD) wait times were half the value of the previous FY at 12.0 (2.1) days (P = .07). This was a 3-fold decrease from wait times in FY 2012 (P = .02). Operative volume increased from 931 patients in FY 2012 to 1090 in FY 2013 and 1072 in FY 2014. Combined clinic, telehealth, and e-consultation encounters increased from 3131 in FY 2012 to 3460 in FY 2013 and 3517 in FY 2014, while the number of no-shows decreased from 366 in FY 2012 to 227 in FY 2014 (P = .02). Improvement in the overall surgical patient experience can stem from multidisciplinary collaboration among systems redesign personnel, clinicians, and surgical staff to reduce systemic inefficiencies. Monitoring and follow-up of system efficiency measures and the employment of lean practices and process improvements can have positive short- and long-term effects on wait times, clinical throughput, and patient care and satisfaction.

Evidence for central venous pressure resetting during initial exposure to microgravity

NASA Technical Reports Server (NTRS)

Convertino, V. A.; Ludwig, D. A.; Elliott, J. J.; Wade, C. E.

2001-01-01

We measured central venous pressure (CVP); plasma volume (PV); urine volume rate (UVR); renal excretion of sodium (UNa); and renal clearances of creatinine, sodium, and osmolality before and after acute volume infusion to test the hypothesis that exposure to microgravity causes resetting of the CVP operating point. Six rhesus monkeys underwent two experimental conditions in a crossover counterbalance design: 1) continuous exposure to 10 degrees head-down tilt (HDT) and 2) a control, defined as 16 h/day of 80 degrees head-up tilt and 8 h prone. After 48 h of exposure to either test condition, a 120-min course of continuous infusion of isotonic saline (0.4 ml. kg(-1). min(-1) iv) was administered. Baseline CVP was lower (P = 0.011) in HDT (2.3 +/- 0.3 mmHg) compared with the control (4.5 +/- 1.4 mmHg) condition. After 2 h of saline infusion, CVP was elevated (P = 0.002) to a similar magnitude (P = 0.485) in HDT (DeltaCVP = 2.7 +/- 0.8 mmHg) and control (DeltaCVP = 2.3 +/- 0.8 mmHg) conditions and returned to preinfusion levels 18 h postinfusion in both treatments. PV followed the same pattern as CVP. The response relationships between CVP and UVR and between CVP and UNa shifted to the left with HDT. The restoration of CVP and PV to lower preinfusion levels after volume loading in HDT compared with control supports the notion that lower CVP during HDT may reflect a new operating point about which vascular volume is regulated. These results may explain the ineffective fluid intake procedures currently employed to treat patients and astronauts.

Inpatients hypospadias care: trends and outcomes from the American nationwide inpatient sample.

PubMed

Meyer, Christian; Sukumar, Shyam; Sood, Akshay; Hanske, Julian; Vetterlein, Malte; Elder, Jack S; Fisch, Margit; Trinh, Quoc-Dien; Friedman, Ariella A

2015-08-01

Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays.

Computerized optimization of multiple isocentres in stereotactic convergent beam irradiation

NASA Astrophysics Data System (ADS)

Treuer, U.; Treuer, H.; Hoevels, M.; Müller, R. P.; Sturm, V.

1998-01-01

A method for the fully computerized determination and optimization of positions of target points and collimator sizes in convergent beam irradiation is presented. In conventional interactive trial and error methods, which are very time consuming, the treatment parameters are chosen according to the operator's experience and improved successively. This time is reduced significantly by the use of a computerized procedure. After the definition of target volume and organs at risk in the CT or MR scans, an initial configuration is created automatically. In the next step the target point positions and collimator diameters are optimized by the program. The aim of the optimization is to find a configuration for which a prescribed dose at the target surface is approximated as close as possible. At the same time dose peaks inside the target volume are minimized and organs at risk and tissue surrounding the target are spared. To enhance the speed of the optimization a fast method for approximate dose calculation in convergent beam irradiation is used. A possible application of the method for calculating the leaf positions when irradiating with a micromultileaf collimator is briefly discussed. The success of the procedure has been demonstrated for several clinical cases with up to six target points.

Study of the application of advanced technologies to laminar flow control systems for subsonic transports. Volume 1: Summary

NASA Technical Reports Server (NTRS)

Sturgeon, R. F.; Bennett, J. A.; Etchberger, F. R.; Ferrill, R. S.; Meade, L. E.

1976-01-01

A study was conducted to evaluate the technical and economic feasibility of applying laminar flow control to the wings and empennage of long-range subsonic transport aircraft compatible with initial operation in 1985. For a design mission range of 10,186 km (5500 n mi), advanced technology laminar-flow-control (LFC) and turbulent-flow (TF) aircraft were developed for both 200 and 400-passenger payloads, and compared on the basis of production costs, direct operating costs, and fuel efficiency. Parametric analyses were conducted to establish the optimum geometry for LFC and TF aircraft, advanced LFC system concepts and arrangements were evaluated, and configuration variations maximizing the effectiveness of LFC were developed. For the final LFC aircraft, analyses were conducted to define maintenance costs and procedures, manufacturing costs and procedures, and operational considerations peculiar to LFC aircraft. Compared to the corresponding advanced technology TF transports, the 200- and 400-passenger LFC aircraft realized reductions in fuel consumption up to 28.2%, reductions in direct operating costs up to 8.4%, and improvements in fuel efficiency, in ssm/lb of fuel, up to 39.4%. Compared to current commercial transports at the design range, the LFC study aircraft demonstrate improvements in fuel efficiency up to 131%. Research and technology requirements requisite to the development of LFC transport aircraft were identified.

A New Surgical Procedure "Dumbbell-Form Resection" for Selected Hilar Cholangiocarcinomas With Severe Jaundice: Comparison With Hemihepatectomy.

PubMed

Wang, Shuguang; Tian, Feng; Zhao, Xin; Li, Dajiang; He, Yu; Li, Zhihua; Chen, Jian

2016-01-01

The aim of the study is to evaluate the therapeutic effect of a new surgical procedure, dumbbell-form resection (DFR), for hilar cholangiocarcinoma (HCCA) with severe jaundice. In DFR, liver segments I, IVb, and partial V above the right hepatic pedicle are resected.Hemihepatectomy is recognized as the preferred procedure; however, its application is limited in HCCAs with severe jaundice.Thirty-eight HCCA patients with severe jaundice receiving DFR and 70 receiving hemihepatectomy from January 2008 to January 2013 were included. Perioperative parameters, operation-related morbidity and mortality, and post-operative survival were analyzed.A total of 21.1% patients (8/38) in the DFR group received percutaneous transhepatic biliary drainage (PTBD), which was significantly <81.4% (57/70) in the hemihepatectomy group. The TBIL was higher in the DFR group at operation (243.7 vs 125.6 μmol/L, respectively). The remnant liver volume was significantly higher after DFR. The operation-related morbidity was significantly lower after DFR than after hemihepatectomy (26.3% vs 48.6%, respectively). None of the patients died during the perioperative period after DFR, whereas 3 died after hemihepatectomy. There was no difference in margin status, histological grade, lymph-node involvement, and distant metastasis between the 2 groups. The 1-, 3-, and 5-year survival rates after DFR (68.4%, 32.1%, and 21.4%, respectively) showed no significant difference with those after hemihepatectomy (62.7%, 34.6%, and 23.3%, respectively). Kaplan-Meier analysis indicated that overall survival and recurrence after DFR demonstrated no significant difference compared with hemihepatectomy.DFR appears to be feasible for selected HCCA patients with severe jaundice. However, its indications should be restricted.

Drain data to predict clinically relevant pancreatic fistula

PubMed Central

Moskovic, Daniel J; Hodges, Sally E; Wu, Meng-Fen; Brunicardi, F Charles; Hilsenbeck, Susan G; Fisher, William E

2010-01-01

Background Post-operative pancreatic fistula (POPF) is a common and potentially devastating complication of pancreas resection. Management of this complication is important to the pancreas surgeon. Objective The aim of the present study was to evaluate whether drain data accurately predicts clinically significant POPF. Methods A prospectively maintained database with daily drain amylase concentrations and output volumes from 177 consecutive pancreatic resections was analysed. Drain data, demographic and operative data were correlated with POPF (ISGPF Grade: A – clinically silent, B – clinically evident, C – severe) to determine predictive factors. Results Twenty-six (46.4%) out of 56 patients who underwent distal pancreatectomy and 52 (43.0%) out of 121 patients who underwent a Whipple procedure developed a POPF (Grade A-C). POPFs were classified as A (24, 42.9%) and C (2, 3.6%) after distal pancreatectomy whereas they were graded as A (35, 28.9%), B (15, 12.4%) and C (2, 1.7%) after Whipple procedures. Drain data analysis was limited to Whipple procedures because only two patients developed a clinically significant leak after distal pancreatectomy. The daily total drain output did not differ between patients with a clinical leak (Grades B/C) and patients without a clinical leak (no leak and Grade A) on post-operative day (POD) 1 to 7. Although the median amylase concentration was significantly higher in patients with a clinical leak on POD 1–6, there was no day that amylase concentration predicted a clinical leak better than simply classifying all patients as ‘no leak’ (maximum accuracy =86.1% on POD 1, expected accuracy by chance =85.6%, kappa =10.2%). Conclusion Drain amylase data in the early post-operative period are not a sensitive or specific predictor of which patients will develop clinically significant POPF after pancreas resection. PMID:20815856

The subdural evacuation port system: outcomes from a single institution experience and predictors of success.

PubMed

Neal, Matthew T; Hsu, Wesley; Urban, Jillian E; Angelo, Nicole M; Sweasey, Thomas A; Branch, Charles L

2013-06-01

Numerous surgical options for treatment of chronic subdural hematomas (cSDH) exist. Several reports have examined the Subdural Evacuating Port System (SEPS), a variation of the twist drill craniotomy (TDC) technique. Although high success rates have been reported, a significant portion of patients treated with SEPS fail and require additional procedures. This report examines the largest single institution experience with the SEPS and explores patient and imaging characteristics associated with successful procedures. A retrospective chart review was performed to identify all patients who have undergone SEPS drainage of cSDH. Demographic and radiographic characteristics were evaluated. Demographic data included patient's age, sex, presenting symptoms, pre-procedural GCS score, and use of anticoagulation or antiplatelet agents. The volume of drainage per procedure and radiographic data including laterality, density, and maximal diameter of the collection, presence of septations, midline shift, resolution of the collection 3 weeks post procedure, and measurements to assess atrophy were collected. Total length of stay and time in the intensive care unit was also recorded. Results were classified as a success or failure based on the need for additional procedures including craniotomy or burr hole craniotomy in the operating room. Patients treated with two SEPS procedures during the same hospitalization and no other procedures were included in the success group for statistical analyses. 171 subdural collections were treated in 159 patients (147 unilateral and 12 bilateral). One hundred thirty three collections (77.8%) were successfully drained. In a comparison of the success and failure groups, there were no statistically significant differences (p<0.05) in the patients' mean age, sex, presenting Glasgow Coma Scale score, coagulation profile, presenting symptoms (except altered mental status and language disturbance), subdural diameter or laterality, midline shift, presence of atrophy, density of most acute portion, or time in hospital. In the success group, there was a shorter mean stay in the intensive care unit (S: 4.1±4.5 days vs F: 5.4±4.6 days; p=0.03) and a larger output drained (S: 131.1±71.2ml vs F: 99.0±84.2ml; p=0.04). Success was less likely with mixed density collections (S: 38.2% vs F: 64.3%; p=0.02) and with collections containing greater than 2 intrahematomal septations (S: 17.1% vs F: 40.7%; p=0.007). In successful cases, mean volumes for collections prior to SEPS, immediately after SEPS, and on delayed scans (≥30 days since SEPS placement) the respective volumes were 83.1±35.1ml, 41.5±23.2ml, and 37.9±26.5ml. Both post-SEPS volumes were less than the pre-SEPS volume (p<0.0001). 76.0% of patients with delayed scans had complete resolution of cSDH or minimal residual cSDH with no local mass effect on the most recent imaging. The mean period of follow-up imaging was 95.6±196.2 days. Only one patient in our series required an emergent craniotomy following immediate complications from SEPS placement. The SEPS is an effective, safe, and durable treatment for cSDH. Although we consider the SEPS a first-line treatment for the majority of patients with cSDH, management of cSDH must be tailored to each patient. In mixed density collections with large proportions of acute hemorrhage and in collections with numerous intrahematomal septations, alternative surgical techniques should be considered as first-line therapies. Copyright © 2012 Elsevier B.V. All rights reserved.

Development of an activity-based costing model to evaluate physician office practice profitability.

PubMed

Dugel, Pravin U; Tong, Kuo Bianchini

2011-01-01

Newer treatment regimens for age-related macular degeneration have significantly affected traditional and non-traditional retinal services across all types of practice settings around the country as they seek to find a balance among delivering best patient care, keeping operating costs under control, and maintaining profitability. A systematic retrospective review of a multi-city, multi-physician retinal practice's accounting system to obtain data on revenues, expenses, and profit. Data reviewed were from practice management systems to obtain claims level data on clinical procedures across 7 primary activity centers: non-laser surgery, laser surgery, office visits, optical coherence tomography (OCT), non-OCT diagnostics, drugs and drug injections, and research. All treated patients from a retina practice from January 1, 2005, to December 31, 2007. Retrospective claims data review from a multi-physician retina practice detailing Current Procedural Terminology and Healthcare Common Procedure Coding System procedures performed and billed, submitted charges, allowed charges, and net collections. Analyses were performed by an outside firm and verified by a risk advisory firm. Identifying practice efficiencies/inefficiencies as they relate to patient care. An elaborate analysis using activity-based costing (ABC) showed that increased office visits and OCT and non-OCT diagnostics had a significant negative impact on the practice's profit margins, whereas surgical procedures contributed to the majority of the practice's profit margins because of the lower operating costs associated with surgery. The practice was able to accommodate the demand in patient volume, medical retina services, and medical imaging with the advent of anti-vascular endothelial growth factor therapy and realized a seismic shift in operating costs. The practice attempted to deliver state-of-the-art patient care in a cost-effective manner, yet underwent a significant decline in its financial health. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Human Integration Design Processes (HIDP)

NASA Technical Reports Server (NTRS)

Boyer, Jennifer

2014-01-01

The purpose of the Human Integration Design Processes (HIDP) document is to provide human-systems integration design processes, including methodologies and best practices that NASA has used to meet human systems and human rating requirements for developing crewed spacecraft. HIDP content is framed around human-centered design methodologies and processes in support of human-system integration requirements and human rating. NASA-STD-3001, Space Flight Human-System Standard, is a two-volume set of National Aeronautics and Space Administration (NASA) Agency-level standards established by the Office of the Chief Health and Medical Officer, directed at minimizing health and performance risks for flight crews in human space flight programs. Volume 1 of NASA-STD-3001, Crew Health, sets standards for fitness for duty, space flight permissible exposure limits, permissible outcome limits, levels of medical care, medical diagnosis, intervention, treatment and care, and countermeasures. Volume 2 of NASASTD- 3001, Human Factors, Habitability, and Environmental Health, focuses on human physical and cognitive capabilities and limitations and defines standards for spacecraft (including orbiters, habitats, and suits), internal environments, facilities, payloads, and related equipment, hardware, and software with which the crew interfaces during space operations. The NASA Procedural Requirements (NPR) 8705.2B, Human-Rating Requirements for Space Systems, specifies the Agency's human-rating processes, procedures, and requirements. The HIDP was written to share NASA's knowledge of processes directed toward achieving human certification of a spacecraft through implementation of human-systems integration requirements. Although the HIDP speaks directly to implementation of NASA-STD-3001 and NPR 8705.2B requirements, the human-centered design, evaluation, and design processes described in this document can be applied to any set of human-systems requirements and are independent of reference missions. The HIDP is a reference document that is intended to be used during the development of crewed space systems and operations to guide human-systems development process activities.

A second-generation constrained reaction volume shock tube

NASA Astrophysics Data System (ADS)

Campbell, M. F.; Tulgestke, A. M.; Davidson, D. F.; Hanson, R. K.

2014-05-01

We have developed a shock tube that features a sliding gate valve in order to mechanically constrain the reactive test gas mixture to an area close to the shock tube endwall, separating it from a specially formulated non-reactive buffer gas mixture. This second-generation Constrained Reaction Volume (CRV) strategy enables near-constant-pressure shock tube test conditions for reactive experiments behind reflected shocks, thereby enabling improved modeling of the reactive flow field. Here we provide details of the design and operation of the new shock tube. In addition, we detail special buffer gas tailoring procedures, analyze the buffer/test gas interactions that occur on gate valve opening, and outline the size range of fuels that can be studied using the CRV technique in this facility. Finally, we present example low-temperature ignition delay time data to illustrate the CRV shock tube's performance.

Large-scale dialysis of sample lipids

USGS Publications Warehouse

Meadows, Jill; Tillitt, Donald E.; Huckins, James; Schroeder, D.

1993-01-01

The use of a semipermeable membrane device (SPMD) for dialysis in an organic solvent phase is an efficient alternative approach to separation of contaminants from large amounts of lipid (up to 50 grams or more) prior to organic chemical analysis. Passive separation of contaminants can be accomplished with a minimum of equipment and a comparatively small volume of solvent. This study examines the effects of factors such as dialytic solvent, lipid type, dialytic solvent:lipid volume ratio, dialysis time, and temperature on the performance of polyethylene SPMDs during lipid-contaminant separations. The experimental conditions for maximal recoveries of organochlorine pesticides and polychlorinated biphenyls with minimal lipid carryover are determined for the examined variables. When the dialytic procedure is optimized, very satisfactory and highly reproducible analyte recoveries can be obtained in a few days while separating > 90% of the lipid material in a single operation.

USAF Bioenvironmental Noise Data Handbook. Volume 155. CH-3 in-flight crew noise

NASA Astrophysics Data System (ADS)

Hille, H. K.

1982-09-01

The CH-3 is a USAF tactical combat transport helicopter. This report provides measured data defining the bioacoustic environments at flight crew/passenger locations inside this helicopter during normal flight operations. Data are reported for nine locations in a wide variety of physical and psychoacoustic measures: overall and band sound pressure levels, C weighted and A weighted sound levels, preferred speech interference level, perceived noise levels and limiting times for total daily exposure of personnel with and without standard Air Force ear protectors. Refer to Volume 1 of this handbook, USAF Bioenvironmental Noise Data handbook, Vol. 1: Organization, Content and Application, AMRL-TR-75-50(1) 1975, for discussion of the objective and design of the handbook, the types of data presented, measurement procedures, instrumentation, data processing, definitions of quantities, symbols, equations, applications, limitations, etc.

A virtual reality-based method of decreasing transmission time of visual feedback for a tele-operative robotic catheter operating system.

PubMed

Guo, Jin; Guo, Shuxiang; Tamiya, Takashi; Hirata, Hideyuki; Ishihara, Hidenori

2016-03-01

An Internet-based tele-operative robotic catheter operating system was designed for vascular interventional surgery, to afford unskilled surgeons the opportunity to learn basic catheter/guidewire skills, while allowing experienced physicians to perform surgeries cooperatively. Remote surgical procedures, limited by variable transmission times for visual feedback, have been associated with deterioration in operability and vascular wall damage during surgery. At the patient's location, the catheter shape/position was detected in real time and converted into three-dimensional coordinates in a world coordinate system. At the operation location, the catheter shape was reconstructed in a virtual-reality environment, based on the coordinates received. The data volume reduction significantly reduced visual feedback transmission times. Remote transmission experiments, conducted over inter-country distances, demonstrated the improved performance of the proposed prototype. The maximum error for the catheter shape reconstruction was 0.93 mm and the transmission time was reduced considerably. The results were positive and demonstrate the feasibility of remote surgery using conventional network infrastructures. Copyright © 2015 John Wiley & Sons, Ltd.

Complications after cardiac implantable electronic device implantations: an analysis of a complete, nationwide cohort in Denmark

PubMed Central

Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard; Jørgensen, Ole Dan; Nielsen, Jens Cosedis

2014-01-01

Aims Complications after cardiac implantable electronic device (CIED) treatment, including permanent pacemakers (PMs), cardiac resynchronization therapy devices with defibrillators (CRT-Ds) or without (CRT-Ps), and implantable cardioverter defibrillators (ICDs), are associated with increased patient morbidity, healthcare costs, and possibly increased mortality. Methods and results Population-based cohort study in all Danish patients who underwent a CIED procedure from May 2010 to April 2011. Data on complications were gathered on review of all patient charts while baseline data were obtained from the Danish Pacemaker and ICD Register. Adjusted risk ratios (aRRs) with 95% confidence intervals were estimated using binary regression. The study population consisted of 5918 consecutive patients. A total of 562 patients (9.5%) experienced at least one complication. The risk of any complication was higher if the patient was a female (aRR 1.3; 1.1–1.6), underweight (aRR 1.5; 1.1–2.3), implanted in a centre with an annual volume <750 procedures (0–249 procedures: aRR 1.6; 1.1–2.2, 250–499: aRR 2.0; 1.6–2.7, 500–749: aRR 1.5; 1.2–1.8), received a dual-chamber ICD (aRR 2.0; 1.4–2.7) or CRT-D (aRR 2.6; 1.9–3.4), underwent system upgrade or lead revision (aRR 1.3; 1.0–1.7), had an operator with an annual volume <50 procedures (aRR 1.9; 1.4–2.6), or underwent an emergency, out-of-hours procedure (aRR 1.5; 1.0–2.3). Conclusion CIED complications are more frequent than generally acknowledged. Both patient- and procedure-related predictors may identify patients with a particularly high risk of complications. This information should be taken into account both in individual patient treatment and in the planning of future organization of CIED treatment. PMID:24347317

Entropy Stable Wall Boundary Conditions for the Three-Dimensional Compressible Navier-Stokes Equations

NASA Technical Reports Server (NTRS)

Parsani, Matteo; Carpenter, Mark H.; Nielsen, Eric J.

2015-01-01

Non-linear entropy stability and a summation-by-parts framework are used to derive entropy stable wall boundary conditions for the three-dimensional compressible Navier-Stokes equations. A semi-discrete entropy estimate for the entire domain is achieved when the new boundary conditions are coupled with an entropy stable discrete interior operator. The data at the boundary are weakly imposed using a penalty flux approach and a simultaneous-approximation-term penalty technique. Although discontinuous spectral collocation operators on unstructured grids are used herein for the purpose of demonstrating their robustness and efficacy, the new boundary conditions are compatible with any diagonal norm summation-by-parts spatial operator, including finite element, finite difference, finite volume, discontinuous Galerkin, and flux reconstruction/correction procedure via reconstruction schemes. The proposed boundary treatment is tested for three-dimensional subsonic and supersonic flows. The numerical computations corroborate the non-linear stability (entropy stability) and accuracy of the boundary conditions.

Study of safety implications for shuttle launched spacecraft using fluorinated oxidizers. Volume 1: Complete text

NASA Technical Reports Server (NTRS)

1975-01-01

The safety implications of space shuttle launched spacecraft using liquid flourine as the oxidizer for spacecraft propulsion were investigated. Feasibility of safe operation was investigated and the equipment and procedures necessary to maximize the chance of success determined. Hazards to the shuttle were found to be similar in kind if not degree to those encountered in use of nitrogen tetroxide (also toxic oxidizer). It was concluded that residual risks from spacecraft using fluorine and nitrogen tetroxide during ground and flight handling may be reduced by isolation of the oxidizer to only its tank. Operation of planetary spacecraft propulsion in the vicinity of the shuttle in earth orbit is not required. The primary hazard to personnel was identified as propellant loading operations, which should be accomplished in an area reasonably remote from personnel and facilities concentrations. Clearing the pad during spacecraft mating with the shuttle orbiter is recommended.

An interactive modular design for computerized photometry in spectrochemical analysis

NASA Technical Reports Server (NTRS)

Bair, V. L.

1980-01-01

A general functional description of totally automatic photometry of emission spectra is not available for an operating environment in which the sample compositions and analysis procedures are low-volume and non-routine. The advantages of using an interactive approach to computer control in such an operating environment are demonstrated. This approach includes modular subroutines selected at multiple-option, menu-style decision points. This style of programming is used to trace elemental determinations, including the automated reading of spectrographic plates produced by a 3.4 m Ebert mount spectrograph using a dc-arc in an argon atmosphere. The simplified control logic and modular subroutine approach facilitates innovative research and program development, yet is easily adapted to routine tasks. Operator confidence and control are increased by the built-in options including degree of automation, amount of intermediate data printed out, amount of user prompting, and multidirectional decision points.

Effect of portal access system and surgery type on surgery times during laparoscopic ovariectomy and salpingectomy in captive African lions and cheetahs.

PubMed

Hartman, Marthinus Jacobus; Monnet, Eric; Kirberger, Robert Murco; Schoeman, Johan Petrus

2016-03-02

A prospective randomized study was used to compare surgery times for laparoscopic ovariectomy and salpingectomy in female African lion (Panthera leo) (n = 14) and cheetah (Acinonyx jubatus) (n = 20) and to compare the use of a multiple portal access system (MPAS) and single portal access system (SPAS) between groups. Two different portal techniques were used, namely MPAS (three separate ports) in lions and SPAS (SILS™ port) in cheetahs, using standard straight laparoscopic instruments. Portal access system and first ovary was not randomized. Five different surgery times were compared for the two different procedures as well as evaluating the use and application of MPAS and SPAS. Carbon dioxide volumes for lions were recorded. In adult lionesses operative time (OPT) (P = 0.016) and total surgical time (TST) (P = 0.032) were significantly shorter for salpingectomy compared to ovariectomy. Similarly in cheetahs OPT (P = 0.001) and TST (P = 0.005) were also shorter for salpingectomy compared to ovariectomy. In contrast, in lion cubs no difference was found in surgery times for ovariectomy and salpingectomy. Total unilateral procedure time was shorter than the respective bilateral time for both procedures (P = 0.019 and P = 0.001) respectively and unilateral salpingectomy was also faster than unilateral ovariectomy (P = 0.035) in cheetahs. Port placement time, suturing time and TST were significantly shorter for SPAS compared to MPAS (P = 0.008). There was, however, no difference in OPT between SPAS and MPAS. Instrument cluttering with SPAS was found to be negligible. There was no difference in mean volume CO2 required to complete ovariectomy in lions but the correlation between bodyweight and total volume of CO2 in lions was significant (rs = 0.867; P = 0.002). Laparoscopic salpingectomy was faster than ovariectomy in both adult lions and cheetahs. Using SPAS, both unilateral procedures were faster than bilateral procedures in cheetahs. Placement and suturing of SPAS in cheetahs was easier and faster compared to three separate ports in lions and lion cubs. The use of standard straight instruments during SPAS did not prolong surgery. Surgery was faster in cubs and CO2 required for laparoscopic sterilization in lions could be determined. Predictable surgery times and CO2 volumes will facilitate the accurate planning and execution of surgery in lions and cheetahs.

Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer.

PubMed

Zhou, Bao-Jun; Song, Wei-Qing; Yan, Qing-Hui; Cai, Jian-Hui; Wang, Feng-An; Liu, Jin; Zhang, Guo-Jian; Duan, Guo-Qiang; Zhang, Zhan-Xue

2008-07-07

To investigate the feasibility and safety of monopolar electrocautery shovel (ES) in laparoscopic total mesorectal excision (TME) with anal sphincter preservation for rectal cancer in order to reduce the cost of the laparoscopic operation, and to compare ES with the ultrasonically activated scalpel (US). Forty patients with rectal cancer, who underwent laparoscopic TME with anal sphincter preservation from June 2005 to June 2007, were randomly divided into ultrasonic scalpel group and monopolar ES group, prospectively. White blood cells (WBC) were measured before and after operation, operative time, blood loss, pelvic volume of drainage, time of anal exhaust, visual analogue scales (VAS) and surgery-related complications were recorded. All the operations were successful; no one was converted to open procedure. No significant differences were observed in terms of preoperative and postoperative d 1 and d 3 WBC counts (P=0.493, P=0.375, P=0.559), operation time (P=0.235), blood loss (P=0.296), anal exhaust time (P=0.431), pelvic drainage volume and VAS in postoperative d 1 (P=0.431, P=0.426) and d 3 (P=0.844, P=0.617) between ES group and US group. The occurrence of surgery-related complications such as anastomotic leakage and wound infection was the same in the two groups. ES is a safe and feasible tool as same as US used in laparoscopic TME with anal sphincter preservation for rectal cancer on the basis of the skillful laparoscopic technique and the complete understanding of laparoscopic pelvic anatomy. Application of ES can not only reduce the operation costs but also benefit the popularization of laparoscopic operation for rectal cancer patients.

Ultrasonically activated scalpel versus monopolar electrocautery shovel in laparoscopic total mesorectal excision for rectal cancer

PubMed Central

Zhou, Bao-Jun; Song, Wei-Qing; Yan, Qing-Hui; Cai, Jian-Hui; Wang, Feng-An; Liu, Jin; Zhang, Guo-Jian; Duan, Guo-Qiang; Zhang, Zhan-Xue

2008-01-01

AIM: To investigate the feasibility and safety of monopolar electrocautery shovel (ES) in laparoscopic total mesorectal excision (TME) with anal sphincter preservation for rectal cancer in order to reduce the cost of the laparoscopic operation, and to compare ES with the ultrasonically activated scalpel (US). METHODS: Forty patients with rectal cancer, who underwent laparoscopic TME with anal sphincter preservation from June 2005 to June 2007, were randomly divided into ultrasonic scalpel group and monopolar ES group, prospectively. White blood cells (WBC) were measured before and after operation, operative time, blood loss, pelvic volume of drainage, time of anal exhaust, visual analogue scales (VAS) and surgery-related complications were recorded. RESULTS: All the operations were successful; no one was converted to open procedure. No significant differences were observed in terms of preoperative and postoperative d 1 and d 3 WBC counts (P = 0.493, P = 0.375, P = 0.559), operation time (P = 0.235), blood loss (P = 0.296), anal exhaust time (P = 0.431), pelvic drainage volume and VAS in postoperative d 1 (P = 0.431, P = 0.426) and d 3 (P = 0.844, P = 0.617) between ES group and US group. The occurrence of surgery-related complications such as anastomotic leakage and wound infection was the same in the two groups. CONCLUSION: ES is a safe and feasible tool as same as US used in laparoscopic TME with anal sphincter preservation for rectal cancer on the basis of the skillful laparoscopic technique and the complete understanding of laparoscopic pelvic anatomy. Application of ES can not only reduce the operation costs but also benefit the popularization of laparoscopic operation for rectal cancer patients. PMID:18609692

Obtaining accreditation by the pharmacy compounding accreditation board, part 2: developing essential standard operating procedures.

PubMed

Cabaleiro, Joe

2007-01-01

A key component of qualifying for accreditation with the Pharmacy Compounding Accreditation Board is having a set of comprehensive standard operating procedures that are being used by the pharmacy staff. The three criteria in standard operating procedures for which the Pharmacy Compounding Accreditation Board looks are: (1)written standard operating procedures; (2)standard operating procedures that reflect what the organization actualy does; and (3) whether the written standard operating procedures are implemented. Following specified steps in the preparation of standard operating procedures will result in procedures that meet Pharmacy Compounding Accreditation Board Requirements, thereby placing pharmacies one step closer to qualifying for accreditation.

On the effect of standard PFEM remeshing on volume conservation in free-surface fluid flow problems

NASA Astrophysics Data System (ADS)

Franci, Alessandro; Cremonesi, Massimiliano

2017-07-01

The aim of this work is to analyze the remeshing procedure used in the particle finite element method (PFEM) and to investigate how this operation may affect the numerical results. The PFEM remeshing algorithm combines the Delaunay triangulation and the Alpha Shape method to guarantee a good quality of the Lagrangian mesh also in large deformation processes. However, this strategy may lead to local variations of the topology that may cause an artificial change of the global volume. The issue of volume conservation is here studied in detail. An accurate description of all the situations that may induce a volume variation during the PFEM regeneration of the mesh is provided. Moreover, the crucial role of the parameter α used in the Alpha Shape method is highlighted and a range of values of α for which the differences between the numerical results are negligible, is found. Furthermore, it is shown that the variation of volume induced by the remeshing reduces by refining the mesh. This check of convergence is of paramount importance for the reliability of the PFEM. The study is carried out for 2D free-surface fluid dynamics problems, however the conclusions can be extended to 3D and to all those problems characterized by significant variations of internal and external boundaries.

40 CFR 792.81 - Standard operating procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 33 2013-07-01 2013-07-01 false Standard operating procedures. 792.81... operating procedures. (a) A testing facility shall have standard operating procedures in writing, setting... data generated in the course of a study. All deviations in a study from standard operating procedures...

40 CFR 792.81 - Standard operating procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 40 Protection of Environment 33 2012-07-01 2012-07-01 false Standard operating procedures. 792.81... operating procedures. (a) A testing facility shall have standard operating procedures in writing, setting... data generated in the course of a study. All deviations in a study from standard operating procedures...

40 CFR 792.81 - Standard operating procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 32 2014-07-01 2014-07-01 false Standard operating procedures. 792.81... operating procedures. (a) A testing facility shall have standard operating procedures in writing, setting... data generated in the course of a study. All deviations in a study from standard operating procedures...

A new simplified volume-loaded heterotopic rabbit heart transplant model with improved techniques and a standard operating procedure.

PubMed

Lu, Wei; Zheng, Jun; Pan, Xu-Dong; Li, Bing; Zhang, Jin-Wei; Wang, Long-Fei; Sun, Li-Zhong

2015-04-01

The classic non-working (NW) heterotopic heart transplant (HTX) model in rodents had been widely used for researches related to immunology, graft rejection, evaluation of immunosuppressive therapies and organ preservation. But unloaded models are considered not suitable for some researches. Accordingly, We have constructed a volume-loaded (VL) model by a new and simple technique. Thirty male New Zealand White rabbits were randomly divided into two groups, group NW with 14 rabbits and group VL with 16 rabbits, which served as donors and recipients. We created a large and nonrestrictive shunt to provide left heart a sufficient preload. The donor superior vena cave and ascending aorta (AO) were anastomosed to the recipient abdominal aorta (AAO) and inferior vena cava (IVC), respectively. No animals suffered from paralysis, pneumonia and lethal bleeding. Recipients' mortality and morbidity were 6.7% (1/15) and 13.3% (2/15), respectively. The cold ischemia time in group VL is slight longer than that in group NW. The maximal aortic velocity (MAV) of donor heart was approximately equivalent to half that of native heart in group VL. Moreover, the similar result was achieved in the parameter of late diastolic mitral inflow velocity between donor heart and native heart in group VL. The echocardiography (ECHO) showed a bidirectional flow in donor SVC of VL model, inflow during diastole and outflow during systole. PET-CT imaging showed the standard uptake value (SUV) of allograft was equal to that of native heart in both groups on the postoperative day 3. We have developed a new VL model in rabbits, which imitates a native heart hemodynamically while only requiring a minor additional procedure. Surgical technique is simple compared with currently used HTX models. We also developed a standard operating procedure that significantly improved graft and recipient survival rate. This study may be useful for investigations in transplantation in which a working model is required.

Collection of Pyrethroids in Water and Sediment Matrices: Development and Validation of a Standard Operating Procedure

USGS Publications Warehouse

Hladik, Michelle; Orlando, James L.; Kuivila, Kathryn

2009-01-01

Loss of pyrethroid insecticides onto surfaces during sample collection can confound the interpretation of analytical and toxicity test results. Sample collection devices, container materials, and water matrix composition have a significant influence on the association of pyrethroids to container walls, which can be as high as 50 percent. Any sample collection method involving transfer through multiple containers or pieces of equipment increases the potential for pyrethroid loss. This loose 'surface-association' with container walls can be reversed through agitation. When sampling water matrices with pumps or autosamplers, no pyrethroids were lost as long as the water was moving continuously through the system. When collecting water matrices in containers, the material with the least amount of pyrethroid sorption is as follows: glass less than (<) plastic less than (<) Teflon. Additionally, pyrethroids were easier to re-suspend from the glass container walls. Since the amount of surface-association is proportional to the ratio of volume-to-contact-area of the sample, taking larger-volume field samples (greater than 3 liters) reduced pyrethroid losses to less than 10 percent. The amount of surface-association cannot be predicted easily because of the dependence on water matrix composition; samples with higher dissolved organic carbon or suspended-sediment concentrations were observed to have lower percent loss. Sediment samples were not affected by glass-container sorption (the only containers tested). Standardized sample-collection protocols are critical to yield accurate pyrethroid concentrations for assessment of potential effects, and have been summarized in an accompanying standard operating procedure.

Pulmonary function after segmentectomy for small peripheral carcinoma of the lung.

PubMed

Takizawa, T; Haga, M; Yagi, N; Terashima, M; Uehara, H; Yokoyama, A; Kurita, Y

1999-09-01

The aim of this study is to compare the pulmonary function after a segmentectomy with that after a lobectomy for small peripheral carcinoma of the lung. Between 1993 and 1996, segmentectomy and lobectomy were performed on 48 and 133 good-risk patients, respectively. Lymph node metastases were detected after the operation in 6 and 24 patients of the segmentectomy and lobectomy groups, respectively. For bias reduction in comparison with a nonrandomized control group, we paired 40 segmentectomy patients with 40 lobectomy patients using nearest available matching method on the estimated propensity score. Twelve months after the operation, the segmentectomy and lobectomy groups had forced vital capacities of 2.67 +/- 0.73 L (mean +/- standard deviation) and 2.57 +/- 0.59 L, which were calculated to be 94.9% +/- 10.6% and 91.0% +/- 13.2% of the preoperative values (P =.14), respectively. The segmentectomy and lobectomy groups had postoperative 1-second forced expiratory volumes of 1.99 +/- 0.63 L and 1.95 +/- 0.49 L, which were calculated to be 93.3% +/- 10.3% and 87.3% +/- 14.0% of the preoperative values, respectively (P =.03). The multiple linear regression analysis showed that the alternative of segmentectomy or lobectomy was not a determinant for postoperative forced vital capacity but did affect postoperative 1-second forced expiratory volume. Pulmonary function after a segmentectomy for a good-risk patient is slightly better than that after a lobectomy. However, segmentectomy should be still the surgical procedure for only poor-risk patients because of the difficulty in excluding patients with metastatic lymph nodes from the candidates for the procedure.

Medical Laboratory Technician--Microbiology (AFSC 90470).

ERIC Educational Resources Information Center

Thompson, Joselyn H.

This four-volume student text is designed for use by Air Force personnel enrolled in a self-study extension course for medical laboratory technicians. Covered in the individual volumes are laboratory procedures in clinical bacteriology (the history of bacteriology; aseptic techniques and sterilization procedures; bacterial morphology and…

Determination of need for water soaking period in measurement of concrete volume of permeable voids : technical summary.

DOT National Transportation Integrated Search

2016-10-01

Water permeability of concrete is one of the key factors concerning : many concrete deterioration problems. It is often evaluated indirectly by : measuring the volume of permeable voids through the KT-73 (2012) testing : procedures. These procedures ...

Declining Operative Experience for Junior-Level Residents: Is This an Unintended Consequence of Minimally Invasive Surgery?

PubMed

Mullen, Matthew G; Salerno, Elise P; Michaels, Alex D; Hedrick, Traci L; Sohn, Min-Woong; Smith, Philip W; Schirmer, Bruce D; Friel, Charles M

2016-01-01

Our group has previously demonstrated an upward shift from junior to senior resident participation in common general surgery operations, traditionally performed by junior-level residents. The objective of this study was to evaluate if this trend would correct over time. We hypothesized that junior resident case volume would improve. A sample of essential laparoscopic and open general surgery procedures (appendectomy, inguinal herniorrhaphy, cholecystectomy, and partial colectomy) was chosen for analysis. The American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried for these procedures between 2005 and 2012. Cases were stratified by participating resident post-graduate year with "junior resident" defined as post-graduate year1-3. Logistic regression was performed to determine change in junior resident participation for each type of procedure over time. A total of 185,335 cases were included in the study. For 3 of the operations we considered, the prevalence of laparoscopic surgery increased from 2005-2012 (all p < 0.001). Cholecystectomy was an exception, which showed an unchanged proportion of cases performed laparoscopically across the study period (p = 0.119). Junior resident participation decreased by 4.5%/y (p < 0.001) for laparoscopic procedures and by 6.2%/y (p < 0.001) for open procedures. The proportion of laparoscopic surgeries performed by junior-level residents decreased for appendectomy by 2.6%/y (p < 0.001) and cholecystectomy by 6.1%/y (p < 0.001), whereas it was unchanged for inguinal herniorrhaphy (p = 0.75) and increased for partial colectomy by 3.9%/y (p = 0.003). A decline in junior resident participation was seen for all open surgeries, with appendectomy decreasing by 9.4%/y (p < 0.001), cholecystectomy by 4.1%/y (p < 0.002), inguinal herniorrhaphy by 10%/y (p < 0.001) and partial colectomy by 2.9%/y (p < 0.004). Along with the proliferation of laparoscopy for common general surgical procedures there has been a concomitant reduction in the participation of junior-level residents. As previously thought, familiarity with laparoscopy has not translated to redistribution of basic operations from senior to junior residents. This trend has significant implications for general surgery resident education. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

8 CFR 1003.40 - Local operating procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Local operating procedures. 1003.40 Section... PROVISIONS EXECUTIVE OFFICE FOR IMMIGRATION REVIEW Immigration Court-Rules of Procedure § 1003.40 Local... establish local operating procedures, provided that: (a) Such operating procedure(s) shall not be...

8 CFR 1003.40 - Local operating procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Local operating procedures. 1003.40 Section... PROVISIONS EXECUTIVE OFFICE FOR IMMIGRATION REVIEW Immigration Court-Rules of Procedure § 1003.40 Local... establish local operating procedures, provided that: (a) Such operating procedure(s) shall not be...

Treatment of Pancreatic and Periampullary Cancers at a Community Hospital: Successful Application of Tertiary Care Treatment Standards

PubMed Central

Moesinger, Robert C.; Davis, Jan W.; Hill, Britani; Johnston, W. Cory; Gray, Carl; Johnson, Harold; Ingersoll, Leslye; Whipple, Gary; Reilly, Mark; Harris, Robert; Hansen, Vincent

2011-01-01

Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented. Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006–2010) at two community hospitals. Results. There were 51 successful resections of 70 explorations (73%) including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards. Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care. PMID:22312532

Latissimus dorsi flap for total autologous immediate breast reconstruction without implants.

PubMed

Santanelli di Pompeo, Fabio; Laporta, Rosaria; Sorotos, Michail; Pagnoni, Marco; Falesiedi, Federica; Longo, Benedetto

2014-12-01

The latissimus dorsi flap provides suitable recipient tissue for fat transfer, with a good blood supply and a reasonable volume of host tissue to inject into. The authors present their experience with use of the pedicled latissimus dorsi flap for fat grafting in total autologous immediate breast reconstruction without implants. From 2010 to 2013, 23 patients underwent breast reconstruction with primary fat augmented latissimus dorsi flaps (21 unilateral procedures and two bilateral procedures). Mean patient age was 52.3 years (range, 39 to 68 years); mean body mass index was 24.77 kg/m2 (range, 21.5 to 28.7 kg/m2). Fat was harvested using the Coleman technique with 10-ml syringes and injected into the adipose layer and muscle fascia of the latissimus dorsi flap skin paddle with 1-ml syringes. The mean size of the harvested skin paddle was 19.7 × 11.04 cm (range, 18 × 10 cm to 21 × 12 cm). Mean operative time was 2.62 hours (range, 2.10 to 3.20 hours) and 4.12 hours (range, 4.10 to 4.15 hours) for unilateral and bilateral reconstructions, respectively. Mean harvested fat volume was 126 ml (range, 90 to 180 ml), and mean injected fat volume was 101 ml (range, 60 to 150 ml). All flaps healed uneventfully, no seroma occurred at the flap donor-site, and no fat grafting-related complications were observed. To the best of the authors' knowledge, this is the first report in which fat transfer was used to achieve immediate latissimus dorsi flap volume augmentation as an alternative for total autologous reconstruction, avoiding implant-related complications.

Hospital Variation in Perioperative Complications for Laparoscopic Sleeve Gastrectomy in Michigan

PubMed Central

Pradarelli, Jason C.; Varban, Oliver A.; Ghaferi, Amir A.; Weiner, Matthew; Carlin, Arthur M.; Dimick, Justin B.

2015-01-01

Structured Abstract Background Laparoscopic sleeve gastrectomy has recently surpassed gastric bypass and laparoscopic adjustable gastric banding as the most common weight-loss procedure. Previously, substantial concerns existed regarding variation in perioperative safety with bariatric surgery. This study aimed to assess rates of perioperative complications for laparoscopic sleeve gastrectomy across hospitals and in relation to procedure volume. Study Design We analyzed 8,693 patients who underwent laparoscopic sleeve gastrectomy from 2013 through 2014 across 40 hospitals in the Michigan Bariatric Surgery Collaborative. Mixed-effects logistic regression was used to assess hospital variation in risk- and reliability-adjusted rates of overall and serious 30-day complications and their relationship with hospital annual stapling procedure volume (gastric bypass and sleeve gastrectomy). Results Overall, 5.4% of patients experienced perioperative complications. Adjusted rates of overall complications varied three-fold across hospitals, ranging from 3.6% (95% CI, 1.9–6.8%) to 11.0% (95% CI, 7.7–15.5%). Serious complications occurred in just 1.2% of patients and varied minimally. In this analysis, hospital volume was not associated with overall or serious complications. The 1 hospital with significantly lower overall complication rates was high-volume (≥125 procedures/year); however, of the 4 hospitals with significantly higher complication rates, 3 were medium-volume (50–124 procedures/year) and 1 was high-volume. The remaining hospitals were not significantly different than the cohort mean. Conclusions Serious complications among patients undergoing laparoscopic sleeve gastrectomy were relatively infrequent. Rates of overall complications varied widely across Michigan hospitals enrolled in a quality collaborative, although this variation was unrelated to volume standards required for accreditation as a comprehensive bariatric surgery center. PMID:26506567

Relationship between volume and in-hospital mortality in digestive oncological surgery.

PubMed

Pérez-López, Paloma; Baré, Marisa; Touma-Fernández, Ángel; Sarría-Santamera, Antonio

2016-03-01

The results previously obtained in Spain in the study of the relationship between surgical caseload and in-hospital mortality are inconclusive. The aim of this study is to evaluate the volume-outcome association in Spain in the setting of digestive oncological surgery. An analytical, cross-sectional study was conducted with data from patients who underwent surgical procedures with curative intent of esophageal, gastric, colorectal and pancreatic neoplasms between 2006-2009 with data from the Spanish MBDS. In-hospital mortality was used as outcome variable. Control variables were patient, health care and hospital characteristics. Exposure variable was the number of interventions for each disease, dividing the hospitals in 3 categories: high volume (HV), mid volume (MV) and low volume (LV) according to the number of procedures. An inverse, statistically significant relationship between procedure volume and in-hospital mortality was observed for both volume categories in both gastric (LV: OR=1,50 [IC 95%: 1,28-1,76]; MV: OR=1,49 (IC 95%: 1,28-1,74)) and colorectal (LV: OR=1,44 [IC 95%: 1,33-1,55]; MV: OR=1,24 [IC 95%: 1,15-1,33]) cancer surgery. In pancreatic procedures, this difference was only statistically significant between LV and HV categories (LV: OR=1,89 [IC 95%: 1,29-2,75]; MV: OR=1,21 [IC 95%: 0,82-1,79]). Esophageal surgery also showed an inverse relationship, which was not statistically significant (LV: OR=1,89 [IC 95%: 0,98-3,64]; MV: OR=1,05 [IC 95%: 0,50-2,21]). The results of this study suggest the existence in Spain of an inverse relationship between caseload and in-hospital mortality in digestive oncological surgery for the procedures analyzed. Copyright © 2015 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Living Liver Donor Selection and Resection at the University of Tokyo Hospital.

PubMed

Akamatsu, N; Kokudo, N

2016-05-01

Donor selection and operative procedures for adult-to-adult living donor liver transplantation at the University of Tokyo are presented. Donor selection criteria are as follows: age between 20 and 65 years, within 3 degrees of consanguinity, without coercion, free from any major comorbidities, body mass index (BMI) < 30, and ABO blood type identical or compatible. Liver biopsy is indicated for BMI > 25 kg/m(2) or any liver function abnormality, and those with macroscopic steatosis >10% are rejected. Thereafter, an indocyanine green retention test and dynamic computed tomography are evaluated. Graft type is determined based on computed tomography volumetry. An estimated graft volume of 40% to recipient standard liver volume ratio is the lower limit. For donor safety, the left liver is the first choice, provided that it satisfies the lower limit. Otherwise, right liver harvesting is indicated, providing that the estimated remnant liver volume is >30% of the donor's total liver volume. A posterior sector graft is a possible option. Between 1996 and 2014, 462 donor hepatectomies were performed, with 257 right livers, 179 left livers, and 26 posterior sectors. There was no mortality, and the incidence of morbidity grades I, II, IIIa, and IIIb was 16%, 5%, 5%, and 3%, respectively, without a difference between right and left liver grafts. The left liver was used without impairing recipient outcome. Two aborted hepatectomies (0.4%) and 3 near-miss events (0.6%) were encountered. Maximal effort should be applied to donor selection and operation for donor safety. Copyright © 2016 Elsevier Inc. All rights reserved.

Association of Very Low-Volume Practice With Vascular Surgery Outcomes in New York.

PubMed

Mao, Jialin; Goodney, Philip; Cronenwett, Jack; Sedrakyan, Art

2017-08-01

Little research has focused on very low-volume surgery, especially in the context of decreasing vascular surgery volume with the adoption of endovascular procedures. To investigate the existence and outcomes of open abdominal aortic aneurysm repair (OAR) and carotid endarterectomy (CEA) performed by very low-volume surgeons in New York. This cohort study examined inpatient data of patients undergoing elective OAR or CEA from 2000 to 2014 from all New York hospitals. Surgeons who performed 1 or less designated procedure per year on average were considered very low volume, as opposed to higher-volume surgeons. Temporal trends of the existence of very low-volume practice were evaluated. Hierarchical logistic regression was used to compare in-hospital outcomes and health care resource use between patients treated by very low-volume surgeons and higher-volume surgeons for both OAR and CEA, adjusting for patient, surgeon, and hospital characteristics. There were 8781 OAR procedures and 68 896 CEA procedures included in the study. The mean (SD) patient age was 71.7 (8.4) years for OAR and 71.5 (9.1) years for CEA. A total of 614 surgeons performed OAR and 1071 performed CEA in New York during the study period. Of these, 318 (51.8%) and 512 (47.8%), respectively, were very low-volume surgeons. Very low-volume surgeons were less likely to be vascular surgeons. The number and proportion of very low-volume surgeons decreased over years. Compared with patients treated by higher-volume surgeons, those treated by very low-volume surgeons were more likely to have higher in-hospital mortality (odds ratio [OR], 2.09; 95% CI, 1.41-3.08) following OAR and higher risks of postoperative myocardial infarction (OR, 1.83; 95% CI, 1.03-3.26) and stroke (OR, 1.78; 95% CI, 1.21-2.62) following CEA. Patients treated by very low-volume surgeons also had greater health care resource use following both surgeries, including prolonged length of stay (OR, 1.37; 95% CI, 1.11-1.70) following OAR as well as higher charges (OR, 1.28; 95% CI, 1.01-1.62) and increased 30-day readmission (OR, 1.30; 95% CI 1.04-1.62) following CEA. The OAR and CEA procedures performed by very low-volume surgeons resulted in worse postoperative outcomes and greater lengths of stay. Although the percentage of very low-volume surgeons declined from 2000 to 2014, it remains concerning, given ready access to higher-volume surgeons. Future research is needed to understand the existence of this practice pattern in other surgical fields. Efforts to eliminate this practice pattern are warranted to ensure high-quality care for all patients.

Initial 12-h operative fluid volume is an independent risk factor for pleural effusion after hepatectomy.

PubMed

Cheng, Xiang; Wu, Jia-Wei; Sun, Ping; Song, Zi-Fang; Zheng, Qi-Chang

2016-12-01

Pleural effusion after hepatectomy is associated with significant morbidity and prolonged hospital stays. Several studies have addressed the risk factors for postoperative pleural effusion. However, there are no researches concerning the role of the initial 12-h operative fluid volume. The aim of this study was to evaluate whether the initial 12-h operative fluid volume during liver resection is an independent risk factor for pleural effusion after hepatectomy. In this study, we retrospectively analyzed clinical data of 470 patients consecutively undergoing elective hepatectomy between January 2011 and December 2012. We prospectively collected and retrospectively analyzed baseline and clinical data, including preoperative, intraoperative, and postoperative variables. Univariate and multivariate analyses were carried out to identify whether the initial 12-h operative fluid volume was an independent risk factor for pleural effusion after hepatectomy. The multivariate analysis identified 2 independent risk factors for pleural effusion: operative time [odds ratio (OR)=10.2] and initial 12-h operative fluid volume (OR=1.0003). Threshold effect analyses revealed that the initial 12 h operative fluid volume was positively correlated with the incidence of pleural effusion when the initial 12-h operative fluid volume exceeded 4636 mL. We conclude that the initial 12-h operative fluid volume during liver resection and operative time are independent risk factors for pleural effusion after hepatectomy. Perioperative intravenous fluids should be restricted properly.

Determination of need for water soaking period in measurement of concrete volume of permeable voids : final report.

DOT National Transportation Integrated Search

2016-10-01

Water permeability of concrete is one of the key factors concerning many concrete deterioration : problems. It is often evaluated indirectly by measuring the volume of permeable voids through the KT-73 : (2012) testing procedures. These procedures in...

A Second Law Based Unstructured Finite Volume Procedure for Generalized Flow Simulation

NASA Technical Reports Server (NTRS)

Majumdar, Alok

1998-01-01

An unstructured finite volume procedure has been developed for steady and transient thermo-fluid dynamic analysis of fluid systems and components. The procedure is applicable for a flow network consisting of pipes and various fittings where flow is assumed to be one dimensional. It can also be used to simulate flow in a component by modeling a multi-dimensional flow using the same numerical scheme. The flow domain is discretized into a number of interconnected control volumes located arbitrarily in space. The conservation equations for each control volume account for the transport of mass, momentum and entropy from the neighboring control volumes. In addition, they also include the sources of each conserved variable and time dependent terms. The source term of entropy equation contains entropy generation due to heat transfer and fluid friction. Thermodynamic properties are computed from the equation of state of a real fluid. The system of equations is solved by a hybrid numerical method which is a combination of simultaneous Newton-Raphson and successive substitution schemes. The paper also describes the application and verification of the procedure by comparing its predictions with the analytical and numerical solution of several benchmark problems.

Solution of the Average-Passage Equations for the Incompressible Flow through Multiple-Blade-Row Turbomachinery

DTIC Science & Technology

1994-02-01

numerical treatment. An explicit numerical procedure based on Runqe-Kutta time stepping for cell-centered, hexahedral finite volumes is...An explicit numerical procedure based on Runge-Kutta time stepping for cell-centered, hexahedral finite volumes is outlined for the approximate...Discretization 16 3.1 Cell-Centered Finite -Volume Discretization in Space 16 3.2 Artificial Dissipation 17 3.3 Time Integration 21 3.4 Convergence

Microfluidics-Based Lab-on-Chip Systems in DNA-Based Biosensing: An Overview

PubMed Central

Dutse, Sabo Wada; Yusof, Nor Azah

2011-01-01

Microfluidics-based lab-on-chip (LOC) systems are an active research area that is revolutionising high-throughput sequencing for the fast, sensitive and accurate detection of a variety of pathogens. LOCs also serve as portable diagnostic tools. The devices provide optimum control of nanolitre volumes of fluids and integrate various bioassay operations that allow the devices to rapidly sense pathogenic threat agents for environmental monitoring. LOC systems, such as microfluidic biochips, offer advantages compared to conventional identification procedures that are tedious, expensive and time consuming. This paper aims to provide a broad overview of the need for devices that are easy to operate, sensitive, fast, portable and sufficiently reliable to be used as complementary tools for the control of pathogenic agents that damage the environment. PMID:22163925

49 CFR 193.2503 - Operating procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

...: FEDERAL SAFETY STANDARDS Operations § 193.2503 Operating procedures. Each operator shall follow one or more manuals of written procedures to provide safety in normal operation and in responding to an... 49 Transportation 3 2013-10-01 2013-10-01 false Operating procedures. 193.2503 Section 193.2503...

49 CFR 193.2503 - Operating procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

...: FEDERAL SAFETY STANDARDS Operations § 193.2503 Operating procedures. Each operator shall follow one or more manuals of written procedures to provide safety in normal operation and in responding to an... 49 Transportation 3 2011-10-01 2011-10-01 false Operating procedures. 193.2503 Section 193.2503...

49 CFR 193.2503 - Operating procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

...: FEDERAL SAFETY STANDARDS Operations § 193.2503 Operating procedures. Each operator shall follow one or more manuals of written procedures to provide safety in normal operation and in responding to an... 49 Transportation 3 2014-10-01 2014-10-01 false Operating procedures. 193.2503 Section 193.2503...

49 CFR 193.2503 - Operating procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

...: FEDERAL SAFETY STANDARDS Operations § 193.2503 Operating procedures. Each operator shall follow one or more manuals of written procedures to provide safety in normal operation and in responding to an... 49 Transportation 3 2012-10-01 2012-10-01 false Operating procedures. 193.2503 Section 193.2503...

0 + 5 Vascular Surgery Residents' Operative Experience in General Surgery: An Analysis of Operative Logs from 12 Integrated Programs.

PubMed

Smith, Brigitte K; Kang, P Chulhi; McAninch, Chris; Leverson, Glen; Sullivan, Sarah; Mitchell, Erica L

2016-01-01

Integrated (0 + 5) vascular surgery (VS) residency programs must include 24 months of training in core general surgery. The Accreditation Council for Graduate Medical Education currently does not require specific case numbers in general surgery for 0 + 5 trainees; however, program directors have structured this time to optimize operative experience. The aim of this study is to determine the case volume and type of cases that VS residents are exposed to during their core surgery training. Accreditation council for graduate medical education operative logs for current 0 + 5 VS residents were obtained and retrospectively reviewed to determine general surgery case volume and distribution between open and laparoscopic cases performed. Standard statistical methods were applied. A total of 12 integrated VS residency programs provided operative case logs for current residents. A total of 41 integrated VS residents in clinical years 2 through 5. During the postgraduate year-1 training year, residents participated in significantly more open than laparoscopic general surgery cases (p < 0.0001). This difference was consistent over the first 3 years of training. The most frequently logged open general surgery cases are hernia repair (20%), skin and soft tissue (7.4%), and breast (6.3%). Residents in programs with core surgery over 3 years participated in significantly more general surgery operations compared with residents in programs with core surgery spread out over 4 years (p = 0.035). 0 + 5 VS residents perform significantly more open operations than laparoscopic operations during their core surgery training. The majority of these operations are minor, nonabdominal procedures. The 0 + 5 VS residency program general surgery operative training requirements should be reevaluated and case minimums defined. The general surgery training component of 0 + 5 VS residencies may need to be restructured to meet the needs of current and future trainees. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Early post-operative weight loss after laparoscopic sleeve gastrectomy correlates with the volume of the excised stomach and not with that of the sleeve! Preliminary data from a multi-detector computed tomography-based study.

PubMed

Pawanindra, Lal; Vindal, Anubhav; Midha, Manoj; Nagpal, Prashant; Manchanda, Alpana; Chander, Jagdish

2015-10-01

Pre- and post-operative stomach volumes can be important determinants for effectiveness of laparoscopic sleeve gastrectomy (LSG) in causing weight loss. There is little existing data on the volumes of stomach preoperatively and that excised during LSG. This study was designed to evaluate the change in gastric volume after LSG using multi-detector CT and to correlate it with early post-operative weight loss. Twenty consecutive patients with BMI ≥ 40 kg/m(2) and medical comorbidities underwent LSG between October 2011 and October 2013 and were analysed prospectively. The pre-operative stomach volume was measured by MDCT done 1-3 days before the surgery. LSG was performed in the standard manner using a 36F bougie. The volume of excised stomach was measured by distending the specimen with saline. MDCT of the upper abdomen was repeated 3 months postoperatively to calculate the gastric sleeve volume. Weight loss and resolution of comorbidities were documented. The mean pre-operative weight of patients was 123.90 kg, and the mean pre-operative stomach volume on MDCT was 1,067 ml. The stomach volume on pre-operative MDCT correlated with pre-operative weight and BMI. The mean volume of the excised stomach was 859 ml when measured by distension of the specimen and 850 ml on MDCT. After 3 months post surgery, the mean volume of gastric sleeve on MDCT was 217 ml, and the mean weight of the patients was 101.22 kg. The volume of the excised stomach calculated by MDCT correlated with the weight loss achieved 3 months postoperatively. However, no correlation was seen between the gastric sleeve volume 3 months postoperatively and weight loss during this period. MDCT is a good method to measure gastric volume before and after LSG. Early post-operative weight loss (3 months) correlates well with the volume of the excised stomach but not with that of the gastric sleeve.

Multipolar hepatic radiofrequency ablation using up to six applicators: preliminary results.

PubMed

Bruners, P; Schmitz-Rode, T; Günther, R W; Mahnken, A

2008-03-01

To evaluate the clinical feasibility and safety of hepatic radiofrequency (RF) ablation using a multipolar RF system permitting the simultaneous use of up to six electrodes. Ten patients (3 female, 7 male, mean age 61) suffering from 29 hepatic metastases (range: 1 - 5) of different tumors were treated with a modified multipolar RF system (CelonLab Power, Celon Medical Instruments, Teltow, Germany) operating four to six needle-shaped internally cooled RF applicators. The procedure duration, applied energy and generator output were recorded during the intervention. The treatment result and procedure-related complications were analyzed. The achieved coagulation volume was calculated on the basis of contrast-enhanced CT scans 24 hours after RF ablation. Complete tumor ablation was achieved in all cases as determined by the post-interventional lack of contrast enhancement in the target region using four applicators in five patients, five applicators in one patient and six applicators in four patients. A mean energy deposition of 353.9 +/- 176.2 kJ resulted in a mean coagulation volume of 115.9 +/- 79.5 cm (3). The mean procedure duration was 74.9 +/- 21.2 minutes. Four patients showed an intraabdominal hemorrhage which necessitated further interventional treatment (embolization; percutaneous histoacryl injection) in two patients. Multipolar RF ablation of hepatic metastasis with up to six applicators was clinically feasible. In our patient population it was associated with an increased risk of intraabdominal bleeding probably due to the multiple punctures associated with the use of multiple applicators.

Comprehensive evaluation of contemporary assisted reproduction technology laboratory operations to determine staffing levels that promote patient safety and quality care.

PubMed

Alikani, Mina; Go, Kathryn J; McCaffrey, Caroline; McCulloh, David H

2014-11-01

To consider how staffing requirements have changed with evolving and increasingly more complex assisted reproduction technology (ART) laboratory practice. Analysis by four laboratory directors from three different ART programs of the level of complexity and time requirements for contemporary ART laboratory activities to determine adequate staffing levels. University-based and private ART programs. None. None. Human resource requirements for ART procedures. Both complexity and time required for completion of a contemporary ART cycle have increased significantly compared with the same requirements for the "traditional cycle" of the past. The latter required roughly 9 personnel hours, but a contemporary cycle can require up to 20 hours for completion. Consistent with this increase, a quantitative analysis shows that the number of embryologists required for safe and efficient operation of the ART laboratory has also increased. This number depends on not only the volume but also the types of procedures performed: the higher the number of complex procedures, the more personnel required. An interactive Personnel Calculator is introduced that can help determine staffing needs. The increased complexity of the contemporary ART laboratory requires a new look at the allocation of human resources. Our work provides laboratory directors with a practical, individualized tool to determine their staffing requirements with a view to increasing the safety and efficiency of operations. The work could serve as the basis for revision of the 2008 American Society for Reproductive Medicine (ASRM) staffing guidelines. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Rapid acquisition of operant conditioning in 5-day-old rat pups: a new technique articulating suckling-related motor activity and milk reinforcement.

PubMed

Arias, Carlos; Spear, Norman E; Molina, Juan Carlos; Molina, Agustin; Molina, Juan Carlos

2007-09-01

Newborn rats are capable of obtaining milk by attaching to a surrogate nipple. During this procedure pups show a gradual increase in head and forelimb movements oriented towards the artificial device that are similar to those observed during nipple attachment. In the present study the probability of execution of these behaviors was analyzed as a function of their contingency with intraoral milk infusion using brief training procedures (15 min). Five-day-old pups were positioned in a smooth surface having access to a touch-sensitive sensor. Physical contact with the sensor activated an infusion pump which served to deliver intraoral milk reinforcement (Paired group). Yoked controls received the reinforcer when Paired neonates touched the sensor. Paired pups trained under a continuous reinforcement schedule emitted significantly more responses than Yoked controls following two (Experiment 1) or one training session (Experiment 2). These differences were also observed during an extinction session conducted immediately after training. The level of maternal deprivation before training (3 or 6 hr) or the volume of milk delivered (1.0 or 1.5 microl per pulse) did not affect acquisition or extinction performances. In addition, it was observed that the rate of responding of Paired pups during the early phase of the extinction session significantly predicted subsequent levels of acceptance of the reinforcer. These results indicate that the frequency of suckling-related behaviors can be rapidly modified by means of associative operant processes. The operant procedure here described represents an alternative tool for the ontogenetic analysis of self-administration or behavior processes of seeking. .

Usefulness of robot-assisted thoracoscopic esophagectomy.

PubMed

Osaka, Yoshiaki; Tachibana, Shingo; Ota, Yoshihiro; Suda, Takeshi; Makuuti, Yosuke; Watanabe, Takafumi; Iwasaki, Kenichi; Katsumata, Kenji; Tsuchida, Akihiko

2018-04-01

We started robot-assisted thoracoscopic esophagectomy using the da Vinci surgical system from June 2010 and operated on 30 cases by December 2013. Herein, we examined the usefulness of robot-assisted thoracoscopic esophagectomy and compared it with conventional esophagectomy by right thoracotomy. Patients requiring an invasion depth of up to the muscularis propria with preoperative diagnosis were considered for surgical adaptation, excluding bulky lymph node metastasis or salvage surgery cases. The outcomes of 30 patients who underwent robot-assisted surgery (robot group) and 30 patients who underwent conventional esophagectomy by right thoracotomy (thoracotomy group) up to December 2013 were retrospectively examined. Five ports were used in the robot-assisted thoracoscopic esophagectomy: 3rd intercostal (da Vinci right arm), 6th intercostal (da Vinci camera), 9th intercostal (da Vinci left arm), 4th and 8th intercostals (for assistance). There was no significant difference in patient characteristics. Robot group/right thoracotomy group: Operation time, 563/398 min; thoracic procedure bleeding volume, 21/135 ml; number of thoracic lymph node radical dissections, 25/23. Postoperative complications were recurrent nerve paralysis, 16.7/16.7%; pneumonia, 6.7%/10.0%; anastomotic leakage, 10.0/20.0%; surgical site infection, 0/10.0%; hospitalization, 17/30 days. For the robot group, the operation time was significantly longer, but the amount of intraoperative bleeding and postoperative hospitalization were significantly reduced. Robot-assisted thoracoscopic esophagectomy enables delicate surgical procedures owing to the 3D effect of the field of view and articulated forceps of the da Vinci. This procedure reduces bleeding and postoperative hospitalization and is less invasive than conventional esophagectomy by right thoracotomy.

Surgical activity of first-year Canadian neurosurgical residents.

PubMed

Fallah, Aria; Ebrahim, Shanil; Haji, Faizal; Gillis, Christopher; Girgis, Fady; Howe, Kathryn; Ibrahim, George M; Radic, Julia; Shahideh, Mehdi; Wallace, M Christopher

2010-11-01

Surgical activity is probably the most important component of surgical training. During the first year of surgical residency, there is an early opportunity for the development of surgical skills, before disparities between the skill sets of residents increase in future years. It is likely that surgical skill is related to operative volumes. There are no published guidelines that quantify the number of surgical cases required to achieve surgical competency. The aim of this study was to describe the current trends in surgical activity in a recent cohort of first-year Canadian neurosurgical trainees. This study utilized retrospective database review and survey methodology to describe the current state of surgical training for first-year neurosurgical trainees. A committee of five residents designed this survey in an effort to capture factors that may influence the operative activity of trainees. Nine out of a cohort of 20 first-year Canadian neurosurgical trainees that began training in July of 2008 participated in the study. The median number of cases completed by a resident during the initial three month neurosurgical rotation was 66, within which the trainee was identified as the primary surgeon in 12 cases. Intracranial hemorrhage and cerebrospinal fluid diversion procedures were the most common operations to have the trainee as primary surgeon. Based on this pilot study, it appears that the operative activity of Canadian first-year residents is at least equivalent to the residents of other studied training systems with respect to volume and diversity of surgical activity.

Variable Operative Experience in Hand Surgery for Plastic Surgery Residents.

PubMed

Silvestre, Jason; Lin, Ines C; Levin, Lawrence Scott; Chang, Benjamin

Efforts to standardize hand surgery training during plastic surgery residency remain challenging. We analyze the variability of operative hand experience at U.S. plastic surgery residency programs. Operative case logs of chief residents in accredited U.S. plastic surgery residency programs were analyzed (2011-2015). Trends in fold differences of hand surgery case volume between the 10th and 90th percentiles of residents were assessed graphically. Percentile data were used to calculate the number of residents achieving case minimums in hand surgery for 2015. Case logs from 818 plastic surgery residents were analyzed of which a minority were from integrated (35.7%) versus independent/combined (64.3%) residents. Trend analysis of fold differences in case volume demonstrated decreasing variability among procedure categories over time. By 2015, fold differences for hand reconstruction, tendon cases, nerve cases, arthroplasty/arthrodesis, amputation, arterial repair, Dupuytren release, and neoplasm cases were below 10-fold. Congenital deformity cases among independent/combined residents was the sole category that exceeded 10-fold by 2015. Percentile data suggested that approximately 10% of independent/combined residents did not meet case minimums for arterial repair and congenital deformity in 2015. Variable operative experience during plastic surgery residency may limit adequate exposure to hand surgery for certain residents. Future studies should establish empiric case minimums for plastic surgery residents to ensure hand surgery competency upon graduation. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Accuracy of external ventricular drainage catheter placement.

PubMed

Abdoh, Mohammad Ghazi; Bekaert, Olivier; Hodel, Jérôme; Diarra, Salia Mamadou; Le Guerinel, Caroline; Nseir, Rémi; Bastuji-Garin, Sylvie; Decq, Philippe

2012-01-01

External ventricular drainage (EVD) is a freehand neurosurgical procedure performed routinely using the anatomical landmarks. The aim of this study was to determine the accuracy of EVD catheter freehand placement. Pre-operative and post-operative computed tomography scans for 66 consecutive EVDs performed in 56 adult patients (26 men, 30 women) in 2008 were retrospectively reviewed. Etiologies of acute hydrocephalus were subarachnoid or intraventricular haemorrhage (43 cases) or miscellaneous (13 cases). Pre-operative lateral ventricular volume, position of the burr hole, length of the catheter and its sagittal and coronal angular variations from a theoretical trajectory were measured. The EVD was placed on the right (53 cases) or left (13 cases) side. The mean pre-operative lateral ventricular volume was 51 cc (10-118 cc). The average distance from the burr hole to the midline was 28 mm (10-49 mm) and to the supra-orbital ridge was 101 mm (75-125 mm). The mean intracranial catheter length was 60 mm (from 39-102 mm). Only 50% of the EVDs in the coronal plane and 40% in the sagittal plane were placed with an angular variation of ±5° to the target. The tip was placed outside of the ventricles in three cases; 13 catheters crossed the midline, and five intracranial minor haemorrhages were detected. Freehand placement of EVDs does not have sufficient accuracy and may lead to drainage dysfunctions. This data suggests that a guidance system for EVD's would be required.