Analytical Tools for the Application of Operational Culture: A Case Study in the Trans-Sahel

DTIC Science & Technology

2011-03-28

Study Team Working Paper 3: Research Methods Discussion for the Study Team Methods229 Generating Empirical Materials In grounded theory ... research I have conducted using these methods . UNCLASSIFIED Analytical Tools for the Application of Operational Culture: A Case Study in the...Survey and a Case Study ,‖ Kjeller, Norway: FFI Glaser, B. G. & Strauss, A. L. (1967). ―The discovery of grounded theory

Rapid Operational Access and Maneuver Support (ROAMS) Platform for Improved Military Logistics Lines of Communication and Operational Vessel Routing

DTIC Science & Technology

2017-06-01

case study in a northeastern American metropolitan area. METHODOLOGY : The ROAMS platform provides expanded analysis, model automation, and enhanced...shoals. An initial route for such operations is selected much like the military logistics case . Subsequent adjustments to routes may be done on an ad...IX-45 June 2017 8 CASE STUDY: The ROAMS platform was applied to a large, northeast American metropolitan region to demonstrate the capability of

Going Boldly Into the Future: A Series of Case Studies of Co-Operative Research Centres and Their Relationships with the VET Sector.

ERIC Educational Resources Information Center

Ferrier, Fran; Trood, Clifford; Whittingham, Karen

This document presents case studies of 10 cooperative research centers (CRCs) across Australia and their relationships with the vocational education and training (VET) sector. The CRCs profiled in the case studies are as follows: Co-operative Research Centre for Sustainable Rice Production; Cast Alloy and Solidification Technology Co-operative…

Strategies for Countering Terrorist Safe Havens

DTIC Science & Technology

2013-12-01

tactical containment, pseudo operations, and surrogate security forces. The thesis draws from four historical case studies to examine these strategies...safe havens, tactical containment, pseudo operations, and surrogate security forces. The thesis draws from four historical case studies to examine...pseudo operations—provide viable potential options for USSOF to counter the complex problem of safe havens. Overall, the case studies will demonstrate

IVHS Institutional Issues and Case Studies: Transcom/Transmit Case Study

DOT National Transportation Integrated Search

1994-04-01

The Transportation Operations Coordinating Committee (TRANSCOM) is a coalition of 15 traffic, transit, and police agencies in the New York, New Jersey, and Connecticut metropolitan area. TRANSCOM's IVHS operational field test, the TRANSCOM System for...

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

PubMed

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

2017-04-01

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

Traffic operational evaluation of traffic impact analysis (TIA) case sites.

DOT National Transportation Integrated Search

2010-09-22

This report summarizes traffic operational evaluation of six select traffic impact analysis (TIA) case sites and the effectiveness of forecasting methods used in TIA studies. Six TIA case sites comprising 15 signalized intersections and 2 unsignalize...

Results of a randomized trial of HERMES-assisted versus non-HERMES-assisted laparoscopic antireflux surgery.

PubMed

Luketich, J D; Fernando, H C; Buenaventura, P O; Christie, N A; Grondin, S C; Schauer, P R

2002-09-01

Speech recognition technology is a recent development in minimally invasive surgery. This study was designed to assess the impact of HERMES on operating room efficiency and user satisfaction. Patients undergoing laparoscopic antireflux operations by surgeons experienced in minimally invasive surgery were randomized to HERMES-assisted or standard laparoscopic operations. The variables of interest were circulating nurse's time spent adjusting devices that are voice-controlled by HERMES, number of adjustments to devices requested, and surgeon and nurse satisfaction measured on a scale from 1 (dissatisfied) to 10 (satisfied). A total of 30 cases were studied. In the non-HERMES cases, nurses were interrupted to make device adjustments an average of 15.3 times per case versus 0.33 times per case in the with-HERMES cases (p < 0.01). The interruptions during the non-HERMES cases averaged 4.35 min per case versus 0.16 min per case in the with-HERMES cases (p = 0.03). Average satisfaction scores for HERMES operations as opposed to non-HERMES operations were 9.2 versus 5.3 for nurses (p < 0.01) and 9.0 versus 5.1 for surgeons (p < 0.01). Physician and nurse acceptance of HERMES was very high because of the smoother interruption-free environment.

Role of intraoperative ultrasound in achieving complete resection of intra-axial solid brain tumours.

PubMed

Mari, Abdul Razaque; Shah, Irfanullah; Imran, Muhammed; Ashraf, Junaid

2014-12-01

To determine the frequency of completeness of resection for intra-axial solid brain tumours with the help of intra-operative ultrasound to detect residual brain tumour. The cross-sectional study was conducted at the Department of Neurosurgery, Dow University of Health Sciences and Civil Hospital Karachi, from September 2009 to June 2010 and comprised patients with intra-axial solid brain lesion. During operation following standard craniotomy, multi-plane sonographic examination was performed using intra-operative ultrasound for tumour localisation and calculation of dimension, followed by tumour resection in the standard fashion. At the end of tumour resection ultrasound was again used for the detection of any residual tumour. Results of intra-operative ultrasound were compared with post-operative contrast magnetic resonance imaging. Of the 39 cases in which intra-operative ultrasound was performed, 32(82.1%) were males and 7(17.9%) were females, with an overall mean age of 42.6±19.7 years. Intra-operative ultrasonography was able to localise and delineate the tumour in all 39 (100%) cases. It showed no residual tumour in 36 (92.3%) cases, but in 3(7.7%) cases residual tumour was detected. Post-operative contrast enhancing magnetic resonance imaging showed no residual tumour in 35(89.7%) cases and in 4(10.3%) cases residual tumour was detected. The frequency of completely resected intra-axial solid brain tumour was 35(89.7%), while in 4(10.3%) cases incomplete resection was observed. The study concluded that intra-operative ultrasonography has an important role in achieving increased frequency of completely resected intra-axial solid brain tumours.

Delays in the operating room: signs of an imperfect system.

PubMed

Wong, Janice; Khu, Kathleen Joy; Kaderali, Zul; Bernstein, Mark

2010-06-01

Delays in the operating room have a negative effect on its efficiency and the working environment. In this prospective study, we analyzed data on perioperative system delays. One neurosurgeon prospectively recorded all errors, including perioperative delays, for consecutive patients undergoing elective procedures from May 2000 to February 2009. We analyzed the prevalence, causes and impact of perioperative system delays that occurred in one neurosurgeon's practice. A total of 1531 elective surgical cases were performed during the study period. Delays were the most common type of error (33.6%), and more than half (51.4%) of all cases had at least 1 delay. The most common cause of delay was equipment failure. The first cases of the day and cranial cases had more delays than subsequent cases and spinal cases, respectively. A delay in starting the first case was associated with subsequent delays. Delays frequently occur in the operating room and have a major effect on patient flow and resource utilization. Thorough documentation of perioperative delays provides a basis for the development of solutions for improving operating room efficiency and illustrates the principles underlying the causes of operating room delays across surgical disciplines.

Simplifying Operational Design

DTIC Science & Technology

2012-05-01

centuries of historical case studies, tracing the 9 evolution and development of what was then in 1997 operational theory. Naveh called his...major cases against operational design is the IDF’s application of SOD in 2006 against Hezbollah in Lebanon. While many blamed Israel’s lack of success...networked centricity.68 This is not the case . War, like ecosystems and economies, is a complex adaptive system. The interactive complexity that comprises

ITS institutional and legal issues program : review of the Travelaid operational test

DOT National Transportation Integrated Search

1995-01-01

The TravelAid operational test was chosen by the Federal Highway Administration to be the subject of a case study. Several case studies were performed under the Intelligent Transportation Systems (ITS) Institutional and Legal Issues Program, which wa...

ITS institutional and legal issues program : review of the SmartTraveler operational test

DOT National Transportation Integrated Search

1994-12-01

The SmarTraveler operational test was chosen by the Federal Highway Administration to be the subject of a case study. Several case studies were performed under the Intelligent Transportation Systems (ITS) Institutional and Legal Issues Program, which...

An Exploratory Analysis of Projected Navy Officer Inventory Strength Using Data Farming

DTIC Science & Technology

2016-09-01

model’s run-time. 3. Base Case In addition to the experimental design, this study includes a base case scenario to serve as a baseline for comparison...47 3. SWO Operating Strength Deviation-Base Case One objective of this study is to determine the risk in operating strength deviation presented by...ANSWERS TO RESEARCH QUESTIONS ................................... 71  B.  RECOMMENDATIONS FOR FUTURE STUDIES ......................... 73  1.  Continuous

New Jersey I-80 and I-287 HOV lane case study

DOT National Transportation Integrated Search

2000-07-01

This report documents the New Jersey I-80 and I-287 high-occupancy vehicle (HOV) lane case study. Information is presented on planning, implementing, operating, and redesignating the HOV lanes on the two freeways. The operation of the lanes is compar...

Network Centric Warfare Case Study. U.S. V Corps and 3rd Infantry Division (Mechanized) During Operation Iraq Freedom Combat Operations (Mar-Apr 2003). Volume 1: Operations

DTIC Science & Technology

2003-11-01

Command Historian , and the personnel from the Center for Army Lessons Learned (CALL) for their assistance in gaining access to the many documents that...after the Network Centric Warfare Case Study operations. The Center for Army Lessons Learned (CALL), the V Corps Command Historian , and other... Historian , Dr. Charles Kirkpatrick, in Heidelberg, Germany, assisted in this effort. Nu- merous documents were collected, both unclassified and classified

Electronic Performance Support for Operational Systems: A Case Study of the Link Monitor and Control Operator Assistant

NASA Technical Reports Server (NTRS)

Hill, Randall W., Jr.; Cooper, Lynne P.

1993-01-01

For complex operational systems, help needs to come from the inside out. It is often not realistic to call a help desk for problems that need immediate attention, especially for tasks that put a heavy cognitive load on the system operator. This session addresses the issues associated with providing electronic performance support for operational systems, including situations where the system is already fielded and can only change through evolution rather than revolution. We present a case study based on our experiences in developing the Link Monitor and Control Operator Assistant for NASA's Deep Space Network (DSN). The goals of the Operator Assistant are to improve the operability of the system and increase the efficiency of mission operations.

[Case-control study on bone setting manipulation for the treatment of over degree II supination-eversion fractures of ankle joint].

PubMed

Qi, Yue-Feng; Chen, Fa-Lin; Bao, Shu-Ren; Li, Cheng-Huan; Zhao, Xing-Wei; Liu, Shi-Ming; Chen, Wen-Xue; Li, Ye; Wang, Peng

2012-08-01

To explore therapeutic effects of bone setting manipulation for the treatment of over degree II supination-eversion fractures of ankle,and analyze manipulative reduction mechanism. From 2005 to 2008, 95 patients with over degree II supination-eversion fractures of ankle were treated respectively by manipulation and operation. There were 43 cases [11 males and 32 females with an average age of (44.95 +/- 12.65) years] in manipulation group, and 2 cases were degree II, 11 cases were degree III, and 30 cases were degree IV. There were 52 cases [21 males and 31 females with an average age of (39.96 +/- 13.28) years] in operative group,and 6 cases were degree II, 18 cases were degree III, and 28 cases were degree IV. Bone setting manipulation and hard splint external fixation were applied to manipulative group. Operative reduction internal fixation was performed in operative group. X-ray was used to evaluate reduction of fracture before and after treatment, 2 months after treatment. Ankle joint function was evaluated according to Olerud-Molander scoring system after 6 months treatment. All patients were followed up with good reduction. Three cases occurred wound complication in operative group, but not in manipulative group. In manipulation group, 19 cases got excellent results, 20 cases good and 4 cases fair; while in operative group, 30 cases got excellent results, 20 cases good and 2 cases poor. There were no significant differences in fracture reduction and ankle joint function recovery between two groups (P > 0.05). Efficacy of operative treatment was better than that of manipulative treatment at degree IV fracture (P < 0.05). Bone setting manipulation is a good method for treating supination-eversion ankle joint fractures, which has advantages of simple and safe operation, reliable efficacy. For ankle join fracture at degree IV, manipulative reduction should be adopted earlier, and operative treatment also necessary

Establishing the Learning Curve of Robotic Sacral Colpopexy in a Start-up Robotics Program.

PubMed

Sharma, Shefali; Calixte, Rose; Finamore, Peter S

2016-01-01

To determine the learning curve of the following segments of a robotic sacral colpopexy: preoperative setup, operative time, postoperative transition, and room turnover. A retrospective cohort study to determine the number of cases needed to reach points of efficiency in the various segments of a robotic sacral colpopexy (Canadian Task Force II-2). A university-affiliated community hospital. Women who underwent robotic sacral colpopexy at our institution from 2009 to 2013 comprise the study population. Patient characteristics and operative reports were extracted from a patient database that has been maintained since the inception of the robotics program at Winthrop University Hospital and electronic medical records. Based on additional procedures performed, 4 groups of patients were created (A-D). Learning curves for each of the segment times of interest were created using penalized basis spline (B-spline) regression. Operative time was further analyzed using an inverse curve and sequential grouping. A total of 176 patients were eligible. Nonparametric tests detected no difference in procedure times between the 4 groups (A-D) of patients. The preoperative and postoperative points of efficiency were 108 and 118 cases, respectively. The operative points of proficiency and efficiency were 25 and 36 cases, respectively. Operative time was further analyzed using an inverse curve that revealed that after 11 cases the surgeon had reached 90% of the learning plateau. Sequential grouping revealed no significant improvement in operative time after 60 cases. Turnover time could not be assessed because of incomplete data. There is a difference in the operative time learning curve for robotic sacral colpopexy depending on the statistical analysis used. The learning curve of the operative segment showed an improvement in operative time between 25 and 36 cases when using B-spline regression. When the data for operative time was fit to an inverse curve, a learning rate of 11 cases was appreciated. Using sequential grouping to describe the data, no improvement in operative time was seen after 60 cases. Ultimately, we believe that efficiency in operative time is attained after 30 to 60 cases when performing robotic sacral colpopexy. The learning curve for preoperative setup and postoperative transition, which is reflective of anesthesia and nursing staff, was approximately 110 cases. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

The Adoption of Systems Innovations in Educational Organizations: A Case Study of Operation Guidance.

ERIC Educational Resources Information Center

Kester, Ralph J.; Howard, John, Jr.

To identify factors which affect the acceptance of innovation in school organizations, a career development product entitled Operation Guidance (OG) was the object of a case study. Five basic organizational characteristics were used to roughly quantify attributes of the organization of the six schools studied. The characteristics were:…

Re-operative thyroid surgery: a 20-year prospective cohort study at a tertiary referral centre.

PubMed

Hardman, John C; Smith, J A; Nankivell, P; Sharma, N; Watkinson, J C

2015-06-01

Re-operative thyroid surgery is a relatively uncommon procedure complicated by distorted anatomy and post-operative tissue changes. Surgery may follow initial benign or malignant pathology. Published outcomes vary widely in the literature. This study aims to report our outcomes from re-operative thyroid surgery. Patient demographics and complication rates for consecutive thyroidectomies performed by a single surgeon at a tertiary centre were collected between 1993 and 2013. Outcomes in re-operative surgery are analysed and compared with local and national data. Cases of re-operative surgery following benign disease are further analysed for histology, re-presenting symptoms and time between procedures. Our cohort comprised 1,657 cases including 164 re-operative procedures (101 malignant, 63 benign). Within our cohort re-operative cases were on average 4 years older (mean 49.9 vs 45.9 years, p = 0.001) and had a higher incidence of haematoma formation (4.3 vs 1.7 %, p = 0.033) and transient recurrent laryngeal nerve palsy (5.5 vs 2.5 %, p = 0.044) compared to primary surgery. Rates of permanent hypocalcaemia (2.4 vs 1.8 %, p = 0.540) and permanent RLN palsy (1.8 vs 0.4 %, p = 0.051) were higher in the re-operative group but did not reach significance. Comparison of complications following re-operation for benign and malignant disease revealed no significant differences. Mean interval to re-operation for benign cases was 17.4 years with 74.6 % found to have multinodular goitre at repeat procedure. Re-operative procedures comprised around 10 % of thyroid surgery at our centre. Re-operative cases experienced more complications than primary surgery but permanent rates were low. Re-operative surgery may therefore be safely considered in experienced hands.

Factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of congenital choledochal malformation: a retrospective case study in Southeast China

PubMed Central

Guo, Wan-liang; Zhan, Yang; Fang, Fang; Deng, Yan-bing; Zhao, Jun-gang

2018-01-01

Objective The aim of this study was to evaluate factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of congenital choledochal malformation (CCM). Design A 3-year retrospective study was undertaken between January 2013 and December 2015 in four centres in China. Setting This involved a retrospective chart review of paediatric patients with CCM in four large hospitals in Southeast China. Participants Sixty-five paediatric patients with CCM were included in this study. We derived all available information on patient demographics, clinical characteristics, preoperative complications and surgical methods from the charts of all these patients. Interventions Univariate and multivariate logistic regression analyses were used to evaluate factors significantly affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of CCM. Results Twenty-three of the 65 case surgeries were performed using laparoscopic technique, and 42 surgeries were performed by conventional open surgery. The median operating time was 215 min (range 120–430 min). The morphological subtype of CCM and the presence of cholecystitis or cholangitis were the only factors found to affect the operating time (p<0.05). Logistic regression analysis confirmed cholangitis as an independent risk factor. Conclusions The morphological subtype of CMM and the presence of cholecystitis or cholangitis are factors affecting the operating time for complete cyst excision and Roux-en-Y hepaticojejunostomy in paediatric cases of CCM, whereas cholangitis is an independent risk factor. PMID:29804066

Using Supercomputers to Speed Execution of the CAISO/PLEXOS 33% RPS Study

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

Meyers, C; Streitz, F; Yao, Y

2011-09-19

The study's official title is 'ISO Study of Operational Requirements and Market Impacts at 33% Renewable Portfolio Standard (RPS).' The stated objectives are twofold: (1) identifying operational requirements and resource options to reliably operate the ISO-controlled grid under a 33% RPS in 2020; and (2) inform market, planning, and policy/regulatory decisions by the ISO, state agencies, market participants, and other stakeholders. The first of these objectives requires the hourly estimates of integration requirements, measured in terms of operational ramp, load following and regulation capacity and ramp rates, as well as additional capacity to resolve operational violations. It also involves considerationmore » of other variables that affect the results, such as the impact of different mixes of renewable technologies, and the impact of forecasting error and variability. The second objective entails supporting the CPUC to identify long-term procurement planning needs, costs, and options, as well as informing other decisions made by the CPUC and state agencies. For the ISO itself this includes informing state-wide transmission planning needs for renewables up to a 33% RPS, and informing design of wholesale markets for energy and ancillary services to facilitate provision of integration capacities. The study is designed in two phases. The first (current) phase is focused on operational requirements and addressing these requirements with existing and new conventional fossil generation; for instance, gas turbines and/or combined cycle units. The second (planned) phase will address the same operational requirements with a combination of conventional fossil generation resources, new non-generation resources, and a renewable resource dispatch. There are seven different scenarios considered in the current phase: a 20% RPS reference case; four 33% RPS cases (a reference case, a high out-of-state case, a high distributed generation case, and a low load case); an alternative 27.5% RPS case; and an all-gas case (no new renewables after 2008). In addition, the CPUC is planning a new set of cases that will alter the anticipated sets of runs.« less

ITS Institutional and Legal Issues Program : Review of the SaFIRES Operational Test

DOT National Transportation Integrated Search

1995-06-30

The SaFIRES operational test was chosen by the FHWA to be the subject of a case study. Several case studies were performed under the Intelligent Transportation Systems ITS Institutional and Legal Issues Program, which was developed in response to the...

Analysis of Mission Effectiveness: Modern System Architecture Tools for Project Developers

DTIC Science & Technology

2017-12-01

operator input and scripted instructions to describe low-level flow. Note that the case study in Chapter IV describes one pass through evaluation...capability of the sensors. A constraint on the case study is that each sensor type must cover the entire operations area. Cost is a function of 53...completed. 5. Assessment This case study focuses on the first recursive refinement phase completed in a multi-phase effort to demonstrate the effects

Evaluating hospital design from an operations management perspective.

PubMed

Vos, Leti; Groothuis, Siebren; van Merode, Godefridus G

2007-12-01

This paper describes an evaluation method for the assessment of hospital building design from the viewpoint of operations management to assure that the building design supports the efficient and effective operating of care processes now and in the future. The different steps of the method are illustrated by a case study. In the case study an experimental design is applied to assess the effect of used logistical concepts, patient mix and technologies. The study shows that the evaluation method provides a valuable tool for the assessment of both functionality and the ability to meet future developments in operational control of a building design.

Case Studies on the Impact of Concentrated Animal Feeding Operations (CAFOs) on Ground Water Quality

EPA Science Inventory

This report describes a series of case studies involving commercial swine, poultry, dairy, and beef CAFO operations where ground water contamination by nitrate and ammonia has occurred to ascertain whether other stressors in CAFO wastes are also being transported through the vado...

Exploring Pre-Operational and Concrete Operational Children's Thinking on Nutrition: A Case Study

ERIC Educational Resources Information Center

Brouse, Corey H.; Chow, Tracy H. F.

2009-01-01

Objective: In this exploratory study, we observed the process in which children make food choices from a cognitive development perspective and the implications that these choices have on the areas of cognitive development and health and nutrition education. Design: This was a cross-sectional case study that involved an in-depth examination of the…

Beliefs and Values about Intra-Operative Teaching and Learning: A Case Study of Surgical Teachers and Trainees

ERIC Educational Resources Information Center

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

2016-01-01

Surgeons require advanced psychomotor skills, critical decision-making and teamwork skills. Much of surgical skills training involve progressive trainee participation in supervised operations where case variability, operating team interaction and environment affect learning, while surgical teachers face the key challenge of ensuring patient…

Does temproray bilateral balloon occlusion of the common iliac arteries reduce the need for intra-operative blood transfusion in cases of placenta accretism?

PubMed

Al-Hadethi, Sinan; Fernando, Shane; Hughes, Simon; Thakorlal, Ajay; Seruga, Adam; Scurry, Bonnie

2017-06-01

Bilateral balloon occlusion has been employed as a prophylactic measure in cases of placenta accretism prior to caesarean section with the aim of reducing blood loss and its associated morbidity/mortality. There is however no clear consensus on its efficacy in the current literature. The objective of this study was to assess the efficacy of bilateral balloon occlusion of the common iliac arteries (CIA) in reducing intra-operative morbidity in cases of placenta accretism. The databases of the pathology department and radiology interventional suite were reviewed over a nine year period. Fifty-two cases of confirmed placental accretism who underwent caesarean section with or without hysterectomy were identified and divided into two groups. Twenty-five cases had temporary occlusion of the common iliac arteries (CIA) during delivery and these were considered the study group. The reminder 27 cases did not have temporary occlusion of the CIA and were considered the control group. The two groups were compared based on gravidity, age group, post-operative haemoglobin, drop in haemoglobin, estimated blood loss (EBL), transfusion requirement and the histopathological sub-types of placenta accretism. There was no statistically difference between the study and the control groups regarding EBL, post-operative haemoglobin drop, transfusion requirement or in the placenta accretism histopathological subtype. Two cases in the study group had acute thromboembolic complications. Both groups had a single patient requiring a massive intra-operative transfusion. Our study was not able to detect a significant difference in blood loss or blood product requirement between patients who underwent CIA balloon in the setting of caesarean section for placenta accreta. This remains a challenging scenario requiring a multidisciplinary approach. © 2016 The Royal Australian and New Zealand College of Radiologists.

Learning Curve Analysis and Surgical Outcomes of Single-port Laparoscopic Myomectomy.

PubMed

Lee, Hee Jun; Kim, Ju Yeong; Kim, Seul Ki; Lee, Jung Ryeol; Suh, Chang Suk; Kim, Seok Hyun

2015-01-01

To identify learning curves for single-port laparoscopic myomectomy (SPLM) and evaluate surgical outcomes according to the sequence of operation. A retrospective study. A university-based hospital (Canadian Task Force classification II-2). The medical records from 205 patients who had undergone SPLM from October 2009 to May 2013 were reviewed. Because the myomectomy time was significantly affected by the size and number of myomas removed by SPLM, cases in which 2 or more of the myomas removed were >7 cm in diameter were excluded. Furthermore, cases involving additional operations performed simultaneously (e.g., ovarian or hysteroscopic surgery) were also excluded. A total of 161 cases of SPLM were included. None. We assessed the SPLM learning curve via a graph based on operation time versus sequence of cases. Patients were chronologically arranged according to their surgery dates and were then placed into 1 of 4 groups according to their operation sequence. SPLM was completed successfully in 160 of 161 cases (99.4%). One case was converted to multiport surgery. Basal characteristics of the patients between the 4 groups did not differ. The median operation times for the 4 groups were 112.0, 92.8, 83.7, and 90.0 minutes, respectively. Operation time decreased significantly in the second, third, and fourth groups compared with that in the first group (p < .001). Proficiency, which is the point at which the slope of the learning curve became less steep, was evident after about 45 operations. Results from the current study suggested that proficiency for SPLM was achieved after about 45 operations. Additionally, operation time decreased with experience without an increase in complication rate. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

Implications Of The Security Cooperation Office Transition in Afghanistan For Special Operations Forces: An Abbreviated Report of the Study’s Primary Findings

DTIC Science & Technology

2017-01-01

for working in an interagency environment can lead to mission success. From the Iraq case study , one former U.S. Forces–Iraq official felt that...of six historical case studies in which the mission of special operations forces (SOF) in country transitioned over time to some level of inclusion...explanation of the methodology applied for case study selec- tion, as well as adopted interview protocols, are provided in the long- form version of

IVHS institutional issues and case studies : ADVANCE case study

DOT National Transportation Integrated Search

1994-04-01

This operational test case study is one of six performed in response to a Volpe National Transportation Systems Center technical task directive (TTD) to Science Applications International Corporation (SAIC) entitled, IVHS Institutional Issues and ...

C++ and operating systems performance - A case study

NASA Technical Reports Server (NTRS)

Russo, Vincent F.; Madany, Peter W.; Campbell, Roy H.

1990-01-01

Object-oriented design and programming has many software engineering advantages. Its application to large systems, however, has previously been constrained by performance concerns. The Choices operating system, which has over 75,000 lines of code, is object-oriented and programmed in C++. This paper is a case study of the performance of Choices.

Once Out the Door: A Study of Division and Corps Level Airborne Assaults

DTIC Science & Technology

2016-05-26

examine Operations Mercury, Dragoon, and Market Garden to extract lessons that will enable effective airborne assault planning at the division and...Dragoon and Operational Art........................................................................................ 38 Case Study 3: Operation Market ...Garden.................................................................................................... 43 The Importance of Operation Market

Impact of Operating Room Environment on Postoperative Central Nervous System Infection in a Resource-Limited Neurosurgical Center in South Asia.

PubMed

Chidambaram, Swathi; Vasudevan, Madabushi Chakravarthy; Nair, Mani Nathan; Joyce, Cara; Germanwala, Anand V

2018-02-01

Postoperative central nervous system infections (PCNSIs) are serious complications following neurosurgical intervention. We previously investigated the incidence and causative pathogens of PCNSIs at a resource-limited, neurosurgical center in south Asia. This follow-up study was conducted to analyze differences in PCNSIs at the same institution following only one apparent change: the operating room air filtration system. This was a retrospective study of all neurosurgical cases performed between December 1, 2013, and March 31, 2016 at our center. Providers, patient demographic data, case types, perioperative care, rate of PCNSI, and rates of other complications were reviewed. These results were then compared with the findings of our previous study of neurosurgical cases between June 1, 2012, and June 30, 2013. All 623 neurosurgical operative cases over the study period were reviewed. Four patients (0.6%) had a PCNSI, and no patients had a positive cerebrospinal fluid (CSF) culture. In the previous study, among 363 cases, 71 patients (19.6%) had a PCNSI and 7 (1.9%) had a positive CSF culture (all Gram-negative organisms). The differences in both parameters are statistically significant (P < 0.001). Between the 2 studies, there was no change in treatment providers, case types, case durations, antibiotic administration practices, and patient demographics. The rates of PCNSI and positive CSF culture were significantly lower in our present cohort compared with the cohort in our previous study. The sole apparent change involves the air filtration system inside the neurosurgical operating rooms; this environmental change occurred during the 5 months between the 2 studies. This study demonstrates the impact of environmental factors in reducing infections. Copyright © 2017 Elsevier Inc. All rights reserved.

American Association of University Women: Branch Operations Data Modeling Case

ERIC Educational Resources Information Center

Harris, Ranida B.; Wedel, Thomas L.

2015-01-01

A nationally prominent woman's advocacy organization is featured in this case study. The scenario may be used as a teaching case, an assignment, or a project in systems analysis and design as well as database design classes. Students are required to document the system operations and requirements, apply logical data modeling concepts, and design…

Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis.

PubMed

Park, Yoonah; Yong, Yuen Geng; Yun, Seong Hyeon; Jung, Kyung Uk; Huh, Jung Wook; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

2015-05-01

This study aimed to compare the learning curves and early postoperative outcomes for conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC). This retrospective study included the initial 35 cases in each group. Learning curves were evaluated by the moving average of operative time, mean operative time of every five consecutive cases, and cumulative sum (CUSUM) analysis. The learning phase was considered overcome when the moving average of operative times reached a plateau, and when the mean operative time of every five consecutive cases reached a low point and subsequently did not vary by more than 30 minutes. Six patients with missing data in the CL RHC group were excluded from the analyses. According to the mean operative time of every five consecutive cases, learning phase of SIL and CL RHC was completed between 26 and 30 cases, and 16 and 20 cases, respectively. Moving average analysis revealed that approximately 31 (SIL) and 25 (CL) cases were needed to complete the learning phase, respectively. CUSUM analysis demonstrated that 10 (SIL) and two (CL) cases were required to reach a steady state of complication-free performance, respectively. Postoperative complications rate was higher in SIL than in CL group, but the difference was not statistically significant (17.1% vs. 3.4%). The learning phase of SIL RHC is longer than that of CL RHC. Early oncological outcomes of both techniques were comparable. However, SIL RHC had a statistically insignificant higher complication rate than CL RHC during the learning phase.

Retrospective testing and case series study of porcine delta coronavirus in U.S. swine herds.

PubMed

McCluskey, Brian J; Haley, Charles; Rovira, Albert; Main, Rodger; Zhang, Yan; Barder, Sunny

2016-01-01

Porcine deltacoronavirus (PDCoV) was first reported in the United States (US) in February 2014. This was the second novel swine enteric coronavirus detected in the US since May 2013. In this study, we conducted retrospective testing of samples submitted to three veterinary diagnostic laboratories where qualifying biological samples were derived from previously submitted diagnostic case submissions from US commercial swine farms with a clinical history of enteric disease or from cases that had been previously tested for transmissible gastroenteritis virus, PEDV, or rotavirus. Overall, 2286 banked samples were tested from 27 States. Samples were collected in 3 separate years and in 17 different months. Test results revealed 4 positive samples, 3 collected in August 2013 and 1 collected in October 2013. In addition, a case series including 42 operations in 10 States was conducted through administration of a survey. Survey data collected included information on characteristics of swine operations that had experienced PDCoV clinical signs. Special emphasis was placed on obtaining descriptive estimates of biosecurity practices and disease status over time of each operation. Clinical signs of PDCoV were reported to be similar to those of PEDV. The average number of animals on each operation exhibiting clinical signs (morbidity) and the average number of case fatalities was greatest for suckling and weaned pigs. Average operation-level weaned pig morbidity was greatest in the first week of the outbreak while average operation-level suckling pig case fatality was greatest in the second week of the outbreak. The survey included questions regarding biosecurity practices for visitors and operation employees; trucks, equipment and drivers; and feed sources. These questions attempted to identify a likely pathway of introduction of PDCoV onto the operations surveyed. Published by Elsevier B.V.

Congenital Heart Surgery Case Mix Across North American Centers and Impact on Performance Assessment.

PubMed

Pasquali, Sara K; Wallace, Amelia S; Gaynor, J William; Jacobs, Marshall L; O'Brien, Sean M; Hill, Kevin D; Gaies, Michael G; Romano, Jennifer C; Shahian, David M; Mayer, John E; Jacobs, Jeffrey P

2016-11-01

Performance assessment in congenital heart surgery is challenging due to the wide heterogeneity of disease. We describe current case mix across centers, evaluate methodology inclusive of all cardiac operations versus the more homogeneous subset of Society of Thoracic Surgeons benchmark operations, and describe implications regarding performance assessment. Centers (n = 119) participating in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2010 through 2014) were included. Index operation type and frequency across centers were described. Center performance (risk-adjusted operative mortality) was evaluated and classified when including the benchmark versus all eligible operations. Overall, 207 types of operations were performed during the study period (112,140 total cases). Few operations were performed across all centers; only 25% were performed at least once by 75% or more of centers. There was 7.9-fold variation across centers in the proportion of total cases comprising high-complexity cases (STAT 5). In contrast, the benchmark operations made up 36% of cases, and all but 2 were performed by at least 90% of centers. When evaluating performance based on benchmark versus all operations, 15% of centers changed performance classification; 85% remained unchanged. Benchmark versus all operation methodology was associated with lower power, with 35% versus 78% of centers meeting sample size thresholds. There is wide variation in congenital heart surgery case mix across centers. Metrics based on benchmark versus all operations are associated with strengths (less heterogeneity) and weaknesses (lower power), and lead to differing performance classification for some centers. These findings have implications for ongoing efforts to optimize performance assessment, including choice of target population and appropriate interpretation of reported metrics. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

[Thyroid cancer in patients with Grave's Disease].

PubMed

Mssrouri, R; Benamr, S; Essadel, A; Mdaghri, J; Mohammadine, El H; Lahlou, M-K; Taghy, A; Belmahi, A; Chad, B

2008-01-01

To evaluate the incidence of thyroid carcinoma in patients operated on for Graves' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy. Retrospective study of all patients who underwent thyroidectomy for Graves' disease between 1995 and 2005. 547 patients underwent subtotal thyroidectomy for Graves' disease during this period. Post-operative pathology examination revealed six cases of thyroid cancer (1.1%). All six cases had differentiated thyroid carcinoma (papillary carcinoma in 3 cases, follicular carcinoma in 2 cases and papillo-follicular carcinoma in 1 case). The indication for initial thyroidectomy was a palpable thyroid nodule in 3 cases (50%), failure of medical treatment for Grave's disease in 2 cases (33%), and signs of goiter compression in 1 case (17%). Five patients underwent re-operative total thyroidectomy. This study shows that while malignancy in Grave's disease is uncommon, the presence of thyroid nodule(s) in patients with Grave's disease may be considered as an indication for radical surgery. The most adequate radical surgery in this situation is to perform a total thyroidectomy.

Applying cost accounting to operating room staffing in otolaryngology: time-driven activity-based costing and outpatient adenotonsillectomy.

PubMed

Balakrishnan, Karthik; Goico, Brian; Arjmand, Ellis M

2015-04-01

(1) To describe the application of a detailed cost-accounting method (time-driven activity-cased costing) to operating room personnel costs, avoiding the proxy use of hospital and provider charges. (2) To model potential cost efficiencies using different staffing models with the case study of outpatient adenotonsillectomy. Prospective cost analysis case study. Tertiary pediatric hospital. All otolaryngology providers and otolaryngology operating room staff at our institution. Time-driven activity-based costing demonstrated precise per-case and per-minute calculation of personnel costs. We identified several areas of unused personnel capacity in a basic staffing model. Per-case personnel costs decreased by 23.2% by allowing a surgeon to run 2 operating rooms, despite doubling all other staff. Further cost reductions up to a total of 26.4% were predicted with additional staffing rearrangements. Time-driven activity-based costing allows detailed understanding of not only personnel costs but also how personnel time is used. This in turn allows testing of alternative staffing models to decrease unused personnel capacity and increase efficiency. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

Strategies for Countering Terrorist Safe Havens

DTIC Science & Technology

2014-02-20

within safe havens, tactical containment, pseudo operations, and surrogate security forces. The thesis draws from four historical case studies to...leadership targeting within safe havens, tactical containment, pseudo operations, and surrogate security forces. The thesis draws from four historical case ...surrogate forces and pseudo operations—provide viable potential options for USSOF to counter the complex problem of safe havens. Overall, the case

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.

Audit of the Functioning of the Elective Neurosurgical Operation Theater in India: A Prospective Study and Review of Literature.

PubMed

Saikia, Amrit Kumar; Sriganesh, Kamath; Ranjan, Manish; Claire, Marie; Mittal, Mohit; Pandey, Paritosh

2015-08-01

Knowledge about the utilization of the operation theater (OT) is essential to improve its efficiency. This study evaluated the neurosurgical operation theater utilization in a neurosciences teaching hospital. Data collected included OT start time, delay in start, anesthesia induction time, surgical preparation time, anesthesia recovery time, operating time, time between cases, and theater closing time. Five hundred thirty-seven surgeries were performed during the study period. The percentage of time used for anesthesia induction, actual surgical procedure, recovery from anesthesia, and theater preparation between the two cases were 8%, 70%, 6% and 5%, respectively. Fourteen percent of scheduled cases were cancelled. On 220 occasions (70.51%), theater was over-run. Late start contributed to loss of 8370 minutes (140 hours) of theater time. This study identified the proportion of time spent on each activity in the neurosurgical OT. This knowledge is likely to facilitate better planning of neurosurgical theater schedule and result in optimal utilization. Copyright © 2015 Elsevier Inc. All rights reserved.

Yangians and Yang-Baxter R-operators for ortho-symplectic superalgebras

NASA Astrophysics Data System (ADS)

Fuksa, J.; Isaev, A. P.; Karakhanyan, D.; Kirschner, R.

2017-04-01

Yang-Baxter relations symmetric with respect to the ortho-symplectic superalgebras are studied. We start with the formulation of graded algebras and the linear superspace carrying the vector (fundamental) representation of the ortho-symplectic supergroup. On this basis we study the analogy of the Yang-Baxter operators considered earlier for the cases of orthogonal and symplectic symmetries: the vector (fundamental) R-matrix, the L-operator defining the Yangian algebra and its first and second order evaluations. We investigate the condition for L (u) in the case of the truncated expansion in inverse powers of u and give examples of Lie algebra representations obeying these conditions. We construct the R-operator intertwining two superspinor representations and study the fusion of L-operators involving the tensor product of such representations.

Risk of surgical site infection in paediatric herniotomies without any prophylactic antibiotics: A preliminary experience.

PubMed

Vaze, Dhananjay; Samujh, Ram; Narasimha Rao, Katragadda Lakshmi

2014-01-01

Different studies underline the use of pre-operative antibiotic prophylaxis in clean surgeries like herniotomy and inguinal orchiopexy. But, the meta-analyses do not recommend nor discard the use of prophylactic pre-operative antibiotics. The scarcity of controlled clinical trials in paediatric population further vitiates the matter. This study assessed the difference in the rate of early post-operative wound infection cases in children who received single dose of pre-operative antibiotics and children who did not receive antibiotics after inguinal herniotomy and orchiopexy. This randomised prospective study was conducted in Paediatric Surgery department of PGIMER Chandigarh. Out of 251 patients, 112 patients were randomised to the case group and 139 were ascribed to the control group. The patients in control group were given a standard regimen of single dose of intravenous antibiotic at the time of induction followed by 3-4 days of oral antibiotic. Case group patients underwent the surgical procedure in similar manner with no antibiotic either at the time of induction or post-operatively. The incidence of surgical site infection in case group was 3.73 % and that in control group was 2.22%. The observed difference in the incidence of surgical site infection was statistically insignificant (P value = 0.7027). The overall infection rate in case and control group was 2.89%. Our preliminary experience suggests that there is no statistically significant difference in the proportion of early post-operative wound infection between the patients who received single dose of pre-operative antibiotics and the patients who received no antibiotics after inguinal herniotomy and orchiopexy. The risk of surgical site infection in paediatric heriotomies does not increase even if the child's weight is less than his/her expected weight for age.

[Rectovaginal endometriosis--analysis of 160 cases].

PubMed

Wilczyński, Miłosz; Wiecka-Płusa, Monika; Antosiak, Beata; Maciołek-Blewniewska, Grazyna; Majchrzak-Baczmańska, Dominika; Malinowski, Andrzej

2015-12-01

The aim of the study was a retrospective analysis of the medical records of patients who underwent surgery due to deep infiltrating rectovaginal endometriosis (mainly with the use of the 'shaving' technique). We analysed 160 cases of patients who underwent surgery due to the deep infiltrating rectovaginal endometriosis in our ward between 2003-2014. Depending on lesion localization, disease severity and clinical characteristics, three possible ways of operation were proposed: laparoscopic, vaginal or a combined vagino-laparoscopic approach. A total of 120 patients underwent laparoscopic removal of the endometrial lesions, whereas 17 were operated vaginally and 23 with the use of the combined approach. Nodule resection was successfully performed in all cases. The combined vagino-laparoscopic operations were characterized by the longest operating time. The rate of perioperative complications was low in the group of patients who underwent laparoscopic or combined operations. The necessity of bowel wall suturing occurred in 15 cases. This procedure was performed in order to strengthen the bowel wall (in cases when no perforation occurred) or due to bowel resection during surgery. Unexpected bowel perforation occurred in only 5 cases. Conclusions: Vaginal, laparoscopic and the combined vagino-laparoscopic surgeries can be safely performed in cases of deep rectovaginal endometriosis.

Diversity in the association between occupation and lung cancer among black and white men.

PubMed

Swanson, G M; Lin, C S; Burns, P B

1993-01-01

A population-based case comparison study of incident lung cancer and occupational risk factors was conducted in the tricounty Detroit metropolitan area. Nearly 6000 lung cancer cases and a comparison group of 3600 colon cancer cases were interviewed. This report includes 3792 white and black male lung cancer cases and 1966 black and white colon cancer referents. Cigarette smoking, age at diagnosis, and lifetime work history were assessed to determine the relationship between length of employment in specific occupations and industries and lung cancer. Diverse patterns of association between work history and lung cancer were observed for black and white men. Significant associations were seen between lung cancer and increasing length of employment in the following occupations: for white men, concrete and terrazzo finishers, grinding machine operators, heat treating machine operators, miscellaneous machine operators, truck drivers, driver sales, and laborers; for black men, farm workers, automobile mechanics, painting machine operators, furnace operators, and garbage collectors; for both black and white men, farmers, slicing and cutting machine operators, and garbage collectors. Distinct patterns for black and white men also were observed for length of employment by industry. This study clearly demonstrates the need to include black men in studies of occupational cancer etiology and to evaluate black and white men separately. It also indicates the necessity for cigarette smoking history to accurately assess workplace cancer risks. We propose guidelines for incorporating the use of biomarkers into further studies of occupational cancer epidemiology.

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

Operational effectiveness and quality assurance mechanisms with stochastic demand of blood supply: blood bank case study.

PubMed

Smith, Alan D

2011-01-01

A general overview of various blood products operational effectiveness and related strategies that can be utilised by service providers (in particular, healthcare providers) is presented in the present study. In terms of the massive volumes of blood products, the North American blood centres collect more than eight million units of whole blood, which represents appropriately 50% of the US and Quebec, Canada?s volunteer donor blood supply. A case study of the quality inspection and inventory control concerns of the Central Blood Bank, located in the metropolitan area of Pittsburgh, PA, is presented. Initially, brief introduction to its general operating environment is followed by sections describing its general situation, quality-service initiatives, and followed by a fairly detailed discussion of the practical applications of lessons learned from the case study.

Operative reports: form and function.

PubMed

Stewart, Lygia; Hunter, John G; Wetter, Alberto; Chin, Brian; Way, Lawrence W

2010-09-01

Little is known about how closely operative reports reflect what was actually performed during an operation, nor has the construction of operative reports been adequately studied with the aims of clarifying the objectives of those reports and improving their efficacy. We hypothesized that if more attention is paid to the objectives of operative reports, their content will more predictably contain the most relevant information, which might channel thinking in beneficial directions during performance of the operation. Multivariate analysis of 250 laparoscopic cholecystectomy operative reports (125 uncomplicated and 125 with bile duct injury). Academic research. University (105 cases) and community (145 cases) hospitals. Variations in content and design of operative reports. Cognitive task analysis of laparoscopic cholecystectomy was conducted, and a model operative report was generated and compared with the actual operative reports. Descriptions of key elements in adequate dissection of the Calot triangle were present in 24.8% and 0.0% of operative reports from uncomplicated and bile duct injury cases, respectively. Thorough dissection of the Calot triangle, identification of the cystic duct-infundibulum junction, and lateral retraction of the infundibulum correlated with uncomplicated cases, while irregular cues (eg, perceived anatomic or other deviations) correlated with bile duct injury cases. Current practice generates operative reports that vary widely in content and too often omit important elements. This research suggests that the construction of operative reports should be constrained such that the reports routinely include the fundamental goals of the operation and what was performed to meet them. Cognitive task analysis is based on the ways the mind controls the performance of tasks; it is an excellent method for determining the extra content needed in operative reports. The resulting designs should also serve as mental guidelines to facilitate learning and to enhance the safety of the operation.

Learning curves for single incision and conventional laparoscopic right hemicolectomy: a multidimensional analysis

PubMed Central

Park, Yoonah; Yong, Yuen Geng; Jung, Kyung Uk; Huh, Jung Wook; Cho, Yong Beom; Kim, Hee Cheol; Lee, Woo Yong; Chun, Ho-Kyung

2015-01-01

Purpose This study aimed to compare the learning curves and early postoperative outcomes for conventional laparoscopic (CL) and single incision laparoscopic (SIL) right hemicolectomy (RHC). Methods This retrospective study included the initial 35 cases in each group. Learning curves were evaluated by the moving average of operative time, mean operative time of every five consecutive cases, and cumulative sum (CUSUM) analysis. The learning phase was considered overcome when the moving average of operative times reached a plateau, and when the mean operative time of every five consecutive cases reached a low point and subsequently did not vary by more than 30 minutes. Results Six patients with missing data in the CL RHC group were excluded from the analyses. According to the mean operative time of every five consecutive cases, learning phase of SIL and CL RHC was completed between 26 and 30 cases, and 16 and 20 cases, respectively. Moving average analysis revealed that approximately 31 (SIL) and 25 (CL) cases were needed to complete the learning phase, respectively. CUSUM analysis demonstrated that 10 (SIL) and two (CL) cases were required to reach a steady state of complication-free performance, respectively. Postoperative complications rate was higher in SIL than in CL group, but the difference was not statistically significant (17.1% vs. 3.4%). Conclusion The learning phase of SIL RHC is longer than that of CL RHC. Early oncological outcomes of both techniques were comparable. However, SIL RHC had a statistically insignificant higher complication rate than CL RHC during the learning phase. PMID:25960990

Insufficient restoration of lumbar lordosis and FBI index following pedicle subtraction osteotomy is an indicator of likely mechanical complication.

PubMed

Le Huec, J C; Cogniet, A; Demezon, H; Rigal, J; Saddiki, R; Aunoble, S

2015-01-01

Pedicle subtraction osteotomies (PSO) enable correction of spinal deformities but remain difficult and are associated with high complication rates. This study aimed to prospectively review different post-operative complications and mechanical problems in patients who underwent PSO as treatment for sagittal imbalance as sequelae of degenerative disc disease or previous spinal fusion. This was a descriptive prospective single center study of 63 patients who underwent sagittal imbalance correction by PSO. Radiographic analysis of pre- and post-operative pelvic and spinal parameters was completed based on EOS images following 3D modeling. Global and sub-group analyses were completed based on the Roussouly classification. A systematic analysis of post-operative complications was conducted during hospital stay and at follow-up visits. Complications included 15 cases (20.2%) of bilateral leg pain, with transient neurological deficit in 6 cases (9.5%), and 9 cases (12.5%) of early surgical site infections. Intra-operative complications included five tears of the dura mater and two cases of excessive blood loss (>5,000 mL). Two mortalities occurred from major intracerebral bleeds in the early post-operative period. Mechanical complications were principally non-union (9 cases) and junctional kyphosis (3 cases). All 19 post-operative complications (28.1%) were revised at an average of 2 years following surgery. All mechanical complications were found in the patients who had insufficient imbalance correction and this was mainly associated with high PI (>60°) or a moderate PI (45-60º) combined with excess FBI pre-operatively that remained >10° post-operatively. Infection and neurologic complications following PSO are relatively common, and frequently reported in the literature. The principal cause of mechanical complications, such as non-union or junctional kyphosis, was insufficient sagittal correction, characterized by post-operative FBI >10°. The risks of insufficient correction are greater in patients with higher pelvic incidence and those patients who required very high correction.

Reconstruction with different free flaps in oro-facial cancer patients.

PubMed

Bhathena, H M; Savant, D N; Kavarana, N M; Parikh, D M; Sanghvi, V D

1996-01-01

In 75 patients following ablative surgery of head and neck cancer, reconstruction was attempted with free tissue transfer techniques under magnification. It was possible to do free tissue transfers in 69 cases. In 6 cases it was not possible to harvest free flaps successfully and alternative reconstructive procedure was carried out due to unavoidable circumstances and various reasons: 1. unsuitable venous drainage, as in Anterior Rib Osteomyocutaneous Composite Flap, AROCF (2 cases), 2. injury to vessels during flap harvest, as in parascapular flap (1 case), 3. residual disease unable to excise (2 cases) and 4. unsuitable proposition (1 case), due to emergency curfew imposed suddenly. These 6 cases were not included in the study. Free tissue transfer was successful in 64 cases (92.7%) and there was a total failure in 5 cases where delayed secondary salvage surgery was performed. Out of 69 cases, in 65 cases reconstructions were carried out immediately, primarily as one-stage operative procedure. Their functional, cosmetic results and complications during the operative and post-operative period are analyzed and discussed. Inter-maxillary fixation was never used to maintain the bite alignment. All cases were given a bite guide prosthesis in the early post-operative period, to improve the bite alignment when it was necessary.

Long-term impacts of unconventional drilling operations on human and animal health.

PubMed

Bamberger, Michelle; Oswald, Robert E

2015-01-01

Public health concerns related to the expansion of unconventional oil and gas drilling have sparked intense debate. In 2012, we published case reports of animals and humans affected by nearby drilling operations. Because of the potential for long-term effects of even low doses of environmental toxicants and the cumulative impact of exposures of multiple chemicals by multiple routes of exposure, a longitudinal study of these cases is necessary. Twenty-one cases from five states were followed longitudinally; the follow-up period averaged 25 months. In addition to humans, cases involved food animals, companion animals and wildlife. More than half of all exposures were related to drilling and hydraulic fracturing operations; these decreased slightly over time. More than a third of all exposures were associated with wastewater, processing and production operations; these exposures increased slightly over time. Health impacts decreased for families and animals moving from intensively drilled areas or remaining in areas where drilling activity decreased. In cases of families remaining in the same area and for which drilling activity either remained the same or increased, no change in health impacts was observed. Over the course of the study, the distribution of symptoms was unchanged for humans and companion animals, but in food animals, reproductive problems decreased and both respiratory and growth problems increased. This longitudinal case study illustrates the importance of obtaining detailed epidemiological data on the long-term health effects of multiple chemical exposures and multiple routes of exposure that are characteristic of the environmental impacts of unconventional drilling operations.

Case-Mix Variables and Predictors for Outcomes of Laparoscopic Hysterectomy: A Systematic Review.

PubMed

Driessen, Sara R C; Sandberg, Evelien M; la Chapelle, Claire F; Twijnstra, Andries R H; Rhemrev, Johann P T; Jansen, Frank Willem

2016-01-01

The assessment of surgical quality is complex, and an adequate case-mix correction is missing in currently applied quality indicators. The purpose of this study is to give an overview of all studies mentioning statistically significant associations between patient characteristics and surgical outcomes for laparoscopic hysterectomy (LH). Additionally, we identified a set of potential case-mix characteristics for LH. This systematic review was conducted according to the Meta-Analysis of Observational Studies in Epidemiology guidelines. We searched PubMed and EMBASE from January 1, 2000 to August 1, 2015. All articles describing statistically significant associations between patient characteristics and adverse outcomes of LH for benign indications were included. Primary outcomes were blood loss, operative time, conversion, and complications. The methodologic quality of the included studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. The included articles were summed per predictor and surgical outcome. Three sets of case-mix characteristics were determined, stratified by different levels of evidence. Eighty-five of 1549 identified studies were considered eligible. Uterine weight and body mass index (BMI) were the most mentioned predictors (described, respectively, 83 and 45 times) in high quality studies. For longer operative time and higher blood loss, uterine weight ≥ 250 to 300 g and ≥500 g and BMI ≥ 30 kg/m(2) dominated as predictors. Previous operations, adhesions, and higher age were also considered as predictors for longer operative time. For complications and conversions, the patient characteristics varied widely, and uterine weight, BMI, previous operations, adhesions, and age predominated. Studies of high methodologic quality indicated uterine weight and BMI as relevant case-mix characteristics for all surgical outcomes. For future development of quality indicators of LH and to compare surgical outcomes adequately, a case-mix correction is suggested for at least uterine weight and BMI. A potential case-mix correction for adhesions and previous operations can be considered. For both surgeons and patients it is valuable to be aware of potential factors predicting adverse outcomes and to anticipate this. Finally, to benchmark clinical outcomes at an international level, it is of the utmost importance to introduce uniform outcome definitions. Copyright © 2016 AAGL. Published by Elsevier Inc. All rights reserved.

On the Far Bank: The Effects of Gap Crossing on Operational Reach

DTIC Science & Technology

2015-05-25

operations. 15. SUBJECT TERMS United States Army; Gap crossing; River crossing; Operational reach; Operation Market -Garden; Operation Plunder...3 Case Study: Operation Market Garden...successful gap crossing. The Allied failure in Operation Market -Garden during World War II showed that successfully crossing a river such as the Waal does

[Endoscopic realignment with drainage via a peel-away sheath for the treatment of urethral rupture: A report of 21 cases].

PubMed

Han, Cong-Xiang; Xu, Wei-Jie; Li, Wei; Yu, Zhong-Ying; Li, Jin-Yu; Lin, Xia-Cong; Zhao, Li

2016-07-01

To study the clinical effect endoscopic realignment with drainage via a peel-away sheath in the treatment of urethral rupture. We treated 21 urethral rupture patients by endoscopic realignment with drainage via a peel-away sheath using normal saline for irrigation under the normal nephroscope or Li Xun nephroscope, followed by analysis of the clinical results. The operation was successfully accomplished in 20 cases but failed in 1 and none experienced urinary extravasation. In the 14 cases of bulbar urethral rupture, the mean operation time was (5.1±1.6) min and the mean Foley catheter indwelling time was (26.0±5.1) d. Urethral stricture developed in 57.1% (8/14) of the cases after catheter removal, of which 1 was cured by internal urethrotomy and the other 7 by urethral sound dilation, with an average maximum urinary flow rate of (18.8±1.8) ml/s at 12 months after operation. In the 6 cases of posterior urethral rupture, the mean operation time was (15.8±7.5) min and the mean Foley catheter indwelling time was 8 weeks. Urethral stricture developed in all the 6 cases after catheter removal, of which 3 cases were cured by urethral dilation, 1 by internal urethrotomy, and 2 by open urethroplasty. The average maxium urinary flow rate of the 4 cases exempt from open surgery was (17.9±1.9) ml/s at 12 months after operation. Endoscopic realignment with drainage via a peel-away sheath can keep the operative field clear, avoid intraoperative rinse extravasation, shorten the operation time, improve the operation success rate, and achieve satisfactory early clinical outcomes in the treatment of either bulbar or posterior urethral rupture.

Validation of self-reported start year of mobile phone use in a Swedish case-control study on radiofrequency fields and acoustic neuroma risk.

PubMed

Pettersson, David; Bottai, Matteo; Mathiesen, Tiit; Prochazka, Michaela; Feychting, Maria

2015-01-01

The possible effect of radiofrequency exposure from mobile phones on tumor risk has been studied since the late 1990s. Yet, empirical information about recall of the start of mobile phone use among adult cases and controls has never been reported. Limited knowledge about recall errors hampers interpretations of the epidemiological evidence. We used network operator data to validate the self-reported start year of mobile phone use in a case-control study of mobile phone use and acoustic neuroma risk. The answers of 96 (29%) cases and 111 (22%) controls could be included in the validation. The larger proportion of cases reflects a more complete and detailed reporting of subscription history. Misclassification was substantial, with large random errors, small systematic errors, and no significant differences between cases and controls. The average difference between self-reported and operator start year was -0.62 (95% confidence interval: -1.42, 0.17) years for cases and -0.71 (-1.50, 0.07) years for controls, standard deviations were 3.92 and 4.17 years, respectively. Agreement between self-reported and operator-recorded data categorized into short, intermediate and long-term use was moderate (kappa statistic: 0.42). Should an association exist, dilution of risk estimates and distortion of exposure-response patterns for time since first mobile phone use could result from the large random errors in self-reported start year. Retrospective collection of operator data likely leads to a selection of "good reporters", with a higher proportion of cases. Thus, differential recall cannot be entirely excluded.

[Application of TB type thermal balloon endometrial ablation for the treatment of abnormal uterine bleeding].

PubMed

Wang, W; Zhai, Y; Zhang, Z H; Li, Y; Zhang, Z Y

2016-11-08

Objective: To investigate the clinical efficacy, safety and promotion value of TB type thermal balloon endometrial ablation in the treatment of abnormal uterine bleeding. Methods: Fourty three patients who had received TB type endometrial ablation system for treatment of abnormal uterine bleeding from January, 2015 to January, 2016 in theDepartment of gynecology, Beijing Chaoyang Hospital were enrolled in this study. The intra-operative and post-operative complications and improvement of abnormal uterine bleeding and dysmenorrhea were observed. Results: There were nointra-operative complication occurred, such as uterine perforation, massive hemorrhage or surrounding organ damage. At 6 months after operation, 32 patients developed amenorrhea, 6 developed menstrual spotting, 3 developed menstruation with a small volume and 1 had a normal menstruation. No menstruation with an increased volume occurred. The occurrence of amenorrhea was 76.19% and the response rate was 97.62%.At 6 months after operation, 1 case had no response, 2 cases had partial response and 11 cases had complete response among the 14 cases of pre-operative dysmenorrhea; only 3 cases still had anemia among the 23 cases of pre-operative anemia. Compared with before treatment, patients with dysmenorrhea and anemia both significantly reduced with a statistically significant difference( P <0.01). Conclusion: TB type thermal balloon endometrial ablation has a significant efficacy with high safety for the treatment of abnormal uterine bleeding, which could have clinical promotion practice.

ACGME case logs: Surgery resident experience in operative trauma for two decades

PubMed Central

Drake, Frederick Thurston; Van Eaton, Erik G.; Huntington, Ciara R.; Jurkovich, Gregory J.; Aarabi, Shahram; Gow, Kenneth W.

2014-01-01

BACKGROUND Surgery resident education is based on experiential training, which is influenced by changes in clinical management strategies, technical and technologic advances, and administrative regulations. Trauma care has been exposed to each of these factors, prompting concerns about resident experience in operative trauma. The current study analyzed the reported volume of operative trauma for the last two decades; to our knowledge, this is the first evaluation of nationwide trends during such an extended time line. METHODS The Accreditation Council for Graduate Medical Education (ACGME) database of operative logs was queried from academic year (AY) 1989–1990 to 2009–2010 to identify shifts in trauma operative experience. Annual case log data for each cohort of graduating surgery residents were combined into approximately 5-year blocks, designated Period I (AY1989–1990 to AY1993–1994), Period II (AY1994–1995 to AY1998–1999), Period III (AY1999–2000 to AY2002–2003), and Period IV (AY2003–2004 to AY2009–2010). The latter two periods were delineated by the year in which duty hour restrictions were implemented. RESULTS Overall general surgery caseload increased from Period I to Period II (p < 0.001), remained stable from Period II to Period III, and decreased from Period III to Period IV (p < 0.001). However, for ACGME-designated trauma cases, there were significant declines from Period I to Period II (75.5 vs. 54.5 cases, p < 0.001) and Period II to Period III (54.5 vs. 39.3 cases, p < 0.001) but no difference between Period III and Period IV (39.3 vs. 39.4 cases). Graduating residents in Period I performed, on average, 31 intra-abdominal trauma operations, including approximately five spleen and four liver operations. Residents in Period IV performed 17 intra-abdominal trauma operations, including three spleen and approximately two liver operations. CONCLUSION Recent general surgery trainees perform fewer trauma operations than previous trainees. The majority of this decline occurred before implementation of work-hour restrictions. Although these changes reflect concurrent changes in management of trauma, surgical educators must meet the challenge of training residents in procedures less frequently performed. LEVEL OF EVIDENCE Epidemiologic study, level III; therapeutic study, level IV. PMID:23188243

The Impact of Different Postgraduate Year Training in Neurosurgery Residency on 30-Day Return to Operating Room: A National Surgical Quality Improvement Program Study.

PubMed

Macki, Mohamed; Fakih, Mohamed; Kandagatla, Pridvi; Rubinfeld, Ilan; Chang, Victor

2018-06-01

Because of the health care initiative on quality improvement projects in academic medicine, this study explores the impact of different postgraduate years (PGYs) on unexpected re-operation rates. Using the National Surgical Quality Improvement Program 2005-2014, adult neurosurgical cases were divided into subspecialties: spine, open vascular, cranial, and functional. Comparison groups were cases involving junior residents (PGY 1-PGY 3), mid-level residents (PGY 4 + PGY 5), and senior residents (PGY 6 + PGY 7). Comorbidity disease burden was measured by frailty index. The primary outcome measure was 30-day unintended return to the operating room. Of the 9782 cases, re-operations were higher for those cases featuring a senior resident (5.6%) compared with mid-level resident (4.1%) and junior resident (3.8%) (P = 0.001). Although senior residents operated on patients with a statistically significantly higher neurologic disease burden, greater relative value units, longer operative times, and more 30-day postoperative adverse events, the level of resident training did not have an impact on revision surgery after multivariable logistical regression. The strongest predictors of return to the operating room included the frailty index (adjusted odds ratio [OR adj ] = 5.18, P < 0.001), functional subspecialty (OR adj  = 2.65, P < 0.001), and Wound Class 4 - dirty/infected wound (OR adj  = 2.33, P = 0.016). Resident participation in neurosurgical cases does not affect 30-day unplanned re-operation rates, which were affected by frailty index, functional subspecialty, and wound class. Copyright © 2018 Elsevier Inc. All rights reserved.

Critical operations capabilities in a high cost environment: a multiple case study

NASA Astrophysics Data System (ADS)

Sansone, C.; Hilletofth, P.; Eriksson, D.

2018-04-01

Operations capabilities have been a popular research area for many years and several frameworks have been proposed in the literature. The current frameworks do not take specific contexts into consideration, for instance a high cost environment. This research gap is of particular interest since a manufacturing relocation process has been ongoing the last decades, leading to a huge amount of manufacturing being moved from high to low cost environments. The purpose of this study is to identify critical operations capabilities in a high cost environment. The two research questions were: What are the critical operations capabilities dimensions in a high cost environment? What are the critical operations capabilities in a high cost environment? A multiple case study was conducted and three Swedish manufacturing firms were selected. The study was based on the investigation of an existing framework of operations capabilities. The main dimensions of operations capabilities included in the framework were: cost, quality, delivery, flexibility, service, innovation and environment. Each of the dimensions included two or more operations capabilities. The findings confirmed the validity of the framework and its usefulness in a high cost environment and a new operations capability was revealed (employee flexibility).

Results of neurolysis in established upper limb Volkmann's ischemic contracture

PubMed Central

Meena, Dinesh K; Thalanki, Srikiran; Patni, Poornima; Meena, Ram Khiladi; Bairawa, Dinesh; Bhatia, Chirag

2016-01-01

Background: Treatment of established cases of Volkmann's ischemic contracture (VIC) of upper limb is very tedious. Since the period of Volkmann, various experimental works are being performed for its treatment, but none are effective. Disabilities from nerve palsy and hand muscle paralysis are more problematic than any other deformity in VIC. To solve these problems, we conducted a study to see the result of neurolysis of median and ulnar nerve and their subcutaneous placement in established cases of VIC. Materials and Methods: Twelve cases of established VIC operated between July 2007 and August 2010 with complete records and followup were included in the study. VIC of lower limb and contracture of nonischemic etiology were excluded from the study. Their evaluation was done by the British Medical Research Council grading system for sensory and motor recovery. Followup was done for an average period of 24.3 months (range 15-30 months) (the average age was 8.3 years). Results: To study the results, we divided the cases into two series. One group consisted of cases which were operated within 6 months from onset of VIC. The second group consisted of cases which were operated after 6 months from onset of VIC. Our results revealed that there was no statistically significant difference between the two groups operated, though both had significant improvement in motor and sensory recovery in both median and ulnar nerve distribution. Conclusions: Neurolysis of the nerves definitely improved the outcome for motor and sensory components of median and ulnar nerves but the timing of the surgery did not play a role in the outcome contrary to the clinical assumption. This study can serve as a template and further such studies could help us find the answer to a long standing issue. PMID:27904214

The operating room case-mix problem under uncertainty and nurses capacity constraints.

PubMed

Yahia, Zakaria; Eltawil, Amr B; Harraz, Nermine A

2016-12-01

Surgery is one of the key functions in hospitals; it generates significant revenue and admissions to hospitals. In this paper we address the decision of choosing a case-mix for a surgery department. The objective of this study is to generate an optimal case-mix plan of surgery patients with uncertain surgery operations, which includes uncertainty in surgery durations, length of stay, surgery demand and the availability of nurses. In order to obtain an optimal case-mix plan, a stochastic optimization model is proposed and the sample average approximation method is applied. The proposed model is used to determine the number of surgery cases to be weekly served, the amount of operating rooms' time dedicated to each specialty and the number of ward beds dedicated to each specialty. The optimal case-mix selection criterion is based upon a weighted score taking into account both the waiting list and the historical demand of each patient category. The score aims to maximizing the service level of the operating rooms by increasing the total number of surgery cases that could be served. A computational experiment is presented to demonstrate the performance of the proposed method. The results show that the stochastic model solution outperforms the expected value problem solution. Additional analysis is conducted to study the effect of varying the number of ORs and nurses capacity on the overall ORs' performance.

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

PubMed

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

2012-05-01

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

Safety in out-of-hours operating in trauma and orthopaedics at a district general hospital.

PubMed

Gulamhussein, M A; Chaudhry, S; Noor, S; Chaudhry, T; Guha, A; Knebel, R

2017-05-01

INTRODUCTION According to the National Confidential Enquiry into Perioperative Deaths (NCEPOD), out-of-hours operating in trauma and orthopaedics should be reserved for life or limb threatening cases only. The aim of our study was to determine the nature of non-emergency work carried out in our trust at night in 2015. The overall efficacy and clinical safety of the services provided was evaluated. METHODS Surgical activity undertaken after 9pm was reviewed along with patient ASA (American Society of Anesthesiologists) grade, grade of operating surgeon and any complications that occurred following the procedure. Furthermore, the clinical urgency and safety of cases was assessed based on whether there was any record of life or limb threatening indications at the time of admission. RESULTS Overall, 131 procedures were performed after 9pm, with 102 performed between 9pm and midnight, and 29 after midnight. Consultants performed 16 cases and the remaining 115 cases were operated on by middle grades or specialty trainees. A fifth (20%) of the cases were genuinely life or limb threatening. A total of 123 procedures were classed as having good outcomes. The complication rate was 8%. CONCLUSIONS In our study, 80% of the procedures performed after 9pm could not be categorised as life or limb threatening. Appropriate NCEPOD classification would ensure that only life or limb threatening cases were listed for theatre after 9pm. Alternative methods of operating within working hours should be considered.

Safety in out-of-hours operating in trauma and orthopaedics at a district general hospital

PubMed Central

Chaudhry, S; Noor, S; Chaudhry, T; Guha, A; Knebel, R

2017-01-01

INTRODUCTION According to the National Confidential Enquiry into Perioperative Deaths (NCEPOD), out-of-hours operating in trauma and orthopaedics should be reserved for life or limb threatening cases only. The aim of our study was to determine the nature of non-emergency work carried out in our trust at night in 2015. The overall efficacy and clinical safety of the services provided was evaluated. METHODS Surgical activity undertaken after 9pm was reviewed along with patient ASA (American Society of Anesthesiologists) grade, grade of operating surgeon and any complications that occurred following the procedure. Furthermore, the clinical urgency and safety of cases was assessed based on whether there was any record of life or limb threatening indications at the time of admission. RESULTS Overall, 131 procedures were performed after 9pm, with 102 performed between 9pm and midnight, and 29 after midnight. Consultants performed 16 cases and the remaining 115 cases were operated on by middle grades or specialty trainees. A fifth (20%) of the cases were genuinely life or limb threatening. A total of 123 procedures were classed as having good outcomes. The complication rate was 8%. CONCLUSIONS In our study, 80% of the procedures performed after 9pm could not be categorised as life or limb threatening. Appropriate CEPOD classification would ensure that only life or limb threatening cases were listed for theatre after 9pm. Alternative methods of operating within working hours should be considered. PMID:27917666

The role of smart traffic centers in regional system operations : a Hampton Roads case study.

DOT National Transportation Integrated Search

2005-01-01

The objectives of this study were to define the role of smart traffic centers (STCs) in regional systems operations and to help identify performance measures for monitoring the performance of STCs in the scope of regional systems operations. Without ...

Surgical management and clinical prognosis of adrenocortical carcinoma.

PubMed

Dong, Dexin; Li, Hanzhong; Yan, Weigang; Ji, Zhigang; Mao, Quanzong

2012-01-01

To study the relationship between surgical management and prognosis of adrenocortical carcinoma (ACC) in order to guide the surgical management of ACC. Clinical data of 45 cases of ACC treated in our hospital were retrospectively analyzed. The 45 cases included 3 cases in stage I, 12 cases in stage II, 7 cases in stage III, and 23 cases in stage IV. 17 cases underwent complete excision, 14 cases underwent palliative excision, 8 cases had non-operative treatment and 6 cases gave up treatment. All patients were followed up from 2 to 141 months. The average survival time of 31 patients with surgery was 32.46 months, and the average survival time of 14 patients without surgery was 4.75 months. There were statistically significant differences between the two groups (p < 0.01). There were no statistically significant differences between the two groups in survival time in stage III and stage IV (p > 0.05). Surgery is considered to be the only method to cure ACC. For ACC in stage I and II, tumor resection is the most effective treatment, and second surgical operation is recommended for local recurrence. For ACC in stage III, extensive surgical operation is recommended, and for ACC in stage IV, surgical operation has no effect on the prognosis. Copyright © 2012 S. Karger AG, Basel.

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

PubMed

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

2004-10-01

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

Applying analysis tools in planning for operations : case study #1 -- operations strategy impact reference and deployment guidance

DOT National Transportation Integrated Search

2009-09-01

More and more, transportation system operators are seeing the benefits of strengthening links between planning and operations. A critical element in improving transportation decision-making and the effectiveness of transportation systems related to o...

Aggressive operative treatment of isolated blunt traumatic brain injury in the elderly is associated with favourable outcome.

PubMed

Wutzler, Sebastian; Lefering, Rolf; Wafaisade, Arasch; Maegele, Marc; Lustenberger, Thomas; Walcher, Felix; Marzi, Ingo; Laurer, Helmut

2015-09-01

Outcome after traumatic brain injury (TBI) in the elderly has not been fully elucidated. The present retrospective observational study investigates the age-dependent outcome of patients suffering from severe isolated TBI with regard to operative and non-operative treatment. Data were prospectively collected in the TraumaRegister DGU. Anonymous datasets of 8629 patients with isolated severe blunt TBI (AISHead≥3, AISBody≤1) documented from 2002 to 2011 were analysed. Patients were grouped according to age: 1-17, 18-59, 60-69, 70-79 and ≥80 years. Cranial fractures (44.8%) and subdural haematomas (42.6%) were the most common TBIs. Independent from the type of TBI the group of patients with operative treatment declined with rising age. Subgroup analysis of patients with critical TBI (AISHead=5) revealed standardised mortality ratios (SMRs) of 0.81 (95% CI 0.75-0.87) in case of operative treatment (n=1201) and 1.13 (95% CI 1.09-1.18) in case of non-operative treatment (n=1096). All age groups ≥60 years showed significantly reduced SMRs in case of operative treatment. Across all age groups the group of patients with low/moderate disability according to the GOS (4 or 5 points) was higher in case of operative treatment. Results of this retrospective observational study have to be interpreted cautiously. However, good outcome after TBI with severe space-occupying haemorrhage is more frequent in patients with operative treatment across all age groups. Age alone should not be the reason for limited care or denial of operative intervention. Copyright © 2015 Elsevier Ltd. All rights reserved.

Managing Community: Professional Community in Charter Schools Operated by Educational Management Organizations

ERIC Educational Resources Information Center

Bulkley, Katrina E.; Hicks, Jennifer

2005-01-01

This article examines ways in which entities external to schools, in this case for-profit educational management organizations (EMOs), can influence development of school professional community. Drawing on case studies of six charter schools operated by three EMOs, we examine the five elements of professional community described by Kruse, Louis,…

Adoption of robotics in a general surgery residency program: at what cost?

PubMed

Mehaffey, J Hunter; Michaels, Alex D; Mullen, Matthew G; Yount, Kenan W; Meneveau, Max O; Smith, Philip W; Friel, Charles M; Schirmer, Bruce D

2017-06-01

Robotic technology is increasingly being utilized by general surgeons. However, the impact of introducing robotics to surgical residency has not been examined. This study aims to assess the financial costs and training impact of introducing robotics at an academic general surgery residency program. All patients who underwent laparoscopic or robotic cholecystectomy, ventral hernia repair (VHR), and inguinal hernia repair (IHR) at our institution from 2011-2015 were identified. The effect of robotic surgery on laparoscopic case volume was assessed with linear regression analysis. Resident participation, operative time, hospital costs, and patient charges were also evaluated. We identified 2260 laparoscopic and 139 robotic operations. As the volume of robotic cases increased, the number of laparoscopic cases steadily decreased. Residents participated in all laparoscopic cases and 70% of robotic cases but operated from the robot console in only 21% of cases. Mean operative time was increased for robotic cholecystectomy (+22%), IHR (+55%), and VHR (+61%). Financial analysis revealed higher median hospital costs per case for robotic cholecystectomy (+$411), IHR (+$887), and VHR (+$1124) as well as substantial associated fixed costs. Introduction of robotic surgery had considerable negative impact on laparoscopic case volume and significantly decreased resident participation. Increased operative time and hospital costs are substantial. An institution must be cognizant of these effects when considering implementing robotics in departments with a general surgery residency program. Copyright © 2017 Elsevier Inc. All rights reserved.

Trainee-Associated Factors and Proficiency at Percutaneous Nephrolithotomy.

PubMed

Aghamir, Seyed Mohammad Kazem; Behtash, Negar; Hamidi, Morteza; Farahmand, Hasan; Salavati, Alborz; Mortaz Hejri, Sara

2017-07-01

Percutaneous nephrolithotomy (PNL) is a complicated procedure for urology trainees. This study was designed to investigate the effect of trainees' ages and previous experience, as well as the number of operated cases, on proficiency at PNL by using patient outcomes. A cross sectional observational study was designed during a five-year period. Trainees in PNL fellowship programs were included. At the end of the program, the trainees' performance in PNL was assessed regarding five competencies and scored 1-5. If the overall score was 4 or above, the trainee was considered as proficient. The trainees' age at the beginning of the program and the years passed from their residency graduation were asked and recorded. Also, the number of PNL cases operated by each trainee was obtained via their logbooks. The age, years passed from graduation, and number of operated cases were compared between two groups of proficient and non-proficient trainees. Univariate and multivariate binary logistic regression analysis was applied to estimate the effect of aforementioned variables on the occurrence of the proficiency. Forty-two trainees were included in the study. The mean and standard deviation for the overall score were 3.40 (out of 5) and 0.67, respectively. Eleven trainees (26.2%) recognized as proficient in performing PNL. Univariate regression analysis indicated that each of three variables (age, years passed from graduation and number of operated cases) had statistically significant effect on proficiency. However, the multivariate regression analysis revealed that just the number of cases had significant effect on achieving proficiency. Although it might be assumed that trainees' age negatively correlates with their scores, in fact, it is their amount of practice that makes a difference. A certain number of cases is required to be operated by a trainee in order to reach the desired competency in PNL.

Management of Liver Trauma in Minia University Hospital, Egypt.

PubMed

Saleh, Abdel Fattah; Al Sageer, Emad; Elheny, Amr

2016-12-01

The aim of this study is to present the outcome of operative and non-operative management of patients with liver injury treated in a single institution depending on imaging. This study was conducted at the Causality Unit of Minia University Hospital, and included 60 patients with hepatic trauma from March 2012 to January 2013. In our study, males represent 80 % while females represent 20 % of the traumatized patients. The peak age for trauma found was 11-30 years. Blunt trauma is the most common cause of liver injury as it was the cause in 48 patients (80 %). Firearm injuries are the most common cause of penetrating trauma (60 %) followed by stab injuries (40 %). More than one half of our patients (34 out of 60) were treated with non-operative management (NOM) with a high success rate. The operative procedures done were suture hepatorrhaphy (20 cases), non-anatomical resection in one case, anatomical resection in one case, and damage control therapy using pads in two cases. In another two cases, nothing was done as subcapsular hematoma had resolved. Minia University Hospital is a big tertiary Hospital in Egypt at which blunt liver trauma is more common than penetrating liver trauma. Surgery is no longer the only option available. It has been reserved for extensive lesions with condition of hemodynamic instability or for the treatment of the complications. NOM is an effective treatment modality in most cases.

[Clinical studies of pedicle screw-rod fixation of thoracolumbar burst fractures through posterior unilateral approach after vertebrae corpectomy fusion].

PubMed

Hua, Yong-jun; Wang, Ren-yan; Guo, Zhi-hui; Shu, Cun-hong; Li, Chao-hua

2016-01-01

To compare the clinical curative effect of thoracolumbar burst fracture treated by the posterior unilateral approach corpectomy fusion screw-rod fixation and anterior corpectomy bone fusion screw plate fixation. From January 2008 to May 2014,36 cases of thoracolumbar burst fracture underwent operation of decompression, fusion, and internal fixation was retrospective analyzed. Among them, 16 patients were treated through posterior approach as posterior group, including 13 males and 3 females aged from 37 to 62 years old; 9 cases caused by falling injury, 3 cases by traffic accident injury,4 cases by heavy aboved;the injury segment was on T₁₂ in 2 cases, L₁ in 5 cases, L₂ in 7 cases, L₃ in 2 cases; according ASIA grade, 3 cases were grade A, 2 cases were grade B, 2 cases were grade C, 5 cases were grade D, 4 cases were grade E; the time between injury and operation ranged from 5 to 15 days. Other 20 patients were treated through anterior-lateral approach as anterior-lateral group, including 15 males and 5 females with age from 27 to 62 years old; 12 cases caused by falling injury, 4 cases by traffic accident injury, 4 cases by heavy aboved; the injury segment was on T₁₂ in 2 cases, L₁, in 7 cases, L₂ in 9 cases, L₃ in 2 cases; for ASIA grade: 4 cases were grade A, 2 cases were grade B, 4 cases were grade C, 6 cases were grade D, 4 cases were grade E; the time between injury and operation ranged from 4 to 12 days. The operation time, bleeding during operation and postoperative drainage volume were observed in two groups,and the changes of nerve function of ASIA grade, clinical efficacy,improved degree of thoracic and lumbar lordosis,and bony fusion were compared between two groups. All patients were followed up from 12 to 24 months with an average of (15.8 ± 3.3) months. The operation time, bleeding during operation, and postoperative drainage volume had no significant different between two groups (P > 0.05). As compared with preoperative, ASIA grade of two groups at last follow-up had statistically significantly different (P < 0.01), the neural function of two groups after operation was recovered for different extent. The JOA score of two groups was compared between last follow-up and preoperative, the difference had statistically significant (P < 0.01), the two groups showed good clinical effect. The clinical results of ASIA grade, JOA score and RIS had no significant differences between two groups. All patients of two groups were obtained fusion. Thoracic and lumbar lordosis angle improvement degree had no significant difference between two groups ,it bad significant difference had statistical significance compared with preoperative, the two approaches could effectively restore the spinal sequence. For patients with thoracolumbar burst fracture just treated by anterior decompression and reconstruction of anterior column, according to the degree of operation performer' skill proficiency and the patient' condition to choose, but for patients must performed the spinal canal decompression anterior and posterior, the three column-reconstruction to required anterior-posterior approach, the posterior unilateral approach corpectomy fusion screw-rod fixation obviously shorten operation time, reduce the operation wound, it is worth the clinical promotion.

Does expert opinion match the operational definition of the Lupus Low Disease Activity State (LLDAS)? A case-based construct validity study.

PubMed

Golder, Vera; Huq, Molla; Franklyn, Kate; Calderone, Alicia; Lateef, Aisha; Lau, Chak Sing; Lee, Alfred Lok Hang; Navarra, Sandra Teresa V; Godfrey, Timothy; Oon, Shereen; Hoi, Alberta Yik Bun; Morand, Eric Francis; Nikpour, Mandana

2017-06-01

To evaluate the construct validity of the Lupus Low Disease Activity State (LLDAS), a treatment target in systemic lupus erythematosus (SLE). Fifty SLE case summaries based on real patients were prepared and assessed independently for meeting the operational definition of LLDAS. Fifty international rheumatologists with expertise in SLE, but with no prior involvement in the LLDAS project, responded to a survey in which they were asked to categorize the disease activity state of each case as remission, low, moderate, or high. Agreement between expert opinion and LLDAS was assessed using Cohen's kappa. Overall agreement between expert opinion and the operational definition of LLDAS was 77.96% (95% CI: 76.34-79.58%), with a Cohen's kappa of 0.57 (95% CI: 0.55-0.61). Of the cases (22 of 50) that fulfilled the operational definition of LLDAS, only 5.34% (59 of 22 × 50) of responses classified the cases as moderate/high activity. Of the cases that did not fulfill the operational definition of LLDAS (28 of 50), 35.14% (492 of 28 × 50) of responses classified the cases as remission/low activity. Common reasons for discordance were assignment to remission/low activity of cases with higher corticosteroid doses than defined in LLDAS (prednisolone ≤ 7.5mg) or with SLEDAI-2K >4 due to serological activity (high anti-dsDNA antibody and/or low complement). LLDAS has good construct validity with high overall agreement between the operational definition of LLDAS and expert opinion. Discordance of results suggests that the operational definition of LLDAS is more stringent than expert opinion at defining a low disease activity state. Copyright © 2017 Elsevier Inc. All rights reserved.

Applying analysis tools in planning for operations : case study #3 -- using archived data as a tool for operations planning

DOT National Transportation Integrated Search

2009-09-01

More and more, transportation system operators are seeing the benefits of strengthening links between planning and operations. A critical element in improving transportation decision-making and the effectiveness of transportation systems related to o...

Enhancing the quality of case studies in health services research.

PubMed Central

Yin, R K

1999-01-01

OBJECTIVE: To provide guidance on improving the quality of case studies in health services research. DATA SOURCES: Secondary data, drawing from previous case study research. RESEARCH DESIGN: Guidance is provided to two audiences: potential case study investigators (eight items) and reviewers of case study proposals (four additional items). PRINCIPAL FINDINGS: The guidance demonstrates that many operational steps can be undertaken to improve the quality of case studies. These steps have been a hallmark of high-quality case studies in related fields but have not necessarily been practiced in health services research. CONCLUSIONS: Given higher-quality case studies, the case study method can become a valuable tool for health services research. Images Figure 3 PMID:10591280

Impact of operator experience and training strategy on procedural outcomes with leadless pacing: Insights from the Micra Transcatheter Pacing Study.

PubMed

El-Chami, Mikhael; Kowal, Robert C; Soejima, Kyoko; Ritter, Philippe; Duray, Gabor Z; Neuzil, Petr; Mont, Lluis; Kypta, Alexander; Sagi, Venkata; Hudnall, John Harrison; Stromberg, Kurt; Reynolds, Dwight

2017-07-01

Leadless pacemaker systems have been designed to avoid the need for a pocket and transvenous lead. However, delivery of this therapy requires a new catheter-based procedure. This study evaluates the role of operator experience and different training strategies on procedural outcomes. A total of 726 patients underwent implant attempt with the Micra transcatheter pacing system (TPS; Medtronic, Minneapolis, MN, USA) by 94 operators trained in a teaching laboratory using a simulator, cadaver, and large animal models (lab training) or locally at the hospital with simulator/demo model and proctorship (hospital training). Procedure success, procedure duration, fluoroscopy time, and safety outcomes were compared between training methods and experience (implant case number). The Micra TPS procedure was successful in 99.2% of attempts and did not differ between the 55 operators trained in the lab setting and the 39 operators trained locally at the hospital (P = 0.189). Implant case number was also not a determinant of procedural success (P = 0.456). Each operator performed between one and 55 procedures. Procedure time and fluoroscopy duration decreased by 2.0% (P = 0.002) and 3.2% (P < 0.001) compared to the previous case. Major complication rate and pericardial effusion rate were not associated with case number (P = 0.755 and P = 0.620, respectively). There were no differences in the safety outcomes by training method. Among a large group of operators, implantation success was high regardless of experience. While procedure duration and fluoroscopy times decreased with implant number, complications were low and not associated with case number. Procedure and safety outcomes were similar between distinct training methodologies. © 2017 Wiley Periodicals, Inc.

Financial Indicators of Reduced Impact Logging Performance in Brazil: Case Study Comparisons

Treesearch

Thomas P. Holmes; Frederick Boltz; Douglas R. Carter

2001-01-01

Indicators of financial performance are compared for three case studies in the Brazilian Amazon. Each case study presents parameters obtained from monitoring initial harvest entries into primary forests for reduced impact logging (RIL) and conventional logging (CL) operations. Differences in cost definitions and data collection protocols complicate the analysis, and...

Real Time Locations Systems or Outsourcing: A Case Study

ERIC Educational Resources Information Center

Lawrence, Cameron; Firth, David; Khumalo, Floyd

2013-01-01

Information Technology has transformed almost all aspects of modern healthcare and is playing a vital role in the administration of hospitals around the world. This case study examines one hospital's struggle to solve crucial operational problems related to the efficient management of medical equipment inventory. This case study is the result of…

Method for Assessing Impacts of Global Sea Level Rise on Navigation Gate Operations

NASA Astrophysics Data System (ADS)

Obrien, P. S.; White, K. D.; Friedman, D.

2015-12-01

Coastal navigation infrastructure may be highly vulnerable to changing climate, including increasing sea levels and altered frequency and intensity of coastal storms. Future gate operations impacted by global sea level rise will pose unique challenges, especially for structures 50 years and older. Our approach is to estimate future changes in gate operational frequency based on a bootstrapping method to forecast future water levels. A case study will be presented to determine future changes in frequency of operations over the next 100 years. A statistical model in the R programming language was developed to apply future sea level rise projections using the three sea level rise scenarios prescribed by USACE Engineer Regulation ER 1100-2-8162. Information derived from the case study will help forecast changes in operational costs caused by increased gate operations and inform timing of decisions on adaptation measures.

Factors associated with survival of epiploic foramen entrapment colic: a multicentre, international study.

PubMed

Archer, D C; Pinchbeck, G L; Proudman, C J

2011-08-01

Epiploic foramen entrapment (EFE) has been associated with reduced post operative survival compared to other types of colic but specific factors associated with reduced long-term survival of these cases have not been evaluated in a large number of horses using survival analysis. To describe post operative survival of EFE cases and to identify factors associated with long-term survival. A prospective, multicentre, international study was conducted using clinical data and long-term follow-up information for 126 horses diagnosed with EFE during exploratory laparotomy at 15 clinics in the UK, Ireland and USA. Descriptive data were generated and survival analysis performed to identify factors associated with reduced post operative survival. For the EFE cohort that recovered following anaesthesia, survival to hospital discharge was 78.5%. Survival to 1 and 2 years post operatively was 50.6 and 34.3%, respectively. The median survival time of EFE cases undergoing surgery was 397 days. Increased packed cell volume (PCV) and increased length of small intestine (SI) resected were significantly associated with increased likelihood of mortality when multivariable analysis of pre- and intraoperative variables were analysed. When all pre-, intra- and post operative variables were analysed separately, only horses that developed post operative ileus (POI) were shown to be at increased likelihood of mortality. Increased PCV, increased length of SI resected and POI are all associated with increased likelihood of mortality of EFE cases. This emphasises the importance of early diagnosis and treatment and the need for improved strategies in the management of POI in order to reduce post operative mortality in these cases. The present study provides evidence-based information to clinicians and owners of horses undergoing surgery for EFE about long-term survival. These results are applicable to university and large private clinics over a wide geographical area. © 2011 EVJ Ltd.

[Comparative study on laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment transfer].

PubMed

Zhang, Dawei; Zhang, Jun; Wang, Huanying; Li, Bin; Zhu, Xiaoxing; Wang, Liying; Wu, Jixiang

2014-03-01

To study the clinical effect of laparoscopic vaginoplasty using pedicled ileal and sigmoid colon segment. From January 2004 to December 2009, 105 cases undergoing laparoscope-assisted vaginoplasty using a vascularized pedicled intestinal flap were studied retrospectively. Operation time, blood loss in operating, bowel movement after operation, postoperation hospital duration, side effect, and artificial vagina were compared between two surgical management. The vaginoplasty were preformed successfully in all 105 cases. There were 48 patients treated by aparoscope-assisted ileal vaginoplasty and 57 patients treated by laparoscope-assisted sigmoid colon vaginoplasty. The values of the operation time [(141 ± 22) minutes versus (159 ± 18) minutes, P = 0.000], blood loss in operating [(42 ± 6) ml versus (83 ± 14) ml, P = 0.000], bowel movement after operation (36 ± 9) hours versus (68 ± 8) hours(P = 0.000), and postoperation hospital duration [(9.8 ± 2.0) days versus (11.1 ± 1.3) days, P = 0.004] in the sigmoid colon vaginoplasty group were longer or higher than those in ileal vaginoplasty group (P < 0.05).No intraoprative complication occurred. There were four postoperative complications: 2 cases with intestinal obstruction in sigmoid colon vaginoplasty group, 1 case with urethral orifice stenosis and 1 case with vaginal-rectal fistula in ileal vaginoplasty group. At follow-up of 6-62 months, all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length. Vaginal discharges resembled a milky white water or mucus without odour. Fifty-five patients with sexual intercourse reported satisfactory results.Six patients complained vaginal stenosis:5 patients in ileal vaginoplasty group and 1 patient in sigmoid colon vaginoplasty group. Laparoscope-assisted vaginoplasty using pedicled ileum or sigmoid colon segment are both the effective ways in forming vagina. The latter management takes more time and blood loss while operating, yet the incidence of vaginal opening contracture appeared to be decreasing trend.

The impact of resident involvement on post-operative morbidity and mortality following orthopaedic procedures: a study of 43,343 cases.

PubMed

Schoenfeld, Andrew J; Serrano, Jose A; Waterman, Brian R; Bader, Julia O; Belmont, Philip J

2013-11-01

Few studies have addressed the role of residents' participation in morbidity and mortality after orthopaedic surgery. The present study utilized the 2005-2010 National Surgical Quality Improvement Program (NSQIP) dataset to assess the risk of 30-day post-operative complications and mortality associated with resident participation in orthopaedic procedures. The NSQIP dataset was queried using codes for 12 common orthopaedic procedures. Patients identified as having received one of the procedures had their records abstracted to obtain demographic data, medical history, operative time, and resident involvement in their surgical care. Thirty-day post-operative outcomes, including complications and mortality, were assessed for all patients. A step-wise multivariate logistic regression model was constructed to evaluate the impact of resident participation on mortality- and complication-risk while controlling for other factors in the model. Primary analyses were performed comparing cases where the attending surgeon operated alone to all other case designations, while a subsequent sensitivity analysis limited inclusion to cases where resident participation was reported by post-graduate year. In the NSQIP dataset, 43,343 patients had received one of the 12 orthopaedic procedures queried. Thirty-five percent of cases were performed with resident participation. The mortality rate, overall, was 2.5 and 10 % sustained one or more complications. Multivariate analysis demonstrated a significant association between resident participation and the risk of one or more complications [OR 1.3 (95 % CI 1.1, 1.4); p < 0.001] as well as major systemic complications [OR 1.6 (95 % CI 1.3, 2.0); p < 0.001] for primary joint arthroplasty procedures only. These findings persisted even after sensitivity testing. A mild to moderate risk for complications was noted following resident involvement in joint arthroplasty procedures. No significant risk of post-operative morbidity or mortality was appreciated for the other orthopaedic procedures studied. II (Prognostic).

Innovation in government : workforce practices.

DOT National Transportation Integrated Search

2009-01-01

A review of the literature on innovation within government provides detailed case studies on innovative practices adopted by transportation agencies across the U.S. These case studies focus on operational innovations adopted by transportation agencie...

[Post-operative peritoneal washing cytology in cases of stage IIIa endometrial carcinoma with positive peritoneal cytology].

PubMed

Kato, T; Hirai, Y; Hasumi, K

1995-07-01

According to the new FIGO staging of corpus cancer, the cases with positive peritoneal cytology alone belong in stage IIIa. The authors previously reported, however, good prognosis of IIIa cases with only positive peritoneal cytology. In order to assess the potential of malignant cells in the peritoneal cavity to metastasize, post-operative peritoneal washing cytology was undertaken. This study was conducted on a total of 115 consecutive patients with endometrial carcinoma who underwent primary surgical therapy at the Cancer Institute Hospital during the 25-month period from December, 1991 to December, 1993. Fifteen cases were included in stage IIIa with positive intraoperative peritoneal cytology alone. In 12 cases with endometrioid adenocarcinoma, a Silascon tube was indwelt in the abdominal cavity before closure of the abdomen. The peritoneal cavity was washed with 500 ml of physiological saline through the indwelt tube 14 days after the operation. The cytology of recovered washings was negative in all cases. Only two cases received postoperative chemotherapy owing to other prognostic factors. These 12 cases are alive with no evidence of disease after 12 to 36 months. The present study demonstrated that malignant cells in the peritoneal cavity appear to have a very low potential for implantation into the peritoneum.

Parameter Impact on Sharing Studies Between UAS CNPC Satellite Transmitters and Terrestrial Systems

NASA Technical Reports Server (NTRS)

Kerczewski, Robert J.; Wilson, Jeffrey D.; Bishop, William D.

2015-01-01

In order to provide a control and non-payload communication (CNPC) link for civil-use unmanned aircraft systems (UAS) when operating in beyond-line-of-sight (BLOS) conditions, satellite communication links are generally required. The International Civil Aviation Organization (ICAO) has determined that the CNPC link must operate over protected aviation safety spectrum allocations. Although a suitable allocation exists in the 5030-5091 MHz band, no satellites provide operations in this band and none are currently planned. In order to avoid a very lengthy delay in the deployment of UAS in BLOS conditions, it has been proposed to use existing satellites operating in the Fixed Satellite Service (FSS), of which many operate in several spectrum bands. Regulatory actions by the International Telecommunications Union (ITU) are needed to enable such a use on an international basis, and indeed Agenda Item (AI) 1.5 for the 2015 World Radiocommunication Conference (WRC) was established to decide on the enactment of possible regulatory provisions. As part of the preparation for AI 1.5, studies on the sharing FSS bands between existing services and CNPC for UAS are being contributed by NASA and others. These studies evaluate the potential impact of satellite CNPC transmitters operating from UAS on other in-band services, and on the potential impact of other in-band services on satellite CNPC receivers operating on UAS platforms. Such studies are made more complex by the inclusion of what are essentially moving FSS earth stations, compared to typical sharing studies between fixed elements. Hence, the process of determining the appropriate technical parameters for the studies meets with difficulty. In order to enable a sharing study to be completed in a less-than-infinite amount of time, the number of parameters exercised must be greatly limited. Therefore, understanding the impact of various parameter choices is accomplished through selectivity analyses. In the case of sharing studies for AI 1.5, identification of worst-case parameters allows the studies to be focused on worst-case scenarios with assurance that other parameter combinations will yield comparatively better results and therefore do not need to be fully analyzed. In this paper, the results of such sensitivity analyses are presented for the case of sharing between UAS CNPC satellite transmitters and terrestrial receivers using the Fixed Service (FS) operating in the same bands, and the implications of these analyses on sharing study results.

Misstaging of ovarian cancer.

PubMed

McGowan, L; Lesher, L P; Norris, H J; Barnett, M

1985-04-01

The thoroughness of intraoperative evaluation of the extent of disease in 291 women with primary ovarian cancer was investigated. Notable differences among physician specialties but not types of hospitals where initial surgery was performed were observed. A review of medical record documentation revealed that 97% of the cases operated on by gynecologic oncologists had complete staging evaluations performed intraoperatively, but only 52 and 35% of cases operated on by obstetricians/gynecologists and general surgeons, respectfully, were adequately evaluated. Roughly one-half of the cases diagnosed in community hospitals and in hospitals with teaching affiliations were found to be completely studied, and 66% of those operated on in university hospitals received complete intraoperative evaluations.

Learning curve in transradial cardiac catheterization: procedure-related parameters stratified by operators' transradial volume.

PubMed

Kasasbeh, Ehab S; Parvez, Babar; Huang, Robert L; Hasselblad, Michele Marie; Glazer, Mark D; Salloum, Joseph G; Cleator, John H; Zhao, David X

2012-11-01

To determine whether radial artery access is associated with a reduction in fluoroscopy time, procedure time, and other procedural variables over a 27-month period during which the radial artery approach was incorporated in a single academic Medical Center. Although previous studies have demonstrated a relationship between increased volume and decreased procedural time, no studies have looked at the integration of radial access over time. Data were collected from consecutive patients who presented to the Vanderbilt University Medical Center cardiac catheterization laboratory from January 1, 2009 to April 1, 2011. Patients who underwent radial access diagnostic catheterization with and without percutaneous coronary intervention were included in this study. A total of 1112 diagnostic cardiac catheterizations through the radial access site were analyzed. High-volume, intermediate-volume, and low-volume operators were grouped based on the percentage of procedures performed through a radial approach. From 2009 to 2011, there was a significant decrease in fluoroscopy time in all operator groups for diagnostic catheterization (P=.035). The high-volume operator group had 1.88 and 3.66 minute reductions in fluoroscopy time compared to the intermediate- and low-volume operator groups, respectively (both P<.001). Likewise, the intermediate-volume operator group had a 1.77 minute improvement compared to the low-volume operator group, but this did not reach statistical significance (P=.102). The improvement in fluoroscopy time and other procedure-related parameters was seen after approximately 25 cases with further improvement after 75 cases. The incorporation of the radial access approach in the cardiac catheterization laboratory led to a decrease in fluoroscopy time for each operator and operator group over the last 3 years. Our data demonstrated that higher-volume radial operators have better procedure, room, and fluoroscopy times when compared to intermediate- and low-volume operators. However, lower-volume operators have a reduction in procedure-related parameters with increased radial cases. Number of procedures needed to become sufficient was demonstrated in the current study.

Procurement Integrity in Contingency Operations: A Case Study of Army Contracting Officer Corruption in Operations Iraqi and Enduring Freedom Utilizing Occupational Fraud Theory

DTIC Science & Technology

2011-12-01

Study of Army Contracting Officer Corruption in Operations Iraqi and Enduring Freedom Utilizing Occupational Fraud Theory By: Amanda H...Operations Iraqi and Enduring Freedom Utilizing Occupational Fraud Theory 6. AUTHOR(S) Amanda H. Flint 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION...CCOs) during Operations Iraqi Freedom and Enduring Freedom (OIF/OEF) by applying occupational fraud theory, specifically the classic sociological

A case study of hospital operations management.

PubMed

Cheng, T C

1987-12-01

This paper discusses a study to investigate various operations management problems in a newly opened, modern regional hospital in Hong Kong. The findings of the study reveal that there exist in the hospital a number of current and potential problem areas. Recommendations for solving these problems are suggested with a view to improving the overall operational efficiency and effectiveness of the hospital.

A case-control study of bladder cancer in the United States rubber and tyre industry.

PubMed

Checkoway, H; Smith, A H; McMichael, A J; Jones, F S; Monson, R R; Tyroler, H A

1981-08-01

A case-control study of bladder cancer was conducted in five United States rubber and tyre companies to determine if there were high-risk jobs and work areas within the industry. The study included 220 male cases of bladder cancer, of whom 107 were identified from hospital record reviews and 113 from death certificates. Each case was matched individually with two industry controls by sex, race, year of birth, and company. One control was matched additionally by year of hire and duration of employment. Comparisons of cases and controls not matched by year of hire and age of hire showed no differences for those variables, which suggests that age and calendar period of first exposure to the industry were not risk determinants. When the work histories of both cases and controls were contrasted it was found that cases were more likely than controls to have worked in milling (odds ratio (OR) = 1.91) and calender operation (OR = 2.21) jobs. The relative risk estimates for milling and calender operation both exhibited linear trends of increase with duration of exposure. Milling and calender operation jobs entail potential exposures to volatilised reaction products from heated rubber stock. A better understanding of aetiological associations with job type will require more detailed characterisation of the work environment with regard to the sources and levels of aromatic amines and other suspected bladder carcinogens.

A case-control study of bladder cancer in the United States rubber and tyre industry.

PubMed Central

Checkoway, H; Smith, A H; McMichael, A J; Jones, F S; Monson, R R; Tyroler, H A

1981-01-01

A case-control study of bladder cancer was conducted in five United States rubber and tyre companies to determine if there were high-risk jobs and work areas within the industry. The study included 220 male cases of bladder cancer, of whom 107 were identified from hospital record reviews and 113 from death certificates. Each case was matched individually with two industry controls by sex, race, year of birth, and company. One control was matched additionally by year of hire and duration of employment. Comparisons of cases and controls not matched by year of hire and age of hire showed no differences for those variables, which suggests that age and calendar period of first exposure to the industry were not risk determinants. When the work histories of both cases and controls were contrasted it was found that cases were more likely than controls to have worked in milling (odds ratio (OR) = 1.91) and calender operation (OR = 2.21) jobs. The relative risk estimates for milling and calender operation both exhibited linear trends of increase with duration of exposure. Milling and calender operation jobs entail potential exposures to volatilised reaction products from heated rubber stock. A better understanding of aetiological associations with job type will require more detailed characterisation of the work environment with regard to the sources and levels of aromatic amines and other suspected bladder carcinogens. PMID:7272236

Resident Autonomy in the Operating Room: Expectations Versus Reality.

PubMed

Meyerson, Shari L; Sternbach, Joel M; Zwischenberger, Joseph B; Bender, Edward M

2017-09-01

There is concern about graduating thoracic trainees' independent operative skills due to limited autonomy in training. This study compared faculty and trainee expected levels of autonomy with intraoperative measurements of autonomy for common cardiothoracic operations. Participants underwent frame-of-reference training on the 4-point Zwisch scale of operative autonomy (show and tell → active help → passive help → supervision only) and evaluated autonomy in actual cases using the Zwisch Me!! mobile application. A separate "expected autonomy" survey elicited faculty and resident perceptions of how much autonomy a resident should have for six common operations: decortication, wedge resection, thoracoscopic lobectomy, coronary artery bypass grafting, aortic valve replacement, and mitral valve repair. Thirty-three trainees from 7 institutions submitted evaluations of 596 cases over 18 months (March 2015 to September 2016). Thirty attendings subsequently provided their evaluation of 476 of those cases (79.9% response rate). Expected autonomy surveys were completed by 21 attendings and 19 trainees from 5 institutions. The six operations included in the survey constituted 47% (226 of 476) of the cases evaluated. Trainee and attending expectations did not differ significantly for senior trainees. Both groups expected significantly higher levels of autonomy than observed in the operating room for all six types of cases. Although faculty and trainees both expect similar levels of autonomy in the operating room, real-time measurements of autonomy show a gap between expectations and reality. Decreasing this gap will require a concerted effort by both faculty and residents to focus on the development of independent operative skills. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Learning curve evaluation using cumulative summation analysis-a clinical example of pediatric robot-assisted laparoscopic pyeloplasty.

PubMed

Cundy, Thomas P; Gattas, Nicholas E; White, Alan D; Najmaldin, Azad S

2015-08-01

The cumulative summation (CUSUM) method for learning curve analysis remains under-utilized in the surgical literature in general, and is described in only a small number of publications within the field of pediatric surgery. This study introduces the CUSUM analysis technique and applies it to evaluate the learning curve for pediatric robot-assisted laparoscopic pyeloplasty (RP). Clinical data were prospectively recorded for consecutive pediatric RP cases performed by a single-surgeon. CUSUM charts and tests were generated for set-up time, docking time, console time, operating time, total operating room time, and postoperative complications. Conversions and avoidable operating room delay were separately evaluated with respect to case experience. Comparisons between case experience and time-based outcomes were assessed using the Student's t-test and ANOVA for bi-phasic and multi-phasic learning curves respectively. Comparison between case experience and complication frequency was assessed using the Kruskal-Wallis test. A total of 90 RP cases were evaluated. The learning curve transitioned beyond the learning phase at cases 10, 15, 42, 57, and 58 for set-up time, docking time, console time, operating time, and total operating room time respectively. All comparisons of mean operating times between the learning phase and subsequent phases were statistically significant (P=<0.001-0.01). No significant difference was observed between case experience and frequency of post-operative complications (P=0.125), although the CUSUM chart demonstrated a directional change in slope for the last 12 cases in which there were high proportions of re-do cases and patients <6 months of age. The CUSUM method has a valuable role for learning curve evaluation and outcome quality monitoring. In applying this statistical technique to the largest reported single surgeon series of pediatric RP, we demonstrate numerous distinctly shaped learning curves and well-defined learning phase transition points. Copyright © 2015 Elsevier Inc. All rights reserved.

Is case triaging a useful tool for emergency surgeries? A review of 106 trauma surgery cases at a level 1 trauma center in South Africa.

PubMed

Chowdhury, Sharfuddin; Nicol, Andrew John; Moydien, Mahammed Riyaad; Navsaria, Pradeep Harkison; Montoya-Pelaez, Luis Felipe

2018-01-01

The optimal timing for emergency surgical interventions and implementation of protocols for trauma surgery is insufficient in the literature. The Groote Schuur emergency surgery triage (GSEST) system, based on Cape Triaging Score (CTS), is followed at Groote Schuur Hospital (GSH) for triaging emergency surgical cases including trauma cases. The study aimed to look at the effect of delay in surgery after scheduling based on the GSEST system has an impact on outcome in terms of postoperative complications and death. Prospective audit of patients presenting to GSH trauma center following penetrating or blunt chest, abdominal, neck and peripheral vascular trauma who underwent surgery over a 4-month period was performed. Post-operative complications were graded according to Clavien-Dindo classification of surgical complications. One-hundred six patients underwent surgery during the study period. One-hundred two (96.2%) cases were related to penetrating trauma. Stab wounds comprised 71 (67%) and gunshot wounds (GSW) 31 (29.2%) cases. Of the 106 cases, 6, 47, 40, and 13 patients were booked as red, orange, yellow, and green, respectively. The median delay for green, yellow, and orange cases was within the expected time. The red patients took unexpectedly longer (median delay 48 min, IQR 35-60 min). Thirty-one (29.3%) patients developed postoperative complications. Among the booked red, orange, yellow, and green cases, postoperative complications developed in 3, 18, 9, and 1 cases, respectively. Only two (1.9%) postoperative deaths were documented during the study period. There was no statistically significant association between operative triage and post-operative complications ( p  = 0.074). Surgical case categorization has been shown to be useful in prioritizing emergency trauma surgical cases in a resource constraint high-volume trauma center.

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.

Music and communication in the operating theatre.

PubMed

Weldon, Sharon-Marie; Korkiakangas, Terhi; Bezemer, Jeff; Kneebone, Roger

2015-12-01

To observe the extent and the detail with which playing music can impact on communication in the operating theatre. According to the cited sources, music is played in 53-72% of surgical operations performed. Noise levels in the operating theatre already exceed World Health Organisation recommendations. There is currently a divide in opinions on the playing of music in operating theatres, with few studies conducted and no policies or guidance provided. An ethnographic observational study of teamwork in operating theatres through video recordings. Quantitative and qualitative data analysis approaches were used. This study was conducted between 2012-2013 in the UK. Video recordings of 20 operations over six months in two operating theatres were captured. The recordings were divided into music and non-music playing cases. Each case was logged using a request/response sequence identified through interactional analysis. Statistical analysis, using a χ(2) , explored the difference between the proportion of request repetitions and whether music was playing or not. Further interactional analysis was conducted for each request repetition. Request/response observations (N = 5203) were documented. A chi-square test revealed that repeated requests were five times more likely to occur in cases that played music than those that did not. A repeated request can add 4-68 seconds each to operation time and increased tensions due to frustration at ineffective communication. Music played in the operating theatre can interfere with team communication, yet is seldom recognized as a potential safety hazard. Decisions around whether music is played and around the choice of music and its volume, are determined largely by surgeons. Frank discussions between clinicians, managers, patients and governing bodies should be encouraged for recommendations and guidance to be developed. © 2015 John Wiley & Sons Ltd.

Closure of the operator product expansion in the non-unitary bootstrap

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

Esterlis, Ilya; Fitzpatrick, A. Liam; Ramirez, David M.

We use the numerical conformal bootstrap in two dimensions to search for finite, closed sub-algebras of the operator product expansion (OPE), without assuming unitarity. We find the minimal models as special cases, as well as additional lines of solutions that can be understood in the Coulomb gas formalism. All the solutions we find that contain the vacuum in the operator algebra are cases where the external operators of the bootstrap equation are degenerate operators, and we argue that this follows analytically from the expressions in arXiv:1202.4698 for the crossing matrices of Virasoro conformal blocks. Our numerical analysis is a specialmore » case of the “Gliozzi” bootstrap method, and provides a simpler setting in which to study technical challenges with the method. In the supplementary material, we provide a Mathematica notebook that automates the calculation of the crossing matrices and OPE coefficients for degenerate operators using the formulae of Dotsenko and Fateev.« less

Closure of the operator product expansion in the non-unitary bootstrap

DOE PAGES

Esterlis, Ilya; Fitzpatrick, A. Liam; Ramirez, David M.

2016-11-07

We use the numerical conformal bootstrap in two dimensions to search for finite, closed sub-algebras of the operator product expansion (OPE), without assuming unitarity. We find the minimal models as special cases, as well as additional lines of solutions that can be understood in the Coulomb gas formalism. All the solutions we find that contain the vacuum in the operator algebra are cases where the external operators of the bootstrap equation are degenerate operators, and we argue that this follows analytically from the expressions in arXiv:1202.4698 for the crossing matrices of Virasoro conformal blocks. Our numerical analysis is a specialmore » case of the “Gliozzi” bootstrap method, and provides a simpler setting in which to study technical challenges with the method. In the supplementary material, we provide a Mathematica notebook that automates the calculation of the crossing matrices and OPE coefficients for degenerate operators using the formulae of Dotsenko and Fateev.« less

[Digital gigantism of the foot: a clinical study of 12 cases].

PubMed

Wang, Hai-hua; Tian, Guang-lei; Zhu, Yin; Zhang, You-le; Zhao, Jun-hui; Tian, Wen

2008-03-15

To summarize the clinical characteristic and outcome of digital gigantism of the foot. Retrospectively analyze the clinical documents of cases of digital gigantism of the foot. Twelve 12 cases with 13 feet in this study included 8 male and 4 female with an average 4.6-years-old. All the deformities were found at birth. Multiple toes involved were more than single toe, and tibial toe involved more than fibular. Forefoot was enlarged. All the phalanges involved and partial metatarsal bones were enlarged. Marked increase in subcutaneous fat was found in all cases in the operation which infiltrated interossei and articular capsules. The appearance of the nerves and its branches in the foot were normal and fat infiltrating was not discovered. The operation types included debulking, epiphyseal arrest, amputation, nerve stripping and anastomosis. Seven cases were followed up with mean periods 25.6 months. Functional evaluation according to a criterion formulated by author revealed a result of 2 excellent, 2 good and 3 fair. Digital gigantism of the foot is an uncommon congenital deformity of the foot characterized by overgrowth of both the soft-tissue and the osseous elements of the enlarged toe and forefoot. Surgical treatment is the unique method, and the goal is to reduce the size of the foot to allow fitting regular shoes and walking readily. There are several types of operations which to be chosen. The indication, the timing of operative intervention and the selection of operation type should be paid more attention.

How can sludge dewatering devices be assessed? Development of a new DSS and its application to real case studies.

PubMed

Bertanza, Giorgio; Papa, Matteo; Canato, Matteo; Collivignarelli, Maria Cristina; Pedrazzani, Roberta

2014-05-01

A key issue in biological Waste Water Treatment Plants (WWTPs) operation is represented by the sludge management. Mechanical dewatering is a crucial stage for sludge volume reduction; though, being a costly operation, its optimization is required. We developed an original experimental methodology to evaluate the technical (dewatering efficiency) and financial (total treatment costs) performance of dewatering devices, which might be used as a DSS (Decision Support System) for WWTP managers. This tool was then applied to two real case studies for comparing, respectively, three industrial size centrifuges, and two different operation modes of the same machine (fixed installation vs. outsourcing service). In both the cases, the best option was identified, based jointly on economic and (site-specific) technical evaluations. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Study on gasless-laparoscopic vaginoplasty using sigmoid colon segment].

PubMed

Bu, Lan; Wang, Huan-ying; Zhang, Jun; Wang, Li-ying; Wu, Ji-xiang; Li, Bin

2013-07-01

To study the clinical effect of gasless-laparoscopic vaginoplasty using sigmoid colon segment. Clinical data of 119 cases undergoing laparoscopic or gasless-laparoscopic vaginoplasty using a vascularized pedicled sigmoid colon segment in Beijing Anzhen Hospital from January 2007 to December 2010 were reviewed retrospectively. Those patients were classified into 57 cases with laparoscopic sigmoid colon vaginoplasty and 62 cases with gasless-laparoscopic sigmoid colon vaginoplasty. The operation time, blood loss in operating, bowel movement after operation, postoperation hospital duration, side effect, and artificial vagina were compared between laparoscopic and gasless-laparoscopic group. The vaginoplasty were preformed successfully in 119 cases. The mean operation time of were (159 ± 18) min in laparoscopic group and (146 ± 17) min in gasless-laparoscopic group, respectively, which reached statistical difference (P < 0.01). The blood loss in operating were (83 ± 14) ml and (86 ± 13) ml, bowel movement after operation were (68 ± 8) hours and (68 ± 11) hours, and postoperation hospital duration were (11.1 ± 1.3) days and (11.4 ± 1.9) days respectively in laparoscopic group and gasless-laparoscopic group. No significant difference were found in the blood loss in operating, bowel movement after operation, and postoperation hospital duration between two groups (P > 0.05) .No intraoperative complication occurred. There were two cases with incomplete adhesive intestinal obstruction at 15-20 days postoperatively, which one was in laparoscopic group and one was in gas-less laparoscopic group. At 6-50 months of following up (median time 12 months), all artificial vaginas had a capacity of over two fingers in wideness and 12-15 cm in length. Vaginal discharges resembled a milky white water or mucus without odour. Eighty-five patients with sexual intercourse reported satisfactory feeling. One patients complained vaginal stenosis in laparoscopic group. Gasless-laparoscopic vaginoplasty using sigmoid colon segment is an alternative feasible and practical treatment.

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.

Strategic Usefulness of Conventional Force/Special Operations Force Interdependence in Irregular Warfare

DTIC Science & Technology

2017-06-01

17  III.  METHODOLOGY ..............................................................................................19  A... CASE STUDY SELECTION ..................................................................19  B.  RESEARCH APPROACH...20  IV.  GLOBAL WAR ON TERRORISM CASE STUDY .........................................21  A.  AFGHANISTAN

Indocyanine green videoangiography (ICGV)-guided surgery of parasagittal meningiomas occluding the superior sagittal sinus (SSS).

PubMed

d'Avella, Elena; Volpin, Francesco; Manara, Renzo; Scienza, Renato; Della Puppa, Alessandro

2013-03-01

Maximal safe resection is the goal of correct surgical treatment of parasagittal meningiomas, and it is intimately related to the venous anatomy both near and directly involved by the tumor. Indocyanine green videoangiography (ICGV) has already been advocated as an intra-operative resourceful technique in brain tumor surgery for the identification of vessels. The aim of this study was to investigate the role of ICGV in surgery of parasagittal meningiomas occluding the superior sagittal sinus (SSS). In this study, we prospectively analyzed clinical, radiological and intra-operative findings of patients affected by parasagittal meningioma occluding the SSS, who underwent ICGV assisted-surgery. Radiological diagnosis of complete SSS occlusion was pre-operatively established in all cases. ICGV was performed before dural opening, before and during tumor resection, at the end of the procedure. Five patients were included in our study. In all cases, ICGV guided dural opening, tumor resection, and venous management. The venous collateral pathway was easily identified and preserved in all cases. Radical resection was achieved in four cases. Surgery was uneventful in all cases. Despite the small number of patients, our study shows that ICG videoangiography could play a crucial role in guiding surgery of parasagittal meningioma occluding the SSS. Further studies are needed to define the role of this technique on functional and oncological outcome of these patients.

Seasat-A ASVT: Commercial demonstration experiments. Results analysis methodology for the Seasat-A case studies

NASA Technical Reports Server (NTRS)

1979-01-01

The SEASAT-A commercial demonstration program ASVT is described. The program consists of a set of experiments involving the evaluation of a real time data distributions system, the SEASAT-A user data distribution system, that provides the capability for near real time dissemination of ocean conditions and weather data products from the U.S. Navy Fleet Numerical Weather Central to a selected set of commercial and industrial users and case studies, performed by commercial and industrial users, using the data gathered by SEASAT-A during its operational life. The impact of the SEASAT-A data on business operations is evaluated by the commercial and industrial users. The approach followed in the performance of the case studies, and the methodology used in the analysis and integration of the case study results to estimate the actual and potential economic benefits of improved ocean condition and weather forecast data are described.

An Application of Six Sigma to Reduce Supplier Quality Cost

NASA Astrophysics Data System (ADS)

Gaikwad, Lokpriya Mohanrao; Teli, Shivagond Nagappa; Majali, Vijay Shashikant; Bhushi, Umesh Mahadevappa

2016-01-01

This article presents an application of Six Sigma to reduce supplier quality cost in manufacturing industry. Although there is a wider acceptance of Six Sigma in many organizations today, there is still a lack of in-depth case study of Six Sigma. For the present research the case study methodology was used. The company decided to reduce quality cost and improve selected processes using Six Sigma methodologies. Regarding the fact that there is a lack of case studies dealing with Six Sigma especially in individual manufacturing organization this article could be of great importance also for the practitioners. This paper discusses the quality and productivity improvement in a supplier enterprise through a case study. The paper deals with an application of Six Sigma define-measure-analyze-improve-control methodology in an industry which provides a framework to identify, quantify and eliminate sources of variation in an operational process in question, to optimize the operation variables, improve and sustain performance viz. process yield with well-executed control plans. Six Sigma improves the process performance (process yield) of the critical operational process, leading to better utilization of resources, decreases variations and maintains consistent quality of the process output.

Prospective case-control study of efficacy of bilateral selective neck dissection in primary surgical treatment of supraglottic laryngeal cancers with clinically negative cervical findings (N0).

PubMed

Djordjevic, V; Bukurov, B; Arsovic, N; Dimitrijevic, M; Jesic, S; Nesic, V; Petrovic, Z

2016-12-01

To evaluate the efficacy of bilateral selective neck dissection of levels II-IV in elective and therapeutic management of the neck as a part of primary surgical treatment of patients with supraglottic laryngeal cancer and clinically negative cervical findings (N0). Institutional, observational, case-control study with historic control of patients who underwent primary supraglottic tumour surgery, and a prospective cohort of patient, who underwent, besides the operation of primary tumour, bilateral selective neck dissection (level II-IV). University, tertiary level hospital, national referral centre. The study included 193 patients with supraglottic cancer and without palpable or ultrasound positive cervical findings who were surgically treated from 1988 to 2005. Besides the operation of primary tumour, all patients in the study group underwent bilateral selective neck dissection (level II-IV). Patients in the control group (N = 51) underwent primary tumour operation only and were followed up regularly. In cases with postoperative regional recurrences, the radical neck dissection was performed. All patients with histopathological confirmation of occult metastases were administered radiotherapy treatment (60 Gy) in the postoperative period. Five-year overall survival rate. Occult cervical metastases were found in 18% of patients. They were present in level II in 77.5%, in level III in 20% of cases and in one patient in level IV (2.5%); the extracapsular spread was observed in 20% of cases. Postoperative regional metastases were found in 4.15% of cases in the study group, and in 11.8% in the control group, which proved to be significantly higher. The five-year overall survival rate showed no significant difference between the study group and the control group. The incidence of postoperative regional recurrences could be reduced by performing bilateral selective neck dissection simultaneously with primary tumour operation, but with no influence on the survival rate. © 2015 John Wiley & Sons Ltd.

[Malignant tumors of the female genital track in the elderly].

PubMed

Gottwald, Leszek; Akoel, Kindah Mo; Wójcik-Krowiranda, Katarzyna; Bieńkiewicz, Andrzej

2003-09-01

In senium the increase in the incidence of most malignant neoplasms, as well as gynecological cancers is found. In this period of life the vast number of women do not apply for the preventive and follow-up examinations, which increases the number of malignant diseases diagnosed at advanced clinical stages. The coexisting another diseases often limits the possibility of the operative treatment in those cases. To assess the profile of malignant tumors of the genital tract and their treatment in women above 70 year old. 61 women aged from 71 yrs. to 88 yrs. treated operatively between 1997-2001 due to gynecological cancers were included into the study. The structure and detectability of the neoplasms, as well as the type of performed surgical procedures were analysed. 30 endometrial cancers (49.2%), 16 ovarian cancers (26.2%), 14 vulvar cancers (22.9%) and 1 cervical cancer were diagnosed and surgically treated. The endometrial cancer stage I was detected in 18 cases, stage II in 4 cases and stage III in 8 cases. In each case the radical operation was done (total hysterectomy, lymphadenectomy and appendectomy). The ovarian cancer stage I was detected in 3 cases, stage II in 2 cases, stage III in 5 cases, and stage IV in 6 cases. Only in 5 cases out of this group the radical surgery was performed (total hysterectomy, omentectomy and appendectomy). The vulvar cancer stage I was detected in 2 cases, stage II in 11 cases, and FIGO stage III in 4 cases. In each of these women the vulva and bilateral inguinal lymph nodes were resected, and in 2 cases additionally at the same time the Miles operation was performed. The cervical cancer clinical stage I was detected, and the Wertheim operation was performed. The most often diagnosed malignant neoplasm in women above 70 yrs. was the endometrial cancer. The worst first-time diagnosis structure was observed in the ovarian cancer, what significantly decreased the ability of surgical treatment in this group.

Evaluation of short-duration unscheduled absences among transit operators : TriMet case study

DOT National Transportation Integrated Search

2009-09-01

This report analyzes factors contributing to short duration (one to three days) unscheduled absences among operators : at TriMet, the transit provider for the Portland, Oregon metropolitan region. The analysis draws on a wide array of : operator-spec...

Evaluation of short-duration, unscheduled absences among transit operators: TriMet case study.

DOT National Transportation Integrated Search

2009-09-01

This report analyzes factors contributing to short duration (one to three days) unscheduled absences among operators at TriMet, the transit provider for the Portland, Oregon metropolitan region. The analysis draws on a wide array of operator-specific...

Transit Operations Decision Support System (TODSS) core requirements prototype development case study and lessons learned.

DOT National Transportation Integrated Search

2010-02-01

Transit Operations Decision Support Systems (TODSS) are systems designed to support dispatchers and others in real-time operations : management in response to incidents, special events, and other changing conditions. As part of a joint Federal Transi...

Effect of the 16-hour work limit on general surgery intern operative case volume: a multi-institutional study.

PubMed

Schwartz, Samuel I; Galante, Joseph; Kaji, Amy; Dolich, Matthew; Easter, David; Melcher, Marc L; Patel, Kevin; Reeves, Mark E; Salim, Ali; Senagore, Anthony J; Takanishi, Danny M; de Virgilio, Christian

2013-09-01

The 80-hour work-week limit for all residents was instituted in 2003 and studies looking at its effect have been mixed. Since the advent of the 16-hour mandate for postgraduate year 1 residents in July 2011, no data have been published regarding the effect of this additional work-hour restriction. To determine whether the 16-hour intern work limit, implemented in July 2011, has adversely affected operative experience. A retrospective review of categorical postgraduate year 1 Accreditation Council for Graduate Medical Education case logs from the intern class (N = 52) (with 16-hour work limit) compared with the 4 preceding years (2007-2010; N = 197) (without 16-hour work limit). A total of 249 categorical general surgery interns from 10 general surgery residency programs in the western United States were included. Total, major, first-assistant, and defined-category case totals. As compared with the preceding 4 years, the 2011-2012 interns recorded a 25.8% decrease in total operative cases (65.9 vs 88.8, P = .005), a 31.8% decrease in major cases (54.9 vs 80.5, P < .001), and a 46.3% decrease in first-assistant cases (11.1 vs 20.7, P = .008). There were statistically significant decreases in cases within the defined categories of abdomen, endocrine, head and neck, basic laparoscopy, complex laparoscopy, pediatrics, thoracic, and soft tissue/breast surgery in the 16-hour shift intern era, whereas there was no decrease in trauma, vascular, alimentary, endoscopy, liver, and pancreas cases. The 16-hour work limit for interns, implemented in July 2011, is associated with a significant decrease in categorical intern operative experience. If the 16-hour shift were to be extended to all postgraduate year levels, one can anticipate that additional years of training will be needed to maintain the same operative volume.

Mineral scale management. Part 1, Case studies

Treesearch

Peter W. Hart; Alan W. Rudie

2006-01-01

Mineral scale increases operating costs, extends downtime, and increases maintenance requirements. This paper presents several successful case studies detailing how mills have eliminated scale. Cases presented include calcium carbonate scale in a white liquor strainer, calcium oxalate scale in the D0 stage of the bleach plant, enzymatic treatment of brown stock to...

Analysis of the learning curve for peroral endoscopic myotomy for esophageal achalasia: Single-center, two-operator experience.

PubMed

Lv, Houning; Zhao, Ningning; Zheng, Zhongqing; Wang, Tao; Yang, Fang; Jiang, Xihui; Lin, Lin; Sun, Chao; Wang, Bangmao

2017-05-01

Peroral endoscopic myotomy (POEM) has emerged as an advanced technique for the treatment of achalasia, and defining the learning curve is mandatory. From August 2011 to June 2014, two operators in our institution (A&B) carried out POEM on 35 and 33 consecutive patients, respectively. Moving average and cumulative sum (CUSUM) methods were used to analyze the POEM learning curve for corrected operative time (cOT), referring to duration of per centimeter myotomy. Additionally, perioperative outcomes were compared among distinct learning curve phases. Using the moving average method, cOT reached a plateau at the 29th case and at the 24th case for operators A and B, respectively. CUSUM analysis identified three phases: initial learning period (Phase 1), efficiency period (Phase 2) and mastery period (Phase 3). The relatively smooth state in the CUSUM graph occurred at the 26th case and at the 24th case for operators A and B, respectively. Mean cOT of distinct phases for operator A were 8.32, 5.20 and 3.97 min, whereas they were 5.99, 3.06 and 3.75 min for operator B, respectively. Eckardt score and lower esophageal sphincter pressure significantly decreased during the 1-year follow-up period. Data were comparable regarding patient characteristics and perioperative outcomes. This single-center study demonstrated that expert endoscopists with experience in esophageal endoscopic submucosal dissection reached a plateau in learning of POEM after approximately 25 cases. © 2016 Japan Gastroenterological Endoscopy Society.

Analysis of critical operating conditions for LV distribution networks with microgrids

NASA Astrophysics Data System (ADS)

Zehir, M. A.; Batman, A.; Sonmez, M. A.; Font, A.; Tsiamitros, D.; Stimoniaris, D.; Kollatou, T.; Bagriyanik, M.; Ozdemir, A.; Dialynas, E.

2016-11-01

Increase in the penetration of Distributed Generation (DG) in distribution networks, raises the risk of voltage limit violations while contributing to line losses. Especially in low voltage (LV) distribution networks (secondary distribution networks), impacts of active power flows on the bus voltages and on the network losses are more dominant. As network operators must meet regulatory limitations, they have to take into account the most critical operating conditions in their systems. In this study, it is aimed to present the impact of the worst operation cases of LV distribution networks comprising microgrids. Simulation studies are performed on a field data-based virtual test-bed. The simulations are repeated for several cases consisting different microgrid points of connection with different network loading and microgrid supply/demand conditions.

Expert system development methodology and the transition from prototyping to operations: FIESTA, a case study

NASA Technical Reports Server (NTRS)

Happell, Nadine; Miksell, Steve; Carlisle, Candace

1989-01-01

A major barrier in taking expert systems from prototype to operational status involves instilling end user confidence in the operational system. The software of different life cycle models is examined and the advantages and disadvantages of each when applied to expert system development are explored. The Fault Isolation Expert System for Tracking and data relay satellite system Applications (FIESTA) is presented as a case study of development of an expert system. The end user confidence necessary for operational use of this system is accentuated by the fact that it will handle real-time data in a secure environment, allowing little tolerance for errors. How FIESTA is dealing with transition problems as it moves from an off-line standalone prototype to an on-line real-time system is discussed.

Expert system development methodology and the transition from prototyping to operations - Fiesta, a case study

NASA Technical Reports Server (NTRS)

Happell, Nadine; Miksell, Steve; Carlisle, Candace

1989-01-01

A major barrier in taking expert systems from prototype to operational status involves instilling end user confidence in the operational system. The software of different life cycle models is examined and the advantages and disadvantages of each when applied to expert system development are explored. The Fault Isolation Expert System for Tracking and data relay satellite system Applications (FIESTA) is presented as a case study of development of an expert system. The end user confidence necessary for operational use of this system is accentuated by the fact that it will handle real-time data in a secure environment, allowing little tolerance for errors. How FIESTA is dealing with transition problems as it moves from an off-line standalone prototype to an on-line real-time system is discussed.

[Case control study of fractures-dislocations of ankle joint with conservative and operative treatment].

PubMed

Zhang, Song-Tu; Lin, Yi-Rong; Chen, Lian-Yuan

2010-10-01

To compare the clinical efficacy of grade III, IV supination-eversion fractures-dislocations of ankle joint between manipulative treatment and operative treatment. From September 2007 to December 2008, the clinical data of 60 patients with grade III, IV supination-eversion fractures-dislocations of ankle joint were retrospectively analyzed. There were 32 males and 28 females, ranging in age from 18 to 70 years with an average age of 38.17 years. All patients were respectively treated with manipulative treatment (conservative group, 30 cases) and operative treatment (operative group, 30 cases). The joint function was compared with Mazur standard; the reduction and shifting of fractures were observed with X-ray; the hospitalization day and the therapeutic cost were compared between two groups. All patients were followed up with an average of 15.27 months (ranged, 6 to 25 months). In conservative group, 16 cases got excellent result in joint function, 10 good, 3 fair, 1 poor; in operative group, 20 cases got excellent result, 8 good, 2 fair, 0 poor. In conservative group in the X-ray showed 25 cases obtained excellent and good reduction, 4 fair, 1 poor; and in operative group in the X-ray showed 28 cases obtained excellent and good reduction, 2 fair, 0 poor. There was no significant difference at the joint function and X-ray film after treatment between two groups (P > 0.05). The hospital day was respectively (7.87 +/- 3.34), (17.37 +/- 4.64) d in conservative group and operative group; and the therapeutic cost was respectively (2 506.67 +/- 649.10), (11 473.33 +/- 1 564.90) yuan. There was significant difference at hospital day and therapeutic cost between two groups (P < 0.05). Conservative treatment and operative treatment can both reach a very good result in treating grade III, IV supination-eversion fractures and dislocations of ankle joint. However, conservative treatment has advantage of high safety factor, low therapeutic cost, can reduce medical costs for patients.

Comparative study of oxihydrogen injection in turbocharged compression ignition engines

NASA Astrophysics Data System (ADS)

Barna, L.; Lelea, D.

2018-01-01

This document proposes for analysis, comparative study of the turbocharged, compression-ignition engine, equipped with EGR valve, operation in case the injection in intake manifold thereof a maximum flow rate of 1l/min oxyhydrogen resulted of water electrolysis, at two different injection pressures, namely 100 Pa and 3000 Pa, from the point of view of flue gas opacity. We found a substantial reduction of flue gas opacity in both cases compared to conventional diesel operation, but in different proportions.

Case Studies of Predictive Analysis Applications in Law Enforcement

DTIC Science & Technology

2015-12-01

analysis to crime problems to be considered effective. To test this hypothesis, case studies were conducted on municipal police departments in the...Forecasting in Law Enforcement Operations. 6 Vlahos, “The Department of Pre -Crime.” 4 studies were conducted on municipal police departments in the... case studies are described and recommendations for future research , as well as recommendations for police executives considering an investment in

Increase in Operator's Sympathetic Nerve Activity during Complicated Hepatobiliary Surgery: Evidence for Surgeons' Mental Stress.

PubMed

Yamanouchi, Kosho; Hayashida, Naomi; Kuba, Sayaka; Sakimura, Chika; Kuroki, Tamotsu; Togo, Michita; Katayama, Noritada; Takamura, Noboru; Eguchi, Susumu

2015-11-01

Surgeons often experience stress during operations. The heart rate variability (HRV) is the variability in the beat-to-beat interval, which has been used as parameters of stress. The purpose of this study was to evaluate mental stress of surgeons before, during and after operations, especially during pancreaticoduodenectomy (PD) and living donor liver transplantation (LDLT). Additionally, the parameters were compared in various procedures during the operations. By frequency domain method using electrocardiograph, we measured the high frequency (HF) component, representing the parasympathetic activity, and the low frequency (LF)/HF ratio, representing the sympathetic activity. In all 5 cases of PD, the surgeon showed significantly lower HF component and higher LF/HF during operation, indicating predominance of sympathetic nervous system and increased stress, than those before the operation (p < 0.01) and these did not return to the baseline level one hour after the operation. Out of the 4 LDLT cases, the value of HF was decreased in two and the LF/HF increased in three cases (p < 0.01) during the operation compared to those before the operation. In all cases, the value of HF was decreased and/or the LF/HF increased significantly during the reconstruction of the vessels or bile ducts than during the removal of the liver. Thus, sympathetic nerve activity increased during hepatobiliary surgery compared with the level before the operation, and various procedures during the operations induced diverse changes in the autonomic nervous activities. The HRV analysis could assess the chronological changes of mental stress by measuring the autonomic nervous balances.

Co-Operation: The Antidote to Isolated Misery

ERIC Educational Resources Information Center

Jones, Sarah

2013-01-01

This is a case study demonstrating the impact the co-operative movement has had on one co-operative school in south-west England. Lipson Co-operative Academy in Plymouth was one of the first schools to convert to become a co-operative school in 2009. The article has been co-written by members of the Academy and focuses on three transformational…

The Use of Case Studies in OR Teaching

ERIC Educational Resources Information Center

Penn, Marion L.; Currie, Christine S. M.; Hoad, Kathryn A.; O'Brien, Frances A.

2016-01-01

This article investigates the current use of case studies in the teaching of Operational Research (OR) in the UK: how and where they are used; how they are developed; and whether there is an interest in training this area. It is aimed at lecturers teaching OR who are using or planning to use case studies in their teaching. It may also be of…

Palliative Surgery in Treating Painful Metastases of the Upper Cervical Spine

PubMed Central

Wu, Xinghuo; Ye, Zhewei; Pu, Feifei; Chen, Songfeng; Wang, Baichuan; Zhang, Zhicai; Yang, Cao; Yang, Shuhua; Shao, Zengwu

2016-01-01

Abstract Increased incidence of upper cervical metastases and higher life expectancy resulted in higher operative rates in patients. The purpose of this study was to explore the methods and the clinical outcomes of palliative surgery for cervical spinal metastases. A systematic review of a 15-case series of upper cervical metastases treated with palliative surgery was performed. All cases underwent palliative surgery, including anterior tumor resection and internal fixation in 3 cases, posterior tumor resection and internal fixation in 10 cases, and combined anterior and posterior tumor resection and internal fixation in 2 cases. Patients were followed-up clinically and radiologically after the operation, and visual analog scale (VAS) and activities of daily living scores were calculated. In addition, a literature review was performed and patients with upper cervical spine metastases were analyzed. The mean follow-up period was 12.5 months (range, 3–26 months) in this consecutive case series. The pain was substantially relieved in 93.3% (14/15) of the patients after the operation. The VAS and Japanese Orthopedic Association scores showed improved clinical outcomes, from 7.86 ± 1.72 and 11.13 ± 2.19 preoperatively to 2.13 ± 1.40 and 14.26 ± 3.03 postoperatively, respectively. The mean survival time was 9.5 months (range, 5–26 months). Dural tear occurred in 1 patient. Wound infections, instrumentation failure, and postoperative death were not observed. Among our cases and other cases reported in the literature, 72% of the patients were treated with simple anterior or posterior operation, and only 12% of the patients (3/25) underwent complex combined anterior and posterior operation. Metastatic upper cervical spine disease is not a rare occurrence. Balancing the perspective of patients on palliative surgery concerning the clinical benefits of operation versus its operative risks can assist the decision for surgery. PMID:27149472

Vascular Trauma Operative Experience is Inadequate in General Surgery Programs.

PubMed

Yan, Huan; Maximus, Steven; Koopmann, Matthew; Keeley, Jessica; Smith, Brian; Virgilio, Christian de; Kim, Dennis Y

2016-05-01

Vascular injuries may be challenging, particularly for surgeons who have not received formal vascular surgery fellowship training. Lack of experience and improper technique can result in significant complications. The objective of this study was to examine changes in resident experience with operative vascular trauma over time. A retrospective review was performed using Accreditation Council for Graduate Medical Education (ACGME) case logs of general surgery residents graduating between 2004 and 2014 at 2 academic, university-affiliated institutions associated with level 1 trauma centers. The primary outcome was number of reported vascular trauma operations, stratified by year of graduation and institution. A total of 112 residents graduated in the study period with a median 7 (interquartile range 4.5-13.5) vascular trauma cases per resident. Fasciotomy and exposure and/or repair of peripheral vessels constituted the bulk of the operative volume. Linear regression showed no significant trend in cases with respect to year of graduation (P = 0.266). Residents from program A (n = 53) reported a significantly higher number of vascular trauma cases when compared with program B (n = 59): 12.0 vs. 5.0 cases, respectively (P < 0.001). Level 1 trauma center verification does not guarantee sufficient exposure to vascular trauma. The operative exposure in program B is reflective of the national average of 4.0 cases per resident as reported by the ACGME, and this trend is unlikely to change in the near future. Fellowship training may be critical for surgeons who plan to work in a trauma setting, particularly in areas lacking vascular surgeons. Copyright © 2016 Elsevier Inc. All rights reserved.

e-Consultation Improves Efficacy in Thoracic Surgery Outpatient Clinics.

PubMed

Novoa, Nuria M; Gómez, Maria Teresa; Rodríguez, María; Jiménez López, Marcelo F; Aranda, Jose L; Bollo de Miguel, Elena; Diez, Florentino; Hernández Hernández, Jesús; Varela, Gonzalo

2016-11-01

The aim of this study is analysing the impact of the systematic versus occasional videoconferencing discussion of patients with two respiratory referral units along 6 years of time over the efficiency of the in-person outpatient clinics of a thoracic surgery service. Retrospective and comparative study of the evaluated patients through videoconferencing and in-person first visits during two equivalents periods of time: Group A (occasional discussion of cases) between 2008-2010 and Group B (weekly regular discussion) 2011-2013. Data were obtained from two prospective and electronic data bases. The number of cases discussed using e-consultation, in-person outpatient clinics evaluation and finally operated on under general anaesthesia in each period of time are presented. For efficiency criteria, the index: number of operated on cases/number of first visit outpatient clinic patients is created. Non-parametric Wilcoxon test is used for comparison. The mean number of patients evaluated at the outpatient clinics/year on group A was 563 versus 464 on group B. The median number of cases discussed using videoconferencing/year was 42 for group A versus 136 for group B. The mean number of operated cases/first visit at the outpatient clinics was 0.7 versus 0.87 in group B (P=.04). The systematic regular discussion of cases using videoconferencing has a positive impact on the efficacy of the outpatient clinics of a Thoracic Surgery Service measured in terms of operated cases/first outpatient clinics visit. Copyright © 2016 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

Case-control study of surgical site infections associated with pacemakers and implantable cardioverter-defibrillators.

PubMed

Marschall, Jonas; Hopkins-Broyles, Diane; Jones, Marilyn; Fraser, Victoria J; Warren, David K

2007-11-01

In 2000, the rate of surgical site infections (SSIs) associated with pacemaker and implantable cardioverter-defibrillator (ICD) procedures performed in the cardiothoracic operating rooms of hospital A was 16% (19 of 116 procedures resulted in infections). This study investigates risks for SSI associated with these procedures in the cardiothoracic operating room. Unmatched 1 : 3 case-control study performed over a 12-month period among patients who had undergone implantation of a pacemaker and/or ICD. A standardized observation scrutinized infection control practices in the area where the procedures were performed. The cardiothoracic operating rooms of hospital A, which belongs to a hospital consortium in the midwestern United States. Patients with SSI were identified as case patients. Control patients were chosen from the group of uninfected patients who had procedures performed during the same period as case patients. A total of 19 SSIs associated with pacemaker and ICD procedures were retrospectively identified among the patients who underwent procedures in these cardiothoracic operating rooms. Culture samples were obtained from 7 patients; 2 yielded coagulase-negative Staphylococcus on culture, 2 yielded Staphylococcus aureus, 1 yielded Serratia marcescens, and 2 showed no growth. In the case-control study, age, race, sex, diabetes mellitus, smoking history, timing of antibiotic therapy, and hair removal did not differ significantly between case patients and control patients. Case patients were more likely to have an abdominal device in place (odds ratio [OR], 5.5 [95% confidence interval {CI}, 1.6-19.3]; P=.006) and less likely to have received a new implant (OR 0.3 [95% CI, 0.1-0.8]; P=.02) or to have had new leads placed (OR, 0.2 [95% CI, 0.1-0.6]; P=.003). Abdominal placement of implanted devices was associated with occurrence of an SSI after pacemaker and/or ICD procedures.

Metropolitan transportation management center : a case study : COMPASS : effectively managing traffic and incidents

DOT National Transportation Integrated Search

1999-10-01

The following case study provides a snapshot of the Downsview, Ontario transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting ...

Generic health/safety/environment cases

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

Kelland, A.N.; Primrose, M.; Pickles, J.C.

1996-12-31

A desire to implement HSE Management Systems including HSE Cases in all Shell companies operations prompted the development of a relational data base software package (THESIS) to provide a structured way of preparing an HSE Case. The software includes features which facilitate the management of {open_quotes}Keeping the Case Alive{close_quotes}, enabling the dissemination of tasks and hazard information to the workplace. During the software development it was recognized that a significant reduction could be made in the resources which would be required to prepare an HSE Case for each and every operation by the building of {open_quotes}Generic HSE Cases{close_quotes} addressing specificmore » activities which were repeated across the Company`s operations. This was recognized to be particularly valid for the smaller Single String Venture type of operations. The activities selected for the initial Generic HSE Case development include Land Drilling Operations, Land Seismic Acquisition, and Land Transport. To establish the Generic HSE Case, the THESIS data base is populated with data for a generic operation, identifying all the hazards and activities associated with that operation including all the associated controls, with established formats for the textual sections. In effect, the Generic Case defines the standards required for that type of operation. To generate an operation specific HSE Case, the Generic Case thereafter requires to be modified/adapted so that it represents the actual situation in the operation which it defines. This process includes itemization of all the operation specific details, and may involve the inclusion/deletion of any additional/existing activities or hazards together with their associated controls.« less

Does cataract surgery alleviate poverty? Evidence from a multi-centre intervention study conducted in Kenya, the Philippines and Bangladesh.

PubMed

Kuper, Hannah; Polack, Sarah; Mathenge, Wanjiku; Eusebio, Cristina; Wadud, Zakia; Rashid, Mamunur; Foster, Allen

2010-11-09

Poverty and blindness are believed to be intimately linked, but empirical data supporting this purported relationship are sparse. The objective of this study is to assess whether there is a reduction in poverty after cataract surgery among visually impaired cases. A multi-centre intervention study was conducted in three countries (Kenya, Philippines, Bangladesh). Poverty data (household per capita expenditure--PCE, asset ownership and self-rated wealth) were collected from cases aged ≥50 years who were visually impaired due to cataract (visual acuity<6/24 in the better eye) and age-sex matched controls with normal vision. Cases were offered free/subsidised cataract surgery. Approximately one year later participants were re-interviewed about poverty. 466 cases and 436 controls were examined at both baseline and follow-up (Follow up rate: 78% for cases, 81% for controls), of which 263 cases had undergone cataract surgery ("operated cases"). At baseline, operated cases were poorer compared to controls in terms of PCE (Kenya: $22 versus £35 p = 0.02, Bangladesh: $16 vs $24 p = 0.004, Philippines: $24 vs 32 p = 0.0007), assets and self-rated wealth. By follow-up PCE had increased significantly among operated cases in each of the three settings to the level of controls (Kenya: $30 versus £36 p = 0.49, Bangladesh: $23 vs $23 p = 0.20, Philippines: $45 vs $36 p = 0.68). There were smaller increases in self-rated wealth and no changes in assets. Changes in PCE were apparent in different socio-demographic and ocular groups. The largest PCE increases were apparent among the cases that were poorest at baseline. This study showed that cataract surgery can contribute to poverty alleviation, particularly among the most vulnerable members of society. This study highlights the need for increased provision of cataract surgery to poor people and shows that a focus on blindness may help to alleviate poverty and achieve the Millennium Development Goals.

Study of VLCC tanker ship damage stability during off-shore operation

NASA Astrophysics Data System (ADS)

Hanzu-Pazara, R.; Arsenie, P.; Duse, A.; Varsami, C.

2016-08-01

Today, for the carriage of crude oil on sea are used larger tanker ships, especially from VLCC class. The operation of this type of ships requires in many cases special conditions, mainly related to water depth in the terminal area and enough maneuvering space for entrance and departure. Because, many ports from all over the world don't have capacity to operate this type of ships inside, in designed oil terminal, have chosen for development of outside terminals, off-shore oil terminals. In case of this type of terminals, the problems of water depth and manoeuvring space are fixed, but other kind of situations appears, regarding the safety in operation and environment factors impact on ship during mooring at oil transfer buoy. In the present paper we intend to show a study made using simulation techniques about VLCC class tanker ship in case of a damage condition resulted after a possible collision with another ship during loading operation at an off-shore terminal. From the beginning, we take in consideration that the ship intact stability, during all loading possible situations, has to be high enough, so that in case of some damage with flooding of different compartments due to hypothetical dimension water hole, the ship stability in the final stage of flooding to correspond to the requirements for damage stability and, also, to complementary requirements for damage ship stability.

Applying analysis tools in planning for operations : case study #4 -- application of microsimulation in combination with travel demand models

DOT National Transportation Integrated Search

2009-09-01

More and more, transportation system operators are seeing the benefits of strengthening links between planning and operations. A critical element in improving transportation decision-making and the effectiveness of transportation systems related to o...

Applying analysis tools in planning for operations : case study #2 -- incorporating Highway Capacity Manual procedures into long-range transportation planning

DOT National Transportation Integrated Search

2009-09-01

More and more, transportation system operators are seeing the benefi ts of strengthening links between : planning and operations. A critical element in improving transportation decision-making and the effectiveness : of transportation systems related...

The use of standard operating procedures in day case anterior cruciate ligament reconstruction.

PubMed

Khan, T; Jackson, W F; Beard, D J; Marfin, A; Ahmad, M; Spacie, R; Jones, R; Howes, S; Barker, K; Price, A J

2012-08-01

The current rate of day-case anterior cruciate ligament reconstruction (ACLR) in the UK remains low. Although specialised care pathways with standard operating procedures (SOPs) have been effective in reducing length of stay following some surgical procedures, this has not been previously reported for ACLR. We evaluate the effectiveness of SOPs for establishing day-case ACLR in a specialist unit. Fifty patients undergoing ACLR between May and September 2010 were studied prospectively ("study group"). SOPs were designed for pre-operative assessment, anaesthesia, surgical procedure, mobilisation and discharge. We evaluated length of stay, readmission rates, patient satisfaction and compliance to SOPs. A retrospective analysis of 50 patients who underwent ACLR prior to implementation of the day-case pathway was performed ("standard practice group"). Eighty percent of patients in the study group were discharged on the day of surgery (mean length of stay=5.3h) compared to 16% in the standard practice group (mean length of stay=21.6h). This difference was statistically significant (p<0.05, Mann-Whitney U test). All patients were satisfied with the day case pathway. Ninety-two percent of the study group were discharged on the day of surgery when all SOPs were followed and 46% where they were not. High rates of day-case ACLR with excellent patient satisfaction can be achieved with the use of a specialised patient pathway with SOPs. Copyright © 2011 Elsevier B.V. All rights reserved.

Transperineal ultrasound in the assessment of haemorrhoids and haemorrhoidectomy: a pilot study.

PubMed

Zbar, A P; Murison, R

2010-06-01

The purpose of the study was the measurement of the anal cushion area using static transperineal ultrasound in a group of patients with symptomatic grade III and IV haemorrhoids about to undergo haemorrhoidectomy and compare them with a group of age-matched normals and the measured area following haemorrhoidectomy. Transperineal sonography was performed using a linear transducer measuring the anal cushion area by subtracting the measured luminal diameter of the undisturbed anal canal from the inner border of the internal anal sphincter. Measures were made 6 weeks following haemorrhoidectomy. Comparisons were made between 22 normals and 36 patients with haemorrhoids (31 evaluable post-operatively). The median area of normals was 0.78 cm², that of pre-operative patients 2.25 cm² and that of post-operative cases 1.20 cm². There was a significant difference between pre- and post-operative cases with cushion areas of normal patients being significantly lower than post-operative cases. Variance of measurement in all 3 groups was negligible. Static transperineal sonography measuring the anal cushion area is reproducible and shows marked differences between normals and patients with symptomatic haemorrhoids. There is a marked effect on measured area resultant from haemorrhoidectomy.

Integrating Solar PV in Utility System Operations: Analytical Framework and Arizona Case Study

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

Wu, Jing; Botterud, Audun; Mills, Andrew

2015-06-01

A systematic framework is proposed to estimate the impact on operating costs due to uncertainty and variability in renewable resources. The framework quantifies the integration costs associated with subhourly variability and uncertainty as well as day-ahead forecasting errors in solar PV (photovoltaics) power. A case study illustrates how changes in system operations may affect these costs for a utility in the southwestern United States (Arizona Public Service Company). We conduct an extensive sensitivity analysis under different assumptions about balancing reserves, system flexibility, fuel prices, and forecasting errors. We find that high solar PV penetrations may lead to operational challenges, particularlymore » during low-load and high solar periods. Increased system flexibility is essential for minimizing integration costs and maintaining reliability. In a set of sensitivity cases where such flexibility is provided, in part, by flexible operations of nuclear power plants, the estimated integration costs vary between $1.0 and $4.4/MWh-PV for a PV penetration level of 17%. The integration costs are primarily due to higher needs for hour-ahead balancing reserves to address the increased sub-hourly variability and uncertainty in the PV resource. (C) 2015 Elsevier Ltd. All rights reserved.« less

[Comparative study on Chinese medical syndrome typing and treatment combined different surgical methods for treating clomiphene-resistant polycystic ovary syndrome].

PubMed

Zeng, Lei; Zeng, Cheng; Tao, Li-Li

2012-11-01

To observe the therapeutic efficacy of Chinese medical syndrome typing and treatment combined cold needle puncture drainage operation or unipolar electrocoagulation drilling technique under laparoscope for treating clomiphene-resistant polycystic ovary syndrome (PCOS). Forty infertility patients with clomiphene-resistant PCOS were assigned to two groups using stratified random sampling method according to age, infertility time, and body mass index, 20 in each group. Patients in Group A were treated with Chinese medical syndrome typing and treatment combined cold needle puncture drainage operation, while those in Group B were treated with Chinese medical syndrome typing and treatment combined unipolar electrocoagulation drilling technique. After operation Chinese herbal treatment was administered to all patients according to syndrome typing. The serum levels of luteinizing hormone (LH), follicle stimulating hormone (FSH), androgen (T), estradiol (E2), and prolactin (PRL) were determined before and after operation. The ovulation was monitored. The pregnancy rate and the pregnancy outcomes were recorded after operation. There was no statistical difference in the 3-month spontaneous ovulation rate or the 1-year pregnancy rate (P > 0.05). The levels of LH, T, and PRL were significantly lower after operation than before operation in the two groups (P < 0.05). The menstruation and ovulation were obviously improved after operation. The total ovulation rate was 95% (19/20) in Group A. Successful pregnancy occurred in 15 cases of Group A. Ovarian hyperstimulation syndrome (OHSS) occurred in 1 case of Group A. The total ovulation rate was 90% (18/20) in Group B. Successful pregnancy occurred in 13 cases of Group B. Hypovaria occurred in 1 case of Group B. Luteinized unruptured follicle (LUFS) occurred in 2 cases of Group A and 1 case of Group B. Chinese medical syndrome typing and treatment combined cold needle puncture drainage operation or unipolar electrocoagulation drilling technique could effectively promote the ovulation. The two methods showed similar therapeutic effects.

Shared-use bus priority lanes on city streets : case studies in design and management [research brief].

DOT National Transportation Integrated Search

2012-04-01

This study examines the design and operations of bus lanes in major congested urban centers. It focuses on shared-use bus lanes that operate in mixed traffic conditions. : Study Methods : The key questions addressed are: : 1. How do the many public a...

Learning curve for robotic-assisted surgery for rectal cancer: use of the cumulative sum method.

PubMed

Yamaguchi, Tomohiro; Kinugasa, Yusuke; Shiomi, Akio; Sato, Sumito; Yamakawa, Yushi; Kagawa, Hiroyasu; Tomioka, Hiroyuki; Mori, Keita

2015-07-01

Few data are available to assess the learning curve for robotic-assisted surgery for rectal cancer. The aim of the present study was to evaluate the learning curve for robotic-assisted surgery for rectal cancer by a surgeon at a single institute. From December 2011 to August 2013, a total of 80 consecutive patients who underwent robotic-assisted surgery for rectal cancer performed by the same surgeon were included in this study. The learning curve was analyzed using the cumulative sum method. This method was used for all 80 cases, taking into account operative time. Operative procedures included anterior resections in 6 patients, low anterior resections in 46 patients, intersphincteric resections in 22 patients, and abdominoperineal resections in 6 patients. Lateral lymph node dissection was performed in 28 patients. Median operative time was 280 min (range 135-683 min), and median blood loss was 17 mL (range 0-690 mL). No postoperative complications of Clavien-Dindo classification Grade III or IV were encountered. We arranged operative times and calculated cumulative sum values, allowing differentiation of three phases: phase I, Cases 1-25; phase II, Cases 26-50; and phase III, Cases 51-80. Our data suggested three phases of the learning curve in robotic-assisted surgery for rectal cancer. The first 25 cases formed the learning phase.

Interpolatability distinguishes LOCC from separable von Neumann measurements

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

Childs, Andrew M.; Leung, Debbie; Mančinska, Laura

2013-11-15

Local operations with classical communication (LOCC) and separable operations are two classes of quantum operations that play key roles in the study of quantum entanglement. Separable operations are strictly more powerful than LOCC, but no simple explanation of this phenomenon is known. We show that, in the case of von Neumann measurements, the ability to interpolate measurements is an operational principle that sets apart LOCC and separable operations.

A flash from the past: a case on long term follow-up of a "corridor" operation.

PubMed

Ricciardi, Danilo; Sarkozy, Andrea; Wauters, Kristel; Brugada, Pedro

2013-01-01

An electrophysiological study in a patient with a previous corridor operation was performed because of syncope. The atrial electrograms showed the persistence of the sinus rhythm in the right atrial corridor despite an organized atrial fibrillation in the left atrium. The first case described of a long term follow-up in a corridor operation, one of the first described surgical approach for the treatment of atrial fibrillation, that gave the beginning to the non-pharmacological approach of this arrhythmia. Copyright © 2013 Elsevier Inc. All rights reserved.

[Laparoscopic cholecystectomy. First year experience at the Salvador Zubirán National Institute of Nutrition].

PubMed

Orozco, H; Mercado, M A; Prado, E

1993-01-01

The results at our institution with laparoscopic cholecystectomy in its first year are informed. The patients included in this study were routinely evaluated for an open procedure. The operation was done with the standard technique and equipment. In the postoperative period, ultrasound was done. Seventy-eight patients were included, 63 of them females. Age averaged 49.5 years (range 20-77). In three cases, choledocholithiasis was also demonstrated; these patients were treated with transendoscopic sphincterotomy. In 74 cases only cholelithiasis was demonstrated, two of them with shrinked gallbladder. In one case adenomyosis was found. Sixty-five cases had associated diseases which did not preclude the operation. Six cases were converted to an open cholecystectomy: two because of bleeding, the two cases with shrinked gallbladders, one with intrahepatic gallbladder, and the last one because of a Mirizzi syndrome with bile duct injury. In all cases, the conversion resolved the indication including the Mirizzi syndrome that required biliary reconstruction. No operative mortality was recorded. wound infection four, wound hematoma one, subhepatic hematoma two, and bile duct injury one.

Two-tier Haddon matrix approach to fault analysis of accidents and cybernetic search for relationship to effect operational control: a case study at a large construction site.

PubMed

Mazumdar, Atmadeep; Sen, Krishna Nirmalya; Lahiri, Balendra Nath

2007-01-01

The Haddon matrix is a potential tool for recognizing hazards in any operating engineering system. This paper presents a case study of operational hazards at a large construction site. The fish bone structure helps to visualize and relate the chain of events, which led to the failure of the system. The two-tier Haddon matrix approach helps to analyze the problem and subsequently prescribes preventive steps. The cybernetic approach has been undertaken to establish the relationship among event variables and to identify the ones with most potential. Those event variables in this case study, based on the cybernetic concepts like control responsiveness and controllability salience, are (a) uncontrolled swing of sheet contributing to energy, (b) slippage of sheet from anchor, (c) restricted longitudinal and transverse swing or rotation about the suspension, (d) guilt or uncertainty of the crane driver, (e) safe working practices and environment.

A subleading operator basis and matching for gg → H

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

Moult, Ian; Stewart, Iain W.; Vita, Gherardo

The Soft Collinear Effective Theory (SCET) is a powerful framework for studying factorization of amplitudes and cross sections in QCD. While factorization at leading power has been well studied, much less is known at subleading powers in the λ << 1 expansion. In SCET subleading soft and collinear corrections to a hard scattering process are described by power suppressed operators, which must be fixed case by case, and by well established power suppressed Lagrangians, which correct the leading power dynamics of soft and collinear radiation. Here we present a complete basis of power suppressed operators for gg → H, classifyingmore » all operators which contribute to the cross section at O(λ 2), and showing how helicity selection rules significantly simplify the construction of the operator basis. We perform matching calculations to determine the tree level Wilson coefficients of our operators. These results are useful for studies of power corrections in both resummed and fixed order perturbation theory, and for understanding the factorization properties of gauge theory amplitudes and cross sections at subleading power. As one example, our basis of operators can be used to analytically compute power corrections for N -jettiness subtractions for gg induced color singlet production at the LHC.« less

A subleading operator basis and matching for gg → H

DOE PAGES

Moult, Ian; Stewart, Iain W.; Vita, Gherardo

2017-07-01

The Soft Collinear Effective Theory (SCET) is a powerful framework for studying factorization of amplitudes and cross sections in QCD. While factorization at leading power has been well studied, much less is known at subleading powers in the λ << 1 expansion. In SCET subleading soft and collinear corrections to a hard scattering process are described by power suppressed operators, which must be fixed case by case, and by well established power suppressed Lagrangians, which correct the leading power dynamics of soft and collinear radiation. Here we present a complete basis of power suppressed operators for gg → H, classifyingmore » all operators which contribute to the cross section at O(λ 2), and showing how helicity selection rules significantly simplify the construction of the operator basis. We perform matching calculations to determine the tree level Wilson coefficients of our operators. These results are useful for studies of power corrections in both resummed and fixed order perturbation theory, and for understanding the factorization properties of gauge theory amplitudes and cross sections at subleading power. As one example, our basis of operators can be used to analytically compute power corrections for N -jettiness subtractions for gg induced color singlet production at the LHC.« less

Using RFID Tagging in a Mining Industry Maintenance, Repair, and Operating (MRO) Supply Warehouse: A Case Study

ERIC Educational Resources Information Center

Smith, George D.

2008-01-01

The use of Radio Frequency Identification (RFID) technology has been shown to be successful by reducing operating costs in the retail and manufacturing industries, but has never been considered in the literature for a mining industry maintenance, repair, and operating (MRO) supply chain. This field study was conducted to determine whether or not…

Best Practices for Port Operations

EPA Pesticide Factsheets

This page provides links to best practice resources for port authorities, terminal operators and fleet owners, drayage truckers, and rail and locomotives as well as a link to case studies on best practice.

Rarity of late anastomotic leakage after low anterior resection of the rectum.

PubMed

Maeda, Hiromichi; Okamoto, Ken; Namikawa, Tsutomu; Akimori, Toyokazu; Kamioka, Norihito; Shiga, Mai; Dabanaka, Ken; Hanazaki, Kazuhiro; Kobayashi, Michiya

2015-06-01

Late anastomotic leakage is reported to account for half of all anastomotic leakages after low anterior resection of the rectum. An important clinical question is whether late and early anastomotic leakages are different entities. We retrospectively reviewed the medical records of patients who experienced anastomotic leakage after low anterior resection in two Japanese hospitals. The clinical characteristics were extracted and analyzed. During the study period, 179 patients underwent low anterior resection. A pelvic drainage tube was routinely utilized in all cases and was generally removed 4 to 6 days after the operation. Twenty-six patients had anastomotic leakage; the diagnosis was based on fecal contamination of the drainage in 24 cases. The median interval between operation and detection of anastomotic leakage was 3.5 days. Anastomotic leakage was diagnosed within 7 days of the operation in 25 cases and on postoperative day 20 (after hospital discharge) in one case. There was no instance of anastomotic leakage diagnosed more than 30 days after the operation. There was no relationship between clinical variables and days of leakage diagnosis. The rarity of late anastomotic leakage in our study, compared with previous studies, may relate to the relatively extended period of pelvic drainage tube usage in our institutes, which likely shortens the interval before leakage diagnosis. Our results suggest that late anastomotic leakage is a delayed symptom of subtle early anastomotic leakage rather than a separate entity.

Automated Transformation of CDISC ODM to OpenClinica.

PubMed

Gessner, Sophia; Storck, Michael; Hegselmann, Stefan; Dugas, Martin; Soto-Rey, Iñaki

2017-01-01

Due to the increasing use of electronic data capture systems for clinical research, the interest in saving resources by automatically generating and reusing case report forms in clinical studies is growing. OpenClinica, an open-source electronic data capture system enables the reuse of metadata in its own Excel import template, hampering the reuse of metadata defined in other standard formats. One of these standard formats is the Operational Data Model for metadata, administrative and clinical data in clinical studies. This work suggests a mapping from Operational Data Model to OpenClinica and describes the implementation of a converter to automatically generate OpenClinica conform case report forms based upon metadata in the Operational Data Model.

Toll facilities in the United States : bridges, roads, tunnels, ferries

DOT National Transportation Integrated Search

1994-06-01

Minnesota Guidestar's Travlink and Genesis operational tests were chosen by the FHWA to be the subjects of case studies. The case studies were performed under the Intelligent Vehicle Highway Systems Institutional and Legal Issues Program, which was d...

Metropolitan transportation management center : a case study : Long Island INFORM : identifying incidents and informing travelers

DOT National Transportation Integrated Search

1999-10-01

The following case study provides a snapshot of Long Island's INFORM transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting St...

EPA Hydraulic Fracturing Study Technical Workshop #2 March 10-11, 2011: Well Integrity Case Study by Lloyd H. Hetrick

EPA Pesticide Factsheets

This case study defines well integrity by the prevention of vertical migration of fluids to protect drinking water resources. A generic shale development well is presented, including design, construction, operational phase, and its plug and abandonment.

Subtotal colectomy in severe ulcerative and Crohn's colitis: what benefit does the laparoscopic approach confer?

PubMed

Messenger, David E; Mihailovic, Dana; MacRae, Helen M; O'Connor, Brenda I; Victor, J Charles; McLeod, Robin S

2014-12-01

Comparative outcome data for laparoscopic and open subtotal colectomy in IBD are lacking and often difficult to interpret owing to low case volumes, heterogeneity in case mix, and variation in laparoscopic technique. This study aimed to determine the safety of laparoscopic subtotal colectomy in severe colitis and to determine whether the laparoscopic approach improved short-term outcomes in comparison with the open approach. This was a retrospective cohort study using data from a prospectively maintained clinical database. This study was conducted at a single center, Mount Sinai Hospital, Toronto. All patients undergoing subtotal colectomy for either ulcerative or Crohn's colitis between 2000 and 2011 were included. A standardized operative technique was used for both laparoscopic and open subtotal colectomies. Cases performed by non-laparoscopic surgeons were excluded. Perioperative outcome measures were operative duration, estimated blood loss, total morphine requirement, and length of postoperative stay. Postoperative outcome measures were the rates of minor and major complications. Laparoscopic subtotal colectomies were performed in 131 of 290 cases (45.2%). Nine patients required conversion to an open procedure (6.9%). The uptake of laparoscopic subtotal colectomy increased from 10.2% in 2000/2001 to 71.7% in 2010/2011. Regression analysis with propensity-score adjustment for operative approach revealed that the operative duration was 25.5 minutes longer in laparoscopic cases (95% CI 12.3-38.6; p < 0.001), but that patients experienced fewer minor complications (OR 0.47; 95% CI 0.23-0.96; p = 0.04) and required less morphine (adjusted difference, -72.8 mg; 95% CI 4.9-141; p = 0.04). The inherent selection bias of this retrospective cohort study may not be accounted for by multivariate analysis with propensity-score adjustment. Laparoscopic subtotal colectomy is safe and may reduce the rate of minor postoperative complications. The increase in operative duration reflects the technical demands associated with this procedure (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A160).

Treatment of Chronic Breath-Holding in an Adult with Severe Mental Retardation: A Clinical Case Study

ERIC Educational Resources Information Center

Reed, Derek D.; Martens, Brian K.

2008-01-01

We describe a clinical case study surrounding the behavioral assessment and operant treatment of, an adult with severe mental retardation who engaged in chronic breath-holding. In this clinical case, previous neurological and medical testing had ruled out biological bases for the individual's breath-holding. A functional behavioral assessment…

Operant Conditioning and Education.

ERIC Educational Resources Information Center

de Noronha, Mario

A case study of a learning disabled 8-year-old with behavior disturbancs is presented to highlight the use of operant conditioning in cutting down educational costs and easing the teacher's class management problems. (CL)

What factors influence attending surgeon decisions about resident autonomy in the operating room?

PubMed

Williams, Reed G; George, Brian C; Meyerson, Shari L; Bohnen, Jordan D; Dunnington, Gary L; Schuller, Mary C; Torbeck, Laura; Mullen, John T; Auyang, Edward; Chipman, Jeffrey G; Choi, Jennifer; Choti, Michael; Endean, Eric; Foley, Eugene F; Mandell, Samuel; Meier, Andreas; Smink, Douglas S; Terhune, Kyla P; Wise, Paul; DaRosa, Debra; Soper, Nathaniel; Zwischenberger, Joseph B; Lillemoe, Keith D; Fryer, Jonathan P

2017-12-01

Educating residents in the operating room requires balancing patient safety, operating room efficiency demands, and resident learning needs. This study explores 4 factors that influence the amount of autonomy supervising surgeons afford to residents. We evaluated 7,297 operations performed by 487 general surgery residents and evaluated by 424 supervising surgeons from 14 training programs. The primary outcome measure was supervising surgeon autonomy granted to the resident during the operative procedure. Predictor variables included resident performance on that case, supervising surgeon history with granting autonomy, resident training level, and case difficulty. Resident performance was the strongest predictor of autonomy granted. Typical autonomy by supervising surgeon was the second most important predictor. Each additional factor led to a smaller but still significant improvement in ability to predict the supervising surgeon's autonomy decision. The 4 factors together accounted for 54% of decision variance (r = 0.74). Residents' operative performance in each case was the strongest predictor of how much autonomy was allowed in that case. Typical autonomy granted by the supervising surgeon, the second most important predictor, is unrelated to resident proficiency and warrants efforts to ensure that residents perform each procedure with many different supervisors. Copyright © 2017 Elsevier Inc. All rights reserved.

Shared-use bus priority lanes on city streets : case studies in design and management

DOT National Transportation Integrated Search

2012-04-01

This report examines the policies and strategies governing the design and, especially, operations of bus lanes in major congested urban centers. It focuses on bus lanes that operate in mixed traffic conditions; the study does not examine practices co...

Surgical residents' perception of competence and relevance of the clinical curriculum to future practice.

PubMed

Fronza, Jeffrey Scott; Prystowsky, Jay P; DaRosa, Debra; Fryer, Jonathan P

2012-01-01

General surgery residents maintain a case log throughout residency in order to achieve a targeted number of designated operations. Program directors must certify that each graduate is competent to enter general surgery practice without direct supervision. Our purpose was twofold, to determine: 1) graduates' perception of competence and relevance of specific operations to their practice; and 2) if case volume is related to competence. Six classes from a general surgery residency program (n=26) were surveyed one year after graduation. The survey was piloted and revised base on findings. It listed 67 operations encompassing all facets of general surgery. Each operation corresponded to two four-point scales (strongly agree to strongly disagree). One scale was headed with "I was well prepared to work-up, independently perform the operation, and effectively care for the patient post-operatively" and the other "This operation is relevant to my current practice profile". A linear regression analysis was utilized to study the relationship between total case volume and overall competence. An unpaired T-test was utilized to study the relationship between volume of specific operations and perceptions of competence. Twenty-two graduates completed the survey (85% response rate). All respondents felt prepared to perform 24% (16/67) of the operations. Fifty percent or more of respondents felt prepared to perform 91% (61/67) of the operations. Fifty percent or more did not feel competent performing the surgical treatment of necrotizing enterocolitis, orchiopexy, transhiatal esophagectomy, adrenalectomy, and open/endovascular abdominal aortic aneurysm repair. Twenty-six operations were felt to be irrelevant to the practice of 50% or more of graduates. No operation was unanimously felt to be relevant. For 12% of operations (8/67) at least 10% of graduates felt the operation was relevant to their practice but were not comfortable performing it. These operations (abdominoperineal resection, transanal excision of tumor, transhiatal esophagectomy, superficial inguinal lymph node dissection, right hepatectomy, whipple, colonoscopy, and adrenalectomy) were considered to be in need of educational improvement at a program level. After analyzing individual case logs, increased case volume only correlated with competence for esophagectomy (5 vs. 1 p = .014), EGD (32 vs. 9 p = .018), orchiopexy (2.5 vs. 0 p = .03), and adrenalectomy (3 vs. 1 p = .001). Total major operations performed did not correlate with overall competence (p = .12). As program directors must document graduates' competency they must do so with confidence. Our results suggest graduates to not feel competent performing many operations, and several are relevant to their practice. Competence in all aspects of general surgery may be unrealistic, even with robust volume. These findings might help in the restructuring curricula of residency. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Evaluating Coding Accuracy in General Surgery Residents' Accreditation Council for Graduate Medical Education Procedural Case Logs.

PubMed

Balla, Fadi; Garwe, Tabitha; Motghare, Prasenjeet; Stamile, Tessa; Kim, Jennifer; Mahnken, Heidi; Lees, Jason

The Accreditation Council for Graduate Medical Education (ACGME) case log captures resident operative experience based on Current Procedural Terminology (CPT) codes and is used to track operative experience during residency. With increasing emphasis on resident operative experiences, coding is more important than ever. It has been shown in other surgical specialties at similar institutions that the residents' ACGME case log may not accurately reflect their operative experience. What barriers may influence this remains unclear. As the only objective measure of resident operative experience, an accurate case log is paramount in representing one's operative experience. This study aims to determine the accuracy of procedural coding by general surgical residents at a single institution. Data were collected from 2 consecutive graduating classes of surgical residents' ACGME case logs from 2008 to 2014. A total of 5799 entries from 7 residents were collected. The CPT codes entered by residents were compared to departmental billing records submitted by the attending surgeon for each procedure. Assigned CPT codes by institutional American Academy of Professional Coders certified abstract coders were considered the "gold standard." A total of 4356 (75.12%) of 5799 entries were identified in billing records. Excel 2010 and SAS 9.3 were used for analysis. In the event of multiple codes for the same patient, any match between resident codes and billing record codes was considered a "correct" entry. A 4-question survey was distributed to all current general surgical residents at our institution for feedback on coding habits, limitations to accurate coding, and opinions on ACGME case log representation of their operative experience. All 7 residents had a low percentage of correctly entered CPT codes. The overall accuracy proportion for all residents was 52.82% (range: 43.32%-60.07%). Only 1 resident showed significant improvement in accuracy during his/her training (p = 0.0043). The survey response rate was 100%. Survey results indicated that inability to find the precise code within the ACGME search interface and unfamiliarity with available CPT codes were by far the most common perceived barriers to accuracy. Survey results also indicated that most residents (74%) believe that they code accurately most of the time and agree that their case log would accurately represent their operative experience (66.6%). This is the first study to evaluate correctness of residents' ACGME case logs in general surgery. The degree of inaccuracy found here necessitates further investigation into the etiology of these discrepancies. Instruction on coding practices should also benefit the residents after graduation. Optimizing communication among attendings and residents, improving ACGME coding search interface, and implementing consistent coding practices could improve accuracy giving a more realistic view of residents' operative experience. Published by Elsevier Inc.

Using Large-Scale Cooperative Control to Manage Operational Uncertainties for Aquifer Thermal Energy Storage

NASA Astrophysics Data System (ADS)

Jaxa-Rozen, M.; Rostampour, V.; Kwakkel, J. H.; Bloemendal, M.

2017-12-01

Seasonal Aquifer Thermal Energy Storage (ATES) technology can help reduce the demand of energy for heating and cooling in buildings, and has become a popular option for larger buildings in northern Europe. However, the larger-scale deployment of this technology has evidenced some issues of concern for policymakers; in particular, recent research shows that operational uncertainties contribute to inefficient outcomes under current planning methods for ATES. For instance, systems in the Netherlands typically use less than half of their permitted pumping volume on an annual basis. This overcapacity gives users more flexibility to operate their systems in response to the uncertainties which drive building energy demand; these include short-term operational factors such as weather and occupancy, and longer-term, deeply uncertain factors such as changes in climate and aquifer conditions over the lifespan of the buildings. However, as allocated subsurface volume remains unused, this situation limits the adoption of the technology in dense areas. Previous work using coupled agent-based/geohydrological simulation has shown that the cooperative operation of neighbouring ATES systems can support more efficient spatial planning, by dynamically managing thermal interactions in response to uncertain operating conditions. An idealized case study with centralized ATES control thus showed significant improvements in the energy savings which could obtained per unit of allocated subsurface volume, without degrading the recovery performance of systems. This work will extend this cooperative approach for a realistic case study of ATES planning in the city of Utrecht, in the Netherlands. This case was previously simulated under different scenarios for individual ATES operation. The poster will compare these results with a cooperative case under which neighbouring systems can coordinate their operation to manage interactions. Furthermore, a cooperative game-theoretical framework will be used to analyze the theoretical conditions under which cooperation between ATES operators could be assumed to be stable and beneficial, under a range of scenarios for climate trends and ATES adoption pathways.

On- and off-grid operation of hybrid renewable power plants: When are the economics favorable?

NASA Astrophysics Data System (ADS)

Petrakopoulou, F.; Santana, D.

2016-12-01

Hybrid renewable energy conversion systems offer a good alternative to conventional systems in locations where the extension of the electrical grid is difficult or not economical or where the cost of electricity is high. However, stand-alone operation implies net energy output restrictions (limited to exclusively serve the energy demand of a region), capacity oversizing and large storage facilities. In interconnected areas, on the other hand, the operational restrictions of the power stations change significantly and the efficiencies and costs of renewable technologies become more favorable. In this paper, the operation of three main renewable technologies (CSP, PV and wind) is studied assuming both hybrid and individual operation for both autonomous and inter-connected operation. The case study used is a Mediterranean island of ca. 3,000 inhabitants. Each system is optimized to fully cover the energy demand of the community. In addition, in the on-grid operation cases, it is required that the annual energy generated from the renewable sources is net positive (i.e., the island generates at least as much energy as it uses). It is found that when connected to the grid, hybridization of more than one technology is not required to satisfy the energy demand, as expected. Each of the renewable technologies investigated can satisfy the annual energy demand individually, without significant complications. In addition, the cost of electricity generated with the three studied technologies drops significantly for on-grid applications, when compared to off-grid operation. However, when compared to business-as-usual scenarios in both the on- and off-grid cases, both investigated hybrid and single-technology renewable scenarios are found to be economically viable. A sensitivity analysis reveals the limits of the acceptable costs that make the technologies favorable when compared to conventional alternatives.

Improving perioperative performance: the use of operations management and the electronic health record.

PubMed

Foglia, Robert P; Alder, Adam C; Ruiz, Gardito

2013-01-01

Perioperative services require the orchestration of multiple staff, space and equipment. Our aim was to identify whether the implementation of operations management and an electronic health record (EHR) improved perioperative performance. We compared 2006, pre operations management and EHR implementation, to 2010, post implementation. Operations management consisted of: communication to staff of perioperative vision and metrics, obtaining credible data and analysis, and the implementation of performance improvement processes. The EHR allows: identification of delays and the accountable service or person, collection and collation of data for analysis in multiple venues, including operational, financial, and quality. Metrics assessed included: operative cases, first case on time starts; reason for delay, and operating revenue. In 2006, 19,148 operations were performed (13,545 in the Main Operating Room (OR) area, and 5603, at satellite locations); first case on time starts were 12%; reasons for first case delay were not identifiable; and operating revenue was $115.8M overall, with $78.1M in the Main OR area. In 2010, cases increased to 25,856 (+35%); Main OR area increased to 13,986 (+3%); first case on time starts improved to 46%; operations outside the Main OR area increased to 11,870 (112%); case delays were ascribed to nurses 7%, anesthesiologists 22%, surgeons 33%, and other (patient, hospital) 38%. Five surgeons (7%) accounted for 29% of surgical delays and 4 anesthesiologists (8%) for 45% of anesthesiology delays; operating revenue increased to $177.3M (+53%) overall, and in the Main OR area rose to $101.5M (+30%). The use of operations management and EHR resulted in improved processes, credible data, promptly sharing the metrics, and pinpointing individual provider performance. Implementation of these strategies allowed us to shift cases between facilities, reallocate OR blocks, increase first case on time starts four fold and operative cases by 35%, and these changes were associated with a 53% increase in operating revenue. The fact that revenue increase was greater than case volume (53% vs. 35%) speaks for improved performance. Copyright © 2013 Elsevier Inc. All rights reserved.

The Military Assistance Command-Vietnam Studies and Observations Group-A Case Study in Special Operations Campaigning

DTIC Science & Technology

2016-06-10

viewed as the panacea for all military problems. Politicians view SOF as a low risk minimalist investment that produces results; even for problems...of published work that has been dedicated to discussing special operations theory as an element of military strategy. A good starting point to...utility. Doctrine As a starting point for framing understanding of special operations, Joint Publication (JP) 3-05 Special Operations, provides the basis

Bacterial and fungal endophthalmitis in upper Egypt: related species and risk factors.

PubMed

Gharamah, A A; Moharram, A M; Ismail, M A; Al-Hussaini, A K

2012-08-01

To study risk factors, contributing factors of bacterial and fungal endophthalmitis in Upper Egypt, test the isolated species sensitive to some therapeutic agents, and to investigate the air-borne bacteria and fungi in opthalmology operating rooms. Thirty one cases of endophthalmitis were clinically diagnosed and microbiologically studied. Indoor air-borne bacteria and fungi inside four air-conditioned operating rooms in the Ophthalmology Department at Assiut University Hospitals were also investigated. The isolated microbes from endophthalmitis cases were tested for their ability to produce some extracellular enzymes including protease, lipase, urease, phosphatase and catalase. Also the ability of 5 fungal isolates from endophthalmitis origin to produce mycotoxins and their sensitivity to some therapeutic agents were studied. Results showed that bacteria and fungi were responsihle for infection in 10 and 6 cases of endophthalmitis, respectively and only 2 cases produced a mixture of bacteria and fungi. Trauma was the most prevalent risk factor of endophthalmitis where 58.1% of the 31 cases were due to trauma. In ophthalmology operating rooms, different bacterial and fungal species were isolated. 8 bacterial and 5 fungal isolates showed their ability to produce enzymes while only 3 fungal isolates were able to produce mycotoxins. Terbinafine showed the highest effect against most isolates in vitro. The ability of bacterial and fungal isolates to produce extracellular enzymes and mycotoxins may be aid in the invasion and destruction of eye tissues. Microbial contamination of operating rooms with air-borne bacteria and fungi in the present work may be a source of postoperative endophthalmitis.

External rhinoplasty: a critical analysis of 500 cases.

PubMed

Foda, Hossam M T

2003-06-01

The study presents a comprehensive statistical analysis of a series of 500 consecutive rhinoplasties of which 380 (76 per cent) were primary and 120 (24 per cent) were secondary cases. All cases were operated upon using the external rhinoplasty technique; simultaneous septal surgery was performed in 350 (70 per cent) of the cases. Deformities of the upper two-thirds of the nose that occurred significantly more in the secondary cases included; dorsal saddling, dorsal irregularities, valve collapse, open roof and pollybeak deformities. In the lower third of the nose; secondary cases showed significantly higher incidences of depressed tip, tip over-rotation, tip asymmetry, retracted columella, and alar notching. Suturing techniques were used significantly more in primary cases, while in secondary cases grafting techniques were used significantly more. The complications encountered intra-operatively included; septal flap tears (2.8 per cent) and alar cartilage injury (1.8 per cent), while post-operative complications included; nasal trauma (one per cent), epistaxis (two per cent), infection (2.4 per cent), prolonged oedema (17 per cent), and nasal obstruction (0.8 per cent). The overall patient satisfaction rate was 95.6 per cent and the transcolumellar scar was found to be unacceptable in only 0.8 per cent of the patients.

An Integrated Planning Representation Using Macros, Abstractions, and Cases

NASA Technical Reports Server (NTRS)

Baltes, Jacky; MacDonald, Bruce

1992-01-01

Planning will be an essential part of future autonomous robots and integrated intelligent systems. This paper focuses on learning problem solving knowledge in planning systems. The system is based on a common representation for macros, abstractions, and cases. Therefore, it is able to exploit both classical and case based techniques. The general operators in a successful plan derivation would be assessed for their potential usefulness, and some stored. The feasibility of this approach was studied through the implementation of a learning system for abstraction. New macros are motivated by trying to improve the operatorset. One heuristic used to improve the operator set is generating operators with more general preconditions than existing ones. This heuristic leads naturally to abstraction hierarchies. This investigation showed promising results on the towers of Hanoi problem. The paper concludes by describing methods for learning other problem solving knowledge. This knowledge can be represented by allowing operators at different levels of abstraction in a refinement.

[Anatomicopathological relation between facial nerve and large vestibular Schwannoma].

PubMed

Jiang, T; Yu, C; Guo, E; Guan, S; Yan, C

2001-05-10

To study the anatomicopathological relation between facial nerve and large vestibular schwannoma. Operation by suboccipital retrosigmoid sinus approach was performed on 40 cases with large vestibular schwannoma, During the operation, the anatomicopathological relation between the facial nerve and the vestibular schwannoma was observed directly. The facial nerve was found to be located ventrally (deep under the tumor), dorsally (over the tumor), at the upper pole of the tumor (near the tentorium cerebelli), at the lower pole of the tumor (near the rear group cranial nerves), or aberrant (unable to be identified because of infiltration of tumor). In 31 cases, mainly with parenchymatous tumor, the facial nerve was flat in shape. In 9 cases, mainly with cystic tumor, the facial nerve was bandlike. The facial nerve varies greatly in neuroanatomy among patients with large vestibular schwannoma. Strengthening of operative monitoring can increase the safety of operation.

Metropolitan transportation management center : a case study : Milwaukee MONITOR : addressing congestion while improving safety and air quality

DOT National Transportation Integrated Search

1999-10-01

The following case study provides a snapshot of Milwaukee's MONITOR transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting Stu...

Metropolitan Transportation Management Center : a case study : Houston TranStar maximizing safety and mobility for the public

DOT National Transportation Integrated Search

1999-10-01

The following case study provides a snapshot of Houston's TranStar transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting Stud...

Metropolitan transportation management center : a case study : Arizona Trailmaster : providing a safe and efficient travel environment for users

DOT National Transportation Integrated Search

1999-10-01

The following case study provides a snapshot of Arizona's TrailMaster statewide transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross...

Case Studies in Library Computer Systems.

ERIC Educational Resources Information Center

Palmer, Richard Phillips

Twenty descriptive case studies of computer applications in a variety of libraries are presented in this book. Computerized circulation, serial and acquisition systems in public, high school, college, university and business libraries are included. Each of the studies discusses: 1) the environment in which the system operates, 2) the objectives of…

Study on casing treatment and stator matching on multistage fan

NASA Astrophysics Data System (ADS)

Wu, Chuangliang; Yuan, Wei; Deng, Zhe

2017-10-01

Casing treatments are required for expanding the stall margin of multi-stage high-load turbofans designed with high blade-tip Mach numbers and high leakage flow. In the case of a low mass flow, the casing treatment effectively reduces the blockages caused by the leakage flow and enlarges the stall margin. However, in the case of a high mass flow, the casing treatment affects the overall flow capacity of the fan, the thrust when operating at the high speeds usually required by design-point specifications. Herein, we study a two-stage high-load fan with three-dimensional numerical simulations. We use the simulation results to propose a scheme that enlarges the stall margin of multistage high-load fans without sacrificing the flow capacity when operating with a large mass flow. Furthermore, a circumferential groove casing treatment is used and adjustments are made to the upstream stator angle to match the casing treatment. The stall margin is thus increased to 16.3%, with no reduction in the maximum mass flow rate or the design thrust performance.

Evaluation of the rate of decompression in anterior cervical corpectomy using an intra-operative computerized tomography scan (O-Arm system).

PubMed

Costa, Francesco; Tomei, Massimo; Sassi, Marco; Cardia, Andrea; Ortolina, Alessandro; Servello, Domenico; Fornari, Maurizio

2012-02-01

The purpose of this study was to evaluate the efficacy of intra-operative computerized tomography (CT) scanning in the analysis of bone removal accuracy during anterior cervical corpectomy, in order to allow any necessary immediate correction in the event of inadequate bone removal. From September 2009 to December 2010 we performed an intra-operative (CT) scan using the O-Arm(™) Image system to assess the rate of central and lateral decompression in all patients treated for cervical spondylotic myelopathy by anterior cervical corpectomy and fusion. Out of a population of 187 patients admitted to our department, with a diagnosis of myelopathy due to spondylotic degenerative cervical stenosis, 15 patients underwent a surgical treatment with anterior cervical corpectomy and fusion. There were nine males (60%) and six females (40%); the mean age was 52.4 years, ranging from 41 to 57 years. The pre-operative radiologic investigations (MRI and CT scans) revealed in the nine patients (60%) the extent of the compression to one vertebral body (C4 one case, C5 four cases, C6 four cases), while in the six cases (40%) the compression regarded two vertebral body (C3 and C4 one case, C4 and C5 two cases, C5 and C6 three cases). During surgery, when the decompression was judged completely, a CT scan was performed: in 11 cases (73.3%) the decompression was considered adequate, while in four cases (26.7%) it was deemed insufficient and the surgical strategy was changed in order to optimize the bone removal. In these cases an additional scan was taken to prove the efficacy of decompression, achieved in all patients. Intra-operative CT scan performed during cervical corpectomy is a really useful tool in helping to ensure complete bone removal and the adequacy of surgery. The O-arm(™) Image system grants optimal image quality, allowing correctly assessing the rate of decompression and, in any case of doubt, allows an intra-operative evaluation of the final correct positioning of the graft.

The Marketing Firm: Operant Interpretation of Corporate Behavior

ERIC Educational Resources Information Center

Vella, Kevin J.; Foxall, Gordon R.

2013-01-01

In this article we address the issue of applying operant psychology to derive plausible and useful interpretations of complex firm behavior in natural settings. The objective is to discuss an appropriate methodology based on case study design, developed specifically in Vella and Foxall (2011), to produce an operant interpretation of secondary…

Center for the Built Environment: Research on Building Envelope Systems

Science.gov Websites

Studies Facade and Perimeter Zone Field Study Facades and Thermal Comfort Facade Symposium Mixed-Mode Research Adaptive Comfort Model Mixed-Mode Case Studies Operable Windows and Thermal Comfort Occupant thermal preferences in naturally ventilated as sealed buildings? Case Study Research of Mixed-Mode Office

Day to Day Operations of Home School Families: Selecting from a Menu of Educational Choices to Meet Students' Individual Instructional Needs

ERIC Educational Resources Information Center

Anthony, Kenneth V.; Burroughs, Susie

2012-01-01

This study examined the day to day operations of home schools. The case study method was used with four families from a larger pool of families that held membership in a home school organization. Data was gathered using interviews, observations, and artifacts. Findings suggest that these families operated their home schools using traditional…

A flowsheet model of a well-mixed fluidized bed dryer: Applications in controllability assessment and optimization

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

Langrish, T.A.G.; Harvey, A.C.

2000-01-01

A model of a well-mixed fluidized-bed dryer within a process flowsheeting package (SPEEDUP{trademark}) has been developed and applied to a parameter sensitivity study, a steady-state controllability analysis and an optimization study. This approach is more general and would be more easily applied to a complex flowsheet than one which relied on stand-alone dryer modeling packages. The simulation has shown that industrial data may be fitted to the model outputs with sensible values of unknown parameters. For this case study, the parameter sensitivity study has found that the heat loss from the dryer and the critical moisture content of the materialmore » have the greatest impact on the dryer operation at the current operating point. An optimization study has demonstrated the dominant effect of the heat loss from the dryer on the current operating cost and the current operating conditions, and substantial cost savings (around 50%) could be achieved with a well-insulated and airtight dryer, for the specific case studied here.« less

The Impact of a new Surgery Residency Program on Case Volume and Case Complexity in a Sub Saharan African Hospital

PubMed Central

Kendig, Claire; Tyson, Anna; Young, Sven; Mabedi, Charles; Cairns, Bruce; Charles, Anthony

2014-01-01

Background Improved access to surgical care could prevent a significant burden of disease and disability-adjusted life years (DALYs), and workforce shortages are the biggest obstacle to surgical care. To address this shortage, a 5-year surgical residency program was established at Kamuzu Central Hospital (KCH) in July 2009. As the residency enters its fourth year, we hypothesized that the initiation of a general surgical residency program would result in an increase in the overall case volume and complexity at KCH. Methods We conducted a retrospective analysis of operated cases at KCH during the three years prior to and the third year after the implementation of the KCH- Surgical residency program, from July 2006 to July 2009, and the calendar year 2012, respectively. Results During the three years prior to the initiation of the surgical residency, an average of 2317 operations were performed per year, while in 2012, 2773 operations were performed, representing a 20% increase. Pre-residency, an average of 1191 major operations per year were performed, and in 2012, 1501 major operations were performed, representing a 26% increase. Conclusion Our study demonstrates that operative case volume and complexity increases following the initiation of a surgical residency program in a sub Saharan tertiary hospital. We believe that by building on established partnerships and emphasizing education, research, and clinical care, we can start to tackle the issues of surgical access and care. PMID:25456410

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.

[Clinical study of induced abortion of early-early pregnancy: an analysis of 10, 404 cases].

PubMed

Kang, Jian; Wang, Xue-fen; Zhang, Li; Liu, Jian-hua

2012-01-03

To evaluate the advantages and disadvantages of early-early pregnancy induced abortion (EPIA). A total of 10 404 cases of EPIA performed at our hospital from January 1993 to December 2003 were retrospectively analyzed and compared with 9434 cases of common induced abortion (CIA). The amount of hemorrhage and operative duration, degree of pain, rate of induced-abortion syndrome, rate of incomplete abortion, menstrual changes and post-operative onset of Asherman's syndrome were observed and compared between 2 groups. The average age, ratio of parous cases, ratio of the cases of first-pregnancy induced abortion were not different between 2 groups (P > 0.05). The amount of hemorrhage bleeding ((4.9 ± 3.2) ml), operative duration ((90.3 ± 12.4) s), degree of pain, rate of induced-abortion syndrome, menstrual changes and the rate of Asherman's syndrome in the EPIA group were all significantly less than those in the CIA group (P < 0.05). However, the rate of incomplete abortion (0.44%) in the EPIA group was significantly higher than that (0.21%) in the CIA group (P < 0.05). EPIA has the advantages of lesser hemorrhage, less pain, shorter operative duration and fewer complications over CIA. Therefore the recovery of EPIA cases is earlier than that of CIA cases. While the risk of incomplete abortion stays high.

The Current State of Sensing, Health Management, and Control for Small-To-Medium-Sized Manufacturers

PubMed Central

Helu, Moneer; Weiss, Brian

2017-01-01

The development of digital technologies for manufacturing has been challenged by the difficulty of navigating the breadth of new technologies available to industry. This difficulty is compounded by technologies developed without a good understanding of the capabilities and limitations of the manufacturing environment, especially within small-to-medium enterprises (SMEs). This paper describes industrial case studies conducted to identify the needs, priorities, and constraints of manufacturing SMEs in the areas of performance measurement, condition monitoring, diagnosis, and prognosis. These case studies focused on contract and original equipment manufacturers with less than 500 employees from several industrial sectors. Solution and equipment providers and National Institute of Standards and Technology (NIST) Hollings Manufacturing Extension Partnership (MEP) centers were also included. Each case study involved discussions with key shop-floor personnel as well as site visits with some participants. The case studies highlight SME's strong need for access to appropriate data to better understand and plan manufacturing operations. They also help define industrially-relevant use cases in several areas of manufacturing operations, including scheduling support, maintenance planning, resource budgeting, and workforce augmentation. PMID:28736773

Effect of Resident Involvement on Operative Time and Operating Room Staffing Costs.

PubMed

Allen, Robert William; Pruitt, Mark; Taaffe, Kevin M

The operating room (OR) is a major driver of hospital costs; therefore, operative time is an expensive resource. The training of surgical residents must include time spent in the OR, but that experience comes with a cost to the surgeon and hospital. The objective of this article is to determine the effect of surgical resident involvement in the OR on operative time and subsequent hospital labor costs. The Kruskal-Wallis statistical test is used to determine whether or not there is a difference in operative times between 2 groups of cases (with residents and without residents). This difference leads to an increased cost in associated hospital labor costs for the group with the longer operative time. Cases were performed at Greenville Memorial Hospital. Greenville Memorial Hospital is part of the larger healthcare system, Greenville Health System, located in Greenville, SC and is a level 1 trauma center with up to 33 staffed ORs. A total of 84,997 cases were performed at the partnering hospital between January 1st, 2011 and July 31st, 2015. Cases were only chosen for analysis if there was only one CPT code associated with the case and there were more than 5 observations for each group being studied. This article presents a comprehensive retrospective analysis of 29,134 cases covering 246 procedures. The analysis shows that 45 procedures took significantly longer with a resident present in the room. The average increase in operative time was 4.8 minutes and the cost per minute of extra operative time was determined to be $9.57 per minute. OR labor costs at the partnering hospital was found to be $2,257,433, or $492,889 per year. Knowing the affect on operative time and OR costs allows managers to make smart decisions when considering alternative educational and training techniques. In addition, knowing the connection between residents in the room and surgical duration could help provide better estimates of surgical time in the future and increase the predictability of procedure duration. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

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

Evaluating the Learning Curve for Percutaneous Nephrolithotomy under Total Ultrasound Guidance.

PubMed

Song, Yan; Ma, YaNan; Song, YongSheng; Fei, Xiang

2015-01-01

To investigate the learning curve of percutaneous nephrolithotomy under total ultrasound guidance. One hundred and twenty consecutive PCNL operations under total ultrasound guidance performed by a novice surgeon in a tertiary referral center were studied. Operations were analyzed in cohorts of 15 to determine when a plateau was reached for the variables such as operation duration, ultrasound screening time, tract dilation time, stone-free rate and complication rate. Comparison was made with the results of a surgeon who had performed more than 1000 PCNLs. Fluoroscopy was not used at all during procedure. The mean operation time dropped from 82.5 min for the first 15 patients to a mean of 64.7 min for cases 46 through 60(P = 0.047). The ultrasound screening time was a peak of 6.4 min in the first 15 cases, whereas it dropped to a mean of 3.9 min for cases 46 through 60(P = 0.01). The tract dilation time dropped from 4.9 min for the first 15 patients to a mean of 3.8 min for cases 46 through 60(P = 0.036). The senior surgeon had a mean operating time, screening time and tract dilation time equivalent to those of the novice surgeon after 60 cases. There was no significant difference in stone free rate and complication rate. The competence of ultrasound guided PCNL is reached after 60 cases with good stone free rate and without major complications.

Defining Special-Use Lanes: Case Studies and Guidelines

DOT National Transportation Integrated Search

2000-10-01

This research assesses the feasibility of high-occupancy vehicle (HOV)and high-occupancy vehicle/toll (HOT) facilities. In this report, current operational facilities are described and guidelines for the operation, design, agency involvement, and mon...

Instructional Developer as Content Specialist: Three Case Studies Utilizing the Instructional Development-Operations Research Model.

ERIC Educational Resources Information Center

Faust, Stephen M.

1980-01-01

Presents a 3-phase model (content research, specification, delivery) for instructional development-operations research and describes its application in developing courses in zoology, geology, and paleontology. (MER)

International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres.

PubMed

van Lent, Wineke A M; de Beer, Relinde D; van Harten, Wim H

2010-08-31

Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC), three chemotherapy day units (CDU) were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations.Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found. The improved benchmarking process and the success factors can produce relevant input to improve the operations management of specialty hospitals.

International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres

PubMed Central

2010-01-01

Background Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Methods Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC), three chemotherapy day units (CDU) were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. Results We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations. Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found. Conclusions The improved benchmarking process and the success factors can produce relevant input to improve the operations management of specialty hospitals. PMID:20807408

Systems Engineering Case Studies: Synopsis of the Learning Principles

DTIC Science & Technology

2010-05-17

Engineering Case Study HST refers to the Hubble Space Telescope Systems Engineering Case Study TBMCS refers to the Theater Battle Management Core System...going to orbit undetected in spite of substantial evidence that could have been used to prevent this occurrence. TBMCS /1 Requirements Definition...baseline was volatile up to system acceptance, which took place after TBMCS passed operational test and evaluation. TBMCS /2 System Architecture The

A Case Study of Information Resource Management in the Department of Defense

DTIC Science & Technology

1992-03-01

prepared to make effective decisions in a military environment. The justification for the use of information technology (IT) in support of operations...t ement No PfICt NO [ask No r 11 TITLE (Include Security Classification) A Case Study ofinformation Resourcc Management in the Departnentufl)clelse...block number) FIELD GROUP SUBGROUP Case study,Corporate Information Management, CIM. Information Hesource Munagenitnt IRM 19 ABSTRACT (continue on

Metropolitan transportation management center : a case study : Georgia NaviGAtor : accurate and timely information to navigate Georgia roads

DOT National Transportation Integrated Search

1999-10-01

The following case study provides a snapshot of Atlanta's NaviGAtor transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting Stu...

[Case allocation of extensive operations on head and neck within the German DRG system 2004-2007: what is the net result of the continued developments in case allocation?].

PubMed

Franz, D; Franz, K; Roeder, N; Hörmann, K; Fischer, R-J; Alberty, Jürgen

2007-07-01

When the German DRG system was implemented there was some doubt about whether patients with extensive head and neck surgery would be properly accounted for. Significant efforts have therefore been invested in analysis and case allocation of those in this group. The object of this study was to investigate whether the changes within the German DRG system have led to improved case allocation. Cost data received from 25 ENT departments on 518 prospective documented cases of extensive head and neck surgery were compared with data from the German institute dealing with remuneration in hospitals (InEK). Statistical measures used by InEK were used to analyse the quality of the overall system and the homogeneity of the individual case groups. The reduction of variance of inlier costs improved by about 107.3% from the 2004 version to the 2007 version of the German DRG system. The average coefficient of cost homogeneity rose by about 9.7% in the same period. Case mix index and DRG revenues were redistributed from less extensive to the more complex operations. Hospitals with large numbers of extensive operations and university hospitals will gain most benefit from this development. Appropriate case allocation of extensive operations on the head and neck has been improved by the continued development of the German DRG system culminating in the 2007 version. Further adjustments will be needed in the future.

Schrödinger Operator with Non-Zero Accumulation Points of Complex Eigenvalues

NASA Astrophysics Data System (ADS)

Bögli, Sabine

2017-06-01

We study Schrödinger operators {H=-Δ + V} in {L2(Ω)} where {Ω} is R^d or the half-space R+d, subject to (real) Robin boundary conditions in the latter case. For {p > d} we construct a non-real potential {V \\in Lp(Ω) \\cap L^{∞}(Ω)} that decays at infinity so that H has infinitely many non-real eigenvalues accumulating at every point of the essential spectrum {σ_ess(H)=[0,∞)}. This demonstrates that the Lieb-Thirring inequalities for selfadjoint Schrödinger operators are no longer true in the non-selfadjoint case.

Vending Reimbursable Lunches to High School Students: A Study of Two Successes

ERIC Educational Resources Information Center

Carr, Deborah H.; Cross, Evelina W.

2008-01-01

Objectives: The objectives were to investigate the operational requirements for offering healthful vended reimbursable lunches to students and to identify barriers to implementation. Methods: A descriptive case study method was utilized to explore the operations of two school nutrition programs offering vended reimbursable lunches. Two school…

[Use of four kinds of three-dimensional printing guide plate in bone tumor resection and reconstruction operation].

PubMed

Fu, Jun; Guo, Zheng; Wang, Zhen; Li, Xiangdong; Fan, Hongbin; Li, Jing; Pei, Yanjun; Pei, Guoxian; Li, Dan

2014-03-01

To explore the effectiveness of excision and reconstruction of bone tumor by using operation guide plate made by variety of three-dimensional (3-D) printing techniques, and to compare the advantages and disadvantages of different 3-D printing techniques in the manufacture and application of operation guide plate. Between September 2012 and January 2014, 31 patients with bone tumor underwent excision and reconstruction of bone tumor by using operation guide plate. There were 19 males and 12 females, aged 6-67 years (median, 23 years). The disease duration ranged from 15 days to 12 months (median, 2 months). There were 13 cases of malignant tumor and 18 cases of benign tumor. The tumor located in the femur (9 cases), the spine (7 cases), the tibia (6 cases), the pelvis (5 cases), the humerus (3 cases), and the fibula (1 case). Four kinds of 3-D printing technique were used in processing operation guide plate: fused deposition modeling (FDM) in 9 cases, stereo lithography appearance (SLA) in 14 cases, 3-D printing technique in 5 cases, and selective laser sintering (SLS) in 3 cases; the materials included ABS resin, photosensitive resin, plaster, and aluminum alloy, respectively. Before operation, all patients underwent thin layer CT scanning (0.625 mm) in addition to conventional imaging. The data were collected for tumor resection design, and operation guide plate was designed on the basis of excision plan. Preoperatively, the operation guide plates were made by 3-D printing equipment. After sterilization, the guide plates were used for excision and reconstruction of bone tumor. The time of plates processing cycle was recorded to analyse the efficiency of 4 kinds of 3-D printing techniques. The time for design and operation and intraoperative fluoroscopy frequency were recorded. Twenty-eight patients underwent similar operations during the same period as the control group. The processing time of operation guide plate was (19.3 +/- 6.5) hours in FDM, (5.2 +/- 1.3) hours in SLA, (8.6 +/- 1.9) hours in 3-D printing technique, and (51.7 +/- 12.9) hours in SLS. The preoperative design and operation guide plate were successfully made, which was used for excision and reconstruction of bone tumor in 31 cases. Except 3 failures (operation guide plate fracture), the resection and reconstruction operations followed the preoperative design in the other 28 cases. The patients had longer design time, shorter operation time, and less fluoroscopy frequency than the patients of the control group, showing significant differences (P < 0.05). The follow-up time was 1-12 months (mean, 3.7 months). Postoperative X-ray and CT showed complete tumor resection and stable reconstruction. 3-D printing operation guide plates are well adapted to the requirements of individual operation for bone tumor resection and reconstruction. The 4 kinds of 3-D printing techniques have their own advantages and should be chosen according to the need of operation.

Late post-operative recurrent osteosarcoma: Three case reports with a review of the literature

PubMed Central

YU, XIUCHUN; WU, SUJIA; WANG, XUQUAN; XU, MING; XU, SONGFENG; YUAN, YE

2013-01-01

The aim of the present study was to investigate the clinical characteristics and treatment of late recurrent osteosarcoma following surgery. The cases of three patients with late recurrent osteosarcoma, who were treated at the General Hospital of Jinan Military Command, General Hospital of Nanjing Military Command and Xinan Hospital of The Third Military Medical University, were analyzed retrospectively. Furthermore, 10 cases of late recurrent osteosarcoma were retrieved from the literature. In total, eight male and five female cases were selected for the present study. The mean age at recurrence was 25.56 years (range, 13–42 years). The locations of the osteosarcomas were as follows: five cases in the distal femur, two cases in the distal tibia and acetabulum, respectively, and one case in the proximal tibia (the remaining cases were not described). The tumors were histologically classified into three cases of fibroblastic, two cases of traditional-type; two cases of mixed-type and one case each of osteoblastic-, chondroblastic- and telangiectasia-type osteosarcoma (the remaining cases were not described). The mean recurrence time following surgery was 10.02 years (range, 5.2–19.3 years). With regard to the treatment modalities, five patients accepted surgery and chemotherapy, one patient accepted surgery and radiotherapy, two patients accepted surgery alone and one patient did not complete the treatment (the remaining cases were not described). From the 12 cases that were followed-up for between 0.5 and 4.7 years (mean, 2.28 years), one case was lost to follow-up, six patients survived (up to 4.5 years) and six patients succumbed to their condition (0.6–4.7 years). The present study highlights the fact that more focus should be placed upon the long-term follow-up of patients with osteosarcoma. A follow-up is required once every six months, from five years after the diagnosis. The abnormal changes in the surgical site should also receive further attention, in addition to the pulmonary and systemic metastases. Following a diagnosis of late post-operative recurrence, surgery and post-operative chemotherapy are commonly used in clinical treatment, however, the clinical outcome of osteosarcoma requires further observation. PMID:23946772

Endoscope-assisted approach to excision of branchial cleft cysts.

PubMed

Teng, Stephanie E; Paul, Benjamin C; Brumm, John D; Fritz, Mark; Fang, Yixin; Myssiorek, David

2016-06-01

The purpose of this study is to describe an endoscope-assisted surgical technique for the excision of branchial cleft cysts and compare it to the standard approach. Retrospective case series review. Twenty-seven cases described as branchial cleft excisions performed by a single surgeon at one academic medical center were identified between 2007 and 2014. Twenty-five cases (8 endoscopic, 17 standard approach) were included in the study. Cases were excluded if final pathology was malignant. Patient charts were reviewed, and two techniques were compared through analysis of incision size, operative time, and surgical outcomes. This study showed that the length of incision required for the endoscopic approach (mean = 2.13 ± 0.23) was significantly less than that of the standard approach (mean = 4.10 ± 1.46, P = 0.008) despite the fact that there was no significant difference in cyst size between the two groups (P = 0.09). The other variables examined, including operative time and surgical outcomes, were not significantly different between the two groups. This transcervical endoscope-assisted approach to branchial cleft cyst excision is a viable option for uncomplicated cases. It provides better cosmetic results than the standard approach and does not negatively affect outcomes, increase operative time, or result in recurrence. 4. Laryngoscope, 126:1339-1342, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Incidence of Negative Appendectomy: Experience From a Company Hospital in Nigeria

PubMed Central

Osime, OC; Ajayi, PA

2005-01-01

Objective: The aim of this study was to determine the rate of negative appendectomy in a company hospital in Nigeria. Background: Appendicitis is one of the most common abdominal conditions requiring surgical intervention. Appendectomy, like most surgical procedures, has its complications and therefore should only be undertaken when indicated. Case series have reported the incidence of negative appendectomy in Western nations. The purpose of this retrospective study is to evaluate the incidence of negative appendectomy in a Nigerian hospital, where all the operations were carried out by consultant surgeons. Methods: All case files of patients who received an appendectomy at Chevron Hospital in Warri, Nigeria between January, 1999 and December, 2003 were reviewed. Demographic data, symptoms and signs on presentation, intra-operative findings and histological reports on the excised vermiform appendixes were extracted from the case files and analyzed. Results: The incidence of negative appendectomy in this study was 16.1%; all nine patients that had negative appendectomy were female. Conclusion: The incidence of negative appendectomy observed at Chevron Hospital in Warri, Nigeria is lower than that reported by most studies; one factor may be that all the patients in the present study were evaluated and operated on by consultant surgeons. PMID:20847869

At most hospitals in the state of Iowa, most surgeons' daily lists of elective cases include only 1 or 2 cases: Individual surgeons' percentage operating room utilization is a consistently unreliable metric.

PubMed

Dexter, Franklin; Jarvie, Craig; Epstein, Richard H

2017-11-01

Percentage utilization of operating room (OR) time is not an appropriate endpoint for planning additional OR time for surgeons with high caseloads, and cannot be measured accurately for surgeons with low caseloads. Nonetheless, many OR directors claim that their hospitals make decisions based on individual surgeons' OR utilizations. This incongruity could be explained by the OR managers considering the earlier mathematical studies, performed using data from a few large teaching hospitals, as irrelevant to their hospitals. The important mathematical parameter for the prior observations is the percentage of surgeon lists of elective cases that include 1 or 2 cases; "list" meaning a combination of surgeon, hospital, and date. We measure the incidence among many hospitals. Observational cohort study. 117 hospitals in Iowa from July 2013 through September 2015. Surgeons with same identifier among hospitals. Surgeon lists of cases including at least one outpatient surgical case, so that Relative Value Units (RVU's) could be measured. Averaging among hospitals in Iowa, more than half of the surgeons' lists included 1 or 2 cases (77%; P<0.00001 vs. 50%). Approximately half had 1 case (54%; P=0.0012 vs. 50%). These percentages exceeded 50% even though nearly all the surgeons operated at just 1 hospital on days with at least 1 case (97.74%; P<0.00001 vs. 50%). The cases were not of long durations; among the 82,928 lists with 1 case, the median was 6 intraoperative RVUs (e.g., adult inguinal herniorrhaphy). Accurate confidence intervals for raw or adjusted utilizations are so wide for individual surgeons that decisions based on utilization are equivalent to decisions based on random error. The implication of the current study is generalizability of that finding from the largest teaching hospital in the state to the other hospitals in the state. Copyright © 2017 Elsevier Inc. All rights reserved.

Using Aspen to Teach Chromatographic Bioprocessing: A Case Study in Weak Partitioning Chromatography for Biotechnology Applications

ERIC Educational Resources Information Center

Evans, Steven T.; Huang, Xinqun; Cramer, Steven M.

2010-01-01

The commercial simulator Aspen Chromatography was employed to study and optimize an important new industrial separation process, weak partitioning chromatography. This case study on antibody purification was implemented in a chromatographic separations course. Parametric simulations were performed to investigate the effect of operating parameters…

Sustainability of Social Programs: A Comparative Case Study Analysis

ERIC Educational Resources Information Center

Savaya, Riki; Spiro, Shimon; Elran-Barak, Roni

2008-01-01

The article reports on the findings of a comparative case study of six projects that operated in Israel between 1980 and 2000. The study findings identify characteristics of the programs, the host organizations, and the social and political environment, which differentiated programs that are sustained from those that are not. The findings reaffirm…

Exploring Community College Peer Mentoring Practices within Central California: A Multiple Case Study

ERIC Educational Resources Information Center

Brown, Lenis Colton

2017-01-01

The purpose of this qualitative, multiple case study was to illuminate the prevalence and configurations of peer mentoring programs at Central California Community Colleges with emphasis on how the programs impacted student retention. The study's sample was drawn from ten campuses and five centers that operate within five California Community…

Strategically Focused Training in Six Sigma Way: A Case Study

ERIC Educational Resources Information Center

Pandey, Ashish

2007-01-01

Purpose: The purpose of the current study is to examine the utility of Six Sigma interventions as a performance measure and explore its applicability for making the training design and delivery operationally efficient and strategically effective. Design/methodology/approach: This is a single revelatory case study. Data were collected from multiple…

Extraboard performance : TriMet case study.

DOT National Transportation Integrated Search

2012-02-01

This paper examines extraboard operations and management at TriMet, the transit provider for the Portland Oregon metropolitan area. The : extraboard consists of a pool of operators who fill open work resulting from absences and other causes. The pape...

Characterizing the Relationship Between Surgical Resident and Faculty Perceptions of Autonomy in the Operating Room.

PubMed

Young, Katelyn A; Lane, Samantha M; Widger, John E; Neuhaus, Nina M; Dove, James T; Fluck, Marcus; Hunsinger, Marie A; Blansfield, Joseph A; Shabahang, Mohsen M

Characterize the concordance among faculty and resident perceptions of surgical case complexity, resident technical performance, and autonomy in a diverse sample of general surgery procedures using case-specific evaluations. A prospective study was conducted in which a faculty surgeon and surgical resident independently completed a postoperative assessment examining case complexity, resident operative performance (Milestone assessment) and autonomy (Zwisch model). Pearson correlation coefficients (r) reaching statistical significance (p < 0.05) were further classified as moderate (r ≥ 0.40), strong (r ≥ 0.60), or very strong (r ≥ 0.80). This study was conducted in the General Surgery Residency Program at an academic tertiary care facility (Geisinger Medical Center, Danville, PA). Participants included 6 faculty surgeons, in addition to 5 postgraduate year (PGY) 1, 6 midlevel (PGY 2-3), and 4 chief (PGY 4-5) residents. In total, 75 surgical cases were analyzed. Midlevel residents accounted for the highest number of cases (35, 46.6%). Overall, faculty and resident perceptions of case complexity demonstrated a strong correlation (r = 0.76, p < 0.0001). Technical performance scores were also strongly correlated (r = 0.66, p < 0.0001), whereas perceptions of autonomy demonstrated a moderate correlation (r = 0.56, p < 0.0001). Subgroup analysis revealed very strong correlations among faculty perceptions of case complexity and the perceptions of PGY 1 (r = 0.80, p < 0.0001) and chief residents (r = 0.82, p < 0.0001). All other intergroup correlations were strong with 2 notable exceptions as follows: midlevel and chief residents failed to correlate with faculty perceptions of autonomy and operative performance, respectively. General surgery residents generally demonstrated high correlations with faculty perceptions of case complexity, technical performance, and operative autonomy. This generalized accord supports the use of the Milestone and Zwisch assessments in residency programs. However, discordance among perceptions of midlevel resident autonomy and chief resident operative performance suggests that these trainees may need more direct communication from the faculty. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

[Municipal landfill site in Krzyz near Tarnów as source of microbiological factors harmful to environment and human health].

PubMed

Fraczek, Krzysztof; Barabasz, Wiesław

2004-01-01

The present study aimed to evaluate microbiological pollution of air with microorganisms belonging to different taxonomic and physiological groups, and to examine whether the effect of the municipal landfill site in Krzyz changes at various study sites located: in so called "zero zone" (operating landfill), at different distances from the landfill and in Tarnów. Microbiological studies of atmospheric air were carried out from May 1998 to April 2001. Measurements were taken at 10 study sites located at the operating municipal landfill site in Krzyz, inside and outside of its protection zone. Microbial air pollution standard (PN-89/Z-04111/02 and PN-89/Z-04111/03) were used to evaluate the impact of municipal landfill site on the atmospheric environment. The standards were most often exceeded by hemolytic bacteria, (277 cases out of 360 measurements) i.e. 76.9%, and Actinomycetes (213 cases out of 360 measurements) i.e 59.1%, while by fungi (26 cases out of 360 measurements) i.e 7.2% and bacteria (42 cases out of 360 measurements) i.e 11.6% in a lesser degree. The standards were most often exceeded in operating land fill site sector, at the gateway to the land fill site and in partially reclaimed sector. Fewest cases of standard exceedance were recorded in control site (located outside the landfill site), near built-up area and before the entrance to the land fill site.

An academic medical center's response to widespread computer failure.

PubMed

Genes, Nicholas; Chary, Michael; Chason, Kevin W

2013-01-01

As hospitals incorporate information technology (IT), their operations become increasingly vulnerable to technological breakdowns and attacks. Proper emergency management and business continuity planning require an approach to identify, mitigate, and work through IT downtime. Hospitals can prepare for these disasters by reviewing case studies. This case study details the disruption of computer operations at Mount Sinai Medical Center (MSMC), an urban academic teaching hospital. The events, and MSMC's response, are narrated and the impact on hospital operations is analyzed. MSMC's disaster management strategy prevented computer failure from compromising patient care, although walkouts and time-to-disposition in the emergency department (ED) notably increased. This incident highlights the importance of disaster preparedness and mitigation. It also demonstrates the value of using operational data to evaluate hospital responses to disasters. Quantifying normal hospital functions, just as with a patient's vital signs, may help quantitatively evaluate and improve disaster management and business continuity planning.

Forecasting the Economic Impact of Future Space Station Operations

NASA Technical Reports Server (NTRS)

Summer, R. A.; Smolensky, S. M.; Muir, A. H.

1967-01-01

Recent manned and unmanned Earth-orbital operations have suggested great promise of improved knowledge and of substantial economic and associated benefits to be derived from services offered by a space station. Proposed application areas include agriculture, forestry, hydrology, public health, oceanography, natural disaster warning, and search/rescue operations. The need for reliable estimates of economic and related Earth-oriented benefits to be realized from Earth-orbital operations is discussed and recent work in this area is reviewed. Emphasis is given to those services based on remote sensing. Requirements for a uniform, comprehensive and flexible methodology are discussed. A brief review of the suggested methodology is presented. This methodology will be exercised through five case studies which were chosen from a gross inventory of almost 400 user candidates. The relationship of case study results to benefits in broader application areas is discussed, Some management implications of possible future program implementation are included.

An activity-based methodology for operations cost analysis

NASA Technical Reports Server (NTRS)

Korsmeyer, David; Bilby, Curt; Frizzell, R. A.

1991-01-01

This report describes an activity-based cost estimation method, proposed for the Space Exploration Initiative (SEI), as an alternative to NASA's traditional mass-based cost estimation method. A case study demonstrates how the activity-based cost estimation technique can be used to identify the operations that have a significant impact on costs over the life cycle of the SEI. The case study yielded an operations cost of $101 billion for the 20-year span of the lunar surface operations for the Option 5a program architecture. In addition, the results indicated that the support and training costs for the missions were the greatest contributors to the annual cost estimates. A cost-sensitivity analysis of the cultural and architectural drivers determined that the length of training and the amount of support associated with the ground support personnel for mission activities are the most significant cost contributors.

Metropolitan transportation management center : a case study : Boston Central Artery/Tunnel Integrated Project control system : responding to incidents rapidly and effectively

DOT National Transportation Integrated Search

1999-10-01

The following case study provides a snapshot of the Boston Central Artery/Tunnel Integration Project Control System (IPCS) operations control center. It follows the outline provided in the companion document, Metropolitan Transportation Management Ce...

Cow Power: A Case Study of Renewable Compressed Natural Gas as a Transportation Fuel

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

Mintz, Marianne; Tomich, Matthew

This case study explores the production and use of renewable compressed natural gas (R-CNG)—derived from the anaerobic digestion (AD) of dairy manure—to fuel 42 heavy-duty milk tanker trucks operating in Indiana, Michigan, Tennessee, and Kentucky.

The Perceived Effect of Hidden Costs on the Operational Management of Information Technology Outsourcing: A Qualitative Study

ERIC Educational Resources Information Center

Swift, Ian

2011-01-01

Information technology (IT) outsourcing is a business trend aimed at reducing costs and enabling companies to concentrate on their core competencies. This qualitative multiple case design research study explored the effects of hidden costs on the operational management of IT outsourcing. The study involved analyzing IT outsourcing agreements as…

Does gender discrimination exist in a gynecology training program in a private hospital?

PubMed

Geisler, J P; Mernitz, C S; Geisler, M J; Harsha, C G; Eskew, P N

1999-01-01

Does gender discrimination by attending physicians exists in a residency in regard to residents' opportunities to perform complete/operative management of hysterectomies versus just being surgical assistants? The program studied is a 4-year program in obstetrics and gynecology residency with 3 residents per year. All cases involving a resident were recorded in a computer program designed by one of the authors (C.S.M.) to collect data for Residency Review Committee reports. Data were able to be sorted in a variety of methods including level of management, date of procedure, Physicians' Current Procedural Terminology codes, and attending physician name or resident name. Only intrafascial and extrafascial hysterectomies for benign disease were included in the study. Data were collected from July 1, 1996 to March 31, 1997. Five hundred and forty-nine hysterectomies with residents participating as primary surgeon (complete/operative management) or surgical assistant were performed during the study period. Complete/operative management was performed by the resident in 82.5% of cases while the resident was surgical assistant in 17.5%. Male residents were responsible for complete/operative management in 81.6% of cases and female residents in 83.2% of cases (P = 0.33). Male attending physicians were more likely to allow residents (male or female) to participate as the primary surgeon in abdominal hysterectomies (95.3%) and vaginal hysterectomies (68.5%) than female attending physicians (abdominal, 87.0% and vaginal, 57.3%) (P < 0.001 and P = 0.006, respectively). Although male attending physicians were more likely than female attending physicians to allow residents to perform complete/operative management, there was no discrimination as to whether the resident in question was male or female. When determining the level of management private gynecologists will allow residents to perform they do not practice gender discrimination.

The accuracy of colonoscopic localisation of colorectal tumours: a prospective, multi-centred observational study.

PubMed

Johnstone, M S; Moug, S J

2014-05-01

Colonoscopy is essential for accurate pre-operative colorectal tumour localisation, but its accuracy for localisation remains undetermined due to limitations of previous work. This study aimed to establish the accuracy of colonoscopic localisation and to determine how frequently inaccuracy results in altered surgical management. A prospective, multi-centred, powered observational study recruited 79 patients with colorectal tumours that underwent curative surgical resection. Patient and colonoscopic factors were recorded. Pre-operative colonoscopic and radiological lesion localisations were compared to intra-operative localisation using pre-defined anatomical bowel segments to determine accuracy, with changes in planned surgical management documented. Colonoscopy accurately located the colorectal tumour in 64/79 patients (81%). Five out of 15 inaccurately located patients required on-table alteration in planned surgical management. Pre-operative imaging was unable to visualise the primary tumour in 23.1% of cases, a finding that was more prevalent amongst bowel screener patients compared to symptomatic patients (45.8% vs. 13%; p = 0.003). Colonoscopic lesion localisation is inaccurate in 19.0% of cases and occurred throughout the colon with a change in on-table surgical management in 6.3%. With CT unable to visualise lesions in just under a quarter of cases, particularly in the screening population, preoperative localisation is heavily reliant on colonoscopy.

High efficiency endocrine operation protocol: From design to implementation.

PubMed

Mascarella, Marco A; Lahrichi, Nadia; Cloutier, Fabienne; Kleiman, Simcha; Payne, Richard J; Rosenberg, Lawrence

2016-10-01

We developed a high efficiency endocrine operative protocol based on a mathematical programming approach, process reengineering, and value-stream mapping to increase the number of operations completed per day without increasing operating room time at a tertiary-care, academic center. Using this protocol, a case-control study of 72 patients undergoing endocrine operation during high efficiency days were age, sex, and procedure-matched to 72 patients undergoing operation during standard days. The demographic profile, operative times, and perioperative complications were noted. The average number of cases per 8-hour workday in the high efficiency and standard operating rooms were 7 and 5, respectively. Mean procedure times in both groups were similar. The turnaround time (mean ± standard deviation) in the high efficiency group was 8.5 (±2.7) minutes as compared with 15.4 (±4.9) minutes in the standard group (P < .001). Transient postoperative hypocalcemia was 6.9% (5/72) and 8.3% (6/72) for the high efficiency and standard groups, respectively (P = .99). In this study, patients undergoing high efficiency endocrine operation had similar procedure times and perioperative complications compared with the standard group. The proposed high efficiency protocol seems to better utilize operative time and decrease the backlog of patients waiting for endocrine operation in a country with a universal national health care program. Copyright © 2016 Elsevier Inc. All rights reserved.

Work Organisation and Qualifications in the Retail Sector. The Case of Micro-Enterprise. Synthesis Report. CEDEFOP Document.

ERIC Educational Resources Information Center

Kruse, Wilfried; van den Tillaart, Harry; van den Berg, Sjaak; King, Richard

Using the case study method, research was synthesized on micro-enterprises in Europe and the effects of changes in work organizations on employee qualifications and vice versa. The research focused on retail operations employing 10 or fewer staff. Five case studies were conducted in each of four member states of the European Union--Greece,…

The efficacy of radiofrequency ablation in the treatment of pediatric arrhythmia and its effects on serum IL-6 and hs-CRP

PubMed Central

Li, Chunli; Jia, Libo; Wang, Zhenzhou; Niu, Ling; An, Xinjiang

2017-01-01

The aim of this study was to investigate the efficacy of radiofrequency ablation in the treatment of pediatric arrhythmia and to assess the changes in serum interleukin-6 (IL-6) and hs-CRP levels after treatment. Hundred and six children with tachyarrhythmia who were admitted to Xuzhou Children's Hospital from November, 2014 to December, 2015 were recruited for study. The efficacies of radiofrequency in the treatment of different types of arrhythmia were analyzed. Successful ablation was found in 104 cases (98.11%) and recurrence was found in 7 cases (6.73%). Among 62 cases of atrioventricular reentrant tachycardia (AVRT), successful ablation was found in 60 cases (96.77%) and recurrence was found in 3 cases (4.84%). Among 33 cases of atrioventricular nodal reentrant tachycardia (AVNRT), successful ablation was found in 33 cases (100%) and recurrence was found in 2 cases (6.06%). Among 5 cases of ventricular tachycardia (VT), successful ablation was found in 5 cases (100%) and no recurrence was found. Among 4 cases of atrial tachycardia (AT), successful ablation was found in 4 cases (100%) and recurrence was found in 1 case (25%). Among 2 cases of atrial flutter (AFL), successful ablation was found in both (100%) and recurrence was found in 1 case (50%). After operation, the levels of IL-6 and hs-CRP were increased and were continually increased within 6 h after operation. The levels of IL-6 and hs-CRP at 24 h after operation were reduced but still higher than preoperative levels. The duration of radiofrequency and ablation energy were positively correlated with the levels of IL-6 and hs-CRP, while the number of discharges was not significantly correlated with either. In conclusion, radiofrequency ablation is a safe and effective treatment for pediatric arrhythmia. Postoperative monitoring of IL-6 and hs-CRP levels is conducive to understanding postoperative myocardial injury and inflammatory response. PMID:29042948

The efficacy of radiofrequency ablation in the treatment of pediatric arrhythmia and its effects on serum IL-6 and hs-CRP.

PubMed

Li, Chunli; Jia, Libo; Wang, Zhenzhou; Niu, Ling; An, Xinjiang

2017-10-01

The aim of this study was to investigate the efficacy of radiofrequency ablation in the treatment of pediatric arrhythmia and to assess the changes in serum interleukin-6 (IL-6) and hs-CRP levels after treatment. Hundred and six children with tachyarrhythmia who were admitted to Xuzhou Children's Hospital from November, 2014 to December, 2015 were recruited for study. The efficacies of radiofrequency in the treatment of different types of arrhythmia were analyzed. Successful ablation was found in 104 cases (98.11%) and recurrence was found in 7 cases (6.73%). Among 62 cases of atrioventricular reentrant tachycardia (AVRT), successful ablation was found in 60 cases (96.77%) and recurrence was found in 3 cases (4.84%). Among 33 cases of atrioventricular nodal reentrant tachycardia (AVNRT), successful ablation was found in 33 cases (100%) and recurrence was found in 2 cases (6.06%). Among 5 cases of ventricular tachycardia (VT), successful ablation was found in 5 cases (100%) and no recurrence was found. Among 4 cases of atrial tachycardia (AT), successful ablation was found in 4 cases (100%) and recurrence was found in 1 case (25%). Among 2 cases of atrial flutter (AFL), successful ablation was found in both (100%) and recurrence was found in 1 case (50%). After operation, the levels of IL-6 and hs-CRP were increased and were continually increased within 6 h after operation. The levels of IL-6 and hs-CRP at 24 h after operation were reduced but still higher than preoperative levels. The duration of radiofrequency and ablation energy were positively correlated with the levels of IL-6 and hs-CRP, while the number of discharges was not significantly correlated with either. In conclusion, radiofrequency ablation is a safe and effective treatment for pediatric arrhythmia. Postoperative monitoring of IL-6 and hs-CRP levels is conducive to understanding postoperative myocardial injury and inflammatory response.

Improving operating theatre efficiency: an intervention to significantly reduce changeover time.

PubMed

Soliman, Bishoy A B; Stanton, Raymond; Sowter, Steven; Rozen, Warren Matthew; Shahbaz, Shekib

2013-07-01

Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays. A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken. There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13). The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.

Study of the performances of nano-case treatment cutting tools on carbon steel work material during turning operation

NASA Astrophysics Data System (ADS)

Afolalu, S. A.; Okokpujie, I. P.; Salawu, E. Y.; Abioye, A. A.; Abioye, O. P.; Ikumapayi, O. M.

2018-04-01

The degree of holding temperature and time play a major role in nano-case treatment of cutting tools which immensely contributed to its performance during machining operation. The objective of this research work is to carryout comparative study of performance of nano-case treatment tools developed using low and medium carbon steel as work piece. Turning operation was carried out under two different categories with specific work piece on universal lathe machine using HSS cutting tools 100 mm × 12mm × 12mm that has been nano-case treated under varying conditions of temperatures and timeof 800,850, 900, 950°C and 60, 90, 120 mins respectively. The turning parameters used in evaluating this experiment were cutting speed of 270, 380 and 560mm/min, feed rate of 0.15, 0.20 and 0.25 mm/min, depth of cut of 2mm, work piece diameter of 25mm and rake angle of 7° each at three levels. The results of comparative study of their performances revealed that the timespent in the machining of low carbon steel material at a minimum temperature and time of 800°C, 60 mins were1.50, 2.17 mins while at maximum temperature and time of 950°C, 120 mins were 1.19, 2.02 mins. It was also observed that at a corresponding constant speed of 270,380 and 560mm/min at higher temperature and time, a relative increased in the length of cut were observed. Critical observation of the result showed that at higher case hardening temperature and time (950°C/120mins), the HSS cutting tool gave a better performance as lesser time was consumed during the turning operation.

[Surgery of ipsilateral Hawkins Ⅲ talus neck and ankle joint fractures via internal and lateral approaches with Herbert screws].

PubMed

Zhang, P; Dong, Q R; Wang, Z Y; Chen, B; Wan, J H; Wang, L

2016-11-08

Objective: To explore the manual operation skills of operative treatment of ipsilateral Hawkins Ⅲ talus neck and ankle joint fractures via internal and lateral approaches with Herbert screws, and to study the clinical results. Method: From Jan 2009 to Dec 2014, the clinical data of 13 patients with ipsilateral Hawkins Ⅲ talus neck and ankle joint fractres via internal and lateral approaches with Herbert screws were retrospectively analyzed in our department.There were 10 males and 3 female, ranging in age from 20 to 60 years with an average age of 31.5 years.The fractures occurred on the right side in 9 patients and on the left side in 4 patients.Three cases had the complication of medial malleolar fracture.Ten cases had the complication of medial and lateral malleolar fracture. Totally 11 cases were made calcaneal skeletal traction, and all the were made CT with three-dimensional image reconstruction.Two cases were treated with emergency operation.Eleven cases were treated with selective operation.The operation time was 5 hours-10 days after injury. The functional results were evaluated by American Orthopaedic Foot and Ankle Society (AOFAS). Result: The average duration of follow-up was 22.6 months (range, 14-65 months). There was skin necrosis in one cases, no incision infection, malunion and nonunion of the fractures and loss of reduction. At final follow-up, AOFAS ankle score was 75.2 (range, 42 to 93), higher than preoperative 39.2 (range, 23 to 60), the difference was statistically significant ( P =0.023). The result was excellent in 4 cases, good in 5 cases, fair in 3 cases and 1 cases in poor, and the overall excellent or good rate was 69.2%. Avascular necrosis occurred in 3 cases (23.1%, 3/13). Traumatic arthritis was found in 5 cases (38.5%, 5/13), involved tibial astragaloid joint in 2 cases, involved subtalar joint in 1 case, involved tibial astragaloid joint and subtalar joint in 2 cases. Conclusion: The effect of surgical treatment for ipsilateral Hawkins Ⅲ talus neck and ankle joint fractures via internal and lateral approaches with Herbert screws is satisfactory.Correct operative approach and pay more attention to protect blood circulation of intraoperative, anatomical precision and strong reduction and fixation are the key to achieve and gain better long-term results for the surgical treatment of ipsilateral Hawkins Ⅲ talus neck and ankle joint fractures.

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.

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

The unsuspected prosthetic joint infection : incidence and consequences of positive intra-operative cultures in presumed aseptic knee and hip revisions.

PubMed

Jacobs, A M E; Bénard, M; Meis, J F; van Hellemondt, G; Goosen, J H M

2017-11-01

Positive cultures are not uncommon in cases of revision total knee and hip arthroplasty (TKA and THA) for presumed aseptic causes. The purpose of this study was to assess the incidence of positive intra-operative cultures in presumed aseptic revision of TKA and THA, and to determine whether the presence of intra-operative positive cultures results in inferior survival in such cases. A retrospective cohort study was assembled with 679 patients undergoing revision knee (340 cases) or hip arthroplasty (339 cases) for presumed aseptic causes. For all patients three or more separate intra-operative cultures were obtained. Patients were diagnosed with a previously unsuspected prosthetic joint infection (PJI) if two or more cultures were positive with the same organism. Records were reviewed for demographic details, pre-operative laboratory results and culture results. The primary outcome measure was infection-free implant survival at two years. The incidence of unsuspected PJI was 27 out of 340 (7.9%) in TKA and 41 out of 339 (12.1%) in THA. Following revision TKA, the rate of infection-free implant survival in patients with an unsuspected PJI was 88% (95% confidence intervals (CI) 60 to 97) at two years compared with 98% (95% CI 94 to 99) in patients without PJI (p = 0.001). After THA, the rate of survival was similar in those with unsuspected PJI (92% (95% CI 73 to 98) at two years) and those without (94% (95% CI 89 to 97), p = 0.31). Following revision of TKA and THA for aseptic diagnoses, around 10% of cases were found to have positive cultures. In the knee, such cases had inferior infection-free survival at two years compared with those with negative cultures; there was no difference between the groups following THA. Cite this article: Bone Joint J 2017;99-B:1482-9. ©2017 The British Editorial Society of Bone & Joint Surgery.

Low-cost and no-cost practice to achieve energy efficiency of government office buildings: A case study in federal territory of Malaysia

NASA Astrophysics Data System (ADS)

Tahir, Mohamad Zamhari; Nawi, Mohd Nasrun Mohd; Ibrahim, Amlus

2016-08-01

This paper presents the findings of a case study to achieve energy-efficient performance of conventional office buildings in Malaysia. Two multi-storey office buildings in Federal Territory of Malaysia have been selected. The aim is to study building energy saving potential then to highlight the appropriate measures that can be implemented. Data was collected using benchmarking method by comparing the measured consumption to other similar office buildings and a series of preliminary audit which involves interviews, a brief review of utility and operating data as well as a walkthrough in the buildings. Additionally, in order to get a better understanding of major energy consumption in the selected buildings, general audit have been conducted to collect more detailed information about building operation. In the end, this study emphasized low-cost and no-cost practice to achieve energy efficiency with significant results in some cases.

Intraoperative visible bubbling of air may be the first sign of venous air embolism during posterior surgery for scoliosis.

PubMed

Wills, John; Schwend, Richard M; Paterson, Andrew; Albin, Maurice S

2005-10-15

Case report of two children sustaining venous air embolism (VAE) during posterior surgery for scoliosis. To report 2 cases where visible bubbling at the operative site was the first clinical indication of VAE-induced cardiovascular collapse and to raise the level of consciousness that VAE in the prone position can occur, often with serious consequences. Twenty-two cases of VAE during surgery for scoliosis in the prone position have been reported. Ten were fatal and ten were in children. Visible bubbling at the operative site was noted in two published cases. Retrospective study of 2 cases of VAE at one institution. Clinical, anesthetic, and radiographic features are presented. Details of previously published cases are reviewed and discussed. Both patients were girls with adolescent scoliosis who underwent prone positioned posterior spinal fusion with instrumentation. Visible bubbling of air at the thoracic aspect of the surgical site was noted near the completion of instrumentation and was the first indication of VAE. In both cases, this was clinically recognized and promptly treated. One patient survived normally and the other died. Visible air bubbling at the operative site may herald the onset of massive VAE during multilevel posterior spinal fusion and instrumentation. A prospective multicenter study using precordial Doppler, central venous catheter, and end-tidal CO2 is recommended to determine the true incidence of VAE in spinal deformity surgery and to evaluate monitoring and treatment methods.

Behavioral Treatment of Hysterical Coughing and Mutism: A Case Study

ERIC Educational Resources Information Center

Munford, Paul R.; And Others

1976-01-01

This case study demonstrates the value of conceptualizing functional somatic disorders as operants. The subject, an adolescent girl, diagnosed as having a "hysterical neurosis," manifested the symptoms of incessant coughing and mutism. The cough and mutism were treated by extinction and shaping, respectively. Positive results were obtained.…

CVISN electronic credentialing for commercial vehicles in Washington State, a case study : easier licensing and credentials processing for the motor carrier industry

DOT National Transportation Integrated Search

2004-09-01

The following case study provides an in-depth view of the deployment of Commercial Vehicle Information Systems and Networks (CVISN) Electronic Credentialing in Washington State. It describes successful practices and lessons learned in operations and ...

Upgrade of Compressed Air Control System Reduces Energy Costs at Michelin Tire Plant. Office of Industrial Technologies (OIT) BestPractices Project Case Study

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

Not Available

2002-01-01

This case study highlights the upgraded compressed air system at a Michelin tire manufacturing plant in Spartanburg, South Carolina. The controls upgrade project enabled multiple compressor operation without blow-off, and significantly reduced energy costs.

Case Studies in Broadcast Management.

ERIC Educational Resources Information Center

Coleman, Howard W.

This collection of case studies, based on factual situations which have challenged broadcast managers in recent years, is designed to stimulate thinking about and solving of "real world" problems in commercial radio and television operations. Topics of a serious, long-run nature include enlarging the radio audience; station revenue and economy;…

Using the Internship as a Tool for Assessment: A Case Study.

ERIC Educational Resources Information Center

Graham, Beverly; Bourland-Davis, Pamela G.; Fulmer, Hal W.

1997-01-01

States communication programs are expected to operate in some harmony with communication activities of organizations outside the university in professional settings. Describes one possible activity in this matrix: use of student internships as a means of assessing the communication program. Presents a case study involving public relations…

It depends on your perspective: Resident satisfaction with operative experience.

PubMed

Perone, Jennifer A; Fankhauser, Grant T; Adhikari, Deepak; Mehta, Hemalkumar B; Woods, Majka B; Tyler, Douglas S; Brown, Kimberly M

2017-02-01

Resident satisfaction is a key performance metric for surgery programs; we studied factors influencing resident satisfaction in operative cases, and the concordance of faculty and resident perceptions on these factors. Resident and faculty were separately queried on satisfaction immediately following operative cases. Statistical significance of the associations between resident and faculty satisfaction and case-related factors were tested by Chi-square or Fisher's exact test. Residents and faculty were very satisfied in 56/87 (64%) and 36/87 (41%) of cases respectively. Resident satisfaction was associated with their perceived role as surgeon (p < 0.04), performing >50% of the case (p < 0.01), autonomy (p < 0.03), and PGY year 4-5(p < 0.02). Faculty taking over the case was associated with both resident and faculty dissatisfaction. Faculty satisfaction was associated with resident preparation (p < 0.01), faculty perception of resident autonomy (p < 0.01), and faculty familiarity with resident's skills (p < 0.01). Resident and faculty satisfaction are associated with the resident's competent performance of the case, suggesting interventions to optimize resident preparation for a case or faculty's ability to facilitate resident autonomy will improve satisfaction with OR experience. Copyright © 2016 Elsevier Inc. All rights reserved.

Endoscopic Endonasal Pituitary Surgery: Impact of Surgical Education on Operation Length and Patient Morbidity

PubMed Central

Dedhia, Raj C.; Lord, Christopher A.; Pinheiro-Neto, Carlos D.; Fernandez-Miranda, Juan C.; Wang, Eric W.; Gardner, Paul A.; Snyderman, Carl H.

2012-01-01

Objectives To determine the difference in operative times and associated complications for cases performed solely by attending-level surgeons versus cases assisted by surgeons-in-training for endoscopic endonasal pituitary surgeries. Design Retrospective chart review. Setting Tertiary-care academic medical center. Participants A total of 228 patients having undergone endoscopic endonasal pituitary surgery from 2005 to 2011. Main Outcome Measure Duration of surgery comparing attending only (AO) and trainee-assisted (TA) surgeries. Results Thirty-seven (19%) of 198 cases were identified as AO surgeries, the remaining 161 (81%) were TA. Operative times (minutes) for the AO group were significantly shorter than the TA group (149.1 ± 54.8 vs 219.5 ± 83.7, p < 0.001). The AO group had fewer intraoperative cerebrospinal fluid leaks (30% vs 39%, p = 0.318), decreased estimated blood loss (408 mL vs 523 mL, p = 0.176), fewer postoperative complications (27% vs 37%, p = 0.268), and shorter length of stay (3.5 vs 4.3 days, p = 0.294). Conclusions This is the first study in otolaryngology or neurosurgery to compare operative times and outcomes for AO versus TA cases at a single academic institution. Operative times were significantly decreased and a trend toward a decrease in patient morbidity was noted for cases performed solely by attendings. The valuation of teaching activities in the operating room is a necessary first step toward optimizing the allocation of resources and funding of surgical education. PMID:24294558

Using transurethral Ho:YAG-laser resection to treat urethral stricture and bladder neck contracture

NASA Astrophysics Data System (ADS)

Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin

2005-07-01

Objective: Ho:YAG laser had been used to treat the common diseases of urinary system such as bladder cancer and benign prostatic hyperplasia in our hospital. This study is to assess the efficacy and safety of transurethral Ho:YAG-laser resection to treat the urethral stricture and bladder neck contracture. Methods: From May 1997 to August 2004, 26 cases of urethral stricture and 33 cases of bladder neck contracture were treated by transurethral Ho:YAG-laser resection. These patients were followed up at regular intervals after operation. The uroflow rate of these patients was detected before and one-month after operation. The blood loss and the energy consumption of holmium-laser during the operation as well as the complications and curative effect after operation were observed. Results: The therapeutic effects were considered successful, with less bleeding and no severe complications. The Qmax of one month postoperation increased obviously than that of preoperation. Of the 59 cases, restenosis appeared in 11 cases (19%) with the symptoms of dysuria and weak urinary stream in 3-24 months respectively. Conclusions: The Ho:YAG-laser demonstrated good effect to treat the obstructive diseases of lower urinary tract such as urethral stricture and bladder neck contracture. It was safe, minimal invasive and easy to operate.

Long-term results of small-diameter proximal splenorenal venous shunt: A retrospective study

PubMed Central

Chen, Hao; Yang, Wei-Ping; Yan, Ji-Qi; Li, Qin-Yu; Ma, Di; Li, Hong-Wei

2011-01-01

AIM: To investigate recurrent variceal hemorrhage and long-term survival rates of patients treated with partial proximal splenorenal venous shunt. METHODS: Patients with variceal hemorrhage who were treated with small-diameter proximal splenorenal venous shunt in Ruijin Hospital between 1996 and 2009 were included in this study. Shunt diameter was determined before operation using Duplex Doppler ultrasonography. Peri-operative and long-term results in term of rehemorrhage, encephalopathy and mortality were followed up. RESULTS: Ninety-eight patients with Child A and B variceal hemorrhage received small-diameter proximal splenorenal venous shunt with a diameter of 7-10 mm. After operation, the patients’ mean free portal pressure (P < 0.01) and the flow rate of main portal vein (P < 0.01) decreased significantly compared with that before operation. The rates of rebleeding and mortality were 6.12% (6 cases) and 2.04% (2 cases), respectively. Ninety-one patients were followed up for 7 mo-14 years (median, 48.57 mo). Long-term rates of rehemorrhage and encephalopathy were 4.40% (4 cases) and 3.30% (3 cases), respectively. Thirteen patients (14.29%) died mainly due to progressive hepatic dysfunction. Five- and ten-year survival rates were 82.12% and 71.24%, respectively. CONCLUSION: Small-diameter proximal splenorenal venous shunt affords protection against variceal rehemorrhage with a low occurrence of encephalopathy in patients with normal liver function. PMID:21876638

Assessing the Flipped Classroom in Operations Management: A Pilot Study

ERIC Educational Resources Information Center

Prashar, Anupama

2015-01-01

The author delved into the results of a flipped classroom pilot conducted for an operations management course module. It assessed students' perception of a flipped learning environment after making them experience it in real time. The classroom environment was construed using a case research approach and students' perceptions were studied using…

Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

PubMed Central

Owojuyigbe, Afolabi Muyiwa; Komolafe, Edward O.; Adenekan, Anthony T.; Dada, Muyiwa A.; Onyia, Chiazor U.; Ogunbameru, Ibironke O.; Owagbemi, Oluwafemi F.; Talabi, Ademola O.; Faponle, Fola A.

2016-01-01

Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved. PMID:27251657

Technology Solutions Case Study: Balancing Hydronic Systems in Multifamily Buildings, Chicago, Illinois

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

None

2014-09-01

In multifamily building hydronic systems, temperature imbalance may be caused by undersized piping, improperly adjusted balancing valves, inefficient water temperature and flow levels, and owner/occupant interaction with the boilers, distribution and controls. The effects of imbalance include tenant discomfort, higher energy use intensity and inefficient building operation. In this case study , Partnership for Advanced Residential Retrofit and Elevate Energy. explores cost-effective distribution upgrades and balancing measures in multifamily hydronic systems, providing a resource to contractors, auditors, and building owners on best practices to improve tenant comfort and lower operating costs.

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.

Pre-surgical road map for thyroid cancer and large goiters: Practical benefits of detailed radiological evaluation by surgeon.

PubMed

Panchangam, Ramakanth Bhargav; Guntupalli, Satyam; Seetharamaiah, Thotakura; Kumbhar, Uday Shamrao

2015-01-01

Pre-surgical radiological evaluation of neck is often mandatory for surgical planning in high risk thyroid cancer and large goiters. Frequently, surgeons are overdependent on radiologist's report. In this context, we analysed the practical benefits of surgeon's independent radiological evaluation in our institutional experience. This prospective study was conducted in Endocrine Surgery department of a teaching hospital in South India. Cases operated between January 2011 and June 2012 (18 months) were included. Films of cross-sectional imaging were read in detail by primary and assistant surgeons in correlation with stepwise operative planning and documented. Cases with additional radiological signs on surgeon's evaluation, which were missing in radiologist's report are discussed in detail. F: M ratio is 67:24. Mean age was 45.3 ± 9.8 years (37 - 76). Forty-seven cases of thyroid cancer and 44 cases of large goiters were analysed. Surgeon read additional signs such as obliterated fat plane between goiter and subcutaneous plane; level I lymph nodes; bilateral cervical lymphadenopathy, internal jugular vein thrombus, and pharyngeal invasion helped in pre-operatively planned modification of operative steps for optimal R0 resection and total thyroidectomy. A mean of 1.42 ± 0.83 (1 - 6), additional signs were detected on surgeon's radiological evaluation compared to radiologist's report in 41.7% of cases. These findings modified the pre-operative plan, facilitating better surgical outcome in 28.6% of cases. In high-risk thyroid cancer and large goiters, detailed radiological evaluation by surgeon facilitates optimal surgical resection and superior outcome compared to radiologist report-guided surgery.

Determinants of peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia.

PubMed

Kyei, Mathew Y; Klufio, George O; Mensah, James E; Gepi-Attee, Samuel; Ampadu, Kwabena; Toboh, Bernard; Yeboah, Edward D

2016-03-28

The objective of this study was to determine the factors responsible for peri-operative blood transfusion in a contemporary series of open prostatectomy for benign prostate hyperplasia and thus offer a guide for blood product management for the procedure. This was a prospective study of 200 consecutive patients who underwent open prostatectomy for BPH from January 2010 to September 2013 at the Korle Bu Teaching Hospital, Accra. The data analyzed included the pre-operative blood haemoglobin level (Hb), presence of co-morbidities, the case type, indication for the surgery, ASA score, anaesthetic method used, systolic blood pressure, status of the operating surgeon, duration of surgery and the operative prostate weight. The transfusion of blood peri-operatively was also documented. The mean age of the patients was 69.1 years. Elective cases formed 83.5 % with refractory retention of urine being the commonest indication for surgery (68.0 %). The mean pre-operative Hb was 12.1 g/dl. Consultants performed 56.0 % of the prostatectomies. Transvesical approach was used in 90.0 % of the cases. The mean operative time was 101.3mins (range 35.0-240.0) with a mean operative prostate weight of 110.8 g (range 15-550 g). Most of the patients (82.0 %) had spinal anaesthesia. The blood transfusion rate was 23.5 %. The transfusion rate was significantly higher in patients with anaemia (p = .000), emergency cases (p = .000), the use of general anaesthesia (p = .002), a resident as the operating surgeons (p = .034), prostate weight >100 g (p = .000) and duration of surgery (p = .011). In a multivariable logistic regression analysis however only the pre-operative Hb (p = .000. OR 0.95, 95 % CI [0.035-0.257]) and the duration of surgery (p = .025, OR 1.021, 95 % CI [1.003-1.039]) could predict blood transfusion in open prostatectomy for BPH in this series. A 'group and save' policy should be the preferred blood ordering procedure for patients with Hb ≥ 13.0 g/dl scheduled for an elective open prostatectomy for BPH under spinal anaesthesia. A long operative time however may increase the need for blood transfusion.

Impact of Utility-Scale Distributed Wind on Transmission-Level System Operations

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

Brancucci Martinez-Anido, C.; Hodge, B. M.

2014-09-01

This report presents a new renewable integration study that aims to assess the potential for adding distributed wind to the current power system with minimal or no upgrades to the distribution or transmission electricity systems. It investigates the impacts of integrating large amounts of utility-scale distributed wind power on bulk system operations by performing a case study on the power system of the Independent System Operator-New England (ISO-NE).

Incidence of Endophthalmitis after Intravitreal Bevacizumab using Aliquots Prepared On-site in 2 Operating Rooms in Kuwait

PubMed Central

Wani, Vivek B.; Al-Kandari, Jamal; Sabti, Khalid; Aljassar, Faisal; Qali, Hussain; Kumar, Niranjan; Uboweja, Anilkumar; Al-Sabah, Khalid; Diab, Fahad A.; Al-Rashidi, Saleh

2016-01-01

Purpose: To report the incidence of endophthalmitis after intravitreal injection of bevacizumab and the outcomes of treatment of endophthalmitis at two centers in Kuwait. Subjects and Methods: The aliquots of bevacizumab were prepared under aseptic precautions and administered in the operating theater on the same day at both centers. All patients received antibiotic drops after injection of bevacizumab. Data were collected on the number of cases that received intravitreal bevacizumab (IVB) and those that developed endophthalmitis were identified at the two centers. All cases of endophthalmitis received an intravitreal antibiotic injection and additional treatments as warranted. Data were collected on the outcomes of endophthalmitis treatment. Results: There were 5 cases of endophthalmitis among a total of 5429 injections (0.09%: Confidence interval: 0.084–0.1). The incidence was 3 cases among 4690 (0.06%) and 2 cases among 739 injections (0.027%) at each center, respectively (P = 0.08). Four cases of endophthalmitis were culture-positive and organisms isolated were, coagulase negative Staphylococcus in 2 cases, Staphylococcus lugdunensis and Streptococcus pneumoniae in 1 case each. The final visual acuity was better than pre-IVB in 3 cases, same as pre-IVB in 1 case and worse in 1 case with streptococcal infection. No eyes developed phthisis bulbi or required enucleation. Conclusions: The incidence of endophthalmitis after intravitreal injection of bevacizumab using aliquots prepared in the operating room is comparable to other studies. There were no clusters of endophthalmitis cases. PMID:26957841

[Laparoscopic-assisted vaginal hysterectomy after multiple abdominal surgeries--case study].

PubMed

Malinowski, Andrzej; Wiecka-Płusa, Monika; Mołas, Justyna

2009-11-01

At present the laparoscopic-assisted vaginal hysterectomy (LAVH) is the most widespread and most frequently executed variation of hysterectomy. It is an effective and safe operating alternative for the traditional way--abdominal hysterectomy. Good cosmetic effects, short post-operative stay at hospital and, first of all, a small risk of intra- and postoperative complications are the major driving factors justifying the choice of this method of surgery. In the following article we describe a case of a 43-year-old woman who underwent many interventions in the peritoneal cavity (abdominal surgery) and was shortlisted for the laparoscopic-assisted vaginal hysterectomy. The cause of the operation was recurrent bilateral ovary cystis that could not be treated neither conservatively nor surgically, as well as the uterus myoma leading to abnormal uterus bleeding and hypermenorrhoea. Surgery in patients who have previously undergone abdominal operations is always difficult and the risk of complications is high indeed. In this case, while selecting the method of the next surgical procedure, surgeons must not exclude the vaginal and laparoscopic methods, or use them simultaneously. Experiences of other surgeons, as well as the unique case of a treated patient, show that previous abdominal surgical procedures are not a contraindication for either vaginal or laparoscopic procedures, and in some cases they might be safer than yet another laparotomy.

30 CFR 250.420 - What well casing and cementing requirements must I meet?

Code of Federal Regulations, 2012 CFR

2012-07-01

..., DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations Casing and Cementing Requirements § 250.420 What well casing and cementing... casing design must include safety measures that ensure well control during drilling and safe operations...

Culture and Character Education in a Jewish Day School: A Case Study of Life and Experience

ERIC Educational Resources Information Center

Roso, Calvin G.

2013-01-01

This article addresses how to teach character comprehensively by studying ways a school's concurrent curricula (the official curriculum, the operational curriculum, the extra curriculum, and the hidden curriculum) can be used to teach character to students. A single case study analyzes the curriculum at a Jewish day school by examining school…

33 CFR 209.140 - Operations of the Corps of Engineers under the Federal Power Act.

Code of Federal Regulations, 2010 CFR

2010-07-01

... directing studies to be made. In the case of an application for permit or license for an unconstructed... required to insure coordination of the applicant's studies with the Division or District Engineer in cases... studies, will when requested by the Chief of Engineers submit an estimate of the cost of the investigation...

Operation Team Spirit: Program Review and Analysis

DTIC Science & Technology

2009-06-01

research was strictly qualitative in nature. The specific method being used was exploratory case study analysis... study , method is used for the specific acts of conducting research , while methodology refers to the qualitative nature of research performed. While...the researcher . According to Leedy and Ormrod (2005), some of the types of methods and their respective purposes include: • Case study :

By Force or by Fraud: Optimizing U.S. Information Strategy With Deception

DTIC Science & Technology

2016-06-01

IV. CASE- STUDY ASSESSMENTS ........................................................................37 A. CASE 1 OVERVIEW: THE DHOFAR REBELLION, 1965...xvi SOF Special Operations Forces SOG Studies and Observations Group USIA United States Information Agency VC Viet Cong...The Development of Overt and Covert Propaganda Strategies,” Presidential Studies Quarterly 24, no. 2 (Spring 1994): 265. 6 Ibid. 4 USIA departments

Do surgeons and surgical facilities disturb the clean air distribution close to a surgical patient in an orthopedic operating room with laminar airflow?

PubMed

Cao, Guangyu; Storås, Madeleine C A; Aganovic, Amar; Stenstad, Liv-Inger; Skogås, Jan Gunnar

2018-05-04

Airflow distribution in the operating room plays an important role in ensuring a clean operating microenvironment and preventing surgical site infections (SSIs) caused by airborne contaminations. The objective of this study was to characterize the airflow distribution in proximity to a patient in an orthopedic operating room. Experimental measurements were conducted in a real operating room at St. Olav's Hospital, Norway, with a laminar airflow system. Omnidirectional anemometers were used to investigate the air distribution in the operating zone, and 4 different cases were examined with a real person and a thermal manikin. This study showed that the downward airflow from the laminar airflow system varies in each case with different surgical arrangement, such as the position of the operating lamp. The results indicate that the interaction of thermal plumes from a patient and the downward laminar airflow may dominate the operating microenvironment. The airflow distribution in proximity to a patient is influenced by both the surgical facility and the presence of medical staff. A thermal manikin may be an economical and practical way to study the interaction of thermal plumes and downward laminar airflow. The provision of higher clean airflow rate in the operating microenvironment may be an effective way to prevent the development of SSIs caused by indoor airborne contamination. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Development and Execution of End-of-Mission Operations Case Study of the UARS and ERBS End-of-Mission Plans

NASA Technical Reports Server (NTRS)

Hughes, John; Marius, Julio L.; Montoro, Manuel; Patel, Mehul; Bludworth, David

2006-01-01

This Paper is a case study of the development and execution of the End-of-Mission plans for the Earth Radiation Budget Satellite (ERBS) and the Upper Atmosphere Research Satellite (UARS). The goals of the End-of-Mission Plans are to minimize the time the spacecraft remains on orbit and to minimize the risk of creating orbital debris. Both of these Missions predate the NASA Management Instructions (NMI) that directs missions to provide for safe mission termination. Each spacecrafts had their own unique challenges, which required assessing End-of-Mission requirements versus spacecraft limitations. Ultimately the End-of- Mission operations were about risk mitigation. This paper will describe the operational challenges and the lessons learned executing these End-of-Mission Plans

Scenario-based and scenario-neutral assessment of climate change impacts on operational performance of a multipurpose reservoir

Treesearch

Allison G. Danner; Mohammad Safeeq; Gordon E. Grant; Charlotte Wickham; Desirée Tullos; Mary V. Santelmann

2017-01-01

Scenario-based and scenario-neutral impacts assessment approaches provide complementary information about how climate change-driven effects on streamflow may change the operational performance of multipurpose dams. Examining a case study of Cougar Dam in Oregon, United States, we simulated current reservoir operations under scenarios of plausible future hydrology....

Trainee-associated outcomes in laparoscopic colectomy for cancer: propensity score analysis accounting for operative time, procedure complexity and patient comorbidity.

PubMed

Kasten, Kevin R; Celio, Adam C; Trakimas, Lauren; Manwaring, Mark L; Spaniolas, Konstantinos

2018-02-01

Surgical trainee association with operative outcomes is controversial. Studies are conflicting, possibly due to insufficient control of confounding variables such as operative time, case complexity, and heterogeneous patient populations. As operative complications worsen long-term outcomes in oncologic patients, understanding effect of trainee involvement during laparoscopic colectomy for cancer is of utmost importance. Here, we hypothesized that resident involvement was associated with worsened 30-day mortality and 30-day overall morbidity in this patient population. Patients undergoing laparoscopic colectomy for oncologic diagnosis from 2005 to 2012 were assessed using the American College of Surgeons National Surgical Quality Improvement Program dataset. Propensity score matching accounted for demographics, comorbidities, case complexity, and operative time. Attending only cases were compared to junior, middle, chief resident, and fellow level cohorts to assess primary outcomes of 30-day mortality and 30-day overall morbidity. A total of 13,211 patients met inclusion criteria, with 4075 (30.8%) cases lacking trainee involvement and 9136 (69.2%) involving a trainee. Following propensity matching, junior (PGY 1-2) and middle level (PGY 3-4) resident involvement was not associated with worsened outcomes. Chief (PGY 5) resident involvement was associated with worsened 30-day overall morbidity (15.5 vs. 18.6%, p = 0.01). Fellow (PGY > 5) involvement was associated with worsened 30-day overall morbidity (16.0 vs. 21.0%, p < 0.001), serious morbidity (9.3 vs. 13.5%, p < 0.001), minor morbidity (9.8 vs. 13.1%, p = 0.002), and surgical site infection (7.9 vs. 10.5%, p = 0.006). No differences were seen in 30-day mortality for any resident level. Following propensity-matched analysis of cancer patients undergoing laparoscopic colectomy, chief residents, and fellows were associated with worsened operative outcomes compared to attending along cases, while junior and mid-level resident outcomes were no different. Further study is necessary to determine what effect the PGY surgical trainee level has on post-operative morbidity in cancer patients undergoing laparoscopic colectomy in the context of multiple collinear factors.

Diffuse large B-cell lymphoma (DLBCL) in the bypassed stomach after obesity surgery.

PubMed

Courtney, M J; Chattopadhyay, D; Rao, M; Light, D; Gopinath, B

2014-04-01

Laparoscopic Roux-en-Y gastric bypass is the most commonly performed surgical procedure for obesity and, consequently, post-operative patients are increasingly encountered by all specialties. This is a case of a patient presenting with abdominal pain, nausea and fever 9 months following gastric bypass surgery caused by diffuse large B-cell lymphoma (DLBCL) in the bypassed stomach. It demonstrates well that symptoms that may normally be considered 'red-flags' may not be as obvious or specific following an operation. The case also indicates the importance of considering diagnoses unrelated to surgery presenting in the post-operative period (especially when conventional investigation methods are not feasible), and the potential danger of assuming they are due to the operation alone; had this occurred in this patient then a malignancy may have been missed. This is only the second reported case of DLBCL in the bypassed stomach, and the third for lymphoma of any type. © 2014 The Authors. Clinical Obesity © 2014 International Association for the Study of Obesity.

Building a Recycling Program: A Case Study in Success.

ERIC Educational Resources Information Center

Sabol, Laurie

1992-01-01

Presents the development and ongoing operation of a library recycling program established at Bowling Green State University in Ohio. Discusses the initiation and projects of the library recycling committee, logistics, and future projections for library recycling operations. (two references) (MCO)

Successful strategies for improving operating room efficiency at academic institutions.

PubMed

Overdyk, F J; Harvey, S C; Fishman, R L; Shippey, F

1998-04-01

In this prospective study, we evaluated the etiology of operating room (OR) delays in an academic institution, examined the impact of multidisciplinary strategies to improve OR efficiency, and established OR timing benchmarks for use in future OR efficiency studies. OR times and delay etiologies were collected for 94 cases during the initial phase of the study. Timing data and delay etiologies were analyzed, and 2 wk of multidisciplinary OR efficiency awareness education was conducted for the nursing, surgical, and anesthesia staff. After the education period, timing data were collected from 1787 cases, and monthly reports listing individual case delays and timing data were sent to the Chiefs of Service. For the first case of the day, patient in room, anesthesia ready, surgical preparation start, and procedure start time were significantly earlier (P < 0.01) in the posteducation period compared with the preeducation period, and the procedure start time for the first case of the day occurred, on average, 22 min earlier than all other procedures. For all cases combined, turnover time decreased, on average, by 16 min. Unavailability of surgeons, anesthesiologists, and residents decreased significantly (P < 0.05) as causes of OR delays. Anesthesia induction times were consistently longer for the vascular and cardiothoracic services, whereas surgical preparation time was increased for the neurosurgical and orthopedic services (P < 0.05). Identification of the etiology of OR inefficiency, combined with multidisciplinary awareness training and personal accountability, can improve OR efficiency. The time savings realized are probably most cost-effective when combined with more flexible OR staffing and improved OR scheduling. We achieved significant improvements in operating room efficiency by analyzing operating room data on causes of delays, devising strategies for minimizing the most common delays, and subsequently measuring delay data. Personal accountability, streamlining of procedures, interdisciplinary team work, and accurate data collection were all important contributors to improved efficiency.

Giant cell tumour of tendon sheath and synovial membrane: A review of 26 cases.

PubMed

Kant, Kumar Shashi; Manav, Ajoy Kumar; Kumar, Rakesh; Abhinav; Sinha, Vishvendra Kumar; Sharma, Akshat

2017-11-01

Aim of our study is to highlight the incidence and benign nature of Giant cell tumour of tendon sheath and need for complete removal, thus minimizing the chances of recurrence. A total of 26 cases of Giant cell tumour of tendon sheath operated in the department of Orthopaedics, Patna Medical College & Hospital, Patna from 2003 to 2010 were included in this study. The surgery was performed after clinical evaluation of the lesion and Fine Needle Aspiration Cytology (FNAC). The tumour underwent en bloc marginal excision. The patients were followed up for minimum two year. Our study population consisted of 18 females and 8 males. The mean age at the time of surgery was 38.3 years (range, 18-62 years). Twenty three cases were found in the 3rd and 4th decade. Twenty two cases involved upper extremity and only 4 cases in lower extremity. MRI was done in 2 cases where diagnosis was in doubt. Bony indentation on X-ray film was found in 7 cases and thorough curettage of cortical shell was done. All the cases were treated by marginal excision. Three cases developed post-operative stiffness but regained full range of movement with physiotherapy. Sensory impairment was seen in 3 cases. Recurrence occurred in 2 case and they were treated by repeat marginal excision. Meticulous en-masse marginal excision of the giant cell tumour of tendon sheath in blood less field using magnification is the treatment of choice.

Mediated interruptions of anaesthesia providers using predictions of workload from anaesthesia information management system data.

PubMed

Epstein, R H; Dexter, F

2012-09-01

Perioperative interruptions generated electronically from anaesthesia information management systems (AIMS) can provide useful feedback, but may adversely affect task performance if distractions occur at inopportune moments. Ideally such interruptions would occur only at times when their impact would be minimal. In this study of AIMS data, we evaluated the times of comments, drugs, fluids and periodic assessments (e.g. electrocardiogram diagnosis and train-of-four) to develop recommendations for the timing of interruptions during the intraoperative period. The 39,707 cases studied were divided into intervals between: 1) enter operating room; 2) induction; 3) intubation; 4) surgical incision; and 5) end surgery. Five-minute intervals of no documentation were determined for each case. The offsets from the start of each interval when >50% of ongoing cases had completed initial documentation were calculated (MIN50). The primary endpoint for each interval was the percentage of all cases still ongoing at MIN50. Results were that the intervals from entering the operating room to induction and from induction to intubation were unsuitable for interruptions confirming prior observational studies of anaesthesia workload. At least 13 minutes after surgical incision was the most suitable time for interruptions with 92% of cases still ongoing. Timing was minimally affected by the type of anaesthesia, surgical facility, surgical service, prone positioning or scheduled case duration. The implication of our results is that for mediated interruptions, waiting at least 13 minutes after the start of surgery is appropriate. Although we used AIMS data, operating room information system data is also suitable.

A Framework for Violence: Clarifying the Role of Motivation in Lone-Actor Terrorism

DTIC Science & Technology

2017-03-01

Within the timeframe included in this study , there was, on average, just over one case of lone-actor terrorism per year.60 Spaaij expanded his...informants and sting operations.63 Within the Becker study , twelve out of eighty-four attacks, relied on confidential informants.64 In certain cases , the...indicators of personal or ideological grievances. The data used for this research are publicly available and largely based on two case studies compiled

Variation in day-case nasal surgery - why cannot we improve our day-case rates?

PubMed

Hopkins, C; Browne, J; Slack, R; Brown, P

2007-02-01

The NHS plan states that 75% of all elective operations should be performed as day-cases. We set out to evaluate day surgery rates in sinonasal surgery and to identify factors limiting current practice. Prospective multicentre cohort study. 3128 patients undergoing sinonasal surgery during 2000 and 2001. Same day discharge, complication and readmission rates. There is potential selection bias due to the non-random selection of NHS Trusts and patients in this study. However, as results are similar to Hospital Episode Statistics data such bias is probably small. Only 15.5% of all procedures are performed as day surgery. We are achieving day-case rates of 18, 20 and 6% for nasal polypectomy, intranasal antrostomy and extensive FESS respectively, compared with recently published targets of 90%, 80% and 50%. Factors significantly associated with overnight admission were use of packs, extensive surgery, excess post-operative bleeding and high ASA grade. There was considerable unexplained variation in day-case rates and the use of packs between different surgeons. A third of consultants pack all patients post-operatively. More than 51% of consultants admit all patients, while 5% discharge all patients on the day of surgery. There were no excess adverse events or readmissions amongst the day surgery patients. However, only 17% of in-patients would have liked to be discharged on the day of surgery. Both patient and surgeon must overcome resistance to day case surgery before targets can be reached. Strategies for improving day-case rates in sinonasal surgery. All ASA grade 1 and 2 patients could be considered for day-case surgery, but particularly those with less extensive disease on radiography, and those planned to undergo less extensive procedures. Excess peri-operative bleeding was reported in 6% of patients. There must therefore be provision for overnight admission if required. Greater utilisation of day-case units, selective use of packs, and earlier removal may increase the proportion of patients managed as day-cases. There remains considerable variation in practice at both consultant and trust levels. Units should continue to audit their own figures and compare them against national rates in order to reduce nationwide variation in practice.

A balanced Kalman filter ocean data assimilation system with application to the South Australian Sea

NASA Astrophysics Data System (ADS)

Li, Yi; Toumi, Ralf

2017-08-01

In this paper, an Ensemble Kalman Filter (EnKF) based regional ocean data assimilation system has been developed and applied to the South Australian Sea. This system consists of the data assimilation algorithm provided by the NCAR Data Assimilation Research Testbed (DART) and the Regional Ocean Modelling System (ROMS). We describe the first implementation of the physical balance operator (temperature-salinity, hydrostatic and geostrophic balance) to DART, to reduce the spurious waves which may be introduced during the data assimilation process. The effect of the balance operator is validated in both an idealised shallow water model and the ROMS model real case study. In the shallow water model, the geostrophic balance operator eliminates spurious ageostrophic waves and produces a better sea surface height (SSH) and velocity analysis and forecast. Its impact increases as the sea surface height and wind stress increase. In the real case, satellite-observed sea surface temperature (SST) and SSH are assimilated in the South Australian Sea with 50 ensembles using the Ensemble Adjustment Kalman Filter (EAKF). Assimilating SSH and SST enhances the estimation of SSH and SST in the entire domain, respectively. Assimilation with the balance operator produces a more realistic simulation of surface currents and subsurface temperature profile. The best improvement is obtained when only SSH is assimilated with the balance operator. A case study with a storm suggests that the benefit of the balance operator is of particular importance under high wind stress conditions. Implementing the balance operator could be a general benefit to ocean data assimilation systems.

The Nez Perce Flight to Canada: An Analysis of the Nez Perce-US Cavalry Conflicts: Applying Historical Lessons Learned to Modern Counterinsurgency and Global War on Terrorism Operations

DTIC Science & Technology

2006-06-16

COUNTERINSURGENCY AND GLOBAL WAR ON TERRORISM OPERATIONS A thesis presented to the Faculty of the US Army Command and General Staff College in partial... Terrorism and counterinsurgency operations in Iraq and Afghanistan. The US Cavalry’s clash with the Nez Perce provides an excellent case study. Their...LESSONS LEARNED TO MODERN COUNTERINSURGENCY AND GLOBAL WAR ON TERRORISM OPERATIONS, by MAJ Scott E. Pfau, 81 pages. This study details the Nez

Complexity Leadership Theory: A United States Marine Corps Historical Overlay

DTIC Science & Technology

2017-05-25

methodology is comparative, introducing Dr. Mary Uhl- Bien’s complexity leadership model as the lens to evaluate two historical case studies involving...transformed the Marine Corps, but changed broader warfare. In each case , the US military relied on the innovation for the operating environment that...immediately followed. The case studies indicate a legacy of Marine Corps’ senior leadership fostering a culture with the capacity to circumvent

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.

Cross-sectional evaluation of post-operative pain and flare-ups in endodontic treatments using a type of rotary instruments.

PubMed

Tanalp, Jale; Sunay, Hakki; Bayirli, Gündüz

2013-01-01

The purpose of this clinical study was to evaluate the general incidence of post-operative pain and flare-ups in patients who were endodontically treated by two endodontics specialists using rotary instruments (Hero 642, Micro Mega, France) with the same treatment protocol. Records of 382 teeth belonging to 268 patients treated by two endodontics specialists during a 6-month period were kept and evaluated. Post-operative pain between treatment visits was categorized using a pre-established scoring system. Ninety-five patients were males, whereas 173 were females. Pulpal necrosis without periapical pathosis was determined as the most common indication for endodontic treatment (21.7%) followed by irreversible pulpitis and re-treatment without periapical lesions (18.3%, 18.3%, respectively). The general prevalence of post-operative pain and flare-ups was determined as 8.1%, whereas cases that could be classified as real flare-ups which were severe and required an unscheduled visit (scores 2 and 3) comprised 3.4% of the cases. No statistically significant correlation was determined between gender and post-operative pain and flare-up (p = 0.05). There was a significant correlation between number of appointments and the presence of pain and flare-ups. Teeth undergoing multiple visits had a higher risk of developing post-operative pain and flare-ups compared to those with single appointments with a statistical significance (p = 0.03). Teeth with pre-operative pain were more prone to developing post-operative pain and discomfort with a statistically significant difference (p = 0.02). While no significant correlation was determined between tooth vitality and pain and flare-ups (p = 0.5), a statistically significant relationship existed between the presence of a periapical pathosis and post-operative pain and flare-ups. Cases with a periapical lesion had a higher risk of developing pain and flare-ups compared to those with no periapical involvement (p = 0.0001). Future studies may focus on the influence of rotary instrumentation systems in more specific groups of cases. Meanwhile; microbiological as well as psychological aspects of flare-ups are topics that warrant further investigation.

Effect of the 80-hour work week on resident case coverage.

PubMed

Shin, Susanna; Britt, Rebecca; Britt, L D

2008-05-01

On July 1, 2003, residency training programs were required to institute restricted duty hours as mandated by the Accreditation Council for Graduate Medical Education. A major concern, voiced by both surgical residents and faculty, was an expectation that this would result in a decrease in operative experience. We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees. A retrospective study was performed of operative and endoscopic cases scheduled for a single general surgery practice for a year before and after July 1, 2003. Data collected included operation performed, number of attending surgeons present, whether a resident was present, and level of resident. From July 2002 to June 2003, there were 1,278 cases scheduled; 890 records were available. From July 2004 to June 2005, there were 1,182 cases scheduled; 960 records were available. Before institution of the restricted duty hours, 24.6% of junior-level (PGY1 and 2) cases, 21.7% of intermediate-level (PGY3) cases, and 6.2% of senior-level (PGY4 and 5) cases were not covered by residents. After restricted duty hours were implemented, 27.3% of junior-level cases, 15.9% of intermediate-level cases, and 8.1% of senior-level cases were not covered by residents. Overall 20.8% (185 of 890) and 20.4% (196 of 960) of cases were not covered by residents before and after instituting restricted duty hours, respectively. No difference in case coverage was statistically significant in each category or overall. Restricted duty hours have not affected resident case coverage.

Effect of the 80-hour work week on resident case coverage: corrected article.

PubMed

Shin, Susanna; Britt, Rebecca; Britt, L D

2008-07-01

On July 1, 2003, residency training programs were required to institute restricted duty hours as mandated by the Accreditation Council for Graduate Medical Education. A major concern,voiced by both surgical residents and faculty, was an expectation that this would result in a decrease in operative experience. We hypothesized that implementing restricted duty hours would decrease case coverage by resident trainees. A retrospective study was per formed of operative and endoscopic cases scheduled for a single general surgery practice for a year before and after July 1, 2003. Data collected included operation per formed, number of attending surgeons present, whether a resident was present,and level of resident. From July 2002 to June 2003, there were 1,278 cases scheduled; 890 records were available. From July 2004 to June 2005, there were 1,182 cases scheduled; 960 records were available. Before institution of the restricted duty hours, 24.6% of junior-level (PGY1 and 2) cases, 21.7%of intermediate-level (PGY3) cases, and 6.2% of senior-level (PGY4 and 5) cases were not covered by residents. After restricted duty hours were implemented, 27.3% of junior-level cases,15.9% of intermediate-level cases, and 8.1% of senior-level cases were not covered by residents. Overall 20.8% (185 of 890) and 20.4% (196 of 960) of cases were not covered by residents before and after instituting restricted duty hours, respectively. No difference in case coverage was statistically significant in each category or overall. Restricted duty hours have not affected resident case coverage.

The Impact of Hospital/Surgeon Volume on Acute Renal Failure and Mortality in Liver Transplantation: A Nationwide Cohort Study.

PubMed

Cheng, Chih-Wen; Liu, Fu-Chao; Lin, Jr-Rung; Tsai, Yung-Fong; Chen, Hsiu-Pin; Yu, Huang-Ping

2016-01-01

The aim of this study was to assess whether the case volume of surgeons and hospitals affects the rates of postoperative complications and survival after liver transplantation. This population-based retrospective cohort study included 2938 recipients of liver transplantation performed between 1998 and 2012, enrolled from the Taiwan National Health Insurance Research Database. They were divided into two groups, according to the cumulative case volume of their operating surgeons and the case volume of their hospitals. The duration of intensive care unit stay and post-transplantation hospitalization, postoperative complications, and mortality were analyzed. The results showed that, in the low and high case volume surgeons groups, respectively, acute renal failure occurred at the rate of 14.11% and 5.86% (p<0.0001), and the overall mortality rates were 19.61% and 12.44% (p<0.0001). In the low and high case volume hospital groups, respectively, acute renal failure occurred in 11% and 7.11% of the recipients (p = 0.0004), and the overall mortality was 18.44% and 12.86% (p<0.0001). These findings suggest that liver transplantation recipients operated on higher case volume surgeons or in higher case volume hospitals have a lower rate of acute renal failure and mortality.

A population-based study comparing laparoscopic and robotic outcomes in colorectal surgery.

PubMed

Tam, Michael S; Kaoutzanis, Christodoulos; Mullard, Andrew J; Regenbogen, Scott E; Franz, Michael G; Hendren, Samantha; Krapohl, Greta; Vandewarker, James F; Lampman, Richard M; Cleary, Robert K

2016-02-01

Current data addressing the role of robotic surgery for the management of colorectal disease are primarily from single-institution and case-matched comparative studies as well as administrative database analyses. The purpose of this study was to compare minimally invasive surgery outcomes using a large regional protocol-driven database devoted to surgical quality, improvement in patient outcomes, and cost-effectiveness. This is a retrospective cohort study from the prospectively collected Michigan Surgical Quality Collaborative registry designed to compare outcomes of patients who underwent elective laparoscopic, hand-assisted laparoscopic, and robotic colon and rectal operations between July 1, 2012 and October 7, 2014. We adjusted for differences in baseline covariates between cases with different surgical approaches using propensity score quintiles modeled on patient demographics, general health factors, diagnosis, and preoperative co-morbidities. The primary outcomes were conversion rates and hospital length of stay. Secondary outcomes included operative time, and postoperative morbidity and mortality. A total of 2735 minimally invasive colorectal operations met inclusion criteria. Conversion rates were lower with robotic as compared to laparoscopic operations, and this was statistically significant for rectal resections (colon 9.0 vs. 16.9%, p < 0.06; rectum 7.8 vs. 21.2%, p < 0.001). The adjusted length of stay for robotic colon operations (4.00 days, 95% CI 3.63-4.40) was significantly shorter compared to laparoscopic (4.41 days, 95% CI 4.17-4.66; p = 0.04) and hand-assisted laparoscopic cases (4.44 days, 95% CI 4.13-4.78; p = 0.008). There were no significant differences in overall postoperative complications among groups. When compared to conventional laparoscopy, the robotic platform is associated with significantly fewer conversions to open for rectal operations, and significantly shorter length of hospital stay for colon operations, without increasing overall postoperative morbidity. These findings and the recent upgrades in minimally invasive technology warrant continued evaluation of the role of the robotic platform in colorectal surgery.

Inferior angle of scapula fractures: a review of literature and evidence-based treatment guidelines.

PubMed

Chang, Angela C; Phadnis, Joideep; Eardley-Harris, Nathan; Ranawat, Vijai S; Bain, Gregory I

2016-07-01

Inferior angle of scapula (IAS) fractures are rare, with very few cases reported. They typically present with pain, loss of shoulder motion, and scapula winging. Operative and nonoperative treatments have been trialed with varying success. The aim of this study was to gather data relating to IAS fractures to develop evidence-based treatment guidelines as none are currently available. A search was conducted of the PubMed and Google Scholar databases to identify cases of IAS fractures. Data collected about each case included age and gender of the patient, mechanism of injury, fracture displacement, treatment, and outcome. The authors report 2 additional IAS fracture cases. Ten cases were identified for inclusion in this study, 8 from the literature and 2 described by the authors. Of the 10 cases, 7 described displaced IAS fractures and 3 described undisplaced fractures. All displaced fractures treated nonoperatively resulted in a painful nonunion. All that underwent operative fixation, whether acutely or after failed nonoperative treatment, had resolution of pain and a good functional outcome. All undisplaced fractures were treated nonoperatively; 1 had persisting pain. Surgical exploration identified the fracture fragment attached to serratus anterior in 2 cases and attached to both serratus anterior and latissimus dorsi in 2 cases. There are limited data available about IAS factures. From the cases reviewed, treatment recommendations include the following: (1) displaced IAS fractures should undergo operative fixation to prevent the development of a painful nonunion; (2) suture repair provides adequate fixation; and (3) undisplaced fractures have a variable outcome when treated nonoperatively. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Reservoirs performances under climate variability: a case study

NASA Astrophysics Data System (ADS)

Longobardi, A.; Mautone, M.; de Luca, C.

2014-09-01

A case study, the Piano della Rocca dam (southern Italy) is discussed here in order to quantify the system performances under climate variability conditions. Different climate scenarios have been stochastically generated according to the tendencies in precipitation and air temperature observed during recent decades for the studied area. Climate variables have then been filtered through an ARMA model to generate, at the monthly scale, time series of reservoir inflow volumes. Controlled release has been computed considering the reservoir is operated following the standard linear operating policy (SLOP) and reservoir performances have been assessed through the calculation of reliability, resilience and vulnerability indices (Hashimoto et al. 1982), comparing current and future scenarios of climate variability. The proposed approach can be suggested as a valuable tool to mitigate the effects of moderate to severe and persistent droughts periods, through the allocation of new water resources or the planning of appropriate operational rules.

Management of a water distribution network by coupling GIS and hydraulic modeling: a case study of Chetouane in Algeria

NASA Astrophysics Data System (ADS)

Abdelbaki, Chérifa; Benchaib, Mohamed Mouâd; Benziada, Salim; Mahmoudi, Hacène; Goosen, Mattheus

2017-06-01

For more effective management of water distribution network in an arid region, Mapinfo GIS (8.0) software was coupled with a hydraulic model (EPANET 2.0) and applied to a case study region, Chetouane, situated in the north-west of Algeria. The area is characterized not only by water scarcity but also by poor water management practices. The results showed that a combination of GIS and modeling permits network operators to better analyze malfunctions with a resulting more rapid response as well as facilitating in an improved understanding of the work performed on the network. The grouping of GIS and modeling as an operating tool allows managers to diagnosis a network, to study solutions of problems and to predict future situations. The later can assist them in making informed decisions to ensure an acceptable performance level for optimal network operation.

Resident training in a teaching hospital: How do attendings teach in the real operative environment?

PubMed

Glarner, Carly E; Law, Katherine E; Zelenski, Amy B; McDonald, Robert J; Greenberg, Jacob A; Foley, Eugene F; Wiegmann, Douglas A; Greenberg, Caprice C

2017-07-01

The study aim was to explore the nature of intraoperative education and its interaction with the environment where surgical education occurs. Video and audio recording captured teaching interactions between colorectal surgeons and general surgery residents during laparoscopic segmental colectomies. Cases and collected data were analyzed for teaching behaviors and workflow disruptions. Flow disruptions (FDs) are considered deviations from natural case progression. Across 10 cases (20.4 operative hours), attendings spent 11.2 hours (54.7%) teaching, using directing (M = 250.1), and confirming (M = 236.1) most. FDs occurred 410 times, accounting for 4.4 hours of case time (21.57%). Teaching occurred with FD events for 2.4 hours (22.2%), whereas 77.8% of teaching happened outside FD occurrence. Teaching methods shifted from active to passive during FD events to compensate for patient safety. Understanding how FDs impact operative learning will inform faculty development in managing interruptions and improve its integration into resident education. Copyright © 2016. Published by Elsevier Inc.

Integrating Nuclear Energy to Oilfield Operations – Two Case Studies

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

Eric P. Robertson; Lee O. Nelson; Michael G. McKellar

2011-11-01

Fossil fuel resources that require large energy inputs for extraction, such as the Canadian oil sands and the Green River oil shale resource in the western USA, could benefit from the use of nuclear power instead of power generated by natural gas combustion. This paper discusses the technical and economic aspects of integrating nuclear energy with oil sands operations and the development of oil shale resources. A high temperature gas reactor (HTGR) that produces heat in the form of high pressure steam (no electricity production) was selected as the nuclear power source for both fossil fuel resources. Both cases weremore » based on 50,000 bbl/day output. The oil sands case was a steam-assisted, gravity-drainage (SAGD) operation located in the Canadian oil sands belt. The oil shale development was an in-situ oil shale retorting operation located in western Colorado, USA. The technical feasibility of the integrating nuclear power was assessed. The economic feasibility of each case was evaluated using a discounted cash flow, rate of return analysis. Integrating an HTGR to both the SAGD oil sands operation and the oil shale development was found to be technically feasible for both cases. In the oil sands case, integrating an HTGR eliminated natural gas combustion and associated CO2 emissions, although there were still some emissions associated with imported electrical power. In the in situ oil shale case, integrating an HTGR reduced CO2 emissions by 88% and increased natural gas production by 100%. Economic viabilities of both nuclear integrated cases were poorer than the non-nuclear-integrated cases when CO2 emissions were not taxed. However, taxing the CO2 emissions had a significant effect on the economics of the non-nuclear base cases, bringing them in line with the economics of the nuclear-integrated cases. As we move toward limiting CO2 emissions, integrating non-CO2-emitting energy sources to the development of energy-intense fossil fuel resources is becoming increasingly important. This paper attempts to reduce the barriers that have traditionally separated fossil fuel development and application of nuclear power and to promote serious discussion of ideas about hybrid energy systems.« less

[Application of bilateral direct anterior approach total hip arthroplasty: a report of 22 cases].

PubMed

Tang, J; Lv, M; Zhou, Y X; Zhang, J

2017-04-18

To analyze the operation technique and the methods to avoid early complications on the learning curve for bilateral direct anterior approach (DAA) total hip arthroplasty (THA). We retrospectively studied a series of continued cases with bilateral avascular necrosis of the femoral head (AVN) or degenerative dysplastic hip and rheumatoid arthritis that were treated by DAA THA in Beijing Jishuitan Hospital. A total of 22 patients with 44 hips were analyzed from June 2014 to August 2016 in this study. There were 17 males and 5 females, and the median age was 48 years (range: 34-67 years). All the surgery was done by DAA method by two senior surgeons. The clinic characters, early surgery treatment results and complications were analyzed. We used the cementless stems in all the cases. The average operating time was (167±23) min; the average blood loss was (775±300) mL;the blood transfusion was in average (327±341) mL; the wound drainage in average was (111±73) mL. Most of the patients could move out of the bed by themselves on the first day after operation, 5 patients could walk without crutches on the first operating day, and 13 patients could squat on the third days after operation. The patients were discharged averagely 4 days after operation. We followed up all the patients for averagely 16 months (range: 8-24 months). There was no loosening or failure case in the latest follow up. In the study, 2 patients had great trochanter fracture, 2 patients had thigh pain, 4 patients had lateral femoral cutaneous nerve palsy, and 3 patients had muscle damage. The Harris scores were improved from 29±8 preoperatively to 90±3 postoperatively (P<0.01). The DAA THA can achieve faster recovery and flexible hip joint after operation. However it is a kind of surgery with high technique demanding. Carefully selected patients, and skilled technique, can help the surgeon avoid the early complications. It is associated with high complication rate in the learning curve for bilateral DAA THA.

Analysis of Benefits of an Energy Imbalance Market in the NWPP

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

Samaan, Nader A.; Bayless, Rich; Symonds, Mark

The Northwest Power Pool (NWPP) Market Assessment Committee (MC) Initiative, which was officially launched on March 19, 2012, set out to explore a range of alternatives that could help the Balancing Authorities and scheduling utilities in the NWPP area address growing operational and commercial challenges affecting the regional power system. The MC formed an Analytical Team with technical representatives from each of the member Balancing Areas in the NWPP and with staff of Pacific Northwest National Laboratory (PNNL). This Analytical Team was instructed to conduct extensive studies of intra-hour operation of the NWPP system in the year 2020 and ofmore » the NWPP region with 14,671 MW of wind penetration. The effort utilized a sub-hourly production cost model (the PLEXOS® computer model) that inputs data from the Western Electricity Coordinating Council (WECC)-wide Production Cost Model (PCM) to evaluate potential production cost savings. The Analytical Team was given two general options to evaluate: •Energy Imbalance Market (EIM): establishment of an automated, organized NWPP area market for economically supplying energy imbalance within the hour. •Enhanced Market-Operational Tools (EMT) that might augment or replace an EIM. The Analytical The Analytical Team built on the WECC-wide PCM data from prior work done in the WECC and carried forward the evolution of the original WECC Transmission Expansion Planning Policy Committee (TEPPC) 2020 PC0 data base. A large number of modifications and improvements were made to this case and the data were subjected to extensive review by the team members to improve the model representation of the Northwest (NW). MC meetings that were open to the public were held for interested parties to review and provide input to the study. Results for the test, base, and sensitivity case studies performed by the MC Initiative Analytical Team indicate that there are a wide range of benefits that could be obtained from the operation of an EIM in the NWPP depending on what assumptions are made. The instructions from the MC were to determine a "minimum high confidence" range of potential benefits. The results for the Base Case indicate that the EIM benefits ranged from approximately $40 million to $70 million in annual savings from the operation of an EIM in the NWPP footprint. A number of additional relevant sensitivity cases were performed, including low and high water conditions, low and high natural gas prices, and various flex reserve requirements, resource operations, and amounts of resource capability held back during the preschedule period. Along with the results for the Base Case, the results for these studies yielded EIM benefits that clustered within the range of $70 to $80 million dollars per year with potential benefits ranging from approximately $125 million to as little as $17 million per year. Because the design and operation of an EIM could enable participating Balancing Authorities (BAs) to collectively lower the quantity of resources they must carry to meet within-hour balancing needs, a sensitivity case was also performed to analyze the impact that such reductions might have on the benefits from an EIM. The results for this sensitivity case indicate that such reductions could increase the benefits from the operation of an EIM in the NWPP into the range of approximately $130 million to $160 million per year. Also, a sensitivity case for a WECC-wide EIM was performed with the results indicating that the potential benefits to the NWPP could increase into the range of $197 million to $233 million per year. While there may be potential reliability benefits from the coordinated dispatch process underlying the operation of an EIM, reliability benefits from an EIM were out of the scope of this study. The EIM benefit analyses that were performed by the Analytical Team are provided in this report.« less

Extended operating times are more efficient, save money and maintain a high staff and patient satisfaction.

PubMed

Herron, Jonathan Blair Thomas; French, Rachel; Gilliam, Andrew Douglas

2018-01-01

Current public sector austerity measures necessitate efficiency savings throughout the NHS. Performance targets have resulted in activity being performed in the private sector, waiting list initiative lists and requests for staff to work overtime. This has resulted in staff fatigue and additional agency costs. Adoption of extended operating theatre times (0800-1800 hours) may improve productivity and efficiency, with potentially significant financial savings; however, implementation may adversely affect staff morale and patient compliance. A pilot period of four months of extended operating times (4.5 hour sessions) was completed and included all theatre surgical specialties. Outcome measures included: the number of cases completed, late starts, early finishes, cancelled operations, theatre overruns, preoperative assessment and 18-week targets. The outcomes were then compared to pre-existing normal working day operating lists (0900-1700). Theatre staff, patient and surgical trainee satisfaction with the system were also considered by use of an anonymous questionnaire. The study showed that in-session utilisation time was unchanged by extended operating hours 88.7% (vs 89.2%). The service was rated as 'good' or 'excellent' by 87.5% of patients. Over £345,000 was saved by reducing premium payments. Savings of £225,000 were made by reducing privately outsourced operation and a further £63,000 by reviewing staff hours. Day case procedures increased from 2.8 to 3.2 cases/day with extended operating. There was no significant increase in late starts (5.1% vs 6.8%) or cancellation rates (0.75% vs 1.02%). Theatre over-runs reduced from 5% to 3.4%. The 18 weeks target for surgery was achieved in 93.7% of cases (vs 88.3%). The number of elective procedures increased from 4.1 to 4.89 cases/day. Only 13.33% of trainees (n = 33) surveyed felt that extended operating had a negative impact on training. The study concludes that extended operating increased productivity from 2.8 patients per session to 3.2 patients per session with potential savings of just over £2.4 million per financial year. Extrapolating this to the other 155 trusts in England could be a potential saving of £372 million per year. Staff, trainee and patient satisfaction was unaffected. An improved 18 weeks target position was achieved with a significant reduction in private sector work. However, some staff had difficulty with arranging childcare and taking public transport and this may prevent full implementation.

[Internal fixation treatment of multiple rib fractures with absorbable rib-connecting-pins under epidural anesthesia].

PubMed

Liu, Jinliang; Li, Keyao; Ju, Zhenlong; Bai, Yan

2011-03-01

To study the indications, methods and experience of absorbable rib-connecting-pins fixation in the treatment of multiple rib fractures. 52 cases with multiple rib fractures were performed internal fixation with absorbable rib-connecting-pins under epidural anesthesia. All cases were followed up for 1 to 12 months, with an average of 5 months. All fractures were achieved healing in 3 to 6 months after the operation and were not found chest wall deformity. Absorbable rib-connecting-pins fixation is a simple and effective method and worthies recommending to perform operation for the appropriate cases with multiple rib fractures.

[Exploration of transnasal endoscopic cranialbase approach].

PubMed

Xu, Geng; Li, Yuan; Xie, Minqiang; Wen, Weiping; Shi, Jianbo; Chen, Hexin; Lu, Jianting; Zhang, Gehua; Liu, Xian; Xu, Rui

2002-12-01

To study feasibility and indication of cranialbase surgery by transnasal endoscopic approach. Nine cases treated by transnasal were analysed. Those cases included foreign body, olfactory neuroblastoma, meningoma and inverted papilloma in anterior cranial fossa, sinuses sphenoidalis macrosis cyst invading middle cranial fossa, primary cholesteatoma and space occupying lesion in middle cranial fossa. The complications were not occurred in all cases. Follow-up survey 1-7 years, no-relapse was occurred. It is probability that surgery lesion be close skull base by transnasal endoscopic approach, but indication must be exactitude selected. The operator should be have firm anatomic, skilled operation and richness experience. The malignancy lesion should be compositive treatment after surgery.

Large cell neuroendocrine cervical tumor treated by radical surgery and adjuvant chemotherapy: A case report and literature review.

PubMed

BacalbaȘa, Nicolae; Stoica, Claudia; Marcu, Madalina; Mihalache, Daniela; Vasilescu, Florina; Popa, Ileana; Mirea, Gratiela; Bălescu, Irina

2016-01-01

Neuroendocrine carcinomas of the uterine cervix are rare, but extremely aggressive, gynecological malignancies that are associated with an overall poor prognosis. The present study reports the case of a 41-year-old patient diagnosed with large cell neuroendocrine cervical tumor. A radical total hysterectomy with bilateral adnexectomy, pelvic and lymph node dissection was performed. The post-operative course was uneventful, and the patient was discharged on post-operative day 8.

Implementation of the Chelsea School Project: A Case Study.

ERIC Educational Resources Information Center

Pelavin, Diane; And Others

A case study was done of the Boston University management and operation of the Chelsea (Massachusetts) school system including perceptions of key participants and outcomes of the first year of the partnership. Despite unanticipated levels of hostility between various groups and slow funding, which slowed some first year objectives, the project…

Recruiting Young Volunteers in an Area of Selective Education: A Qualitative Case Study

ERIC Educational Resources Information Center

Dean, Jon

2016-01-01

This article presents findings from a small qualitative case study of a youth volunteering brokerage organisation in England, operating in an area of selective state education. Data show how brokerage workers felt grammar schools managed their students in a concerted way to improve students' chances of attending university. Conversely, workers…

The Influence of Lean on K-12 District Management: A Case Study

ERIC Educational Resources Information Center

Brown, Beverly

2011-01-01

For decades, policymakers and educators have focused on public school equity and adequacy, while paying little attention to efficiency. This qualitative single case study was designed to capture explicit information about Lean management, operations, and culture in a K-12 Michigan school district engaged in Lean training and implementation for a…

Television-Centered, Instructional Delivery Systems: Costs and Case Studies. A Review of Research.

ERIC Educational Resources Information Center

Maher, Thomas G.

This paper reviews the post-1975 research on the capacities, logistics, and costs of the various delivery technologies used in educational television, and details case studies of television-centered operations, particularly in relationship to adult learners. The paper begins with a section on general definitions and the capacities of various…

Training Factory Workers: Three Case Studies. Contractor Report.

ERIC Educational Resources Information Center

Hirschhorn, Larry D.

Case studies examined the context and impact of training in three factories: a bakery, a circuit assembly plant, and a plant that produces microchips. Cookie-Foods, Inc. used Statistical Process Control (SPC) and a course on problem solving to increase the operators' productivity. Impact of the SPC program was limited, because workers who…

Robotic Colorectal Resection With and Without the Use of the New Da Vinci Table Motion: A Case-Matched Study.

PubMed

Palmeri, Matteo; Gianardi, Desirée; Guadagni, Simone; Di Franco, Gregorio; Bastiani, Luca; Furbetta, Niccolò; Simoncini, Tommaso; Zirafa, Cristina; Melfi, Franca; Buccianti, Piero; Moglia, Andrea; Cuschieri, Alfred; Mosca, Franco; Morelli, Luca

2018-06-01

The da Vinci Table Motion (dVTM) is a new device that enables patients to be repositioned with instruments in place within the abdomen, and without undocking the robot. The present study was designed to compare operative and short-term outcomes of patients undergoing colorectal cancer surgery with the da Vinci Xi system, with or without use of the dVTM. Ten patients underwent robotic colorectal resection for cancer with the use of dVTM (Xi-dVTM group) between May 2015 and October 2015 at our center. The intraoperative and short-term clinical outcome were compared, using a case-control methodology (propensity scores approach to create 1:2 matched pairs), with a similar group of patients who underwent robotic colorectal surgery for cancer without the use of the dVTM device (Xi-only group). Overall robotic operative time was shorter in the Xi-dVTM group ( P = .04). Operations were executed fully robotic in all Xi-dVTM cases, while 2 cases of the Xi-only group required conversion to open surgery because of bulky tumors and difficult exposure. Postoperative medical complications were higher in the Xi-only group ( P = .024). In this preliminary experience, the use of the new dVTM with the da Vinci Xi in colorectal surgery, by overcoming the limitations of the fixed positions of the patient, enhanced the workflow and resulted in improved exposure of the operative field. Further studies with a greater number of patients are needed to confirm these benefits of the dVTM-da Vinci Xi robotically assisted colorectal surgery.

Integrated Operations Architecture Technology Assessment Study

NASA Technical Reports Server (NTRS)

2001-01-01

As part of NASA's Integrated Operations Architecture (IOA) Baseline, NASA will consolidate all communications operations. including ground-based, near-earth, and deep-space communications, into a single integrated network. This network will make maximum use of commercial equipment, services and standards. It will be an Internet Protocol (IP) based network. This study supports technology development planning for the IOA. The technical problems that may arise when LEO mission spacecraft interoperate with commercial satellite services were investigated. Commercial technology and services that could support the IOA were surveyed, and gaps in the capability of existing technology and techniques were identified. Recommendations were made on which gaps should be closed by means of NASA research and development funding. Several findings emerged from the interoperability assessment: in the NASA mission set, there is a preponderance of small. inexpensive, low data rate science missions; proposed commercial satellite communications services could potentially provide TDRSS-like data relay functions; and. IP and related protocols, such as TCP, require augmentation to operate in the mobile networking environment required by the space-to-ground portion of the IOA. Five case studies were performed in the technology assessment. Each case represented a realistic implementation of the near-earth portion of the IOA. The cases included the use of frequencies at L-band, Ka-band and the optical spectrum. The cases also represented both space relay architectures and direct-to-ground architectures. Some of the main recommendations resulting from the case studies are: select an architecture for the LEO/MEO communications network; pursue the development of a Ka-band space-qualified transmitter (and possibly a receiver), and a low-cost Ka-band ground terminal for a direct-to-ground network, pursue the development of an Inmarsat (L-band) space-qualified transceiver to implement a global, low data rate network for LEO/MEO, mission spacecraft; and, pursue developmental research for a miniaturized, high data rate optical transceiver.

Application of automation and robotics to lunar surface human exploration operations

NASA Technical Reports Server (NTRS)

Woodcock, Gordon R.; Sherwood, Brent; Buddington, Patricia A.; Bares, Leona C.; Folsom, Rolfe; Mah, Robert; Lousma, Jack

1990-01-01

Major results of a study applying automation and robotics to lunar surface base buildup and operations concepts are reported. The study developed a reference base scenario with specific goals, equipment concepts, robot concepts, activity schedules and buildup manifests. It examined crew roles, contingency cases and system reliability, and proposed a set of technologies appropriate and necessary for effective lunar operations. This paper refers readers to four companion papers for quantitative details where appropriate.

Innovations in Site Characterization Case Study: Hanscom Air Force Base, Operable Unit 1

EPA Pesticide Factsheets

This document is a condensation of the information provided in the much more detailed Hanscom AFB Report entitled A Dynamic Site Investigation: Adaptive Sampling and Analysis Program for Operable Unit 1 at Hanscom Air Force Base, Bedford, Massachusetts.

Advanced laparoscopic fellowship and general surgery residency can coexist without detracting from surgical resident operative experience.

PubMed

Kothari, Shanu N; Cogbill, Thomas H; O'Heron, Colette T; Mathiason, Michelle A

2008-01-01

Concern has been voiced that general surgery residents who train at institutions that also offer advanced laparoscopic fellowships may receive inadequate advanced laparoscopic operative experience. The purpose of our study was to compare the operative experience of general surgery residents who graduated from our institution before initiation of an advanced laparoscopic fellowship with the experience of those who graduated after the fellowship began. Operative case logs of surgery residents who graduated from 2000 through 2007 and of advanced laparoscopic fellows from 2004 through 2007 were reviewed. Surgery resident experience with basic and nonbariatric advanced laparoscopic cases during the 4 years before the fellowship was compared with the experience during the 4 years after the fellowship began. Residents who graduated before 2004 performed a mean of 140.5 +/- 19.4 basic and 77.0 +/- 17.8 advanced laparoscopic cases during their 5-year residency, compared with 193.3 +/- 34.5 basic (p = 0.003) and 113.3 +/- 23.5 advanced cases (p = 0.005) performed by those who graduated in 2004 or later. The number of nonbariatric advanced laparoscopic cases performed by each graduating surgical resident during the chief year ranged from 26 to 47 cases from 2000 to 2003 and from 36 to 69 cases from 2004 to 2007. Fellows reported from 40 to 85 nonbariatric advanced laparoscopic cases annually. General surgery residents did not experience a reduction in the total number of basic and nonbariatric advanced laparoscopic cases with the addition of an advanced laparoscopic fellowship, nor did they perform fewer cases during the chief year. As the result of a cooperative venture between the surgery residency and fellowship directors as well as an expansion of the total number of laparoscopic cases performed at our institution because of changes in clinical practice, surgery residents reported an increase in the number of laparoscopic cases while a successful fellowship was established.

Ear, nose and throat day-case surgery at a district general hospital.

PubMed

Pézier, T; Stimpson, P; Kanegaonkar, R G; Bowdler, D A

2009-03-01

In 2000, The NHS Plan in the UK set a target of 75% for all surgical activity to be performed as day-cases. We aim to assess day-case turnover for ENT procedures and, in particular, day-case rates for adult and paediatric otological procedures together with re-admissions within 72 h as a proxy measure of safety. Retrospective collection of data (procedure and length of stay) from the computerised theatre system (Galaxy) and Patient Information Management System (PIMS) of all elective patients operated over one calendar year. The setting was a district general hospital ENT department in South East England. All ENT operations are performed with the exception of oncological head and neck procedures and complex skull-base surgery. Overall, 2538 elective operations were performed during the study period. A total of 1535 elective adult procedures were performed with 74% (1137 of 1535) performed as day-cases. Of 1003 paediatric operations, 73% (730 of 1003) were day-cases. Concerning otological procedures, 93.4% (311 of 333) of paediatric procedures were day-cases. For adults, we divided the procedures into major and minor, achieving day-case rates of 88% (93 of 101) and 91% (85 of 93), respectively. The overall day-case rate for otological procedures was 91% (528 of 580). Re-admission rates overall were 0.7% (11 of 1535) for adults and 0.9% (9 of 1003) for paediatric procedures. The most common procedure for re-admission was tonsillectomy accounting for 56% of all adult re-admissions and 78% of paediatric re-admissions. The were no deaths following day-case procedures. ENT surgery is well-suited to a day-case approach. UK Government targets are attainable when considering routine ENT surgery. Day-case rates for otology in excess of targets are possible even when considering major ear surgery.

Post-operative pain management in paediatric surgery at Sylvanus Olympio University Teaching Hospital, Togo.

PubMed

Sama, Hamza Doles; Bang'na Maman, Aboudoul Fataou Ouro; Djibril, Mohaman; Assenouwe, Marcellin; Belo, Mofou; Tomta, Kadjika; Chobli, Martin

2014-01-01

The aim of this study was to evaluate pain management in paediatric surgery at Sylvanus Olympio University Teaching Hospital, Lome. A prospective descriptive study was conducted in the Department of Anaesthesiology and Intensive Care at Sylvanus Olympio teaching hospital from 1 January to 30 June 2012. Data collected include: demography, type of surgery, American Society of Anaesthesiologists (ASA) classification, anaesthetic protocol, analgesia technique, post-operative complications and cost of analgesia. The study includes 106 post-operative children. Abdominal surgery was performed in 41.5% and orthopaedic surgery in 31.1%. A total of 75% of patients were classified ASA 1. General anaesthesia (GA) was performed in 88%. Anaesthetists supervised post-operative care in 21.7% cases. Multimodal analgesia was used in every case and 12% of patients received a regional block. The most frequently unwanted effects of analgesics used were nausea and/or vomiting in 12.3%. At H24, child under 7 years have more pain assessment than those from 7 to 15 years (46% vs 24%) and this difference was statistically significant (chi-square = 4.7598; P = 0.0291 < 0.05). The average cost of peri-operative analgesia under loco regional analgesia (LRA) versus GA during the first 48 h post-operative was US $23 versus $46. Our study showed that post-operative pain management in paediatric surgery is often not well controlled and paediatric loco regional analgesia technique is under practiced in sub Saharan Africa.

The Emergence of Untrained Mands and Tacts in Children with Autism

ERIC Educational Resources Information Center

Finn, Heather E.; Miguel, Caio F.; Ahearn, William H.

2012-01-01

Despite Skinner's (1957) assertion that verbal operants are initially functionally independent, recent studies have suggested that in some cases the acquisition of one verbal operant (e.g., mand) gives rise to the other (e.g., tact) without explicit training. The present study aimed to evaluate the functional independence of mands and tacts during…

A systematic review of tibialis anterior tendon rupture treatments and outcomes.

PubMed

Christman-Skieller, Claudia; Merz, Michael K; Tansey, Joseph P

2015-04-01

Tibialis anterior (TA) tendon rupture is a relatively rare injury that has been documented primarily in case reports. This article is the first large systematic review of the literature on treatment techniques for subcutaneous rupture of TA tendons. Studies for review were identified through a PubMed search. Eligible studies involved cases of closed tendon rupture. Of the 87 cases in the study, 72 were treated with surgery, 15 with conservative measures. Mean age was 63.9 years (surgery group) and 72.4 years (conservative treatment group). Primary repair was used most often for newer injuries, autograft most often for older injuries. Operative repair of subcutaneous TA tendon rupture leads to successful outcomes in many patients. A surgeon who is deciding which operative technique to use for a patient should consider the age of the injury and the findings of intraoperative assessment for tendon necrosis.

Governance: Blending Bureaucratic Rules with Day to Day Operational Realities Comment on "Governance, Government, and the Search for New Provider Models".

PubMed

Chinitz, David P

2016-05-31

Richard Saltman and Antonio Duran take up the challenging issue of governance in their article "Governance, Government and the Search for New Provider Models," and use two case studies of health policy changes in Sweden and Spain to shed light on the subject. In this commentary, I seek to link their conceptualization of governance, especially its interrelated roles at the macro, meso, and micro levels of health systems, with the case studies on which they report. While the case studies focus on the shifts in governance between the macro and meso levels and their impacts on achievement of desired policy outcomes, they also highlight the need to better integrate the dynamics of day to day operations within micro organizations into the overall governance picture. © 2016 by Kerman University of Medical Sciences.

The control effect in a detached laminar boundary layer of an array of normal synthetic jets

NASA Astrophysics Data System (ADS)

Valenzuela Calva, Fernando; Avila Rodriguez, Ruben

2016-11-01

In this work, 3D numerical simulations of an array of three normal circular synthetic jets embedded in an attached laminar boundary layer that separates under the influence of an inclined flap are performed for flow separation control. At the beginning of the present study, three cases are used to validate the numerical simulation with data obtained from experiments. The experimental data is chosen based on the cases which presented higher repeatability and reliability. Simulations showed reasonable agreement when compared with experiments. The simulations are undertaken at three synthetic jet operating conditions, i.e. Case A: L = 2, VR = 0.32; Case B: L = 4, VR = 0.64 and Case C: L = 6, VR = 0.96. The vortical structures produced for each synthetic jet operating condition are hairpin vortices for Case A and tilted vortices for Case B and C, respectively. By examining the spatial wall shear stress variations, the effect on the boundary layer prior to separation of the middle synthetic jet is evaluated. For effective flow control, produced at a relatively low the finding from this study suggests that hairpin vortical structures are more desirable structures. Universidad Nacional Autonoma de Mexico.

Reasons for operation cancellations at a teaching hospital: prioritizing areas of improvement.

PubMed

Abeeleh, Mahmoud Abu; Tareef, Tareq M; Hani, Amjad Bani; Albsoul, Nader; Samarah, Omar Q; ElMohtaseb, M S; Alshehabat, Musa; Ismail, Zuhair Bani; Alnoubani, Omar; Obeidat, Salameh S; Halawa, Sami Abu

2017-08-01

To report rates of and reasons for operation cancellation, and to prioritize areas of improvement. Retrospective data were extracted from the monthly reports of cancelled listed operations. Data on 14 theatres were collected by the office of quality assurance at Jordan University Hospital from August 2012 to April 2016. Rates and reasons for operation cancellation were investigated. A Pareto chart was constructed to identify the reasons of highest priority. During the period of study, 6,431 cases (9.31%) were cancelled out of 69,066 listed cases. Patient no-shows accounted for 62.52% of cancellations. A Pareto analysis showed that around 80% of the known reasons for cancellation after admission were due to a lack of surgical theatre time (30%), incomplete preoperative assessment (21%), upper respiratory tract infection (19%), and high blood pressure (13%). This study identified the most common reasons for operation cancellation at a teaching hospital. Potential avoidable root causes and recommended interventions were suggested accordingly. Future research, available resources, hospital policies, and strategic measures directed to tackle these reasons should take priority.

Preparing School Leaders for a Changing World: Case Studies of Exemplary Programs. School Leadership Study. Case Study Summaries

ERIC Educational Resources Information Center

LaPointe, Michelle, Ed.; Darling-Hammond, Linda, Ed.; Meyerson, Debra, Ed.

2007-01-01

In 2003, with funding from The Wallace Foundation, a national team of researchers organized by Stanford University and The Finance Project set out to find and examine a set of exemplary pre- and in-service professional development programs for principals, along with the policy contexts in which they operate. The purpose of the study was to…

Describing an Environment for a Self-Sustaining Technology Transfer Service in a Small Research Budget University: A Case Study

ERIC Educational Resources Information Center

Nieb, Sharon Lynn

2014-01-01

This single-site qualitative study sought to identify the characteristics that contribute to the self sustainability of technology transfer services at universities with small research budgets through a case study analysis of a small research budget university that has been operating a financially self-sustainable technology transfer service for…

Effects of Infrastructure on Ebola Viral Disease

DTIC Science & Technology

2016-06-10

Qualitative Case Study Comparison examining information from the World Health Organization, the United Nations, US Army Africa Operation United...Sierra Leone since the EVD outbreaks of 2013 to 2015. The study is a Qualitative Case Study Comparison examining information from the World Health...United Nations US United States USAID United States Agency for International Development USARAF United States Army Africa WHO World Health

Electronic measurement apparatus movable in a cased borehole and compensating for casing resistance differences

DOEpatents

Vail, W.B. III.

1991-12-24

Methods of operation are described for an apparatus having at least two pairs of voltage measurement electrodes vertically disposed in a cased well to measure the resistivity of adjacent geological formations from inside the cased well. During stationary measurements with the apparatus at a fixed vertical depth within the cased well, the invention herein discloses methods of operation which include a measurement step and subsequent first and second compensation steps respectively resulting in improved accuracy of measurement. The invention also discloses multiple frequency methods of operation resulting in improved accuracy of measurement while the apparatus is simultaneously moved vertically in the cased well. The multiple frequency methods of operation disclose a first A.C. current having a first frequency that is conducted from the casing into formation and a second A.C. current having a second frequency that is conducted along the casing. The multiple frequency methods of operation simultaneously provide the measurement step and two compensation steps necessary to acquire accurate results while the apparatus is moved vertically in the cased well. 6 figures.

Electronic measurement apparatus movable in a cased borehole and compensating for casing resistance differences

DOEpatents

Vail, III, William B.

1991-01-01

Methods of operation of an apparatus having at least two pairs of voltage measurement electrodes vertically disposed in a cased well to measure the resistivity of adjacent geological formations from inside the cased well. During stationary measurements with the apparatus at a fixed vertical depth within the cased well, the invention herein discloses methods of operation which include a measurement step and subsequent first and second compensation steps respectively resulting in improved accuracy of measurement. The invention also discloses multiple frequency methods of operation resulting in improved accuracy of measurement while the apparatus is simultaneously moved vertically in the cased well. The multiple frequency methods of operation disclose a first A.C. current having a first frequency that is conducted from the casing into formation and a second A.C. current having a second frequency that is conducted along the casing. The multiple frequency methods of operation simultaneously provide the measurement step and two compensation steps necessary to acquire accurate results while the apparatus is moved vertically in the cased well.

Utilising Enterprise Risk Management Strategies to Develop a Governance and Operations Framework for a New Research Complex: A Case Study

ERIC Educational Resources Information Center

Clyde-Smith, Jodi

2014-01-01

Enterprise risk management strategies were used to develop a regulatory and operational framework for a new multi-partner Research Institute that will house up to 900 staff from four different institutions in Queensland, Australia. The Institute will operate in a business environment while functioning as a research resource for the higher…

Antiaccess / Area-Denial: Old Concepts, New Frontiers

DTIC Science & Technology

2015-05-21

Vulcan’s Anvil: The American Civil War and the Foundation of the Operational Art (Fort Leavenworth, KS: U.S. Army Command and General Staff College, 2004...all elements of operational design and operational art , as well as all possible methods to exploit the operational environment considered to some...considerations in future military campaigns. Case Studies The Maginot Line Romantically dubbed the “Shield of France,” the Maginot Line included eighty-seven

Lessons In Operational Art: An Analysis of the Allied Expeditionary Forces in North Russia, 1918-1919

DTIC Science & Technology

2014-04-30

operations. To identify these lessons, this monograph first reviews the origins and definitions of operational art. Next, the case study of the...commanders to consider in future expeditionary operations. To identify these lessons, this monograph first reviews the origins and definitions of...environment to better understand the problem or problems at hand.”4 The next section describes the origins and modern theoretical explanations of

[Analyses of the factors relevant to revision tympanomastoid surgery].

PubMed

Li, Li; Fan, Zhaomin; Han, Yuechen; Xu, Lei; Chen, Dong; Wang, Haibo

2016-05-01

To analyze factors relevant to revisional tympanomastoid surgery for chronic otitis media(COM). The clinical data of 159 patients (159 ears), who exhibited either wet ear or relapsed after the initial operation, and were subjected to revisional tympanomastoid surgery, were retrospectively analyzed in this study. Of those 159 consecutive patients, 85 were males and 74 were females, aged 11-64 years, with a median age of 36 years old. The situations in terms of intra-operative findings, surgical procedures, change dressing post-operation, dry ear time, and the improvement of aural ability during the second operation, were recorded and analyzed. The second surgery found that, of those 159 patients underwent the re-operation, 67 presented with cholesteatoma and 92 had no cholesteatoma. In addition, the inadequate skeletonization and insufficient opening for mastoid cavity accounted for 70.4% (112/159) of all previous operations, the external auditory canal stenosis for 98.7% (157/159), the high facial ridge leading to insufficient drainage for 61.0% (97/159), the lesion in tympanic ostium of Eustachian tube for 34.6% (55/159), the insufficient drainage due to inappropriate post-operating dressing for 5.0% (8/159), the postauricular incision for 30.8% (49/159), and the endaural incision for 69.2% (110/159). As for the re-operation of the canal wall down mastoidectomy, tympanoplasty plus plastic repairing of cavity of concha were performed in 94 cases, the modified Bondy plus plastic repairing of cavity of concha in four cases, the radical mastoidectomy plus plastic repairing of cavity of concha in 59 cases, and the simple cleaning for mastoid cavity in two cases. Since one to two weeks after the revisional operations, the post-operating dressing was performed with aid of microscopy once a week on average. The average dry ear time ranged from 2 to 6 weeks (median=3 weeks). During a period of 6-93 months for the follow-up, all patients presented with dry ears. The epithelialization of the operating cavity was well and the tympanic membranes were integrity. Neither granulation tissue nor cholesteatoma was found to reoccur. Both pure tone hearing thresholds and air-bone gap decreased in 87 cases after the revisional operation, with statistically significant different in comparison to those two parameters before the operation (P<0.05). The primary causes responsible for the wet ear or reoccurrent cholesteatoma after tympanomastoid surgery may be related to the improper operation procedures and selection of incision, the non-standard operation, inexhaustive removal of pathological tissues, as well as the irregular postoperation change dressing, and other factors.

Computer-Aided System Engineering and Analysis (CASE/A) Programmer's Manual, Version 5.0

NASA Technical Reports Server (NTRS)

Knox, J. C.

1996-01-01

The Computer Aided System Engineering and Analysis (CASE/A) Version 5.0 Programmer's Manual provides the programmer and user with information regarding the internal structure of the CASE/A 5.0 software system. CASE/A 5.0 is a trade study tool that provides modeling/simulation capabilities for analyzing environmental control and life support systems and active thermal control systems. CASE/A has been successfully used in studies such as the evaluation of carbon dioxide removal in the space station. CASE/A modeling provides a graphical and command-driven interface for the user. This interface allows the user to construct a model by placing equipment components in a graphical layout of the system hardware, then connect the components via flow streams and define their operating parameters. Once the equipment is placed, the simulation time and other control parameters can be set to run the simulation based on the model constructed. After completion of the simulation, graphical plots or text files can be obtained for evaluation of the simulation results over time. Additionally, users have the capability to control the simulation and extract information at various times in the simulation (e.g., control equipment operating parameters over the simulation time or extract plot data) by using "User Operations (OPS) Code." This OPS code is written in FORTRAN with a canned set of utility subroutines for performing common tasks. CASE/A version 5.0 software runs under the VAX VMS(Trademark) environment. It utilizes the Tektronics 4014(Trademark) graphics display system and the VTIOO(Trademark) text manipulation/display system.

Instability study for LOFT for L2-1, L2-2, and L2-3 pretest steady-state operating conditions

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

Eide, S.A.

The results are presented of a thermal-hydrodynamic flow instability study of the LOFT reactor for the L2-1, L2-2, and L2-3 pretest steady-state operating conditions. Comparison is made between the LOFT reactor and a typical PWR, and the effects on stability of differences in operating parameters and geometry are discussed. Results indicate that the LOFT reactor will be thermal-hydrodynamically stable for nominal and worst case operating conditions. The study supports the LOFT Experimental Safety Analyses for the L2-1, L2-2, and L2-3 tests.

A 10 year follow-up study after Roux-Elmslie-Trillat treatment for cases of patellar instability.

PubMed

Endres, Stefan; Wilke, Axel

2011-02-18

A retrospective study concerning patients presenting with patella instability, treated using a Roux-Elmslie-Trillat reconstruction operation and followed up for 10 years following surgery, is presented. Pre-operative and follow-up radiographic evaluation included the weight-bearing anteroposterior and merchant views. Evaluation was carried out using the Insall-Salvati index, sulcus and congruence angle. The Roux-Elmslie-Trillat reconstruction operation was performed on 18 patients. The clinical evaluation at follow-up was performed using the Knee-Society-Score (KSS) and Tegner-Score. Subjective results of the operation were classed as excellent or good in 16 of the 18 patients ten years after surgery; persistent instability of the patella was recorded in only one of the 18 patients. The majority of patients returned to the same level of sporting activity after surgery as they had participated in before injury. The Roux-Elmslie-Trillat procedure could be recommended in cases presenting with an increased q-angle, trochlea dysplasia or failed soft tissue surgery. In the present study the majority of patients report a return to previous sporting activity ten years after surgery.

Video-Assisted Thoracic Surgical Lobectomy for Lung Cancer: Description of a Learning Curve.

PubMed

Yao, Fei; Wang, Jian; Yao, Ju; Hang, Fangrong; Cao, Shiqi; Cao, Yongke

2017-07-01

Video-assisted thoracic surgical (VATS) lobectomy is gaining popularity in the treatment of lung cancer. The aim of this study is to investigate the learning curve of VATS lobectomy by using multidimensional methods and to compare the learning curve groups with respect to perioperative clinical outcomes. We retrospectively reviewed a prospective database to identify 67 consecutive patients who underwent VATS lobectomy for lung cancer by a single surgeon. The learning curve was analyzed by using moving average and the cumulative sum (CUSUM) method. With the moving average and CUSUM analyses for the operation time, patients were stratified into two groups, with chronological order defining early and late experiences. Perioperative clinical outcomes were compared between the two learning curve groups. According to the moving average method, the peak point for operation time occurred at the 26th case. The CUSUM method also showed the operation time peak point at the 26th case. When results were compared between early- and late-experience periods, the operation time, duration of chest drainage, and postoperative hospital stay were significantly longer in the early-experience group (cases 1 to 26). The intraoperative estimated blood loss was significantly less in the late-experience group (cases 27 to 67). CUSUM charts showed a decreasing duration of chest drainage after the 36th case and shortening postoperative hospital stay after the 37th case. Multidimensional statistical analyses suggested that the learning curve for VATS lobectomy for lung cancer required ∼26 cases. Favorable intraoperative and postoperative care parameters for VATS lobectomy were observed in the late-experience group.

Predicting Employment Outcomes of Consumers of State-Operated Comprehensive Rehabilitation Centers

ERIC Educational Resources Information Center

Beach, David Thomas

2009-01-01

This study used records from a state-operated comprehensive rehabilitation center to investigate possible predictive factors related to completing comprehensive rehabilitation center programs and successful vocational rehabilitation (VR) case closure. An analysis of demographic data of randomly selected comprehensive rehabilitation center…

Small City Transit : Bremerton, Washington : Privately Operated Subscription Bus Service to an Industrial Site

DOT National Transportation Integrated Search

1976-03-01

Bremerton, Washington, is an illustration of a privately operated, profitmaking subscription bus service. This case study is one of thirteen examples of a transit service in a small community. The background of the community is discussed along with a...

Field and modeling framework and case study of truck weigh station operations

DOT National Transportation Integrated Search

2002-01-01

Weigh-in-Motion (WIM) systems improve the capacity of weigh station operations significantly by screening trucks while traveling at high speeds and only requiring trucks within a threshold of a maximum permissible gross of axle weight to be weighed o...

Independent School Administration.

ERIC Educational Resources Information Center

Springer, E. Laurence

This book deals with the management of privately supported schools and offers guidelines on how these schools might be operated more effectively and economically. The discussions and conclusions are based on observations and data from case studies of independent school operations. The subjects discussed include the role and organization of…

Matching food security analysis to context: the experience of the Somalia food security assessment unit.

PubMed

Hemrich, Günter

2005-06-01

This case study reviews the experience of the Somalia Food Security Assessment Unit (FSAU) of operating a food security information system in the context of a complex emergency. In particular, it explores the linkages between selected features of the protracted crisis environment in Somalia and conceptual and operational aspects of food security information work. The paper specifically examines the implications of context characteristics for the establishment and operations of the FSAU field monitoring component and for the interface with information users and their diverse information needs. It also analyses the scope for linking food security and nutrition analysis and looks at the role of conflict and gender analysis in food security assessment work. Background data on the food security situation in Somalia and an overview of some key features of the FSAU set the scene for the case study. The paper is targeted at those involved in designing, operating and funding food security information activities.

Turnaround in an aged persons' mental health service in crisis: a case study of organisational renewal.

PubMed

Stafrace, Simon; Lilly, Alan

2008-08-01

This case study demonstrates how leadership was harnessed to turn around a decline in the performance of an aged persons' mental health service - the Namarra Nursing Home at Caulfield General Medical Centre in Melbourne, Australia. In 2000 the nursing home faced a crisis of public confidence due to failings in the management of quality, clinical risk and human resources within the service. These problems reflected structural and operational shortcomings in the clinical directorate and wider organisation. In this article, we detail the process of turnaround from the perspective of senior executive managers with professional and operational responsibility for the service. This turnaround required attention to local clinical accountability and transformation of the mental health program from a collocated but operationally isolated service to one integrated within the governance structures of the auspicing organisation.

A Study of the Optimal Planning Model for Reservoir Sustainable Management- A Case Study of Shihmen Reservoir

NASA Astrophysics Data System (ADS)

Chen, Y. Y.; Ho, C. C.; Chang, L. C.

2017-12-01

The reservoir management in Taiwan faces lots of challenge. Massive sediment caused by landslide were flushed into reservoir, which will decrease capacity, rise the turbidity, and increase supply risk. Sediment usually accompanies nutrition that will cause eutrophication problem. Moreover, the unevenly distribution of rainfall cause water supply instability. Hence, how to ensure sustainable use of reservoirs has become an important task in reservoir management. The purpose of the study is developing an optimal planning model for reservoir sustainable management to find out an optimal operation rules of reservoir flood control and sediment sluicing. The model applies Genetic Algorithms to combine with the artificial neural network of hydraulic analysis and reservoir sediment movement. The main objective of operation rules in this study is to prevent reservoir outflow caused downstream overflow, minimum the gap between initial and last water level of reservoir, and maximum sluicing sediment efficiency. A case of Shihmen reservoir was used to explore the different between optimal operating rule and the current operation of the reservoir. The results indicate optimal operating rules tended to open desilting tunnel early and extend open duration during flood discharge period. The results also show the sluicing sediment efficiency of optimal operating rule is 36%, 44%, 54% during Typhoon Jangmi, Typhoon Fung-Wong, and Typhoon Sinlaku respectively. The results demonstrate the optimal operation rules do play a role in extending the service life of Shihmen reservoir and protecting the safety of downstream. The study introduces a low cost strategy, alteration of operation reservoir rules, into reservoir sustainable management instead of pump dredger in order to improve the problem of elimination of reservoir sediment and high cost.

Specialty hospitals emulating focused factories: a case study.

PubMed

Kumar, Sameer

2010-01-01

For 15 years general hospital managers faced new competition from for-profit specialty hospitals that operate on a "focused factory" model, which threaten to siphon-off the most profitable patients. This paper aims to discuss North American specialty hospitals and to review rising costs impact on general hospital operations. The focus is to discover whether specialty hospitals are more efficient than general hospitals; if so, how significant is the difference and also what can general hospitals do in light of the rising specialty hospitals. The case study involves stochastic frontier regression analysis using Cobb-Douglas and Translog cost functions to compare Minnesota general and specialty hospital efficiency. Analysis is based on data from 117 general and 19 specialty hospitals. The results suggest that specialty hospitals are significantly more efficient than general hospitals. Overall, general hospitals were found to be more than twice as inefficient compared with specialty hospitals in the sample. Some cost-cutting factors highlighted can be implemented to trim rising costs. The case study highlights some managerial levers that general hospital operational managers might use to control rising costs. This also helps them compete with specialty hospitals by reducing overheads and other major costs. The study is based on empirical modeling for an important healthcare operational challenge and provides additional in-depth information that has health policy implications. The analysis and findings enable healthcare managers to guide their institutions in a new direction during a time of change within the industry.

[A clinical study on the relationship of the tail femur distance and the lag screw migration or cutting-out after the third generation of Gamma nail fixation of intertrochanteric fracture].

PubMed

Hou, Yu; Yao, Qi; Zhang, Gen'ai; Ding, Lixiang

2018-01-01

To confirm the association between tail femur distance (TFD) and lag screw migration or cutting-out in the treatment of intertrochanteric fracture with the third generation of Gamma nail (TGN). The clinical data of 124 cases of intertrochanteric fracture treated with TGN internal fixation and followed up more than 18 months between January 2012 and December 2015 were reviewed and analyzed. There were 52 males and 72 females, with an age of 46-93 years (mean, 78.5 years). According to AO/Association for the Study of Internal Fixation (AO/ASIF) classification, 43 cases were type 31-A1, 69 cases were type 31-A2, and 12 cases were type 31-A3. The time from injury to operation was 1-10 days (mean, 2.9 days). According to the fracture healing of the patients, the patients were divided into the healing group and failure group. The age, gender, height, bone mineral density (BMD), fracture AO/ASIF classification, the time from injury to operation, and the TFD value at 1 day after operation were recorded and compared. The risk factors for the migration or cutting-out of lag screw were analyzed by logistic regression. There were 111 cases in healing group, the healing time was 80-110 days (mean, 95.5 days). There were 13 cases in failure group, including 2 cases of lag screw cutting-out and 11 cases of significant migration. Except for the TFD value at 1 day after operation in failure group was significantly higher than that in the healing group( t =5.14, P =0.00), there was no significant difference in gender, age, height, BMD, fracture of AO/ASIF classification, and the time from injury to operation ( P >0.05) between 2 groups. logistic regression analysis showed that TFD value was a risk factor for the migration or cutting-out of lag screw (B=1.22, standardized coefficient=0.32, Wald χ 2 =14.66, P =0.00, OR=3.37). The patients with higher TFD value had higher risk of postoperative lag screw migration or cutting-out. This result indicates that the appropriate length of the lag screw is helpful to reduce TFD value and prevent postoperative lag screw migration or cutting-out.

Management of Hip Fractures in Lateral Position without a Fracture Table.

PubMed

Pahlavanhosseini, Hamid; Valizadeh, Sima; Banadaky, Seyyed Hossein Saeed; Karbasi, Mohammad H Akhavan; Abrisham, Seyed Mohammad J; Fallahzadeh, Hossein

2014-09-01

Hip fracture Management in supine position on a fracture table with biplane fluoroscopic views has some difficulties which leads to prolongation of surgery and increasing x- rays' dosage. The purpose of this study was to report the results and complications of hip fracture management in lateral position on a conventional operating table with just anteroposterior fluoroscopic view. 40 hip fractures (31 trochanteric and 9 femoral neck fractures) were operated in lateral position between Feb 2006 and Oct 2012. Age, gender, fracture classification, operation time, intra-operation blood loss, reduction quality, and complications were extracted from patients' medical records. The mean follow-up time was 30.78±22.73 months (range 4-83). The mean operation time was 76.50 ± 16.88 min (range 50 - 120 min).The mean intra-operative blood loss was 628.75 ± 275.00 ml (range 250-1300ml). Anatomic and acceptable reduction was observed in 95%of cases. The most important complications were malunion (one case in trochanteric group), avascular necrosis of femoral head and nonunion (each one case in femoral neck group). It sounds that reduction and fixation of hip fractures in lateral position with fluoroscopy in just anteroposterior view for small rural hospitals may be executable and probably safe.

Management of Hip Fractures in Lateral Position without a Fracture Table

PubMed Central

Pahlavanhosseini, Hamid; Valizadeh, Sima; Banadaky, Seyyed Hossein Saeed; Karbasi, Mohammad H Akhavan; Abrisham, Seyed Mohammad J; Fallahzadeh, Hossein

2014-01-01

Background: Hip fracture Management in supine position on a fracture table with biplane fluoroscopic views has some difficulties which leads to prolongation of surgery and increasing x- rays' dosage. The purpose of this study was to report the results and complications of hip fracture management in lateral position on a conventional operating table with just anteroposterior fluoroscopic view. Methods: 40 hip fractures (31 trochanteric and 9 femoral neck fractures) were operated in lateral position between Feb 2006 and Oct 2012. Age, gender, fracture classification, operation time, intra-operation blood loss, reduction quality, and complications were extracted from patients' medical records. The mean follow-up time was 30.78±22.73 months (range 4-83). Results: The mean operation time was 76.50 ± 16.88 min (range 50 - 120 min).The mean intra-operative blood loss was 628.75 ± 275.00 ml (range 250-1300ml). Anatomic and acceptable reduction was observed in 95%of cases. The most important complications were malunion (one case in trochanteric group), avascular necrosis of femoral head and nonunion (each one case in femoral neck group). Conclusions: It sounds that reduction and fixation of hip fractures in lateral position with fluoroscopy in just anteroposterior view for small rural hospitals may be executable and probably safe. PMID:25386577

Peri-operative deaths in Singapore: a forensic perspective in a study of 132 cases.

PubMed

Lau, G

1994-05-01

A study of 132, largely non-traumatic, peri-operative deaths out of 6605 Coroner's autopsies, conducted over a three-year period from 1989 to 1991, showed a preponderance of males (M:F ratio = 1.36), with almost half (46.3%) being middle-aged subjects between 40 to 59 years, while infants (< one year old) made up about a tenth of the cases. A total of 51 cases (38.6%) were related to cardiothoracic surgery, which also accounted for the majority of deaths that had occurred intra-operatively (11/21 or 8.3% in all) and within the first postoperative day (16/36 or 12.1% in all). The vast majority of cases (81.8%) were pathologically natural deaths, with 15.2% attributable to complications or mishaps of surgery and invasive diagnostic or therapeutic procedures. There were three anaesthetic deaths which accounted for 2.3% of the cases. Out of 124 completed Coroner's inquiries as at the end of June 1993, verdicts of death from natural causes were recorded in 110 (83.3%) cases. General surgery accounted for the highest proportion of unnatural deaths (6.1%), which was twice that for cardiothoracic surgery (3.0%). While there was close agreement between a finding of a pathologically natural death and a similar Coroner's verdict (107/110 or 97.3%), only a total of ten out of 23 pathologically unnatural deaths received verdicts of misadventure at the time of writing. Although a verdict of misadventure usually pertained to an iatrogenic death, this was not invariably the case. Thus far, no findings of medical negligence was made in any of the Coroner's inquiries into these cases.(ABSTRACT TRUNCATED AT 250 WORDS)

A model for a career in a specialty of general surgery: One surgeon's opinion.

PubMed

Ko, Bona; McHenry, Christopher R

2018-01-01

The integration of general and endocrine surgery was studied as a potential career model for fellowship trained general surgeons. Case logs collected from 1991-2016 and academic milestones were examined for a single general surgeon with a focused interest in endocrine surgery. Operations were categorized using CPT codes and the 2017 ACGME "Major Case Categories" and there frequencies were determined. 10,324 operations were performed on 8209 patients. 412.9 ± 84.9 operations were performed yearly including 279.3 ± 42.7 general and 133.7 ± 65.5 endocrine operations. A high-volume endocrine surgery practice and a rank of tenured professor were achieved by years 11 and 13, respectively. At year 25, the frequency of endocrine operations exceeded general surgery operations. Maintaining a foundation in broad-based general surgery with a specialty focus is a sustainable career model. Residents and fellows can use the model to help plan their careers with realistic expectations. Copyright © 2017. Published by Elsevier Inc.

Preliminary report of associated factors in wound infection after major head and neck neoplasm operations--does the duration of prophylactic antibiotic matter?

PubMed

Liu, S-A; Tung, K-C; Shiao, J-Y; Chiu, Y-T

2008-04-01

The aim of this study was to investigate whether an extended course of prophylactic antibiotic could reduce the wound infection rate in a subtropical country. Fifty-three consecutive cases scheduled to receive major head and neck operations were randomised into one-day or three-day prophylactic antibiotic groups. Thirteen cases (24.5 per cent) developed wound infections after operations. The duration of prophylactic antibiotic was not related to the surgical wound infection. However, pre-operative haemoglobulin less than 10.5 g/dl (odds ratio: 7.24, 95 per cent confidence interval: 1.28-41.0) and reconstruction with a free flap or pectoris major myocutaneous flap during the operation (odds ratio: 11.04, 95 per cent confidence interval: 1.17-104.7) were associated factors significantly influencing post-operative wound infection. Therefore, one day of prophylactic antibiotic was effective in major head and neck procedures but should not be substituted for proper aseptic and meticulous surgical techniques.

Performance analysis of a SOFC under direct internal reforming conditions

NASA Astrophysics Data System (ADS)

Janardhanan, Vinod M.; Heuveline, Vincent; Deutschmann, Olaf

This paper presents the performance analysis of a planar solid-oxide fuel cell (SOFC) under direct internal reforming conditions. A detailed solid-oxide fuel cell model is used to study the influences of various operating parameters on cell performance. Significant differences in efficiency and power density are observed for isothermal and adiabatic operational regimes. The influence of air number, specific catalyst area, anode thickness, steam to carbon (s/c) ratio of the inlet fuel, and extend of pre-reforming on cell performance is analyzed. In all cases except for the case of pre-reformed fuel, adiabatic operation results in lower performance compared to isothermal operation. It is further discussed that, though direct internal reforming may lead to cost reduction and increased efficiency by effective utilization of waste heat, the efficiency of the fuel cell itself is higher for pre-reformed fuel compared to non-reformed fuel. Furthermore, criteria for the choice of optimal operating conditions for cell stacks operating under direct internal reforming conditions are discussed.

Diagnostic accuracy of touch imprint cytology for head and neck malignancies: a useful intra-operative tool in resource limited countries.

PubMed

Naveed, Hania; Abid, Mariam; Hashmi, Atif Ali; Edhi, Muhammad Muzammamil; Sheikh, Ahmareen Khalid; Mudassir, Ghazala; Khan, Amir

2017-01-01

Intraoperative consultation is an important tool for the evaluation of the upper aerodigestive tract (UAT) malignancies. Although frozen section analysis is a preferred method of intra-operative consultation, however in resource limited countries like Pakistan, this facility is not available in most institutes; therefore, we aimed to evaluate the diagnostic accuracy of touch imprint cytology for UAT malignancies using histopathology of the same tissue as gold standard. The study involved 70 cases of UAT lesions operated during the study period. Intraoperatively, after obtaining the fresh biopsy specimen and prior to placing them in fixative, each specimen was imprinted on 4-6 glass slides, fixed immediately in 95% alcohol and stained with Hematoxylin and Eosin stain. After completion of the cytological procedure, the surgical biopsy specimen was processed. The slides of both touch Imprint cytology and histopathology were examined by two consultant histopathologists. The result of touch imprint cytology showed that touch imprint cytology was diagnostic in 68 cases (97.1%), 55 (78.6%) being malignant, 2 cases (2.9%) were suspicious for malignancy, 11 cases (15.7%) were negative for malignancy while 2 cases (2.9%) were false negative. Amongst the 70 cases, 55 cases (78.6%) were malignant showing squamous cell carcinoma in 49 cases (70%), adenoid cystic carcinoma in 2 cases (2.9%), non-Hodgkin lymphoma 2 cases (2.9%), Mucoepidermoid carcinoma 1 case (1.4%), spindle cell sarcoma in 1 case (1.4%). Two cases (2.9%) were suspicious of malignancy showing atypical squamoid cells on touch imprint cytology, while 13 cases (18.6%) were negative for malignancy, which also included 2 false negative cases. The overall diagnostic accuracy of touch imprint cytology came out to be 96.7% with a sensitivity and specificity of 96 and 100%, respectively while PPV and NPV of touch imprint cytology was found to be 100 and 84%, respectively. Our experience in this study has demonstrated that touch imprint cytology provides reliable specific diagnoses and can be used as an adjunct to histopathology, particularly in developing countries, where the facility of frozen section is often not available, since a rapid preliminary diagnosis may help in the surgical management planning.

A unique approach to quantifying the changing workload and case mix in laparoscopic colorectal surgery.

PubMed

Shah, P R; Gupta, V; Haray, P N

2011-03-01

Laparoscopic colorectal surgery includes a range of operations with differing technical difficulty, and traditional parameters, such as conversion and complication rates, may not be sensitive enough to assess the complexity of these procedures. This study aims to define a reproducible and reliable tool for quantifying the total workload and the complexity of the case mix. This is a review of a single surgeon's 10-year experience. The intermediate equivalent value scoring system was used to code complexity of cases. To assess changes in the workload and case mix, the period has been divided into five phases. Three hundred and forty-nine laparoscopic operations were performed, of which there were 264 (75.6%) resections. The overall conversion rate was 17.8%, with progressive improvement over the phases. Complex major operation (CMO), as defined in the British United Provident Association (BUPA) schedule of procedures, accounted for 35% of the workload. In spite of similar numbers of cases in each phase, there was a steady increase in the workload score, correlating with the increasing complexity of the case mix. There was no significant difference in the conversion and complications rates between CMO and non-CMO. The paradoxical increase in the mean operating time with increasing experience corresponded to the progressive increase in the workload score, reflecting the increasing complexity of the case mix. This article establishes a reliable and reproducible tool for quantifying the total laparoscopic colorectal workload of an individual surgeon or of an entire department, while at the same time providing a measure of the complexity of the case mix. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

[The clinical effect of anti-rotation reduction internal fixator on the treatment of fresh thoracolumbar spine fracture].

PubMed

Pan, Xianming; Quan, Yi; Tan, Yingjun; Zhang, Bo; Wang, Yuanshan; Huang, Tong; Ma, Zehui; Liao, Dongfa; Li, Ting; Liu, Jinbiao

2005-03-15

To evaluate the effect of self-designed anti-rotation reduction internal fixator (ARRIF) on treating different spine segment fracture. From August 1999 to March 2003, 76 patients(48 males and 28 females, aged from 22 to 59 with an average of 34.1) with thoracolumbar fracture were operatively treated by ARRIF. The follow-up period ranged from 6 to 21 months (15 months in average). Classification according to injury segment: flexion compression fracture 27 cases, burst fracture 42 cases, flexion distraction injury 3 cases, flexion revolving type fracture dislocation 2 cases, shear force type dislocation 2 cases. Classification according Frankel's grade: A grade 16 cases, B grade 15 cases, C grade 27 cases, D grade 10 cases, E grade 8 cases. Operation duration, volume of bleeding, incidence post-operation complication and effect of reduction-fixation were observed. The operation duration of ARRIF was 1.2 h in average, and there was about 200 ml volume of bleeding during operation. The nerve function showed one Frankel's grade improvement after operation were as follows: A grade 8 cases (50%), B grade 11 cases (73.3%), C grade 20 cases (74.1%), D grade 3 cases (30%); 2 Frankel's E cases have no nerve function changes. The nerve function damage have no aggravation in all the patients, the postoperation Cobb's angle was averagely corrected 22 degrees. The horizontal displacement of dislocation vertebrae was averagely corrected 28% in sagittal plane, the statistical analysis had significant variance (P < 0.01). ARRIF had no complications of the breakage of screws and rods. ARRIF proves to be a valid internal fixator in reducing and fixing different thoracic lumbar segment spine fracture.

The risk of internal hernia or volvulus after laparoscopic colorectal surgery: a systematic review.

PubMed

Toh, J W T; Lim, R; Keshava, A; Rickard, M J F X

2016-12-01

To determine the incidence of internal hernias after laparoscopic colorectal surgery and evaluate the risk factors and strategies in the management of this serious complication. Two databases (MEDLINE from 1946 and Embase from 1949) were searched to mid-September 2015. The search terms included volvulus or internal hernia and laparoscopic colorectal surgery or colorectal surgery or anterior resection or laparoscopic colectomy. We found 49 and 124 articles on MEDLINE and Embase, respectively, an additional 15 articles were found on reviewing the references. After removal of duplicates, 176 abstracts were reviewed, with 33 full texts reviewed and 15 eligible for qualitative synthesis. The incidence of internal hernia after laparoscopic colorectal surgery is low (0.65%). Thirty-one patients were identified. Five cases were from two prospective studies (5/648, 0.8%), 20 cases were from seven retrospective studies (20/3165, 0.6%) and six patients were from case reports. Of the 31 identified cases, 21 were associated with left-sided resection, four with right sided resection, two with transverse colectomy, one with a subtotal colectomy and in three cases the operation was not specified. The majority of cases (64.3%) were associated with a restorative left sided resection. Nearly all cases occurred within 4 months of surgery. All patients required re-operation and reduction of the internal hernia and 35.7% of cases required a bowel resection. In 52.2% of cases, the mesenteric defect was closed at the second operation and 52.6% of cases were successfully managed laparoscopically. There were three deaths (0.08%). Mesenteric hernias are a rare but important complication of laparoscopic colorectal surgery. The evidence does not support routine closure for all cases, but selective closure of the mesenteric defect during left-sided restorative procedures in high-risk patients at the initial surgery may be considered. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

13 CFR 120.839 - Case-by-case application to make a 504 loan outside of a CDC's Area of Operations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 504 loan outside of a CDC's Area of Operations. 120.839 Section 120.839 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Development Company Loan Program (504) Extending A Cdc's Area of Operations § 120.839 Case-by-case application to make a 504 loan outside of a CDC's Area of...

13 CFR 120.839 - Case-by-case application to make a 504 loan outside of a CDC's Area of Operations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 504 loan outside of a CDC's Area of Operations. 120.839 Section 120.839 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Development Company Loan Program (504) Extending A Cdc's Area of Operations § 120.839 Case-by-case application to make a 504 loan outside of a CDC's Area of...

13 CFR 120.839 - Case-by-case application to make a 504 loan outside of a CDC's Area of Operations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 504 loan outside of a CDC's Area of Operations. 120.839 Section 120.839 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Development Company Loan Program (504) Extending A Cdc's Area of Operations § 120.839 Case-by-case application to make a 504 loan outside of a CDC's Area of...

13 CFR 120.839 - Case-by-case application to make a 504 loan outside of a CDC's Area of Operations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 504 loan outside of a CDC's Area of Operations. 120.839 Section 120.839 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Development Company Loan Program (504) Extending A Cdc's Area of Operations § 120.839 Case-by-case application to make a 504 loan outside of a CDC's Area of...

13 CFR 120.839 - Case-by-case application to make a 504 loan outside of a CDC's Area of Operations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 504 loan outside of a CDC's Area of Operations. 120.839 Section 120.839 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION BUSINESS LOANS Development Company Loan Program (504) Extending A Cdc's Area of Operations § 120.839 Case-by-case application to make a 504 loan outside of a CDC's Area of...

No Higher Risk of CRPS After External Fixation of Distal Radial Fractures - Subgroup Analysis Under Randomised Vitamin C Prophylaxis.

PubMed

Zollinger, Paul E; Kreis, Robert W; van der Meulen, Hub G; van der Elst, Maarten; Breederveld, Roelf S; Tuinebreijer, Wim E

2010-02-17

Operative and conservative treatment of wrist fractures might lead to complex regional pain syndrome (CRPS) type I.In our multicenter dose response study in which patients with distal radial fractures were randomly allocated to placebo or vitamin C in a daily dose of 200mg, 500mg or 1500mg during 50 days, an operated subgroup was analyzed.48 (of 427) fractures) were operated (11.2%). Twenty-nine patients (60%) were treated with external fixation, 14 patients (29%) with K-wiring according to Kapandji and five patients (10%) with internal plate fixation. The 379 remaining patients were treated with a plaster.In the operated group of patients who received vitamin C no CRPS (0/37) was seen in comparison with one case of CRPS (Kapandji technique) in the operated group who received placebo (1/11 = 9%, p=.23). There was no CRPS after external fixation.In the conservatively treated group 17 cases of CRPS (17/379 = 4.5%) occurred in comparison with one in case of CRPS in the operated group (1/48 = 2.1%, p=.71).External fixation doesn't necessarily lead to a higher incidence of CRPS in distal radial fractures. Vitamin C may also play a role in this. This subgroup analysis in operated distal radial fractures showed no CRPS occurrence with vitamin C prophylaxis.

Etiology, pathology, management and prognosis of chronic pancreatitis in Chinese population: A retrospective study.

PubMed

Camara, Soriba Naby; Ramdany, Sonam; Zhao, Gang; Gou, Shan-Miao; Xiong, Jiong-Xin; Yang, Zhi-Yong; Yin, Tao; Yang, Ming; Balde, Oumar Taibata; Barry, Ahmed Boubacar; Adji, Seid; Li, Xiang; Jin, Yan; Wu, He-Shui; Wang, Chun-You

2015-06-01

The purpose of this study was to investigate the etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population. The clinical data of 142 patients with chronic pancreatitis were retrospectively studied. All patients were of Chinese nationality and hospitalized from January 2008 to December 2011. Their ages ranged from 14 to 76 years, with a mean of 43 years. Of 142 patients, there were 72 cases of obstructive chronic pancreatitis (50.70%), 19 cases of alcoholic chronic pancreatitis (13.38%), 14 cases of autoimmune pancreatitis (9.86%) and 37 cases of undetermined etiology (26.06%). Pathologically, the average inflammatory mass diameter was 3.8 ± 3.3 cm, biliary obstruction occurred in 36 cases, gall stones in 70 cases, calcification in 88 cases, ductal dilatation in 61 cases, side branch dilatation in 32 cases, ductal irregularity in 10 cases, lymphocytic inflammation in 23 cases, obliterative phlebitis in 14 cases, extra pancreatic lesion in 19 cases and fibrosis in 142 cases. Location of pancreatic lesion in the region of head (n=97), neck (n=16), body (n=12), tail (n=15) and whole pancreas (n=2) influenced the choice of surgical procedures. Ninety-four patients (66.20%) received surgical treatment and 33.80% received other treatments. After operation, 80.85% of 94 patients experienced decreased pain, and 8.51% of 94 showed recovery of endocrine function but with a complication rate of 12.77%. All the operations were performed successfully. According to the pain scale of European Organization for Research and Treatment of Cancer (QLQ-C30) a decrease from 76 ± 22 to 14 ± 18 was observed. Etiology, pathological characteristics, management and prognosis of chronic pancreatitis in the Chinese population vary from others.

Pre-operative prediction of cervical nodal metastasis in papillary thyroid cancer by 99mTc-MIBI SPECT/CT; a pilot study.

PubMed

Tangjaturonrasme, Napadon; Vasavid, Pataramon; Sombuntham, Premsuda; Keelawat, Somboon

2013-06-01

Papillary thyroid cancer has a high prevalence of cervical nodal metastasis. There is no "gold standard" imaging for pre-operative diagnosis. The aim of the present study was to assess the accuracy of pre-operative 99mTc-MBI SPECT/CT in diagnosis of cervical nodal metastasis in patients with papillary thyroid cancer Fifteen patients were performed 99Tc-MlBI SPECT/CT pre-operatively. Either positive pathological report of neck dissection or positive post-treatment I-131 whole body scan with SPECT/CT of neck was concluded for definite neck metastasis. The PPV, NPV, and accuracy of 99mTc-MIBI SPECT/CT were analyzed. The PPV NPV and accuracy were 80%, 88.89%, and 85.71%, respectively. 99mTc-MIBI SPECT/CT could localize the abnormal lymph nodes groups correctly in most cases when compared with pathological results. However the authors found one false positive case with caseating granulomatous lymphadenitis and one false negative case with positive post-treatment 1-131 whole body scan with SPECT/CT of neck on cervical nodes zone II and IV CONCLUSION: 99mTc-MIBI SPECT/CTseem promising for pre-operative staging of cervical nodal involvement in patients with papillary thyroid cancer without the need of using iodinated contrast that may complicate subsequence 1-131 treatment. However, false positive result in granulomatous inflammatory nodes should be aware of especially in endemic areas. 99mTc-MIBI SPECT/CT scan shows a good result when compared with previous study of CT or MRI imaging. The comparative study between different imaging modality and the extension of neck dissection according to MIBI result seems interesting.

A formulation to analyze system-of-systems problems: A case study of airport metroplex operations

NASA Astrophysics Data System (ADS)

Ayyalasomayajula, Sricharan Kishore

A system-of-systems (SoS) can be described as a collection of multiple, heterogeneous, distributed, independent components interacting to achieve a range of objectives. A generic formulation was developed to model component interactions in an SoS to understand their influence on overall SoS performance. The formulation employs a lexicon to aggregate components into hierarchical interaction networks and understand how their topological properties affect the performance of the aggregations. Overall SoS performance is evaluated by monitoring the changes in stakeholder profitability due to changes in component interactions. The formulation was applied to a case study in air transportation focusing on operations at airport metroplexes. Metroplexes are geographical regions with two or more airports in close proximity to one another. The case study explored how metroplex airports interact with one another, what dependencies drive these interactions, and how these dependencies affect metroplex throughput and capacity. Metrics were developed to quantify runway dependencies at a metroplex and were correlated with its throughput and capacity. Operations at the New York/New Jersey metroplex (NYNJ) airports were simulated to explore the feasibility of operating very large aircraft (VLA), such as the Airbus A380, as a delay-mitigation strategy at these airports. The proposed formulation was employed to analyze the impact of this strategy on different stakeholders in the national air transportation system (ATS), such as airlines and airports. The analysis results and their implications were used to compare the pros and cons of operating VLAs at NYNJ from the perspectives of airline profitability, and flight delays at NYNJ and across the ATS.

Small Bowel Volvulus in the Adult Populace of the United States: Results From a Population-Based Study

PubMed Central

Coe, Taylor M.; Chang, David C.; Sicklick, Jason K.

2015-01-01

Background Small bowel volvulus is a rare entity in Western adults. Greater insight into epidemiology and outcomes may be gained from a national database inquiry. Methods The Nationwide Inpatient Sample (1998–2010), a 20% stratified sample of United States hospitals, was retrospectively reviewed for small bowel volvulus cases (ICD-9 560.2 excluding gastric/colonic procedures) in patients ≥18-years old. Results There were 2,065,599 hospitalizations for bowel obstruction (ICD-9 560.x). Of those, there were 20,680 (1.00%) small bowel volvulus cases; 169 were attributable to intestinal malrotation. Most cases presented emergently (89.24%) and operative management was employed more frequently than non-operative (65.21% vs. 34.79%, P<0.0001). Predictors of mortality included age >50-years, Charlson comorbidity index ≥1, emergent admission, peritonitis, acute vascular insufficiency, coagulopathy, and non-operative management (P<0.0001). Conclusions As the first population-based epidemiological study of small bowel volvulus, our findings provide a robust representation of this rare cause of small bowel obstruction in American adults. PMID:26002189

Mining level of control in medical organizations.

PubMed

Çalimli, Olgu; Türkeli, Serkan; Eken, Emir Gökberk; Gönen, Halil Emre

2014-01-01

In literature of strategic management, there are three layers of control defined in organizational structures. These layers are strategic, tactical and operational, in which resides senior, medium level and low level managers respectively. In strategic level, institutional strategies are determined according to senior managers' perceived state of organization. In tactical level, this strategy is processed into methods and activities of a business management plan. Operational level embodies actions and functions to sustain specified business management plan. An acknowledged lead organization in Turkish medical area is examined using case study and data mining method in the scope of this paper. The level of decisions regarded in managerial purposes evaluated through chosen organization's business intelligence event logs report. Hence specification of management level importance of medical organizations is made. Case study, data mining and descriptive statistical method of taken case's reports present that positions of "Chief Executive Officer", "Outpatient Center Manager", "General Manager", monitored and analyzed functions of operational level management more frequently than strategic and tactical level. Absence of strategic management decision level research in medical area distinguishes this paper and consequently substantiates its significant contribution.

Transsexuality: some remarks based on clinical experience.

PubMed

Hertoft, P; Sørensen, T

People with severe gender identity problems have always existed. Some hope to find a solution to their deep intrapersonal conflicts in a so-called sex transformation. The term 'transsexual' was coined by Cauldwell in 1949 and since then an unknown number of people all over the world, probably more biological men than women, have undergone a hormonal and surgical sex-transformation procedure. In this chapter we discuss the impossibility of real sex change from man to woman and vice versa. We briefly touch on two classical cases of sex transformation with some connection with Denmark: the Lili Elbe case of 1930 and the famous Chris Jorgensen case from the early fifties. We discuss the incidence of transsexuality and follow-up studies of patients, and give preliminary results from a Danish study of 110 people (81 men and 29 women) who during the past 25 years have applied for a sex-change operation. Of these, 56 individuals (42 men and 14 women) have had such operations. These are minimum figures since some transsexuals are known to have had operations in other countries but have not contacted Danish hospitals or health personnel.

Delivery of Operative Pediatric Surgical Care by Physicians and Non-Physician Clinicians in Malawi

PubMed Central

Tyson, Anna F; Msiska, Nelson; Kiser, Michelle; Samuel, Jonathan C; Mclean, Sean; Varela, Carlos; Charles, Anthony G

2014-01-01

Background Specialized pediatric surgeons are unavailable in much of sub-Saharan Africa. Delegating some surgical tasks to non-physician clinical officers can mitigate the dependence of a health system on highly skilled clinicians for specific services. Methods We performed a case-control study examining pediatric surgical cases over a 12 month period. Operating surgeon was categorized as physician or clinical officer. Operative acuity, surgical subspecialty, and outcome were then compared between the two groups, using physicians as the control. Results A total of 1186 operations were performed on 1004 pediatric patients. Mean age was 6 years (±5) and 64% of patients were male. Clinical officers performed 40% of the cases. Most general surgery, urology and congenital cases were performed by physicians, while most ENT, neurosurgery, and burn surgery cases were performed by clinical officers. Reoperation rate was higher for patients treated by clinical officers (17%) compared to physicians (7.1%), although this was attributable to multiple burn surgical procedures. Physician and clinical officer cohorts had similar complication rates (4.5% and 4.0%, respectively) and mortality rates (2.5% and 2.1%, respectively). Discussion Fundamental changes in health policy in Africa are imperative as a significant increase in the number of surgeons available in the near future is unlikely. Task-shifting from surgeons to clinical officers may be useful to provide coverage of basic surgical care. PMID:24560846

What Makes for Successful Speaker-Listener Technique? Two Case Studies

ERIC Educational Resources Information Center

Wood, Mary R.

2010-01-01

This article reviews some of the controversy surrounding the use and effectiveness of active listening or the Speaker-Listener Technique (SL) in relational counseling. The purpose and function of SL is described and two case studies are presented to illustrate how SL operates in a therapeutic setting and how the outcomes can vary. These case…

The Power of Natural Selection: A Guided Investigation of Three Case Studies

ERIC Educational Resources Information Center

Beachly, William

2010-01-01

I describe a quantitative approach to three case studies in evolution that can be used to challenge college freshmen to explore the power of natural selection and ask questions that foster a deeper understanding of its operation and relevance. Hemochromatosis, the peppered moth, and hominid cranial capacity are investigated with a common algebraic…

Suggestions for Educational and Therapeutic Interventions with the Rett Syndrome Child.

ERIC Educational Resources Information Center

International Rett Syndrome Association, Inc., Fort Washington, MD.

This paper comprises a compilation of nine case studies of girls (aged 4-16 years) with Rett Syndrome. The educational settings involved are various and include private day school, public elementary school in both integrated and special needs classrooms, and a county-operated preschool program for handicapped children. Each case study outlines the…

Laparoscopic treatment in achalasia of the cardia.

PubMed

Ursut, B; Alecu, L; Tulin, A; Enciu, O

2014-01-01

Achalasia, although a rare disease (an incidence of 1 100 000 individuals each year) is one of the common causes of motor dysphagia and is characterized by loss of peristalsis in the esophageal body and lack of relaxation of the lower esophageal sphincter. The aim of our study was to perform a clinical,therapeutic and evolution evaluation in patients diagnosed with achalasia and operated in our department between 1997 and 2013. We performed a retrospective study using the clinical charts, operatory protocols, imagistic and video database of the 17 patients with achalasia operated in our department. We encountered an equal repartition in women and men and a predominance of urban provenience. Ages were between 24 and 86 years (with an average age of 51). There were two cases of recurrent achalasia at 2, respectively 5 years after the first operation. In all cases, Heller myotomy was used, with the addition of a Dor fundoplication in 12 cases and Toupet fundoplication in five cases, as an antireflux procedure. Mean operation time was 117.6 minutes.There were three iatrogenic perforations of the esophageal mucosa, all of them recognized and treated in the same operative time. No postoperative complications related to the Heller-Dor Heller-Toupet procedure were encountered.The follow-up was between 3 and 72 months. Laparoscopic approach in the treatment of achalasia provides the advantages of minimally invasive surgery, but also and very important, a good visualization of the abdominal esophagus and gastroesophageal junction.Heller esocardiomyotomy is usually associated with anantireflux procedure. A Dor fundoplication is generally used,although the Toupet fundoplication may also be used with the same advantages. It is important to monitor these patients on a yearly basis, knowing the risk of dysplasia carcinoma in achalasia. Celsius.

Does Nasal Carriage of Staphylococcus aureus Increase the Risk of Postoperative Infections After Elective Spine Surgery: Do Most Infections Occur in Carriers?

PubMed

Adogwa, Owoicho; Vuong, Victoria D; Elsamadicy, Aladine A; Lilly, Daniel T; Desai, Shyam A; Khalid, Syed; Cheng, Joseph; Bagley, Carlos A

2018-05-14

Wound infections after adult spinal deformity surgery place a high toll on patients, providers, and the healthcare system. Staphylococcus aureus is a common cause of postoperative wound infections, and nasal colonization by this organism may be an important factor in the development of surgical site infections (SSIs). The aim is to investigate whether post-operative surgical site infections after elective spine surgery occur at a higher rate in patients with methicillin-resistant S. aureus (MRSA) nasal colonization. Consecutive patients undergoing adult spinal deformity surgery between 2011-2013 were enrolled. Enrolled patients were followed up for a minimum of 3 months after surgery and received similar peri-operative infection prophylaxis. Baseline characteristics, operative details, rates of wound infection, and microbiologic data for each case of post-operative infection were gathered by direct medical record review. Local vancomycin powder was used in all patients and sub-fascial drains were used in the majority (88%) of patients. 1200 operative spine cases were performed for deformity between 2011 and 2013. The mean ± standard deviation age and body mass index were 62.08 ± 14.76 years and 30.86 ± 7.15 kg/m 2 , respectively. 29.41% had a history of diabetes. All SSIs occurred within 30 days of surgery, with deep wound infections accounting for 50% of all SSIs. Of the 34 (2.83%) cases of SSIs that were identified, only 1 case occurred in a patient colonized with MRSA. Our study suggests that the preponderance of SSIs occurred in patients without nasal colonization by methicillin-resistant S. aureus. Future prospective multi-institutional studies are needed to corroborate our findings. Copyright © 2018 Elsevier Inc. All rights reserved.

Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study.

PubMed

Singal, Rikki; Dhar, Siddharth

2018-01-01

The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases - underwent open pyelolithotomy. The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon.

Does Cloud Computing in the Atmospheric Sciences Make Sense? A case study of hybrid cloud computing at NASA Langley Research Center

NASA Astrophysics Data System (ADS)

Nguyen, L.; Chee, T.; Minnis, P.; Spangenberg, D.; Ayers, J. K.; Palikonda, R.; Vakhnin, A.; Dubois, R.; Murphy, P. R.

2014-12-01

The processing, storage and dissemination of satellite cloud and radiation products produced at NASA Langley Research Center are key activities for the Climate Science Branch. A constellation of systems operates in sync to accomplish these goals. Because of the complexity involved with operating such intricate systems, there are both high failure rates and high costs for hardware and system maintenance. Cloud computing has the potential to ameliorate cost and complexity issues. Over time, the cloud computing model has evolved and hybrid systems comprising off-site as well as on-site resources are now common. Towards our mission of providing the highest quality research products to the widest audience, we have explored the use of the Amazon Web Services (AWS) Cloud and Storage and present a case study of our results and efforts. This project builds upon NASA Langley Cloud and Radiation Group's experience with operating large and complex computing infrastructures in a reliable and cost effective manner to explore novel ways to leverage cloud computing resources in the atmospheric science environment. Our case study presents the project requirements and then examines the fit of AWS with the LaRC computing model. We also discuss the evaluation metrics, feasibility, and outcomes and close the case study with the lessons we learned that would apply to others interested in exploring the implementation of the AWS system in their own atmospheric science computing environments.

What happened to the no-wait hospital? A case study of implementation of operational plans for reduced waits.

PubMed

Hansson, Johan; Tolf, Sara; Øvretveit, John; Carlsson, Jan; Brommels, Mats

2012-01-01

Both research and practice show that waiting lists are hard to reduce. Implementing complex interventions for reduced waits is an intricate and challenging process that requires special attention for surrounding factors helping and hindering the implementation. This article reports a case study of a hospital implementation of operational plans for reduced waits, with an emphasis on the process of change. A case study research design, theoretically informed by the Pettigrew and Whipp model of strategic change, was applied. Data were gathered from individual and focus group interviews with informants from different organizational levels at different times and from documents and plans. The findings revealed arrangements both helping and hindering the implementation work. Helping factors were the hospital's contemporary savings requirements and experiences from similar change initiatives. Those hindering the actions to plan and agree the changes were unclear support functions and unclear task prioritization. One contribution of this study is to demonstrate the advantages, disadvantages, and challenges of a contextualized case study for increased understanding of factors influencing organizational change implementation. One lesson for current policy is to regard context factors that are critical for successful implementation.

Management of complicated gallstones: results of an alternative approach to difficult cholecystectomies.

PubMed

Lirici, Marco Maria; Califano, Andrea

2010-10-01

Laparoscopic cholecystectomy (LC) is the gold standard treatment of gallstones. Nevertheless, the incidence of conversion and injuries to the biliary tract is still high in difficult cholecystectomies. In this study we sought to determine how using operative risk predictive scores (PSs) and the Nassar scale to grade the difficulty of LC would optimize the perioperative management of complicated gallstone patients. We also evaluated whether the "fundus-first" approach to LC combined with ultrasonic dissection minimizes the risk of conversion and biliary injury in difficult cholecystectomies, and avoids routine intraoperative cholangiography. A prospective non-randomized study was carried out from 2005 to 2007 including 237 patients referred for gallbladder diseases. All patients were evaluated using an operative risk PS. The LC grade of difficulty was assessed according to Nassar. Diagnostic accuracy, sensitivity, and specificity of PS were calculated. LC in difficult cases was accomplished with a fundus-first approach. Outcome measures included: Conversion rate, bile duct (BD) injury rate, and postoperative complications according to Clavien. In 178 out of 237 patients, a higher risk of conversion and complication was predicted. In 146 out of these 178 cases, intra-operative grading confirmed the difficulty of the procedure. The PS diagnostic accuracy was 0.865, sensitivity was 100%, and specificity 65%. Positive predictive value and negative predictive value were 0.82 and 1, respectively. Conversion rate was 2.7%. Mean operating time and postoperative length of hospital stay were 75 minutes and 3.5 days. Intra-operative cholangiography was necessary in five cases, and one intraoperative biliary complication occurred with an uneventful postoperative course. Overall, postoperative complications were 2.7% with a mortality rate of 0.68% (1 myocardial infarction). Fundus-first LC by ultrasonic dissection is safe and minimizes the risk of conversion and biliary injuries in difficult cases. Difficult cholecystectomies may be predicted preoperatively; in these cases the fundus-first approach and ultrasound dissection may be advised.

A prospective outcomes analysis of palliative procedures performed for malignant intestinal obstruction due to recurrent ovarian cancer.

PubMed

Chi, Dennis S; Phaëton, Rebecca; Miner, Thomas J; Kardos, Steven V; Diaz, John P; Leitao, Mario M; Gardner, Ginger; Huh, Jae; Tew, William P; Konner, Jason A; Sonoda, Yukio; Abu-Rustum, Nadeem R; Barakat, Richard R; Jaques, David P

2009-08-01

To obtain prospective outcomes data on patients (pts) undergoing palliative operative or endoscopic procedures for malignant bowel obstruction due to recurrent ovarian cancer. An institutional study was conducted from July 2002 to July 2003 to prospectively identify pts who underwent an operative or endoscopic procedure to palliate the symptoms of advanced cancer. This report focuses on pts with malignant bowel obstruction due to recurrent ovarian cancer. Procedures performed with an upper or lower gastrointestinal (GI) endoscope were considered "endoscopic." All other cases were classified as "operative." Following the procedure, the presence or absence of symptoms was determined and followed over time. All pts were followed until death. Palliative interventions were performed on 74 gynecologic oncology pts during the study period, of which 26 (35%) were for malignant GI obstruction due to recurrent ovarian cancer. The site of obstruction was small bowel in 14 (54%) cases and large bowel in 12 (46%) cases. Palliative procedures were operative in 14 (54%) pts and endoscopic in the other 12 (46%). Overall, symptomatic improvement or resolution within 30 days was achieved in 23 (88%) of 26 patients, with 1 (4%) postprocedure mortality. At 60 days, 10 (71%) of 14 pts who underwent operative procedures and 6 (50%) of 12 pts who had endoscopic procedures had symptom control. Median survival from the time of the palliative procedure was 191 days (range, 33-902) for those undergoing an operative procedure and 78 days (range, 18-284) for those undergoing an endoscopic procedure. Patients with malignant bowel obstructions due to recurrent ovarian cancer have a high likelihood of experiencing relief of symptoms with palliative procedures. Although recurrence of symptoms is common, durable palliation and extended survival are possible, especially in those patients selected for operative intervention.

Case Study: The Use of a Hypercard Simulation to Aid in the Teaching of Laboratory Apparatus Operation.

ERIC Educational Resources Information Center

Waddick, John

1994-01-01

Compares the effect of a chemistry computer simulation, written by the author, with the effect of an instructor demonstration. The study indicates that in this particular situation the operation of a spectrophotometer can be effectively taught by computer simulation method. The program is written using HyperTalk, the HyperCard programming…

Feasibility and Learning Curve of Robotic Laparoendoscopic Single-Site Surgery in Gynecology.

PubMed

Buckley de Meritens, Alexandre; Kim, Julia; Dinkelspiel, Helen; Chapman-Davis, Eloise; Caputo, Thomas; Holcomb, Kevin M

2017-02-01

Single-site laparoscopy has proven to be a desirable option for patients undergoing gynecologic surgery, with some studies indicating improved cosmesis and less perioperative pain compared with standard approaches. This study describes the safety and feasibility of a novel robotic laparoendoscopic single-site surgery (R-LESS) platform as it is incorporated into a surgeon's practice with extensive multiport robotic surgical experience but limited LESS experience. We reviewed 83 women undergoing R-LESS by a single surgeon from September 2013 through August 2015. Operative times (total operative time, console time, docking time) were collected prospectively for the first 53 cases, and total operative time was collected retrospectively for the next 30 cases. Clinical parameters, including age, estimated blood loss, body mass index (BMI), prior abdominal surgeries, conversion to laparotomy, procedure type, uterine weight, length of hospital stay, and complications, were retrospectively collected from medical charts. Eighty-two of 83 surgeries were completed successfully with a single incision. One surgery was converted to multiport robotics for para-aortic lymph node dissection. Twelve surgeries were performed for cancer (ovary 1, uterus 8, and cervix 3). Eight patients underwent pelvic lymph node biopsy. The median total operative time for hysterectomies was 128 minutes (range, 60-275). After the first 13 hysterectomies the total operative time and the console time decreased significantly from 165.3 to 131.1 minutes (p = .032) and from 84.9 to 57.1 minutes (p = .028), respectively. Mean docking time halved from 7.8 minutes to 3.4 minutes comparing the first 10 cases to the last 10 cases. Surgical times were longer with larger BMIs, but the console time decreased with experience regardless of BMI. The mean uterine weight was 164 g (range, 30-460). Complications included 2 umbilical hernias (2.4%) and 1 conversion to multiport. In conclusion, R-LESS is a feasible and safe surgical platform for gynecologic procedures. A small number of cases are needed to significantly improve operative times when it is introduced on a surgeon's practice with limited experience in LESS but familiar with robotic surgery. Further study is needed to investigate the cost, benefits, and long-term outcomes of R-LESS. Published by Elsevier Inc.

Different approaches for centralized and decentralized water system management in multiple decision makers' problems

NASA Astrophysics Data System (ADS)

Anghileri, D.; Giuliani, M.; Castelletti, A.

2012-04-01

There is a general agreement that one of the most challenging issues related to water system management is the presence of many and often conflicting interests as well as the presence of several and independent decision makers. The traditional approach to multi-objective water systems management is a centralized management, in which an ideal central regulator coordinates the operation of the whole system, exploiting all the available information and balancing all the operating objectives. Although this approach allows to obtain Pareto-optimal solutions representing the maximum achievable benefit, it is based on assumptions which strongly limits its application in real world contexts: 1) top-down management, 2) existence of a central regulation institution, 3) complete information exchange within the system, 4) perfect economic efficiency. A bottom-up decentralized approach seems therefore to be more suitable for real case applications since different reservoir operators may maintain their independence. In this work we tested the consequences of a change in the water management approach moving from a centralized toward a decentralized one. In particular we compared three different cases: the centralized management approach, the independent management approach where each reservoir operator takes the daily release decision maximizing (or minimizing) his operating objective independently from each other, and an intermediate approach, leading to the Nash equilibrium of the associated game, where different reservoir operators try to model the behaviours of the other operators. The three approaches are demonstrated using a test case-study composed of two reservoirs regulated for the minimization of flooding in different locations. The operating policies are computed by solving one single multi-objective optimal control problem, in the centralized management approach; multiple single-objective optimization problems, i.e. one for each operator, in the independent case; using techniques related to game theory for the description of the interaction between the two operators, in the last approach. Computational results shows that the Pareto-optimal control policies obtained in the centralized approach dominate the control policies of both the two cases of decentralized management and that the so called price of anarchy increases moving toward the independent management approach. However, the Nash equilibrium solution seems to be the most promising alternative because it represents a good compromise in maximizing management efficiency without limiting the behaviours of the reservoir operators.

Early post-operative cerebrospinal fluid hypovolemia: Report of 7 cases.

PubMed

Hou, Kun; Zhu, Xiaobo; Zhang, Yang; Gao, Xianfeng; Suo, Shihuan; Zhao, Jinchuan; Li, Guichen

2018-06-01

Cerebrospinal fluid (CSF) hypovolemia is a common neurosurgical condition, which may be spontaneous or iatrogenic. At our institution, a substantial number of the reported cases of early post-operative CSF hypovolemia were identified to have unintentional or unrecognized post-operative continuous excessive CSF leakage. Cases who presented with post-operative CSF hypovolemia several days after uneventful intracranial surgeries without continuous CSF leakage were rarely reported. A retrospective review of the medical records of these patients was performed to identify those patients who developed early post-operative CSF hypovolemia without the presence of post-operative continuous CSF leakage. A total of 7 patients, 5 of which were males, were identified in this retrospective study. They experienced CSF hypovolemia between days 1 and 7 after emergency or scheduled intracranial surgeries. Ventricular collapse, cisternal effacement and midline shift are the most common radiological observations. With early diagnosis and management, 4 of the patients achieved a Glasgow Outcome Scale (GOS) score of 5, 1 achieved a GOS score of 4 and the remaining 2 had a GOS score of 3. No mortality was noted in this series. Although rare in incidence, early post-operative CSF hypovolemia may occur without the existence of post-operative continuous CSF leakage. When the diagnosis of CSF hypovolemia is reached, factors that may exacerbate CSF compensation should be promptly terminated. Trendelenburg position and sufficient intravenous hydration are practical and effective managements, and CSF hypovolemia may thereby be reversed in a substantial number of patients.

Effect of the new standards for case logging on resident operative volume: doing better cases or better numbers?

PubMed

Murthy, Raghav; Shepard, Alex; Swartz, Andrew; Woodward, Ann; Reickert, Craig; Horst, Mathilda; Rubinfeld, Ilan

2012-01-01

The Accreditation Council for Graduate Medical Education (ACGME) modified the designation of major (index) operative cases to include those previously considered "minor." This study assessed the potential effect of these changes on resident operative experience. With Institutional Review Board approval, we analyzed National Surgical Quality Improvement Program participant use files for 2005-2008 for general and vascular surgery cases. Primary CPT case coding was mapped to the ACGME major case category using both the old and new classification schemes. The variables were analyzed using χ(2) analysis in SPSS IBM 19 (IBM, Armonk, New York). A total of 576,019 cases were reviewed. Major cases as defined by the new classification represented an increasing proportion of the cases each year, rising from 88.3% in 2005 to 95% by 2008 (p < 0.001). Major cases as defined by the old scheme decreased from 71% in 2005 to 62% by 2008 (p < 0.001). The cases covered by a resident dropped from 82% in 2005 to 61% in 2008 (p < 0.001). When comparing the new to the old scheme, 364,366 (63.3%) cases were considered major and 30,587 (5.3%) were minor by both standards; 7089 (1.2%) cases previously classified as major were changed to minor, whereas 173,977 (30.2%) (p < 0.001) previously classified as minor were now major. This latter group showed top procedures to include excision of breast lesion (22,175 [12.7%]), laparoscopic gastric bypass (18,825 [10.8%]), ventral hernia repair (14,732 [8.5%]), and appendectomy (10,190 [5.9%]). Of these newly designated major cases, the proportion not covered by residents increased from 22% in 2005 to 44% in 2007 and 2008 (p < 0.001). Although some operative cases newly classified as major are technically advanced procedures (eg, Roux-en-Y gastric bypass), other cases are not (eg, breast lesion excision), which raises the issue as to whether the major case category has been diluted by less demanding case types. The implications of these findings may suggest preservation of case volumes at the expense of case quality. Copyright © 2012 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Coalition Logistics: A Case Study in Operation Restore Hope

DTIC Science & Technology

1994-06-03

coalition operations."° In Seland’s interview with Colonel Wolfgang Kopp, chief of staff, German/Franco Brigade, Colonel Kopp stated that key members...February 1994. 21William G. Pagonis and Michael D. Krause , "Operational Logistics and the Gulf War," The Institute of Land Warfare: The Land Warfare...Headquarters, 1989. Pagonis, William G. and Michael D. Krause . "Operational Logistics and the Gulf War." The Land Warfare Paper No. 13. Arlington, Virginia

Pre-use anesthesia machine check; certified anesthesia technician based quality improvement audit.

PubMed

Al Suhaibani, Mazen; Al Malki, Assaf; Al Dosary, Saad; Al Barmawi, Hanan; Pogoku, Mahdhav

2014-01-01

Quality assurance of providing a work ready machine in multiple theatre operating rooms in a tertiary modern medical center in Riyadh. The aim of the following study is to keep high quality environment for workers and patients in surgical operating rooms. Technicians based audit by using key performance indicators to assure inspection, passing test of machine worthiness for use daily and in between cases and in case of unexpected failure to provide quick replacement by ready to use another anesthetic machine. The anesthetic machines in all operating rooms are daily and continuously inspected and passed as ready by technicians and verified by anesthesiologist consultant or assistant consultant. The daily records of each machines were collected then inspected for data analysis by quality improvement committee department for descriptive analysis and report the degree of staff compliance to daily inspection as "met" items. Replaced machine during use and overall compliance. Distractive statistic using Microsoft Excel 2003 tables and graphs of sums and percentages of item studied in this audit. Audit obtained highest compliance percentage and low rate of replacement of machine which indicate unexpected machine state of use and quick machine switch. The authors are able to conclude that following regular inspection and running self-check recommended by the manufacturers can contribute to abort any possibility of hazard of anesthesia machine failure during operation. Furthermore in case of unexpected reason to replace the anesthesia machine in quick maneuver contributes to high assured operative utilization of man machine inter-phase in modern surgical operating rooms.

The value of ultrasound and magnetic resonance imaging in diagnostics and prediction of morbidity in cases of placenta previa with abnormal placentation.

PubMed

Algebally, Ahmed M; Yousef, Reda Ramadan Hussein; Badr, Sanaa Sayed Hussein; Al Obeidly, Amal; Szmigielski, Wojciech; Al Ibrahim, Abdullah A

2014-01-01

The purpose of the study was to evaluate the role of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnostics and management of abnormal placentation in women with placenta previa and to compare the morbidity associated with that to placenta previa alone. The study includes 100 pregnant women with placenta previa with and without abnormal placentation. The results of MRI and US in abnormal placentation were compared with post-operative data. The patients' files were reviewed for assessment of operative and post-operative morbidity. The results of our statistical analysis were compared with data from the literature. US and MRI showed no significant difference in sensitivity and specificity in diagnosing abnormal placentation (97-100% and 94-100%, respectively). MRI was more sensitive than US for the detection of myometrial invasion and the type of abnormal placentation (73.5% and 47%, respectively). The difference between pre- and post-operative hemoglobin values and estimated blood loss were the most significant risk factors for abnormal placentation, added to risk factors known for placenta previa. Post-partum surgical complications and prolonged hospital stay were more common in the cases of placenta previa with abnormal placentation, however statistically insignificant. US and MRI are accurate imaging modalities for diagnosing abnormal placentation. MRI was more sensitive for the detection of the degree of placental invasion. The patient's morbidity increased in cases with abnormal placentation. There was no significant difference in post operative-complications and hospitalization time due to pre-operative planning when the diagnosis was established with US and MRI.

[Development and clinical application of a new type of anatomical locking plate for sternoclavicular joint fracture and dislocation].

PubMed

Sun, Yuanlin; Yang, Yunkang; Ge, Jianhua; Yang, Kun; Xiang, Feifan; Zhou, Ju; Liang, Jie

2018-03-01

To report a new type of anatomical locking plate for sternocalvicular joint, and investigate its effectiveness in treatment of sternoclavicular joint fracture and dislocation. A new type of anatomical locking plate for sternoclavicular joint was developed, which accorded with the anatomical features and biomechanical characteristics of Chinese sternoclavicular joint. By adopting the method of clinical randomized controlled study, 32 patients with the sternoclavicular joint fracture and dislocation who met the selection criteria between June 2008 and May 2015 were randomly divided into groups A and B ( n =16), and the patients were treated with new anatomic locking plate and distal radial T locking plate internal fixation, respectively. There was no significant difference between 2 groups in gender, age, injured side, body mass index, cause of injury, type of injury, the time from injury to operation, and preoperative Rockwood grading score ( P >0.05). The operation time, intraoperative blood loss, incision length, hospitalization time, and postoperative complications in 2 groups were recorded, and the effectiveness was evaluated by Rockwood grading score. The operations of 2 groups completed successfully. The operation time, intraoperative blood loss, and hospitalization time in group A were significantly less than those in group B ( P <0.05), but there was no significant difference in the incision length between 2 groups ( t =0.672, P =0.507). All the patients were followed up 18-30 months (mean, 24 months). In group A, there were 1 case of sternoclavicular joint pain and 2 cases of wound infection; in group B, there were 1 case of sternoclavicular joint pain, 1 case of internal fixation loosening, and 1 case of sternoclavicular joint re-dislocation; there was no significant difference in complication incidence between 2 groups ( P =1.000). The Rockwood grading scores at each time point after operation in 2 groups were significantly higher than those before operation. At 1 month after operation, the Rockwood grading score in group A was significantly higher than that in group B ( t= 2.270, P =0.031); but there was no significant difference in the Rockwood grading scores between the 2 groups at 6 months and at last follow-up ( P >0.05). At last follow-up, according to the Rockwood scoring standard, the results of group A were excellent in 13 cases, good in 2 cases, poor in 1 case, the excellent and good rate was 93.75%; the results of group B were excellent in 11 cases, good in 4 cases, poor in 1 case, and the excellent and good rate was 93.75%; there was no significant difference between 2 groups ( Z =-0.748， P =0.455). The new type of anatomic locking plate accords with the Chinese anatomical characteristics. It has the advantages of easy operative procedure, less surgical trauma, shorter operation time, less intraoperative blood loss, shorter hospitalization time, and it can achieve better results in the treatment of sternoclavicular joint fracture and dislocation.

Corps G-2 Staff Competencies: A Desert Storm Case Study

DTIC Science & Technology

2017-06-09

processing and exploiting new information or produce updated analytic products for dissemination. 43 Intelligence Operations The corps directs IO by...CORPS G-2 STAFF COMPETENCIES: A DESERT STORM CASE STUDY A thesis presented to the Faculty of the US Army Command and General Staff...College in partial fulfillment of the requirements for the degree MASTER OF MILITARY ART AND SCIENCE General Studies by ERIK W

Validation of the GreenLight™ Simulator and development of a training curriculum for photoselective vaporisation of the prostate.

PubMed

Aydin, Abdullatif; Muir, Gordon H; Graziano, Manuela E; Khan, Muhammad Shamim; Dasgupta, Prokar; Ahmed, Kamran

2015-06-01

To assess face, content and construct validity, and feasibility and acceptability of the GreenLight™ Simulator as a training tool for photoselective vaporisation of the prostate (PVP), and to establish learning curves and develop an evidence-based training curriculum. This prospective, observational and comparative study, recruited novice (25 participants), intermediate (14) and expert-level urologists (seven) from the UK and Europe at the 28th European Association of Urological Surgeons Annual Meeting 2013. A group of novices (12 participants) performed 10 sessions of subtask training modules followed by a long operative case, whereas a second group (13) performed five sessions of a given case module. Intermediate and expert groups performed all training modules once, followed by one operative case. The outcome measures for learning curves and construct validity were time to task, coagulation time, vaporisation time, average sweep speed, average laser distance, blood loss, operative errors, and instrument cost. Face and content validity, feasibility and acceptability were addressed through a quantitative survey. Construct validity was demonstrated in two of five training modules (P = 0.038; P = 0.018) and in a considerable number of case metrics (P = 0.034). Learning curves were seen in all five training modules (P < 0.001) and significant reduction in case operative time (P < 0.001) and error (P = 0.017) were seen. An evidence-based training curriculum, to help trainees acquire transferable skills, was produced using the results. This study has shown the GreenLight Simulator to be a valid and useful training tool for PVP. It is hoped that by using the training curriculum for the GreenLight Simulator, novice trainees can acquire skills and knowledge to a predetermined level of proficiency. © 2014 The Authors. BJU International © 2014 BJU International.

Building America Case Study: Residential Mechanical Precooling, Roseville, California

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

A. German and M. Hoeschele

2017-05-01

Precooling is an operational strategy with potentially no up-front cost that cools occupied spaces earlier in the day to minimize or avoid afternoon air conditioner operation. In its simplest form, precooling can be implemented by scheduling air conditioner operation to reduce thermostat setpoints between 2 degrees and 6 degrees F below typical comfort settings in advance of the on-peak time period.

Building America Case Study: Residential Mechanical Precooling, Roseville, California

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

2017-05-08

Precooling is an operational strategy with potentially no up-front cost that cools occupied spaces earlier in the day to minimize or avoid afternoon air conditioner operation. In its simplest form, precooling can be implemented by scheduling air conditioner operation to reduce thermostat setpoints between 2 degrees and 6 degrees F below typical comfort settings in advance of the on-peak time period.

Does Histologic Subtype Influence the Post-Operative Outcome in Spinal Meningioma?

PubMed

Zham, Hanieh; Moradi, Afshin; Rakhshan, Azadeh; Zali, Alireza; Rahbari, Ali; Raee, Mohammadreza; Ashrafi, Farzad; Ahadi, Mahsa; Larijani, Leila; Baikpour, Masoud; Khayamzadeh, Maryam

2016-04-01

Postoperative outcome of spinal meningiomas is an important issue in surgery decision-making. There are limited and conflicting data in the literature about the prognostic factors influencing recovery, especially about the histopathologic subtypes. This study was carried out to evaluate the effect of some of these factors on postoperative outcome. This study was performed on 39 patients operated for spinal meningioma between October 1998 and January 2012; their histopathologic subtype was determined according to WHO criteria. The follow up period ranged between 8 - 120 months. The influence of histopathologic subtype, grade, age, sex, surgical approach, local adhesion and anatomical location was assessed according to Frankel classification of neurologic deficit. From a total number of 39 spinal meningiomas, 34 cases were WHO grade I, from which 15 cases were psammomatous, 7 cases were meningothelial, 9 cases were transitional and 3 cases were fibroblastic. Five cases were grade II, 3 of which had clear cell appearance and the remaining 2 had chordoid appearance. The mean age was 51.6 (22 to 76) years; 25 cases were female and 14 cases were male. This study revealed that grade II meningioma cases had poor prognosis in all 5 cases and psammomatous subtype had poor postoperative outcome in 40% of cases while the other subtypes had good outcome in all cases (P = 0.026). Cervical location of the tumor was also related with poor outcome in 37.5% of the cases, while 22.5% had poor outcome in other locations (P = 0.029). Age below and above 45 years and sex had no significant influence on the outcome. Spinal meningiomas of psammomatous type and grade II spinal meningiomas are associated with less favorable postoperative neurologic outcome. Cervical location has also a negative correlation with a good outcome.

Oral carbohydrate supplementation reduces preoperative discomfort in laparoscopic cholecystectomy.

PubMed

Yildiz, Huseyin; Gunal, Solmaz Eruyar; Yilmaz, Gulsen; Yucel, Safak

2013-04-01

The aim of this study was to investigate the effects of oral carbohydrate solution (CHO) on perioperative discomfort, biochemistry, hemodynamics, and patient satisfaction in elective surgery patients under general anesthesia. Sixty cases in ASA I-II group who were planned to have operation under general anesthesia were included in the study. The cases were randomly divided into two groups having 30 subjects in each. The patients in the study group were given CHO in the evening prior to the surgery and 2-3 hr before the anesthesia while routine fasting was applied in the control group. In the study group; 2-3 hr before the surgery; malaise, thirst, hunger, and weakness; just before the surgery malaise, thirst, hunger, and fatigue; 2 hr after the operation thirst, hunger, weakness, and concentration difficulty; 24 hr after the operation malaise and weakness were found significantly lower. Fasting blood glucose (FBG) level was found to be higher in the control group at the 90th min of the operation. Gastric volumes were higher in the control group; gastric pH values were found significantly higher in the study group. The level of anxiety and depression risk rate were found lower in the study group. In conclusion, preoperative CHO reduces perioperative discomfort and improves perioperative well being when compared to overnight fasting.

CD 99 immunocytochemistry in solid pseudopapillary tumor of pancreas: A study on fine-needle aspiration cytology smears.

PubMed

Ghosh, Ranajoy; Mallik, Saumya R; Mathur, Sandeep R; Iyer, Venkateswaran K

2013-07-01

Solid pseudopapillary tumor of pancreas (SPTP) is a rare pancreatic tumor of uncertain histogenesis usually affecting young women. Though these tumors have characteristic cytomorphology, it is sometimes difficult to differentiate them from neuroendocrine tumors of the pancreas. We reviewed cases of SPTP to delineate the diagnostic cytological features and also observed utility of CD 99 (MIC 2) immunostaining to aid in the diagnosis of this tumor. This study was designed to demonstrate the utility of CD 99 immunostaining along with cytological features for making a pre-operative diagnosis and delineating it from the neuroendocrine tumor of pancreas which is a close mimic. Cytomorphological features of 11 cases of solid pseudopapillary neoplasm diagnosed by pre-operative fine-needle aspiration cytology (FNAC) at our institute were reviewed. Immunocytochemistry for CD 99 was also performed on the smears. All the cases had cellular smears with monomorphic cells lying singly, as loosely cohesive clusters as well as forming delicate pseudopapillae. Presence of intra and extra-cellular basement membrane material, background foamy macrophages and nuclear grooves were the other salient features. Immunocytochemistry for CD 99 could be performed on eight cases and demonstrated typical paranuclear dot-like positivity. Pre-operative early diagnosis of SPTP can be made by FNAC which can further be aided by CD 99 immunocytochemistry.

Communicating for Climate Change Adaptation: Lessons from a Case Study with Nature-Based Tour Operators

NASA Astrophysics Data System (ADS)

Timm, K.; Sparrow, E. B.; Pettit, E. C.; Trainor, S. F.; Taylor, K.

2014-12-01

Increasing temperatures are projected to have a positive effect on the length of Alaska's tourism season, but the natural attractions that tourism relies on, such as glaciers, wildlife, fish, or other natural resources, may change. In order to continue to derive benefits from these resources, nature-based tour operators may have to adapt to these changes, and communication is an essential, but poorly understood, component of the climate change adaptation process. The goal of this study was to determine how to provide useful climate change information to nature-based tour operators by answering the following questions: 1. What environmental changes do nature-based tour operators perceive? 2. How are nature-based tour operators responding to climate and environmental change? 3. What climate change information do nature-based tour operators need? To answer these questions, twenty-four nature-based tour operators representing 20 different small and medium sized businesses in Juneau, Alaska were interviewed. The results show that many of Juneau's nature-based tour operators are observing, responding to, and in some cases, actively planning for further changes in the environment. The types of responses tended to vary depending on the participants' certainty in climate change and the perceived risks to their organization. Using these two factors, this study proposes a framework to classify climate change responses for the purpose of generating meaningful information and communication processes that promote adaptation and build adaptive capacity. During the course of the study, several other valuable lessons were learned about communicating about adaptation. The results of this study demonstrate that science communication research has an important place in the practice of promoting and fostering climate change adaptation. While the focus of this study was tour operators, the lessons learned may be valuable to other organizations striving to engage unique groups in climate change adaptation planning efforts and to social scientists trying to understanding of the role of communication in climate change adaptation.

Improving Operating Room Efficiency: First Case On-Time Start Project.

PubMed

Phieffer, Laura; Hefner, Jennifer L; Rahmanian, Armin; Swartz, Jason; Ellison, Christopher E; Harter, Ronald; Lumbley, Joshua; Moffatt-Bruce, Susan D

Operating rooms (ORs) are costly to run, and multiple factors influence efficiency. The first case on-time start (FCOS) of an OR is viewed as a harbinger of efficiency for the daily schedule. Across 26 ORs of a large, academic medical center, only 49% of cases started on time in October 2011. The Perioperative Services Department engaged an interdisciplinary Operating Room Committee to apply Six Sigma tools to this problem. The steps of this project included (1) problem mapping, (2) process improvements to preoperative readiness, (3) informatics support improvements, and (4) continuous measurement and feedback. By June 2013, there was a peak of 92% first case on-time starts across service lines, decreasing to 78% through 2014, still significantly above the preintervention level of 49% (p = .000). Delay minutes also significantly decreased through the study period (p = .000). Across 2013, the most common delay owners were the patient, the surgeon, the facility, and the anesthesia department. Continuous and sustained improvement of first case on-time starts is attributed to tracking the FCOS metric, establishing embedded process improvement resources and creating transparency of data. This article highlights success factors and barriers to program success and sustainability.

Resident training in a new robotic thoracic surgery program.

PubMed

White, Yasmine N; Dedhia, Priya; Bergeron, Edward J; Lin, Jules; Chang, Andrew A; Reddy, Rishindra M

2016-03-01

The volume of robot-assisted operations has drastically increased over the past decade. New programs have focused on training surgeons, whereas resident training has lagged behind. The objective of this study was to evaluate our institutional experience with resident participation in thoracic robotic surgery cases since the initiation of our program. The first 100 robotic thoracic surgery cases at our institution were retrospectively reviewed and categorized into three sequential cohorts. Procedure type, patient and operative characteristics, level of resident participation (primary surgeon [PS] or assistant), and postoperative variables were evaluated. Of the first 100 cases, 38% were lung resections, 23% were esophageal operations, and 20% were sympathectomies. The distribution of cases changed over time with the proportion of pulmonary resections significantly increasing. Patient age (P < 0.05), body mass index (P = not significant [NS]), and comorbidities (P = NS) increased over time. Resident participation as PS increased from 33%-59% between the early and late cohorts (P < 0.05). A subset analysis of the 20 lobectomies (7 attending PS, 13 residents) showed similar patient characteristics (P = NS): age (67 versus 69), body mass index (29.5 versus 26.1), and American Society of Anesthesiologists category (2.8 versus 2.8). Operative and postoperative characteristics were also similar (P = NS) regardless of PS: operative time (260 versus 249 min), estimated blood loss (187 versus 203 mL), and length of stay (4.8 versus 4.7 d). Residents can participate as the PS in a variety of thoracic operations during the implementation of a robotics program. Operative time, estimated blood loss, and length of stay were similar regardless of level of resident participation. Copyright © 2016 Elsevier Inc. All rights reserved.

30 CFR 250.423 - What are the requirements for pressure testing casing?

Code of Federal Regulations, 2012 CFR

2012-07-01

..., DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations Casing and Cementing Requirements § 250.423 What are the requirements for... of casing. You may not resume drilling or other down-hole operations until you obtain a satisfactory...

30 CFR 250.423 - What are the requirements for pressure testing casing?

Code of Federal Regulations, 2014 CFR

2014-07-01

..., DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations Casing and Cementing Requirements § 250.423 What are the requirements for... of casing. You may not resume drilling or other down-hole operations until you obtain a satisfactory...

30 CFR 250.423 - What are the requirements for pressure testing casing?

Code of Federal Regulations, 2011 CFR

2011-07-01

... ENFORCEMENT, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations Casing and Cementing Requirements § 250.423 What are the... for each string of casing. You may not resume drilling or other down-hole operations until you obtain...

30 CFR 250.423 - What are the requirements for pressure testing casing?

Code of Federal Regulations, 2013 CFR

2013-07-01

..., DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations Casing and Cementing Requirements § 250.423 What are the requirements for... of casing. You may not resume drilling or other down-hole operations until you obtain a satisfactory...

Conjunctival melanocytic tumors in children - a challenge in diagnosis and treatment.

PubMed

Ciuntu, Roxana Elena; Martinescu, Gabriel; Anton, Nicoleta; Danciu, Mihai

2018-01-01

Conjunctival melanocytic lesions are very diverse pigmented tumors that include benign, premalignant and malignant tumors. The aim of this article is to highlight the clinical and histopathological aspects of conjunctival melanocytic tumors at children. This study is a retrospective case series study of three patients selected from fifteen cases with melanocytic conjunctival tumors who were operated in the Department of Ophthalmology, "St. Spiridon" Emergency Hospital, Iasi, Romania. A systematic review of the literature was undertaken, using an electronic search of PubMed/MEDLINE, Google Scholar and ISI Web of Knowledge, to identify original English or French articles and reviews on this subject. Patients were diagnosed by the same doctor between 2004 and 2016, in ambulatory of Department of Ophthalmology of the same Hospital. The age of patients was between 7 and 17 years old. Three cases (boys) were treated by surgery - one patient with conjunctival malignant melanoma (histologically confirmed) derived from a pre-existing benign conjunctival nevus (diagnosed 1.5 years before), a patient was operated for aesthetic reasons (with histological diagnosis of compound conjunctival melanocytic nevus) and one boy was diagnosed of melanocytic conjunctival nevus. All cases operated had normal visual acuity and fundoscopy. There was no regional lymph node present in any case studied. The traditional method for clinical diagnosis of suspected pigmented conjunctival lesions was to remove these lesions surgically and to examine architectural and cytological features with light microscopy. We recommend an immunohistochemical staining for the detection of specific cellular antigens in conjunctival melanocytic tumors in children. The diagnosis, treatment and the follow-up of the patient were challenges for the ophthalmologist.

Non-operative management of abdominal gunshot injuries: Is it safe in all cases?

PubMed

İflazoğlu, Nidal; Üreyen, Orhan; Öner, Osman Zekai; Meral, Ulvi Mehmet; Yülüklü, Murat

2018-01-01

In line with advances in diagnostic methods and expectation of a decrease in the number of negative laparotomies, selective non-operative management of abdominal gunshot wounds has been increasingly used over the last three decades. We aim to detect the possibility of treatment without surgery and present our experience in selected cases referred from Syria to a hospital at the Turkish-Syrian border. Between February 2012 and June 2014, patients admitted with abdominal gunshot wounds were analyzed. Computed tomography was performed for all patients on admission. Patients who were hemodynamically stable and did not have symptoms of peritonitis at the time of presentation were included in the study. The primary outcome parameters were mortality and morbidity. Successful selective non-operative management (Group 1) and unsuccessful selective non-operative management (Group 2) groups were compared in terms of complications, blood transfusion, injury site, injury severity score (ISS), and hospital stay. Of 158 truncal injury patients, 18 were considered feasible for selective non-operative management. Of these, 14 (78%) patients were treated without surgery. Other Four patients were operated upon progressively increasing abdominal pain and tenderness during follow-up. On diagnostic exploration, all of these cases had intestinal perforations. No mortality was observed in selective non-operative management. There was no statistically significant difference between Group 1 and Group 2, in terms of length of hospital stay (96 and 127 h, respectively). Also, there was no difference between groups in terms of blood transfusion necessity, injury site, complication rate, and injury severity score (p>0.05). Decision making on patient selection for selective non-operative management is critical to ensure favorable outcomes. It is not possible to predict the success of selective non-operative management in advance. Cautious clinical examination and close monitoring of these patients is vital; however, emergency laparotomy should be performed in case of change in vital signs and positive symptoms concerning peritonitis.

The Evidentiary Footprints of Appreciative Inquiry in a Community College: An Interpretive Case Study of Three Micro-Cases

ERIC Educational Resources Information Center

Royer, Dan W.

2017-01-01

I examined the embedding of Appreciative Inquiry (AI) in three micro-cases at Northeastern Regional Community College (NERC). This community college is a rarity for the way AI was adopted as an operational philosophy throughout the institution. The purpose of this research was to understand institutional agents' and students' perceptions of the…

Systematic review of general thoracic surgery articles to identify predictors of operating room case durations.

PubMed

Dexter, Franklin; Dexter, Elisabeth U; Masursky, Danielle; Nussmeier, Nancy A

2008-04-01

Previous studies of operating room (OR) information systems data over the past two decades have shown how to predict case durations using the combination of scheduled procedure(s), individual surgeon and assistant(s), and type of anesthetic(s). We hypothesized that the accuracy of case duration prediction could be improved by the use of other electronic medical record data (e.g., patient weight or surgeon notes using standardized vocabularies). General thoracic surgery was used as a model specialty because much of its workload is elective (scheduled) and many of its cases are long. PubMed was searched for thoracic surgery papers reporting operative time, surgical time, etc. The systematic literature review identified 48 papers reporting statistically significant differences in perioperative times. There were multiple reports of differences in OR times based on the procedure(s), perioperative team including primary surgeon, and type of anesthetic, in that sequence of importance. All such detail may not be known when the case is originally scheduled and thus may require an updated duration the day before surgery. Although the use of these categorical data from OR systems can result in few historical data for estimating each case's duration, bias and imprecision of case duration estimates are unlikely to be affected. There was a report of a difference in case duration based on additional information. However, the incidence of the procedure for the diagnosis was so uncommon as to be unlikely to affect OR management. Matching findings of prior studies using OR information system data, multiple case series show that it is important to rely on the precise procedure(s), surgical team, and type of anesthetic when estimating case durations. OR information systems need to incorporate the statistical methods designed for small numbers of prior surgical cases. Future research should focus on the most effective methods to update the prediction of each case's duration as these data become available. The case series did not reveal additional data which could be cost-effectively integrated with OR information systems data to improve the accuracy of predicted durations for general thoracic surgery cases.

Modeling, control, and dynamic performance analysis of a reverse osmosis desalination plant integrated within hybrid energy systems

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

Kim, Jong Suk; Chen, Jun; Garcia, Humberto E.

An RO (reverse osmosis) desalination plant is proposed as an effective, FLR (flexible load resource) to be integrated into HES (hybrid energy systems) to support various types of ancillary services to the electric grid, under variable operating conditions. To study the dynamic (transient) analysis of such system, among the various unit operations within HES, special attention is given here to the detailed dynamic modeling and control design of RO desalination process with a spiral-wound membrane module. The model incorporates key physical phenomena that have been investigated individually into a dynamic integrated model framework. In particular, the solution-diffusion model modified withmore » the concentration polarization theory is applied to predict RO performance over a large range of operating conditions. Simulation results involving several case studies suggest that an RO desalination plant, acting as a FLR, can provide operational flexibility to participate in energy management at the utility scale by dynamically optimizing the use of excess electrical energy. Here, the incorporation of additional commodity (fresh water) produced from a FLR allows a broader range of HES operations for maximizing overall system performance and profitability. For the purpose of assessing the incorporation of health assessment into process operations, an online condition monitoring approach for RO membrane fouling supervision is addressed in the case study presented.« less

Modeling, control, and dynamic performance analysis of a reverse osmosis desalination plant integrated within hybrid energy systems

DOE PAGES

Kim, Jong Suk; Chen, Jun; Garcia, Humberto E.

2016-06-17

An RO (reverse osmosis) desalination plant is proposed as an effective, FLR (flexible load resource) to be integrated into HES (hybrid energy systems) to support various types of ancillary services to the electric grid, under variable operating conditions. To study the dynamic (transient) analysis of such system, among the various unit operations within HES, special attention is given here to the detailed dynamic modeling and control design of RO desalination process with a spiral-wound membrane module. The model incorporates key physical phenomena that have been investigated individually into a dynamic integrated model framework. In particular, the solution-diffusion model modified withmore » the concentration polarization theory is applied to predict RO performance over a large range of operating conditions. Simulation results involving several case studies suggest that an RO desalination plant, acting as a FLR, can provide operational flexibility to participate in energy management at the utility scale by dynamically optimizing the use of excess electrical energy. Here, the incorporation of additional commodity (fresh water) produced from a FLR allows a broader range of HES operations for maximizing overall system performance and profitability. For the purpose of assessing the incorporation of health assessment into process operations, an online condition monitoring approach for RO membrane fouling supervision is addressed in the case study presented.« less

Retrospective evaluation of prehospital triage, presentation, interventions and outcome in paediatric drowning managed by a physician staffed helicopter emergency medical service.

PubMed

Garner, Alan A; Barker, Claire L; Weatherall, Andrew D

2015-11-06

Drowning patients may benefit from the advanced airway management capabilities that can be provided by physician staffed helicopter emergency medical services. The aim of this study is to describe paediatric drowning patients treated by such a service examining tasking systems, initial physiology at the incident scene, survival and neurological outcome. Retrospective analysis of paediatric drowning victims over a 5- year period. Case identification system, patient age, site of drowning, presence or absence of cardiac output, first Glasgow Coma Scale (GCS) score and interventions were collected from prehospital notes, and survival and neurological outcomes from hospital and rehabilitation notes. The P-HEMS direct case identification system operating in parallel with a central control system identified all severe drowning cases but 3 of 7 cases (43%) were missed when the central control system operated in isolation. All severe drowning cases (22) identified for P-HEMS response were intubated and transported directly to a paediatric specialist centre. Intubation required adjuvant anaesthesia in 10 (45%) cases. All children with GCS greater than eight on arrival of the P-HEMS survived neurologically intact. Seven of eight children with a GCS between four and seven survived without neurological impairment and all children with a GCS greater than three survived. Four of twelve asystolic children survived including one child who at 18 months post drowning is neurologically normal. All children who survived had return of spontaneous circulation prior to arrival in the emergency department. P-HEMS played a significant role in the management of severe paediatric drowning in this case series. Requirement for P-HEMS only interventions were high and all identified cases were transferred directly to a paediatric specialist centre. Discontinuation of the P-HEMS direct case identication system that operated during the majority of the study period resulted in deterioration in system performance with some paediatric drowning cases subsequently not identified for P-HEMS response being transported to adult hospitals.

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

PubMed

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

2017-06-07

A growing proportion of veterans treated at the Veterans Health Administration (VA) have a history of post-traumatic-stress-disorder (PTSD), and there exists a higher rate of PTSD amongst veterans than the general population. The purpose of this study is to determine the correlation between PTSD and intra-operative analgesia, intra-operative time, and anesthesia type for cataract surgery in a veteran population. Secondary objectives are to determine if patient age, and first or second eye surgery affect intra-operative pain control or are correlated with type of anesthesia modality. A retrospective study of 330 cataract surgeries performed by resident physicians between January and September 2012 at the Veterans Affairs Medical Center Tennessee Valley Healthcare System, Nashville and Murfreesboro Campuses was completed. Three hundred and thirty veteran patients were selected if their cataract surgery was performed between January and September 2012. Combined cases were excluded. The primary outcome evaluated was intra-operative analgesia. Secondary outcomes included history of post-traumatic-stress-disorder, anesthesia type, first or second eye, pain control, intra-operative heart rate and blood pressure, age, and case complexity. Data was analyzed using an unpaired two-sample Welch's t-test assuming unequal variance and Z test of comparison of proportions. Patients with post-traumatic-stress-disorder reported higher pain scores, had longer operative times, and were more likely to have received a retrobulbar block. Operative time was not associated with an increased pain score, irrespective of anesthesia type, when controlled for PTSD. Complex cases had longer operative times, more sedation, and higher pain scores. P < 0.05 was used consistently. Post-traumatic stress disorder and anxiety are more prevalent in the veteran population. Our data suggests that a history of post-traumatic-stress-disorder was correlated with higher pain scores, longer operative times, and with having received a retrobulbar block. Patients without a history of PTSD were more likely to have received topical anesthesia with or without sedation. The veteran population requires more sedation to allay anxiety and perceptions of discomfort, which may account for longer surgical times. The veteran population is a special population and it is important to investigate how PTSD in the veteran population affects intra-operative analgesia.

Network Centric Operations NCO Case Study. The British Approach to Low-Intensity Operations: Part I

DTIC Science & Technology

2007-02-12

Army’s institutional memory of jungle warfare (during WW2 ) had dissipated by 1948. Nonetheless, individuals within the Army who had experienced such...with a specially stabilised TV camera mounting. It also fitted infrared surveillance systems to its Beaver spotter planes, which helped detect

Organizational Constraints and Goal Setting

ERIC Educational Resources Information Center

Putney, Frederick B.; Wotman, Stephen

1978-01-01

Management modeling techniques are applied to setting operational and capital goals using cost analysis techniques in this case study at the Columbia University School of Dental and Oral Surgery. The model was created as a planning tool used in developing a financially feasible operating plan and a 100 percent physical renewal plan. (LBH)

Making adaptable systems work for mission operations: A case study

NASA Technical Reports Server (NTRS)

Holder, Barbara E.; Levesque, Michael E.

1993-01-01

The Advanced Multimission Operations System (AMMOS) at NASA's Jet Propulsion Laboratory is based on a highly adaptable multimission ground data system (MGDS) for mission operations. The goal for MGDS is to support current flight project science and engineering personnel and to meet the demands of future missions while reducing associated operations and software development costs. MGDS has become a powerful and flexible mission operations system by using a network of heterogeneous workstations, emerging open system standards, and selecting an adaptable tools-based architecture. Challenges in developing adaptable systems for mission operations and the benefits of this approach are described.

First-year Analysis of the Operating Room Black Box Study.

PubMed

Jung, James J; Jüni, Peter; Lebovic, Gerald; Grantcharov, Teodor

2018-06-18

To characterize intraoperative errors, events, and distractions, and measure technical skills of surgeons in minimally invasive surgery practice. Adverse events in the operating room (OR) are common contributors of morbidity and mortality in surgical patients. Adverse events often occur due to deviations in performance and environmental factors. Although comprehensive intraoperative data analysis and transparent disclosure have been advocated to better understand how to improve surgical safety, they have rarely been done. We conducted a prospective cohort study in 132 consecutive patients undergoing elective laparoscopic general surgery at an academic hospital during the first year after the definite implementation of a multiport data capture system called the OR Black Box to identify intraoperative errors, events, and distractions. Expert analysts characterized intraoperative distractions, errors, and events, and measured trainee involvement as main operator. Technical skills were compared, crude and risk-adjusted, among the attending surgeon and trainees. Auditory distractions occurred a median of 138 times per case [interquartile range (IQR) 96-190]. At least 1 cognitive distraction appeared in 84 cases (64%). Medians of 20 errors (IQR 14-36) and 8 events (IQR 4-12) were identified per case. Both errors and events occurred often in dissection and reconstruction phases of operation. Technical skills of residents were lower than those of the attending surgeon (P = 0.015). During elective laparoscopic operations, frequent intraoperative errors and events, variation in surgeons' technical skills, and a high amount of environmental distractions were identified using the OR Black Box.

Challenges in Achieving Trajectory-Based Operations

NASA Technical Reports Server (NTRS)

Cate, Karen Tung

2012-01-01

In the past few years much of the global ATM research community has proposed advanced systems based on Trajectory-Based Operations (TBO). The concept of TBO uses four-dimensional aircraft trajectories as the base information for managing safety and capacity. Both the US and European advanced ATM programs call for the sharing of trajectory data across different decision support tools for successful operations. However, the actual integration of TBO systems presents many challenges. Trajectory predictors are built to meet the specific needs of a particular system and are not always compatible with others. Two case studies are presented which examine the challenges of introducing a new concept into two legacy systems in regards to their trajectory prediction software. The first case describes the issues with integrating a new decision support tool with a legacy operational system which overlap in domain space. These tools perform similar functions but are driven by different requirements. The difference in the resulting trajectories can lead to conflicting advisories. The second case looks at integrating this same new tool with a legacy system originally developed as an integrated system, but diverged many years ago. Both cases illustrate how the lack of common architecture concepts for the trajectory predictors added cost and complexity to the integration efforts.

Case study project: The use of low-VOC/HAP coatings at wood furniture manufacturing facilities. Report for March 1995--March 1999

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

Marshall, A.M.; Jones, J.W.; Fields, J.L.

1999-07-01

The paper discusses a study of pollution prevention and the use of low-VOC/HAP (volatile organic compound/hazardous air pollutant) coatings at wood furniture manufacturing facilities. The study is to identify wood furniture and cabinet manufacturing facilities that have converted to low-VOC/HAP coatings and to develop case studies for those facilities. The case studies include a discussion of the types of products each facility manufactures; the types of low-VOC/HAP coatings each facility is using; problems encountered in converting to low-VOC/HAP coatings; equipment changes that were required; costs associated with the conversion process, including capital costs associated with equipment purchases, research and developmentmore » costs, and operating costs such as operator training in new application techniques;advantages/ disadvantages of the low-VOC/HAP coatings; and customer feedback on products finished with the low-VOC/HAP coatings. The paper discusses the progress of the study and pollution prevention options at wood furniture manufacturing facilities.« less

On the Spectra of Real and Complex Lamé Operators

NASA Astrophysics Data System (ADS)

Haese-Hill, William A.; Hallnäs, Martin A.; Veselov, Alexander P.

2017-07-01

We study Lamé operators of the form L = -{d^2}/{dx^2} + m(m+1)ω^2\\wp(ω x+z_0), with m\\in{N} and ω a half-period of \\wp(z). For rectangular period lattices, we can choose ω and z_0 such that the potential is real, periodic and regular. It is known after Ince that the spectrum of the corresponding Lamé operator has a band structure with not more than m gaps. In the first part of the paper, we prove that the opened gaps are precisely the first m ones. In the second part, we study the Lamé spectrum for a generic period lattice when the potential is complex-valued. We concentrate on the m=1 case, when the spectrum consists of two regular analytic arcs, one of which extends to infinity, and briefly discuss the m=2 case, paying particular attention to the rhombic lattices.

Pathology informatics fellowship retreats: The use of interactive scenarios and case studies as pathology informatics teaching tools.

PubMed

Lee, Roy E; McClintock, David S; Balis, Ulysses J; Baron, Jason M; Becich, Michael J; Beckwith, Bruce A; Brodsky, Victor B; Carter, Alexis B; Dighe, Anand S; Haghighi, Mehrvash; Hipp, Jason D; Henricks, Walter H; Kim, Jiyeon Y; Klepseis, Veronica E; Kuo, Frank C; Lane, William J; Levy, Bruce P; Onozato, Maristela L; Park, Seung L; Sinard, John H; Tuthill, Mark J; Gilbertson, John R

2012-01-01

Last year, our pathology informatics fellowship added informatics-based interactive case studies to its existing educational platform of operational and research rotations, clinical conferences, a common core curriculum with an accompanying didactic course, and national meetings. The structure of the informatics case studies was based on the traditional business school case study format. Three different formats were used, varying in length from short, 15-minute scenarios to more formal multiple hour-long case studies. Case studies were presented over the course of three retreats (Fall 2011, Winter 2012, and Spring 2012) and involved both local and visiting faculty and fellows. Both faculty and fellows found the case studies and the retreats educational, valuable, and enjoyable. From this positive feedback, we plan to incorporate the retreats in future academic years as an educational component of our fellowship program. Interactive case studies appear to be valuable in teaching several aspects of pathology informatics that are difficult to teach in more traditional venues (rotations and didactic class sessions). Case studies have become an important component of our fellowship's educational platform.

The U.S. Armored Brigade Combat Team Versus Current Hybrid Threat: How Should the U.S. ABCT be Organized and Equipped to Address the Current Hybrid Threat

DTIC Science & Technology

2017-06-09

analysis method and focus on analyzing available documents while studying the separate but similar cases of Israel fighting Hezbollah in Lebanon and...two significant case studies will be reviewed. One deals with the conflict between Hezbollah and Israel Defense Forces (IDF) in Israel and Lebanon...Vietnam and in Operation Iraqi Freedom. Captain Houvinen in his research presented a case study from the Second Lebanon War based on the U.S. experience

A Case Study on Collective Cognition and Operation in Team-Based Computer Game Design by Middle-School Children

ERIC Educational Resources Information Center

Ke, Fengfeng; Im, Tami

2014-01-01

This case study examined team-based computer-game design efforts by children with diverse abilities to explore the nature of their collective design actions and cognitive processes. Ten teams of middle-school children, with a high percentage of minority students, participated in a 6-weeks, computer-assisted math-game-design program. Essential…

[Surgery in aged patients: a study on 476 surgical cases].

PubMed

Guglielminetti, D; Angelini, L; Pasi, L; Carosi, V

1990-06-01

The Authors report their experience from 1984 to 1989 with surgery in the elderly. Patients aged 75 years were considered as geriatric and entered the study. Mortality and morbidity rates were analysed in 476 cases operated. Pre-existent diseases were related to postoperative complications. The Authors conclude underlining the feasibility of geriatric surgery as well as the acceptable risk rate.

Exploring Inquiry in the Third Space: Case Studies of a Year in an Urban Teacher-Residency Program

ERIC Educational Resources Information Center

Klein, Emily J.; Taylor, Monica; Onore, Cynthia; Strom, Kathryn; Abrams, Linda

2016-01-01

Using case studies, we describe what happens from novice to apprentice when preservice teachers learn to teach in an urban teacher-residency (UTR) program with a focus on inquiry. Our UTR operates within a "third space" in teacher education, seeking to realign traditional power relationships and to create an alternate arena where the…

Deploying an Intelligent Pairing Assistant for Air Operation Centers

DTIC Science & Technology

2016-06-23

primary contributions of this case study are applying artificial intelligence techniques to a novel domain and discussing the software evaluation...their standard workflows. The primary contributions of this case study are applying artificial intelligence techniques to a novel domain and...users for more efficient and accurate pairing? Participants Participants in the evaluation consisted of three SMEs employed at Intelligent Software

Case Studies of Postponement in the Supply Chain

DTIC Science & Technology

2006-06-14

postponement it is still an underutilized strategy across manufacturing. Costs and benefits are sometimes hard to quantify. However, successful case studies...savings in inventory because the value of the product increases through the addition of each successive component. Manufacturing postponement usually...the instrument during the shipment process. Shortly after achieving successful packaging operations, DB initiated another post- ponement strategy in

Transformation of European Defense Cooperation: A Complex Endeavor

DTIC Science & Technology

2014-06-01

7 Based on a comparison of the results of two case studies of natural disaster relief endeavors ( Elbe ...KFOR); simple disaster response ( Elbe River Flood 2002, Strong Angel III, Golden Phoenix); complex disaster response (Katrina, Tsunami 2004, Pakistan...Complexity of Disaster Relief Operations: Two case Studies of the Tsunami 2004 and Elbe Flood 2002. 13th ICCRTS: C2 for Complex Endeavors. Seattle

The Link between the Process of Change and Coaching in an Organization--A Case Study

ERIC Educational Resources Information Center

Jim, Josephine

2016-01-01

The aim of this case study was to highlight coaching in the process of change using a real life information technology and operational change project in an institution. It demonstrates the critical importance of coaching in change management, for successful change to occur. Any sustaining change requires ongoing coaching as an integral part of the…

Approach of forensic medicine to gossypiboma.

PubMed

Karakaya, M Arif; Koç, Okay; Ekiz, Feza; Ağaçhan, A Feran

2015-01-01

The aim of this study was to assess the risk factors and preventive measures for gossypibomas and their medico-legal implications in forensic medicine in the Turkish legal system. This study involved a retrospective analysis of the records of 39 patients with gossypiboma. Records were available from the Istanbul Forensic Medicine Institution and were surveyed for faulty treatment between 2008 and 2012. Parameters such as distribution of the cases according to specializations, elective and emergency procedures, surgical procedures, radio-opaque sponge and fluoroscopy availability, routine sponge and instrument counting, number of nurses for counting, and control of the operative field by a second surgeon were investigated. All cases were evaluated by the Istanbul Forensic Medicine Institute 3rd Expertise Committee. This committee comprised of specialists from the departments of forensic medicine, orthopedics and traumatology, general surgery, neurology, internal medicine, pediatrics, chest disease, and infectious diseases. All cases were considered as poor medical practice (malpractice) and surgeons were found to be responsible. In 16 of these 39 cases (41%) emergency procedures were performed. No unexpected event was reported in any procedure. In 16 cases (41%), sponge count was performed and was reported to be complete. Operation notes were available in 16 (41%) cases. Control of the operative field was performed by 1 surgeon, and sponge and instrument count was performed by 1 scrub nurse. Radio-opaque sponge and fluoroscopy were available in 9 (23%) centers in these cases. Gossypiboma can be prevented not only with surgeons' care but also with adequate support of medical device and material. However, it is considered as a poor medical practice. Presence of only 1 general surgeon in the expertise committee and ignorance of the working conditions by the surgeons should be questioned.

Improving operating room productivity via parallel anesthesia processing.

PubMed

Brown, Michael J; Subramanian, Arun; Curry, Timothy B; Kor, Daryl J; Moran, Steven L; Rohleder, Thomas R

2014-01-01

Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity. Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime. Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon. Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability. Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved. Simulation modeling can be an effective tool to show practice change effects at a system-wide level.

Switch Panel wear loading - a parametric study regarding governing train operational factors

NASA Astrophysics Data System (ADS)

Hiensch, E. J. M.; Burgelman, N.

2017-09-01

The acting forces and resulting material degradation at the running surfaces of wheels and rail are determined by vehicle, track, interface and operational characteristics. To effectively manage the experienced wear, plastic deformation and crack development at wheels and rail, the interaction between vehicle and track demands a system approach both in maintenance and in design. This requires insight into the impact of train operational parameters on rail- and wheel degradation, in particular at switches and crossings due to the complex dynamic behaviour of a railway vehicle at a turnout. A parametric study was carried out by means of vehicle-track simulations within the VAMPIRE® multibody simulation software, performing a sensitivity analysis regarding operational factors and their impact on expected switch panel wear loading. Additionally, theoretical concepts were cross-checked with operational practices by means of a case study in response to a dramatic change in lateral rail wear development at specific switches in Dutch track. Data from train operation, track maintenance and track inspection were analysed, providing further insight into the operational dependencies. From the simulations performed in this study, it was found that switch rail lateral wear loading at the diverging route of a 1:9 type turnout is significantly influenced by the level of wheel-rail friction and to a lesser extent by the direction of travel (facing or trailing). The influence of other investigated parameters, being vehicle speed, traction, gauge widening and track layout is found to be small. Findings from the case study further confirm the simulation outcome. This research clearly demonstrates the contribution flange lubrication can have in preventing abnormal lateral wear at locations where the wheel-rail interface is heavily loaded.

Lumbar microdiscectomy as a day-case procedure: Scope for improvement?

PubMed

Ahuja, Neeraj; Sharma, Himanshu

2018-06-01

There are no significant differences in outcomes between patients receiving inpatient and day-case lumbar microdiscectomy, but the latter is still underused in the NHS. Here we aimed to identify factors contributing to successful same-day discharge in day-case patients. This was a retrospective observational study of patients undergoing elective lumbar microdiscectomy between August 2012 and December 2014. Age, gender, day of surgery, distance to hospital, ASA grade, regular opiate use, smoking status, order on the operating list, and side and level of surgery were examined by logistic regression to assess their influence on same-day discharge. 28/95 (29.5%) patients were discharged on the day of surgery. Age (p = 0.041), ASA grade (p = 0.016), distance to hospital (p = 0.011), and position on the list (p = 0.004) were associated with day-case discharge by univariate analysis. ASA grade (p = 0.032; OR 0.176), distance to hospital (p = 0.003; OR 0.965), and position on the operating list (morning case; p = 0.011; OR 8.901) remained significant in multivariate analysis. Thirteen (13.7%) patients were identified who could have been managed as day cases had they been listed for morning operations. Day-case lumbar microdiscectomy is viable when patients are carefully selected. Younger, fit patients living close to the hospital and operated on in the morning are more likely to be discharged on the same day. Knowledge of these factors while planning elective lists can help optimise bed space and improve spinal services. Copyright © 2017 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Technical proficiency in hand-assisted laparoscopic colon and rectal surgery: determining how many cases are required to achieve mastery.

PubMed

Pendlimari, Rajesh; Holubar, Stefan D; Dozois, Eric J; Larson, David W; Pemberton, John H; Cima, Robert R

2012-04-01

To determine how many cases are required to achieve technical proficiency for hand-assisted laparoscopic surgery (HALS). Retrospective study. Tertiary care hospital. Using a prospective database, all HALS colorectal resections from 2003 to 2009 by 2 surgeons (A and B) were reviewed. Over 6 years, surgeons A and B performed 397 and 322 cases. Change-Point Analysis (CUSUM) was used to define the number of cases required to effect improvement in operative time. Cases before and after the change point were considered as being in the "learning period" and "skilled period." Operative time; short-term outcomes. The change point occurred after 108 and 105 cases for surgeons A and B, respectively. The learning period and skilled period were similar with respect to age, sex, body mass index, prior abdominal surgery, medical comorbidities, and American Society of Anesthesiologists class. Mean overall operative time decreased from 263 to 185 minutes (P < .001). The decrease in mean operative duration for specific resections were as follows: right colectomy, 35 minutes (P = .003); left colectomy, 63 minutes (P = .006); sigmoid colectomy, 63 minutes (P < .001); anterior resection, 70 minutes (P < .001); coloanal anastomosis, 52 minutes (P = .003); subtotal colectomy, 75 minutes (P < .001); and total proctocolectomy with ileal reservoir, 80 minutes (P < .001). Intraoperative complications and conversion rate were similar, but overall morbidity, infectious complications, readmissions, and length of stay were all significantly (P < .05) lower during the skilled period. For HALS colorectal resection, technical proficiency occurred after approximately 105 cases, and increased surgeon experience resulted in improved short-term outcomes. These data suggest that the learning curve for HALS colorectal resection will extend beyond fellowship training for many colorectal surgeons.

Defining the cost of care for lobectomy and segmentectomy: a comparison of open, video-assisted thoracoscopic, and robotic approaches.

PubMed

Deen, Shaun A; Wilson, Jennifer L; Wilshire, Candice L; Vallières, Eric; Farivar, Alexander S; Aye, Ralph W; Ely, Robson E; Louie, Brian E

2014-03-01

Knowledge about the cost of open, video-assisted thoracoscopic (VATS), or robotic lung resection and drivers of cost is crucial as the cost of care comes under scrutiny. This study aims to define the cost of anatomic lung resection and evaluate potential cost-saving measures. A retrospective review of patients who had anatomic resection for early stage lung cancer, carcinoid, or metastatic foci between 2008 and 2012 was performed. Direct hospital cost data were collected from 10 categories. Capital depreciation was separated for the robotic and VATS cases. Key costs were varied in a sensitivity analysis. In all, 184 consecutive patients were included: 69 open, 57 robotic, and 58 VATS. Comorbidities and complication rates were similar. Operative time was statistically different among the three modalities, but length of stay was not. There was no statistically significant difference in overall cost between VATS and open cases (Δ = $1,207) or open and robotic cases (Δ = $1,975). Robotic cases cost $3,182 more than VATS (p < 0.001) owing to the cost of robotic-specific supplies and depreciation. The main opportunities to reduce cost in open cases were the intensive care unit, respiratory therapy, and laboratories. Lowering operating time and supply costs were targets for VATS and robotic cases. VATS is the least expensive surgical approach. Robotic cases must be shorter in operative time or reduce supply costs, or both, to be competitive. Lessening operating time, eradicating unnecessary laboratory work, and minimizing intensive care unit stays will help decrease direct hospital costs. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Identifying gaps in the surgical training curriculum in Rwanda through evaluation of operative activity at a teaching hospital.

PubMed

Rickard, Jennifer L; Ntakiyiruta, Georges; Chu, Kathryn M

2015-01-01

To define the operations performed by surgical residents at a tertiary referral hospital in Rwanda to help guide development of the residency program. Cross-sectional study of all patients operated by surgical residents from October 2012 to September 2013. University Teaching Hospital of Kigali (Centre Hospitalier Universitaire de Kigali [CHUK]), a public, tertiary referral hospital in Kigali, Rwanda. All patient data were entered into the operative database by surgical residents at CHUK. A total of 2833 cases were entered into the surgical database. Of them, 53 cases were excluded from further analysis because no surgical resident was listed as the primary or assistant surgeon, leaving 2780 cases for analysis. There were 2780 operations involving surgical residents. Of them, 51% of procedures were classified under general surgery, 38% orthopedics, 7% neurosurgery, and 4% urology. Emergency operations accounted for 64% of the procedures, with 56% of those being general surgery and 35% orthopedic. Further, 50% of all operations were trauma, with 71% of those orthopedic and 21% general surgery. Surgical faculty were involved in 45% of operations as either the primary or the assistant surgeons, while the remainder of operations did not involve surgical faculty. Residents were primary surgeons in 68% of procedures and assistant surgeons in 84% of procedures. The operative experience of surgery residents at CHUK primarily involves emergency and trauma procedures. Although this likely reflects the demographics of surgical care within Rwanda, more focus should be placed on elective procedures to ensure that surgical residents are broadly trained. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Learning curve of single port laparoscopic cholecystectomy determined using the non-linear ordinary least squares method based on a non-linear regression model: An analysis of 150 consecutive patients.

PubMed

Han, Hyung Joon; Choi, Sae Byeol; Park, Man Sik; Lee, Jin Suk; Kim, Wan Bae; Song, Tae Jin; Choi, Sang Yong

2011-07-01

Single port laparoscopic surgery has come to the forefront of minimally invasive surgery. For those familiar with conventional techniques, however, this type of operation demands a different type of eye/hand coordination and involves unfamiliar working instruments. Herein, the authors describe the learning curve and the clinical outcomes of single port laparoscopic cholecystectomy for 150 consecutive patients with benign gallbladder disease. All patients underwent single port laparoscopic cholecystectomy using a homemade glove port by one of five operators with different levels of experiences of laparoscopic surgery. The learning curve for each operator was fitted using the non-linear ordinary least squares method based on a non-linear regression model. Mean operating time was 77.6 ± 28.5 min. Fourteen patients (6.0%) were converted to conventional laparoscopic cholecystectomy. Complications occurred in 15 patients (10.0%), as follows: bile duct injury (n = 2), surgical site infection (n = 8), seroma (n = 2), and wound pain (n = 3). One operator achieved a learning curve plateau at 61.4 min per procedure after 8.5 cases and his time improved by 95.3 min as compared with initial operation time. Younger surgeons showed significant decreases in mean operation time and achieved stable mean operation times. In particular, younger surgeons showed significant decreases in operation times after 20 cases. Experienced laparoscopic surgeons can safely perform single port laparoscopic cholecystectomy using conventional or angled laparoscopic instruments. The present study shows that an operator can overcome the single port laparoscopic cholecystectomy learning curve in about eight cases.

Selection, Evaluation, and Modification of a Standard Operating Procedure as a Mechanism for Introducing an Undergraduate Student to Chemical Research: A Case Study

ERIC Educational Resources Information Center

Claycomb, Gregory D.; Venable, Frances A.

2015-01-01

In an effort to broaden the selection of research opportunities available to a student registered in a one-semester, upper-level independent study course at a primarily undergraduate institution (PUI), a highly motivated student was asked to select, evaluate, and modify a standard operating procedure (SOP). The student gained valuable experience…

FREQUENCY OF WOUND INFECTION IN NON-PERFORATED APPENDICITIS WITH USE OF SINGLE DOSE PREOPERATIVE ANTIBIOTICS.

PubMed

Ali, Kishwar; Latif, Humera; Ahmad, Sajjad

2015-01-01

Antibiotics are used both pre and post-operatively in acute appendicitis for preventing wound infection. It has been observed that the routine use of post-operative antibiotics is not necessary in cases of non-perforated appendicitis as only prophylactic antibiotics are sufficient to prevent wound infection. The aim of this study was to see the frequency of wound infection in non-perforated appendicitis with single dose preoperative antibiotics only. This observational study was conducted at the Department of Surgery, Ayub Medical College, Abbottabad from May to November 2014. A total of 121 patients with non-perforated appendicitis were included in the study. Only single dose preoperative antibiotics were used. The patients were followed for wound infection till 8th post-operative day. 121 patients, 56 (46.28%) male and 65 (53.72%) female were included in the study. The mean age of patients was 27.41 +/- 7.12 years with an age range of 18 to 45 years. In the entire series, 7 (5.78%) patients developed wound infection. The infection was minor which settled with conservative therapy. Prophylactic antibiotics were found efficacious in 114 (94.21%) patients. There was no significant association between wound infection and age and gender. Single dose preoperative antibiotics were found effective in controlling post-operative wound infection without the need of extending the antibiotics to post-operative period in cases of non-perforated appendicitis.

[Application of temporary balloon occlusion of the abdominal aorta in the treatment of complete placenta previa complicated with placenta accreta].

PubMed

Cui, S H; Zhi, Y X; Zhang, K; Zhang, L D; Shen, L N; Gao, Y N

2016-09-25

Objective: To investigate the value of temporary balloon occlusion of the abdominal aorta in the treatment of complete placenta previa with placenta accreta. Methods: From January 2015 to February 2016, 24 cases of complete placenta previa with placenta accreta were treated with temporary balloon occlusion of the abdominal aorta(the study group)before cesarean, and 24 cases of complete placenta previa with placenta accreta did not receive balloon occlusion(the control group). The operation time, intraoperative blood loss, intraoperative blood transfusion volume, the perioperative hemoglobin level, the hysterectomy rate and the related complications were compared retrospectively.Also, the hospitalization time, the blood coagulation parameters after operation, including activated partial thromboplastin time(APTT), fibrinogen(FIB), D-Dimer and reperfusion injury parameters including creatine phosphokinase(CK), creatine phosphokinase isoenzyme(CK-MB), lactate dehydrogenase(LDH)and serum creatinine were compared between the 2 groups. Results: The blood loss[750 ml(400- 2 000 ml)vs 2 000 ml(1 500- 2 375 ml); Z =-3.214, P =0.001]and blood transfusion volume[200 ml(0-800 ml)vs 800 ml(0-1 200 ml); Z =- 2.173, P =0.030]in the study group were lower than in the control group. The hemoglobin difference between before and after operation in the study group was lower than the control group[(12.8±13.4)g/L vs(22.9±20.1)g/L; t =-2.041, P =0.047]. In the study group, there were still bleeding in 13 cases after releasing the balloon, 5 of them received uterine artery embolization, 5 cases received uterine artery ligation, and 3 cases received uterine packing. One case had venous thrombosis in the right lower limb. Two cases(8%,2/24)in the control group had hysterectomy, while none in the study group, there was no statistical significance( P = 0.489). Conclusions: Temporary balloon occlusion of the abdominal aorta can effectively reduce blood loss and blood transfusion in the treatment of complete placenta previa with placenta accreta, but there is still the risk of continuing bleeding after releasing the balloon. Other methods of hemostasis might be needed.

[Application of blocking vessels in operative therapy of non-limb hemangioma].

PubMed

Zheng, Fanwei; Cen, Ying; Cui, Zhengjun

2005-04-01

To study the surgical method to reduce bleeding in treating hemangioma at non-limb sites. From November 1998 to November 2003, 49 cases of non-limb hemangioma were treated, aged 3 months to 63 years, including 21 males and 28 females. There were 14 cases of capillary hemangioma, 25 cases of cavernous hemangioma, 7 cases of arterial racemose angioma and 3 cases of mixture hemangioma. According to the position and type of hemangioma, the various methods of blocking blood vessels were adopted to assist resect tumors. After the pulsatile artery was felt in arterial racemose angioma of neck and face by palpation, we sutured and knotted it with 7-0 silk string to block the bleeding. We found out the common iliac artery or external iliac artery or femoral artery and blocked them temporarily to resect arterial racemose angioma in inguen and thigh. We sutured and knotted vessel with 7-0 silk string to block the bleeding in capillary hemangioma and cavernous hemangioma of neck and face and truncus. Intraoperative bleeding obviously decreased and the tumor size reduced to various extent. Of the 49 cases, 47 cases achieved complete success, 2 cases bled within two days after operation. A postoperative follow-up of 6 months to 4 years showed that the appearance and function were satisfactory. The preoperative method of blocking blood vessels obviously can reduce intraoperative bleeding and decrease operative difficulty, which makes it possible to eradicate hemangioma and lower recurrence rate.

Geomechanical Assessments of Simultaneous Operation in the Case of Transition from Open Pit to Underground Mine in Vietnam

NASA Astrophysics Data System (ADS)

Niedbalski, Zbigniew; Nguyen, Phu Minh Vuong; Widzyk-Capehart, Eleonora

2018-03-01

Nowadays, for a number of reasons, many open pit mines are considering a transition from Open Pit (OP) to Underground (UG) to remain competitive. In OP-UG transition, UG operation is operated simultaneously with the OP operation for a certain period of time. Guidelines for the simultaneous operation of OP and UG are very difficult to establish, as there are very few case studies available. Yet, because of the OP-UG interactions; the operation has a higher safety, technical and management requirements than the OP or UG methods when considered separately. In Vietnam, Cao Son is one of many OP mines, which decided to change the operational system from OP to UG. Simultaneous operation started in 2015 and will be conducted until 2030 when the OP mine Cao Son ends its mining activities. In this paper, selected geomechanical considerations of the simultaneous operation are presented. A number of numerical modelling calculations using finitedifference software with code FLAC were carried out for calibration process, slope stability analysis and the OP-UG interaction analysis for the Cao Son - Khe Cham II-IV mine. Based on the results obtained from numerical modelling, the geomechanical assessments of simultaneous operation Cao Son - Khe Cham II-IV are discussed in this paper.

The Value of SysML Modeling During System Operations: A Case Study

NASA Technical Reports Server (NTRS)

Dutenhoffer, Chelsea; Tirona, Joseph

2013-01-01

System models are often touted as engineering tools that promote better understanding of systems, but these models are typically created during system design. The Ground Data System (GDS) team for the Dawn spacecraft took on a case study to see if benefits could be achieved by starting a model of a system already in operations. This paper focuses on the four steps the team undertook in modeling the Dawn GDS: defining a model structure, populating model elements, verifying that the model represented reality, and using the model to answer system-level questions and simplify day-to-day tasks. Throughout this paper the team outlines our thought processes and the system insights the model provided.

The value of SysML modeling during system operations: A case study

NASA Astrophysics Data System (ADS)

Dutenhoffer, C.; Tirona, J.

System models are often touted as engineering tools that promote better understanding of systems, but these models are typically created during system design. The Ground Data System (GDS) team for the Dawn spacecraft took on a case study to see if benefits could be achieved by starting a model of a system already in operations. This paper focuses on the four steps the team undertook in modeling the Dawn GDS: defining a model structure, populating model elements, verifying that the model represented reality, and using the model to answer system-level questions and simplify day-to-day tasks. Throughout this paper the team outlines our thought processes and the system insights the model provided.

Help a Brother Out: A Case Study in Multinational Intelligence Sharing, NATO SOF

DTIC Science & Technology

2011-12-01

increases the likelihood of operational failure and further risks the personal safety of the operators. NATO (and many of the individual member states... personalities in a region. The more 33 Lucien S. Vandenbroucke, Perilous Options: Special Operations as an...ICBMs, tank armies -- they were actually relatively easy to find , but they were very hard to kill. Intelligence was important, don’t get me wrong, but

Operational Art and the ADF Experience

DTIC Science & Technology

2017-05-25

Operations Task Group TF(U) Task Force (Uruzgan) TNI Tentara Nasional Indonesia (Indonesian) translates into the National Army of Indonesia UNAMET...be examined using four research questions. First, what was the ADFs concept of operational art at the time of the case study? Second, what were the...art from the nineteenth century to its articulation as a written theory in AirLand Battle. Naveh identifies four key points in the development of

Improving Operational Readiness through Total Quality Management

DTIC Science & Technology

1991-06-21

DTIC AD-A236 611 EL CT F NAVAL WAR COLL GE C Newport, R. I. IMPROVING OPERATIONAL READINESS THROUGH TOTAL QUALITY MANAGEMENT by Herb Westphal Defense...IMPROVING OPERATIONAL READINESS THROUGH TOTAL QUALITY MANAGEMENT (TQM) A Case Study: The Defense Mapping Agency Combat Support Center (DMACSC) initiated a...of the Defense Mapping Agency Combat Support Center’s (DMACSC) Total Quality Management (TQM) improvement methodology. This allows the reader to

Stability Operations in East Timor 1999-2000: A Case Study

DTIC Science & Technology

2016-04-11

Institute April 11, 2016 Raymond A. Millen Senior Editor The views expressed in this report are those of the authors and do not necessarily reflect...Stability Operations Institute (PKSOI) publications enjoy full academic freedom, pro- vided they do not disclose classified information, jeopardize...to this report are invited and should be forwarded to: Director, Peacekeeping and Stability Operations Institute , U.S. Army War College, 22 Ashburn

Proving Chaotic Behavior of CBC Mode of Operation

NASA Astrophysics Data System (ADS)

Abidi, Abdessalem; Wang, Qianxue; Bouallegue, Belgacem; Machhout, Mohsen; Guyeux, Christophe

2016-06-01

The cipher block chaining (CBC) mode of operation was invented by IBM (International Business Machine) in 1976. It presents a very popular way of encrypting that is used in various applications. In this paper, we have mathematically proven that, under some conditions, the CBC mode of operation can admit a chaotic behavior according to Devaney. Some cases will be properly studied in order to provide evidence for this idea.

Case studies from Oman for coiled tubing deployed completion techniques

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

Taylor, R.W.; Conrad, B.

1996-09-01

Although the use of ultra-large coiled tubing to complete wells is relatively new, it is gaining widespread industry application. This paper will detail the equipment necessary to perform an operation of this type and will present information from several case studies in Oman in which an operator has successfully deployed completion equipment on 3-1/2-inch-OD coiled tubing. In addition to a discussion of the equipment required to perform the necessary operations, the trial parameters that were established by this operator will be given. The information presented has been selected to allow an initial evaluation to be made of coiled tubing completionsmore » in general and will help to determine whether this method can prove to be less expensive than traditional rig-based completions. The topics presented have been chosen to provide the reader with a thorough understanding of the techniques and preparation needed to execute a coiled tubing completion. The summary of experiences will conclude that this innovative completion technique can be a viable method for completing wells. Although long-term advantages regarding production and well maintenance cannot yet be determined, the operator`s experiences to date have confirmed his initial belief that use of coiled tubing in ultra-large continuous-pipe applications can be cost effective.« less

Trigonometry-Integrated 'Lift' Technique (TILT) for Restoring Volar Tilt in Distal Radius Fractures: Description of Technique and Preliminary Results.

PubMed

Sechachalam, Sreedharan; Satku, Mala; Wong, Jian Hao Kevin; Tan, Lester Teong Jin; Yong, Fok Chuan

2017-03-01

Restoration of extra-articular and intra-articular parameters are important considerations during operative fixation of distal radius fractures. Restoration of volar tilt by using visual estimation and the 'lift' technique has previously been described. The aim of our study was to describe a mathematical technique for accurately restoring the volar tilt of the distal radius to acceptable anatomic values. A retrospective review of cases performed using the trigonometry-integrated ' lift' technique (TILT) was performed. This technique uses the pre-operative volar tilt angle as well as the dimensions of the implant to calculate the 'lift' required to restore volar tilt. Intra-operative angles were measured using a marked transparency overlay on fluoroscopic images. Pre-operative and post-operative volar tilt were measured and analysed. Twenty-seven fractures were included in the study, with 20 being classified as Arbeitsgemeinschaft für Osteosynthesefragen (AO) C-type. Pre-'lift' volar tilt ranged from 0° to -20°. Post-'lift' volar tilt ranged from 2° to 16°, with all but three cases ranging from 5° to 15°. The mean volar tilt achieved was 10.2°. The trigonometry-integrated 'lift' technique resulted in reliable intra-operative restoration of anatomic volar tilt in distal radius fractures.

Evaluation of the Emergency Response Dose Assessment System(ERDAS)

NASA Technical Reports Server (NTRS)

Evans, Randolph J.; Lambert, Winifred C.; Manobianco, John T.; Taylor, Gregory E.; Wheeler, Mark M.; Yersavich, Ann M.

1996-01-01

The emergency response dose assessment system (ERDAS) is a protype software and hardware system configured to produce routine mesoscale meteorological forecasts and enhanced dispersion estimates on an operational basis for the Kennedy Space Center (KSC)/Cape Canaveral Air Station (CCAS) region. ERDAS provides emergency response guidance to operations at KSC/CCAS in the case of an accidental hazardous material release or an aborted vehicle launch. This report describes the evaluation of ERDAS including: evaluation of sea breeze predictions, comparison of launch plume location and concentration predictions, case study of a toxic release, evaluation of model sensitivity to varying input parameters, evaluation of the user interface, assessment of ERDA's operational capabilities, and a comparison of ERDAS models to the ocean breeze dry gultch diffusion model.

Extracting information from the text of electronic medical records to improve case detection: a systematic review

PubMed Central

Carroll, John A; Smith, Helen E; Scott, Donia; Cassell, Jackie A

2016-01-01

Background Electronic medical records (EMRs) are revolutionizing health-related research. One key issue for study quality is the accurate identification of patients with the condition of interest. Information in EMRs can be entered as structured codes or unstructured free text. The majority of research studies have used only coded parts of EMRs for case-detection, which may bias findings, miss cases, and reduce study quality. This review examines whether incorporating information from text into case-detection algorithms can improve research quality. Methods A systematic search returned 9659 papers, 67 of which reported on the extraction of information from free text of EMRs with the stated purpose of detecting cases of a named clinical condition. Methods for extracting information from text and the technical accuracy of case-detection algorithms were reviewed. Results Studies mainly used US hospital-based EMRs, and extracted information from text for 41 conditions using keyword searches, rule-based algorithms, and machine learning methods. There was no clear difference in case-detection algorithm accuracy between rule-based and machine learning methods of extraction. Inclusion of information from text resulted in a significant improvement in algorithm sensitivity and area under the receiver operating characteristic in comparison to codes alone (median sensitivity 78% (codes + text) vs 62% (codes), P = .03; median area under the receiver operating characteristic 95% (codes + text) vs 88% (codes), P = .025). Conclusions Text in EMRs is accessible, especially with open source information extraction algorithms, and significantly improves case detection when combined with codes. More harmonization of reporting within EMR studies is needed, particularly standardized reporting of algorithm accuracy metrics like positive predictive value (precision) and sensitivity (recall). PMID:26911811

Simulations of the vortex in the Dellenback abrupt expansion, resembling a hydro turbine draft tube operating at part-load

NASA Astrophysics Data System (ADS)

Nilsson, H.

2012-11-01

This work presents an OpenFOAM case-study, based on the experimental studies of the swirling flow in the abrupt expansion by Dellenback et al.[1]. The case yields similar flow conditions as those of a helical vortex rope in a hydro turbine draft tube working at part-load. The case-study is set up similar to the ERCOFTAC Conical Diffuser and Centrifugal Pump OpenFOAM case-studies [2,3], making all the files available and the results fully reproducable using OpenSource software. The mesh generation is done using m4 scripting and the OpenFOAM built-in blockMesh mesh generator. The swirling inlet boundary condition is specified as an axi-symmetric profile. The outlet boundary condition uses the zeroGradient condition for all variables except for the pressure, which uses the fixed mean value boundary condition. The wall static pressure is probed at a number of locations during the simulations, and post-processing of the time-averaged solution is done using the OpenFOAM sample utility. Gnuplot scripts are provided for plotting the results. The computational results are compared to one of the operating conditions studied by Dellenback, and measurements for all the experimentally studied operating conditions are available in the case-study. Results from five cases are here presented, based on the kEpsilon model, the kOmegaSST model, and a filtered version of the same kOmegaSST model, named kOmegaSSTF [4,5]. Two different inlet boundary conditions are evaluated. It is shown that kEpsilon and kOmegaSST give steady solutions, while kOmegaSSTF gives a highly unsteady solution. The time-averaged solution of the kOmegaSSTF model is much more accurate than the other models. The kEpsilon and kOmegaSST models are thus unable to accurately model the effect of the large-scale unsteadiness, while kOmegaSSTF resolves those scales and models only the smaller scales. The use of two different boundary conditions shows that the boundary conditions are more important than the choice between kEpsilon and kOmegaSST, for the results just after the abrupt expansion.

Management of blunt pancreatic trauma in children: Review of the National Trauma Data Bank☆,☆☆

PubMed Central

Englum, Brian R.; Gulack, Brian C.; Rice, Henry E.; Scarborough, John E.; Adibe, Obinna O.

2016-01-01

Purpose This study aims to examine the current management strategies and outcomes after blunt pancreatic trauma in children using a national patient registry. Methods Using the National Trauma Data Bank (NTDB) from 2007–2011, we identified all patients ≤18 years old who suffered blunt pancreatic trauma. Patients were categorized as undergoing nonoperative pancreatic management (no abdominal operation, abdominal operation without pancreatic-specific procedure, or pancreatic drainage alone) or operative pancreatic management (pancreatic resection/repair). Patient characteristics, operative details, clinical outcomes, and factors associated with operative management were examined. Results Of 610,402 pediatric cases in the NTDB, 1653 children (0.3%) had blunt pancreatic injury and 674 had information on specific location of pancreatic injury. Of these 674 cases, 514 (76.3%) underwent nonoperative pancreatic management. The groups were similar in age, gender, and race; however, pancreatic injury grade > 3, moderate to severe injury severity, and bicycle accidents were associated with operative management in multivariable analysis. Children with pancreatic head injuries or GCS motor score < 6 were less likely to undergo pancreatic operation. Overall morbidity and mortality rates were 26.5% and 5.3%, respectively. Most outcomes were similar between treatment groups, including mortality (2.5% vs. 6.7% in operative vs. nonoperative cohorts respectively; p = 0.07). Conclusion Although rare, blunt pancreatic trauma in children continues to be a morbid injury. In the largest analysis of blunt pancreatic trauma in children, we provide data on which to base future prospective studies. Operative management of pancreatic trauma occurs most often in children with distal ductal injuries, suggesting that prospective studies may want to focus on this group. PMID:27577183

Safe and sustainable increases in day case emergency surgery.

PubMed

Hotchen, Andrew J; Coleman, Grant; O'Callaghan, John M; McWhinnie, Doug

2016-03-01

Selected patients referred to emergency general surgery departments are suitable for day case emergency surgery with no overnight hospital stay. There are no well-described sustainable pathways for these expedited operations and in many hospitals patients undergo unnecessary admissions and experience long waiting times. The authors proposed a new, sustainable, day case emergency surgery pathway which was implemented to streamline the assessment, treatment and discharge of acute surgical referrals. It requires rapid assessment of the patient by a senior clinician, and ready availability of diagnostic services and operating facilities. To assess this pathway, the authors conducted a prospective audit of general surgical referrals to a district general hospital in the UK. During the inclusion period 746 emergency referrals were assessed, 281 (37%) of these underwent an operation. Over a 5-month investigation period, the audit found that approximately 27% of all emergency general surgery patients requiring an operation could be managed with day case emergency surgery. This figure was maintained throughout the duration of the study. Operations included incision and drainage of abscesses, incarcerated hernia repairs and appendicectomies. The average length of stay of all surgical admissions decreased from 5 days to less than 3 days and the median time to senior review was 30 minutes. The authors have developed a pathway involving permanent members of the surgical assessment team that is sustainable over a 5-month period. The pathway has allowed rapid assessment of patients and reduced unnecessary inpatient stay in a sustainable and reproducible manner.

[Comparative study on graft of autogeneic iliac bone and tissue engineered bone].

PubMed

Shen, Bing; Xie, Fu-lin; Xie, Qing-fang

2002-11-01

To compare the clinical results of repairing bone defect of limbs with tissue engineering technique and with autogeneic iliac bone graft. From July 1999 to September 2001, 52 cases of bone fracture were randomly divided into two groups (group A and B). Open reduction and internal fixation were performed in all cases as routine operation technique. Autogeneic iliac bone was implanted in group A, while tissue engineered bone was implanted in group B. Routine postoperative treatment in orthopedic surgery was taken. The operation time, bleeding volume, wound healing and drainage volume were compared. The bone union was observed by the X-ray 1, 2, 3, and 5 months after operation. The sex, age and disease type had no obvious difference between groups A and B. all the wounds healed with first intention. The swelling degree of wound and drainage volume had no obvious difference. The operation time in group A was longer than that in group B (25 minutes on average) and bleeding volume in group A was larger than that in group B (150 ml on average). Bone union completed within 3 to 7 months in both groups. But there were 2 cases of delayed union in group A and 1 case in group B. Repair of bone defect with tissue engineered bone has as good clinical results as that with autogeneic iliac bone graft. In aspect of operation time and bleeding volume, tissue engineered bone graft is superior to autogeneic iliac bone.

Use of observational and model-derived fields and regime model output statistics in mesoscale forecasting

NASA Technical Reports Server (NTRS)

Forbes, G. S.; Pielke, R. A.

1985-01-01

Various empirical and statistical weather-forecasting studies which utilize stratification by weather regime are described. Objective classification was used to determine weather regime in some studies. In other cases the weather pattern was determined on the basis of a parameter representing the physical and dynamical processes relevant to the anticipated mesoscale phenomena, such as low level moisture convergence and convective precipitation, or the Froude number and the occurrence of cold-air damming. For mesoscale phenomena already in existence, new forecasting techniques were developed. The use of cloud models in operational forecasting is discussed. Models to calculate the spatial scales of forcings and resultant response for mesoscale systems are presented. The use of these models to represent the climatologically most prevalent systems, and to perform case-by-case simulations is reviewed. Operational implementation of mesoscale data into weather forecasts, using both actual simulation output and method-output statistics is discussed.

[The clinical features and surgical treatment strategies of cervical kyphosis].

PubMed

Fang, Jia-hu; Jia, Lian-shun; Zhou, Xu-hui; Song, Li-jun; Cai, Wei-hua; Li, Xiang

2010-10-15

To analyze the clinical characteristics and the surgical treatment strategy of cervical kyphosis. From March 2006 to October 2009, 31 cases of cervical kyphosis were treated. According to the clinical features and imaging findings, different treatment methods were used. There were 9 patients in operation group, including 4 male and 5 female patients, aged from 17 to 72 years (average age of 35 years). Among them, 5 cases were idiopathic kyphosis and 4 cases were caused by laminectomy or other reasons. There were 22 patients in conservative treatment group, including 11 male and 11 female patients, aged from 14 to 40 years (average age of 29 years), who were all idiopathic cervical kyphosis. Before and 1 week after operation, clinical assessment were taken for the patients in operation group using Spinal Cord Injuries Classification Standard of American Spinal Injury Association (AISA). During the periodic review, the anteroposterior, normal sagittal films of cervical spine were taken. At 1 week and every 6 months after operation, MRI films were also taken. These films were studied to evaluate the effects of the operations. In the conservative group, assessment of treatment results by studying anteroposterior and normal lateral views of cervical spine were were taken every month. The clinical characteristics and the surgical treatment strategies of these patients were analyzed. In operation group, 9 cases were followed up for 6 to 18 months, all patients did not failed in internal fixation and fusion. AISA neurological score and neurological function significantly improved. Three days after operation the average Cobb angle was -1.29 ° (preoperative 54.24 °). In conservative group, the average Cobb angle was -5.41 ° (before treatment 11.20 °) 4 months after the treatment. The symptoms of neck shoulder and back pain disappeared, and all patients were followed up for 3 to 24 months, with no recurrence of symptoms. In the early period of cervical kyphosis, adopt postural therapy, plaster braces to correct an imbalance in cervical spine biomechanics can prevent deformity development. According to patients' clinical characteristics, choosing individual treatment programs can correct the severe cervical kyphosis and achieve good outcome.

Ultrathin Silicon Sheet in the Management of Unilateral Post-traumatic Temporo-Mandibuar Joint Ankylosis in Children: A Good Alternative to Conventional Techniques.

PubMed

Aggarwal, Sushil Kumar; Ankur, Bhatnagar; Jain, R K

2015-09-01

We have described a new technique of using ultra-thin silicon sheet (0.2 mm) between two transected bony ends for temporo-mandibular joint (TMJ) ankylosis in children with advantages of short operative time, minimal foreign material insertion and faster recovery time post-operatively which makes our technique a good alternative to conventional techniques. Our study is a non-randomized prospective study conducted on 10 children aged between 4 and 15 years who presented to our tertiary care institute with severe trismus after traumatic injury and were willing to undergo this new technique. The main outcome measure taken into consideration was difference between pre-operative, intra-operative (on table) and post-operative mouth opening (minimum 2 years follow-up). The pre-operative mouth opening in our cases varied from 1 to 5 mm. The intra-operative mouth opening achieved ranged from 2.8 to 3.2 cm. The mouth opening was about more than 2.7 cm in all our cases at 2 years of follow-up. Our technique is a good alternative to conventional techniques used for TMJ ankylosis in children but few more randomized controlled trials are required to assess its effectiveness in comparison to conventional techniques and for universal adoption of this technique.

Operationally Comparable Effect Sizes for Quantifying Changes in Behavior, with Application to Meta-Analysis of Single-Case Studies

ERIC Educational Resources Information Center

Pustejovsky, James E.

2013-01-01

Single-case designs (SCDs) are a class of research methods for evaluating intervention effects by taking repeated measurements of an outcome over time on a single case, both before and after the deliberate introduction of a treatment. SCDs are used heavily in fields such as special education, school psychology, social work, and applied behavior…

Analytical study of effect of casing treatment on performance of a multistage compressor

NASA Technical Reports Server (NTRS)

Snyder, R. W.; Blade, R. J.

1972-01-01

The simulation was based on individual stage pressure and efficiency maps. These maps were modified to account for casing treatment effects on the individual stage characteristics. The individual stage maps effects on overall compressor performance were observed. The results show that to improve the performance of the compressor in its normal operating range, casing treatment of the rear stages is required.

Dissipative and nonunitary solutions of operator commutation relations

NASA Astrophysics Data System (ADS)

Makarov, K. A.; Tsekanovskii, E.

2016-01-01

We study the (generalized) semi-Weyl commutation relations UgAU* g = g(A) on Dom(A), where A is a densely defined operator and G ∋ g ↦ Ug is a unitary representation of the subgroup G of the affine group G, the group of affine orientation-preserving transformations of the real axis. If A is a symmetric operator, then the group G induces an action/flow on the operator unit ball of contracting transformations from Ker(A* - iI) to Ker(A* + iI). We establish several fixed-point theorems for this flow. In the case of one-parameter continuous subgroups of linear transformations, self-adjoint (maximal dissipative) operators associated with the fixed points of the flow yield solutions of the (restricted) generalized Weyl commutation relations. We show that in the dissipative setting, the restricted Weyl relations admit a variety of representations that are not unitarily equivalent. For deficiency indices (1, 1), the basic results can be strengthened and set in a separate case.

CASE STUDY. MERCURY POLLUTION NEAR A CHEMICAL PLANT IN NORTHERN KAZAKHSTAN

EPA Science Inventory

In northern Kazakhstan, there is a serious case of mercury pollution near Pavlodar City from an old mercury cell chlor-alkali plant. The soil, sediment, and water are contaminated with more than a thousand tons of mercury and mercury compounds as a result of the operation of the ...

Addressing Problems Encountered in Case-Based Teaching

ERIC Educational Resources Information Center

Turgeon, A. J.

2007-01-01

TURF 436 (Case Studies in Turfgrass Management) is the capstone course for turfgrass science majors at the Pennsylvania State University. Students are introduced to problems and complex problematic situations encountered in the management of golf and sports turf and in professional lawn-care operations. Following completion of the orientation case…

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.

Analyzing workplace exposures using direct reading instruments and video exposure monitoring techniques

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

Gressel, M.G.; Heitbrink, W.A.; Jensen, P.A.

1992-08-01

The techniques for conducting video exposure monitoring were described along with the equipment required to monitor and record worker breathing zone concentrations, the analysis of the real time exposure data using video recordings, and the use of real time concentration data from a direct reading instrument to determine the effective ventilation rate and the mixing factor of a given room at a specific time. Case studies which made use of video exposure monitoring techniques to provide information not available through integrated sampling were also discussed. The process being monitored and the methodology used to monitor the exposures were described formore » each of the case studies. The case studies included manual material weigh out, ceramic casting cleaning, dumping bags of powdered materials, furniture stripping, administration of nitrous-oxide during dental procedures, hand held sanding operation, methanol exposures in maintenance garages, brake servicing, bulk loading of railroad cars and trucks, and grinding operations.« less

Determining system boundaries on commercial broiler chicken production system using ISO 14040/14044 guideline: A case Study

NASA Astrophysics Data System (ADS)

Sidek, ‘A. A.; Suffian, S. A.; Al-Hazza, M. H. F.; Yusof, H. M.

2018-01-01

The demand of poultry product in Malaysia market shows an escalation throughout the year and expected to increase in the future. The expansion of poultry production has led to environmental concern in relation to their operational impact to environmentAt present, assessment of waste management of poultry production in Malaysia is lacking. A case study research was conducted in a commercial broiler farm to identify and assess the system boundaries in the lifecycle supply chain of broiler chicken production using ISO 14040/44 guidelines. ISO 14040/44 standard includes Life Cycle Assessment (LCA) framework guidelines to evaluate environmental influence associated with a product/process throughout its life span. All attributes associated with broiler operation is defined and the system boundaries is determined to identify possible inputs and outputs in the case study. This paper discuss the initial stage in the LCA process, which set the context of the research and prepare for the stage of Life Cycle Inventory.

[Pyogenic abscess of the breast: clinical and therapeutic aspects].

PubMed

Beyrouti, M I; Boujelben, S; Beyrouti, R; Ben Amar, M; Abid, M; Louati, D; Zidi, Z; Ben Salah, K; Abid, O; Ghorbel, A

2007-01-01

The goal of this retrospective work was to study the clinical aspects and the principles of management of the abscess of the breast in order to determine a convenient and recent therapeutic attitude. Our retrospective survey concerns 114 cases of breast abscess collected in a surgery department over a period of 14 years, from 1990 to 2003. All patients have been operated and the diagnosis confirmed through the operation. The puerperal abscesses have been noted in 31 cases. One hundred and four women and ten men were concerned, with a sex-ratio of 0.1. The medium age was 33 years old for the women and 42 years for the men. The diagnosis was based on the clinical criteria, confirmed by the ultrasonography in 11 cases out of 16 and by the mammary puncture in 15 cases out of 22. Two non-puerperal abscesses have revealed an infiltrating canal carcinoma. The Staphylococcus aureus was the germ the most frequently met, concerning 8 cases out of 16. The surgical biopsies carried out in 52 cases revealed a fibrocystic mastopathy in six cases, a canalar ectasia in two cases and an infiltrating canalar carcinoma in two cases. The surgical treatment, performed in any case, was associated to an anti-staphylococcus antibiotherapy. The recurrence of the abscess has been observed in four cases. The frequency of pyogenic abscess of the breast, particularly the puerperal abscesses, has considerably decreased. The non-puerperal abscesses often pose a differential diagnosis problem with the very aggressive inflammatory cancers. The percutaneous ultrasonography guided drainage must be proposed in first intention to treat the abscesses of the breast. However, surgical treatment is still valid with an abscess either relapsing or chronic, or else the failure of the non-operative processes.

[Analysis on influencing factor of the complications of percutaneous dilational tracheotomy].

PubMed

Zhai, Xiang; Zhang, Jinling; Hang, Wei; Wang, Ming; Shi, Zhan; Mi, Yue; Hu, Yunlei; Liu, Gang

2015-01-01

To Analyze the influence factors on the complications of percutaneous dilational tracheotomy. Between August 2008 and February 2014, there were 3 450 patients with the indications of tracheotomy accepted percutaneous dilational tracheostomy, mainly using percutaneous dilational and percutaneous guide wire forceps in these cases. Statistical analysis was performed by SPSS 19.0 software on postoperative complications, the possible influence factors including age, gender, etiology, preoperative hypoxia, obesity, preoperative pulmonary infection, state of consciousness, operation method, operation doctor and whether with tracheal intubation. Among 3 450 patients, there were 164 cases with intraoperative or postoperative complications, including postoperative bleeding in 74 cases (2.14%), subcutaneous emphysema in 54 cases (1.57%), wound infection in 16 cases (0.46%), pneumothorax in 6 cases (0.17%), mediastinal emphysema in 5 cases (0.14%), operation failed and change to conventional incision in 4 cases (0.12%), tracheoesophageal fistula in 2 cases (0.06%), death in 3 cases(0.09%).Obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method were the main influence factors, with significant statistical difference (χ(2) value was 0.010, 0.000, 0.002, 0.000, 0.000, 0.000, all P < 0.05). Gender, age, operation doctor and whether there was the endotracheal intubation were not the main influence factors. There was no significant statistical difference (P > 0.05). Although percutaneous dilational tracheostomy is safe, but the complications can also happen. In order to reduce the complications, it is need to pay attention to the factors of obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method.

Case-mix analysis and variation in rates of non-surgical treatment of older women with operable breast cancer.

PubMed

Morgan, J; Richards, P; Ward, S; Francis, M; Lawrence, G; Collins, K; Reed, M; Wyld, L

2015-08-01

Non-surgical management of older women with oestrogen receptor (ER)-positive operable breast cancer is common in the UK, with up to 40 per cent of women aged over 70 years receiving primary endocrine therapy. Although this may be appropriate for frailer patients, for some it may result in treatment failure, contributing to the poor outcomes seen in this age group. Wide variation in the rates of non-operative management of breast cancer in older women exists across the UK. Case mix may explain some of this variation in practice. Data from two UK regional cancer registries were analysed to determine whether variation in treatment observed between 2002 and 2010 at hospital and clinician level persisted after adjustment for case mix. Expected case mix-adjusted surgery rates were derived by logistic regression using the variables age, proxy Charlson co-morbidity score, deprivation quintile, method of cancer detection, tumour size, stage, grade and node status. Data on 17,129 women aged 70 years or more with ER-positive operable breast cancer were analysed. There was considerable variation in rates of surgery at both hospital and clinician level. Despite adjusting for case mix, this variation persisted at hospital level, although not at clinician level. This study demonstrates variation in selection criteria for older women for operative treatment of early breast cancer, indicating that some older women may be undertreated or overtreated, and may partly explain the inferior disease outcomes in this age group. It emphasizes the urgent need for evidence-based guidelines for treatment selection criteria in older women with breast cancer. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

The impact of fellowships on surgical resident training in a multispecialty cohort in Australia and New Zealand.

PubMed

Petrushnko, Wilson; Perry, Will; Fraser-Kirk, Grant; Ctercteko, Grahame; Adusumilli, Sanjay; O'Grady, Gregory

2015-12-01

Fellowships in surgery are increasing in number, and concerns have been raised regarding their impact on resident training. Although fellows may contribute to resident education and training, they also compete for operative and other experience. This study aimed to quantify the impact of fellowships on resident training in a binational multispecialty cohort. The operative case volumes and primary operator rates of surgery trainees (residents) in Australia and New Zealand were compared between units with and without fellows. Trainees also were surveyed using Likert Scales to assess quality of operative and other experience in units with and without fellows. Data from 911 trainees over 2 terms was analyzed; survey response rate 42%. Of all trainees, 42% worked with fellows. Trainees in units without fellows were involved in more major (P = .03) and minor (P < .0001) cases. Primary operator rates were comparable, but trainees in units without fellows were less often assistants, reported an increased quality of elective operating experience, and reported more favorable completion of learning objectives (all P < .05). These findings were consistent between tertiary and nontertiary hospitals. Thematic analysis showed positive benefits of fellows in teaching, training and mentorship, but negative impacts on case exposure, competition for operating, and clinical experience. Fellows may assist in the teaching and training of residents, but residents working with fellows experience a decreased quantity of operative experience that may impact several aspects of the quality of training. Surgical educators must actively balance the learning needs of fellows and residents. Copyright © 2015 Elsevier Inc. All rights reserved.

[Study on SHI's Bian stone comprehensive therapy for rehabilitation after induced abortion].

PubMed

Ran, Qing-zhen; Shi, An-li

2009-02-01

To explore the rehabilitation effect of SHI's Bian stone comprehensive therapy on the patient after induced abortion. Thirty cases of induced abortion were treated with SHI's Bian stone comprehensive therapy in peri-operative period. Before the operation, scraping therapy was given at the parts of The Urinary Bladder Channel and The Governor Vessel on the back and 30 min after the operation, the patient took a rest in a horizontal position on a mild heat Bian stone blanket and hot compress with a Bian stone plate was given at the lower abdomen. They received thrice return visits respectively on 1, 2, 3 weeks after the operation and SHI's Bian stone comprehensive therapy, including warm massage on The Governor Vessel, scraping the channel, patting Baliao (BL 31, BL 32, BL 33, BL 34), penetration needling Sanyinjiao (SP 6), oblique needling Qihai (CV 6), Guanyuan (CV 4), Zhongji (CV 3), Zigong (EX-CA 1), and the Bian stone plate was placed on the needle hand for warm compress. Colporrhagia, menstrual return, soreness of waist and other symptoms after the operation were observed. After SHI's Bian stone comprehensive therapy, in the patient of induced abortion the colporrhagia volume was less within 3 days after the operation and the colporrhagia stopped more early; of the 30 cases, only 2 has soreness of waist, abdominal pain, fearing cool and other symptoms, and only one case had obviously delayed mestrual cycle. SHI's Bian stone comprehensive therapy used in peri-operative period of induced abortion has a good promoting action on post operative rehabilitation.

Facial Nerve Paralysis after Onyx Embolization of a Jugular Paraganglioma: A Case Report with a Long-Term Follow Up

PubMed Central

Odat, Haitham; Alawneh, Khaled; Al-Qudah, Mohannad

2018-01-01

Jugular paragangliomas are slow growing highly vascular tumors arising from jugular paraganglia. The gold standard of treatment is complete surgical resection. Pre-operative embolization of these highly vascular tumors is essential to reduce intra-operative bleeding, allow safe dissection, and decrease operative time and post-operative complications. Onyx (ethylene-vinyl alcohol copolymer) has been widely used as permanent occluding material for vascular tumors of skull base because of its unique physical properties. We present the case of a 33-year-old woman who had left-sided facial nerve paralysis after Onyx embolization of jugular paraganglioma. The tumor was resected on the next day of embolization. The patient was followed up for 30 months with serial imaging studies and facial nerve assessment. The facial verve function improved from House–Brackmann grade V to grade II at the last visit. PMID:29518926

Facial Nerve Paralysis after Onyx Embolization of a Jugular Paraganglioma: A Case Report with a Long-Term Follow Up.

PubMed

Odat, Haitham; Alawneh, Khaled; Al-Qudah, Mohannad

2018-03-07

Jugular paragangliomas are slow growing highly vascular tumors arising from jugular paraganglia. The gold standard of treatment is complete surgical resection. Pre-operative embolization of these highly vascular tumors is essential to reduce intra-operative bleeding, allow safe dissection, and decrease operative time and post-operative complications. Onyx (ethylene-vinyl alcohol copolymer) has been widely used as permanent occluding material for vascular tumors of skull base because of its unique physical properties. We present the case of a 33-year-old woman who had left-sided facial nerve paralysis after Onyx embolization of jugular paraganglioma. The tumor was resected on the next day of embolization. The patient was followed up for 30 months with serial imaging studies and facial nerve assessment. The facial verve function improved from House-Brackmann grade V to grade II at the last visit.

Retroperitoneal laparoscopic pyelolithotomy in renal pelvic stone versus open surgery - a comparative study

PubMed Central

DHAR, SIDDHARTH

2018-01-01

Background The introduction of endourological procedures such as percutaneous nephrolithotomy and ureterorenoscopy have led to a revolution in the the management of urinary stone disease. The indications for open stone surgery have been narrowed significantly, making it a second- or third-line treatment option. Aims and Objectives To study the safety and efficacy of retroperitoneal laparoscopic pyelolithotomy in retroperitoneal renal stone. We compared the results of laparoscopic and open surgery in terms of easy accessibility, operative period, renal injuries, and early recovery. Methods This prospective study was conducted on renal pelvic stone cases from January 2009 to February 2016 in Suchkhand Hospital, Agra, India. The study included a total of 1700 cases with the diagnosis of solitary renal pelvic stones. In group A - 850 cases - retroperitoneal laparoscopic pyelolithotomy was performed, while group B - 850 cases – underwent open pyelolithotomy. Results The mean operative time was less in group B than group A (74.83 min vs. 94.43 min) which was significant (p<0.001). The blood loss was less in the laparoscopic group than in the open group (63 mL vs. 103mL). There were statistically significant differences in the post-operative pain scores, and postoperative complications compared to group B (p<0.001). The mean hospital stay was less in group A (p<0.03), which was significant. Conclusion Laparoscopic surgery reduces analgesic requirements, hospital stay, and blood loss. The disadvantages include the reduced working space, the cost of equipment and the availability of a trained surgeon. PMID:29440956

Cooperative laparoscopic endoscopic and hybrid laparoscopic surgery for upper gastrointestinal tumors: Current status

PubMed Central

Ntourakis, Dimitrios; Mavrogenis, Georgios

2015-01-01

AIM: To investigate the cooperative laparoscopic and endoscopic techniques used for the resection of upper gastrointestinal tumors. METHODS: A systematic research of the literature was performed in PubMed for English and French language articles about laparoscopic and endoscopic cooperative, combined, hybrid and rendezvous techniques. Only original studies using these techniques for the resection of early gastric cancer, benign tumors and gastrointestinal stromal tumors of the stomach and the duodenum were included. By excluding case series of less than 10 patients, 25 studies were identified. The study design, number of cases, tumor pathology size and location, the operative technique name, the endoscopy team and surgical team role, operative time, type of closure of visceral wall defect, blood loss, complications and length of hospital stay of these studies were evaluated. Additionally all cooperative techniques found were classified and are presented in a systematic approach. RESULTS: The studies identified were case series and retrospective cohort studies. A total of 706 patients were operated on with a cooperative technique. The tumors resected were only gastrointestinal stromal tumors (GIST) in 4 studies, GIST and various benign submucosal tumors in 22 studies, early gastric cancer (pT1a and pT1b) in 6 studies and early duodenal cancer in 1 study. There was important heterogeneity between the studies. The operative techniques identified were: laparoscopic assisted endoscopic resection, endoscopic assisted wedge resection, endoscopic assisted transgastric and intragastric surgery, laparoscopic endoscopic cooperative surgery (LECS), laparoscopic assisted endoscopic full thickness resection (LAEFR), clean non exposure technique and non-exposed endoscopic wall-inversion surgery (NEWS). Each technique is illustrated with the roles of the endoscopic and laparoscopic teams; the indications, characteristics and short term results are described. CONCLUSION: Along with the traditional cooperative techniques, new procedures like LECS, LAEFR and NEWS hold great promise for the future of minimally invasive oncologic procedures. PMID:26604655

[Median nerve constrictive operation combined with tendon transfer to treat brain paralysis convulsive deformity of hand].

PubMed

Ma, Shanjun; Zhou, Tianjian

2014-05-01

To evaluate the effectiveness of the median nerve constrictive operation combined with tendon transfer to treat the brain paralysis convulsive deformity of the hand. The clinical data from 21 cases with brain paralysis convulsive deformity of the hand were analyzed retrospectively between August 2009 and April 2012. Of them, there were 13 males and 8 females with an average age of 15 years (range, 10-29 years). The causes of the convulsive cerebral palsy included preterm deliveries in 11 cases, hypoxia asphyxia in 7, traumatic brain injury in 2, and encephalitis sequela in 1. The disease duration was 2-26 years (mean, 10.6 years). All the 21 patients had cock waists, crooking fingers, and contracture of adductors pollicis, 12 had the forearm pronation deformity. According to Ashworth criteria, there were 2 cases at level I, 5 cases at level II, 8 cases at level III, 4 cases at level IV, and 2 cases at level V. All patients had no intelligence disturbances. The forearm X-ray film showed no bone architectural changes before operation. The contraction of muscle and innervation was analyzed before operation. The median nerve constrictive operation combined with tendon transfer was performed. The functional activities and deformity improvement were evaluated during follow-up. After operation, all the patients' incision healed by first intension, without muscle atrophy and ischemic spasm. All the 21 cases were followed up 1.5-4.5 years (mean, 2.3 years). No superficial sensory loss occurred. The effectiveness was excellent in 13 cases, good in 6 cases, and poor in 2 cases, with an excellent and good rate of 90.4% at last follow-up. The median nerve constrictive operation combined with tendon transfer to treat brain paralysis convulsive deformity of the hand can remove and prevent the recurrence of spasm, achieve the orthopedic goals, to assure the restoration of motor function and the improvement of the life quality.

Childhood intussusception: A prospective study of management trend in a developing country.

PubMed

Ogundoyin, Olakayode Olaolu; Olulana, Dare Isaac; Lawal, Taiwo Akeem

2015-01-01

The management of intussusception has evolved universally from the use of hydrostatic reduction through operative reduction to the use of pneumatic reduction for the acute and uncomplicated cases and surgical reduction for the complicated cases. However, the process of evolution has been very slow in the developing countries, especially sub-Saharan Africa, due to lack of requisite facilities and expertise to manage these patients nonoperatively. This study examined the trends in the management of childhood intussusception in a developing country, compared operative and nonoperative modalities of treatment, and assessed the impact of delayed presentation on the outcome of management. This was a prospective study of the management of children with intussusception at the University College Hospital, Ibadan, Nigeria. Fifty-five consecutive cases of intussusception that presented to the Children Emergency Unit of the University College Hospital between January 2005 and December 2011 were prospectively studied. Details of sex, age of the patients, clinical presentation, duration of symptoms, mode of treatment, and incidence of recurrence were recorded and analyzed. The median age was 7 months. Moreover, the duration of symptoms varied from 1 to 21 days with a mean of 4 days. Twenty-two patients (40%) had attempted hydrostatic reduction; this was successful in 14 patients (63.6%), whereas 8 patients (36.4%) had failed reduction. In all, 41 patients (74.6%) had operative management of intussusceptions; primary operative intervention was carried out in 33 patients (60%) and secondary surgical management in 8 patients (14.5%) with failed hydrostatic reduction. At surgery, manual reduction of intussusception was carried out on 17 patients (30.9%) and resection of devitalized bowel with end to end anastomosis was carried out on the remaining 24 patients (43.6%). The incidence of surgical intervention for intussusception was 74.6%, mortality was 3.6%, and recurrence rate was 3.6%. Nonoperative management of intussusception should be adopted in carefully selected cases of intussusception in this subregion as it will help to reduce the financial burden on the parents while surgical management should be reserved for the complicated cases.

[Electromagnetic navigation interlocking intramedullary nail technology for treatment of femoral shaft fractures].

PubMed

Zuo, Kangkang; Qin, Wei; Guo, Qing; Palati-Ababaikeli; Qiao, Peiliu; Shen, Mingquan; Yin, Lele; Pan, Qilin; Xu, Xiaoxiong

2014-10-01

To explore the value of electromagnetic navigation interlocking intramedullary nail in the treatment of femoral shaft fracture. Between July 2012 and October 2013, 53 cases of femoral shaft fracture were treated. There were 40 males and 13 females, aged 16-52 years (mean, 38.3 years). The causes of injury were traffic accident in 28 cases, falling from height in 11 cases, falling in 7 cases, crush injury in 4 cases, and other in 3 cases. Of 53 cases, there were 3 cases of open fracture (Gustilo I degree) and 50 cases of closed fracture. Fracture was located in the proximal femur in 17 cases, middle femur in 29 cases, and distal femur in 7 cases. According to Winquist classification, 7 cases were rated as type I, 8 cases as type II, 22 cases as type III, and 16 cases as type IV; according to AO classification, 18 cases were rated as type 32-A, 28 cases as type 32-B, and 7 cases as type 32-C. The time from injury to operation was 3-11 days (mean, 5 days). Distal interlocking intramedullary nail was implanted using electromagnetic navigation. The distal locking nail operation with interlocking intramedullary nail was successfully completed under electromagnetic navigation; the one-time success rate of distal locking nail operation reached 100%; and the locking nail time was 5.0-9.5 minutes (mean, 7.0 minutes). Healing of incision by first intention was obtained after operation, and no complication of skin necrosis, infection, and sinus tract occurred. Fifty-three cases were all followed up 5-12 months (mean, 9 months). One case had hip pain and weaken middle gluteal muscle strength, and the symptoms disappeared after removing the nail. During the follow-up period, no broken nails, nail exit, infection, or re-fracture occurred. All fractures achieved clinical healing, and the healing time was 8-22 weeks (mean, 14.5 weeks). In 49 patients followed up 8 months, the Lysholm score was excellent in 44 cases, good in 4 cases, and acceptable in 1 case, with an excellent and good rate of 98%. Electromagnetic navigation system is safe and reliable, with the advantages of high positioning accuracy, short operation time, and no radiation, the clinical application of the system for distal locking nail operation can obtain excellent short-term effectiveness.

[Correction of early cognitive disorders in school-age children operated under total intravenous anaesthesia].

PubMed

Ovezov, A M; Lobov, M A; Panteleeva, M V; Lugovoĭ, A V; Miatchin, P S; Gus'kov, I E

2012-01-01

The aim of the study was to assess the possibility and effectiveness of hopaten acid use for early postoperative cognitive dysfunction correction in children of school age. In compliance with inclusion and exclusion criteria, totally 40 children of school age (7-16 years old, ASA status I-II) with surgical pathology: (varicocele, cryptorchidism, inguinal hernia) were included A comperative assessment of neuropsychic status during pre - and postoperative are period in children, operated under propofol-fentanyl total intravenous anesthesia (TIVA) was conducted All patients were randomized to the control (without cepebroprotection 1st group, 20 children) and experimental (using cepebroprotection with hopaten acid within 1 month after the operation, 2nd group, 20 children) groups. Dimension of the study: Harvard standard monitoring, respiratory gas composition, neuropsychic tests (Bourdon test, "10 words test", etc.). For full compatibility groups (age, ASA status and anthropometric data, equal operation duration and the equipotential drug dosage adjustment is revealed, that in group of propofol-fentanyl TIVA in the early postoperative period in school age children postoperative cognitive dysfunction (POCD) is developing, which in case of absence of the corresponding correction is maintained after 1 month after operation (at least) in 80% of cases. In the application of hopaten acid cerebroprotection (40 mg/kg per day) severity of POCD reliably is reduced or compensated by the time of discharge from the hospital (3-7-th day when non-traumatic interventions), and 1 month after the operation in 30% of patients experienced improvement of cognitive functions, which proves the effectiveness of hopaten acid for POCD treatment. In case of propofol-fentanyl TIVA anesthesia in children of school age is indicated preventive prescription of multimodal cerebroprotectors without age limitations (for example hopaten acid (40 mg/kg per day) for POCD treatment.

The Value of Ultrasound and Magnetic Resonance Imaging in Diagnostics and Prediction of Morbidity in Cases of Placenta Previa with Abnormal Placentation

PubMed Central

Algebally, Ahmed M.; Yousef, Reda Ramadan Hussein; Badr, Sanaa Sayed Hussein; Al Obeidly, Amal; Szmigielski, Wojciech; Al Ibrahim, Abdullah A.

2014-01-01

Summary Background The purpose of the study was to evaluate the role of ultrasound (US) and magnetic resonance imaging (MRI) in the diagnostics and management of abnormal placentation in women with placenta previa and to compare the morbidity associated with that to placenta previa alone. Material/Methods The study includes 100 pregnant women with placenta previa with and without abnormal placentation. The results of MRI and US in abnormal placentation were compared with post-operative data. The patients’ files were reviewed for assessment of operative and post-operative morbidity. The results of our statistical analysis were compared with data from the literature. Results US and MRI showed no significant difference in sensitivity and specificity in diagnosing abnormal placentation (97–100% and 94–100%, respectively). MRI was more sensitive than US for the detection of myometrial invasion and the type of abnormal placentation (73.5% and 47%, respectively). The difference between pre- and post-operative hemoglobin values and estimated blood loss were the most significant risk factors for abnormal placentation, added to risk factors known for placenta previa. Post-partum surgical complications and prolonged hospital stay were more common in the cases of placenta previa with abnormal placentation, however statistically insignificant. Conclusions US and MRI are accurate imaging modalities for diagnosing abnormal placentation. MRI was more sensitive for the detection of the degree of placental invasion. The patient’s morbidity increased in cases with abnormal placentation. There was no significant difference in post operative-complications and hospitalization time due to pre-operative planning when the diagnosis was established with US and MRI. PMID:25411586

30 CFR 250.421 - What are the casing and cementing requirements by type of casing string?

Code of Federal Regulations, 2010 CFR

2010-07-01

... hazards, and water depthsSet casing immediately before drilling into formations known to contain oil or..., DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Oil and Gas Drilling Operations Casing and Cementing Requirements § 250.421 What are the casing and cementing...

Boston University: Sustainability Revolving Loan Fund. Green Revolving Funds in Action: Case Study Series

ERIC Educational Resources Information Center

Flynn, Emily

2011-01-01

Boston University's (BU) Sustainability Revolving Loan Fund was created in 2008 through an allocation of $1 million from the university's administrative budget. The fund is administered by the Vice President of Operations. Potential projects are identified by the university's Director of Energy Administration and Operations along with the…

Practice Brief: Accommodating Deaf and Hard of Hearing Students in Operating Room Environments--A Case Study

ERIC Educational Resources Information Center

Meeks, Lisa M.; Laird-Metke, Elisa; Rollins, Mark; Gandhi, Seema; Stechert, Martin; Jain, Neera R.

2015-01-01

Increasing numbers of deaf students in the health professions require accommodations in the clinical setting to ensure effective learning and accurate communication. Although classroom learning barriers have long been identified and addressed, barriers to clinical education have been far less analyzed. Operating room clerkships, which include many…

Residential Placements for Students with Disabilities: Practice Trends and the Case of Virginia.

ERIC Educational Resources Information Center

Katsiyannis, Antonis

A study of 14 residential facilities operating schools for children with disabilities in Virginia gathered information on the following topics: (1) nature of operation, profit versus nonprofit, fund-raising activities, plans for future expansion, and affiliations with national chains; (2) student profiles including disabilities served, number of…

Promoting Inter-Professional Teamwork and Learning--The Case of a Surgical Operating Theatre

ERIC Educational Resources Information Center

Collin, Kaija; Paloniemi, Susanna; Mecklin, Jukka-Pekka

2010-01-01

Hospitals, and surgical operating theatres (OTs) in particular, are environments in which inter-professional teamwork and learning are essential to secure patient safety and effective practice. However, it has been revealed in many studies that inter-professional collaborative work in hospital organisations faces many challenges and constraints.…

In Hot Water: A Cooling Tower Case Study

ERIC Educational Resources Information Center

Cochran, Justin; Raju, P. K.; Sankar, Chetan

2005-01-01

Problem Statement: Vogtle Electric Generating Plant operated by Southern Nuclear Operating Company, a subsidiary of Southern Company, has found itself at a decision point. Vogtle depends on their natural draft cooling towers to remove heat from the power cycle. Depending on the efficiency of the towers, the cycle can realize more or less power…

The role of predictive uncertainty in the operational management of reservoirs

NASA Astrophysics Data System (ADS)

Todini, E.

2014-09-01

The present work deals with the operational management of multi-purpose reservoirs, whose optimisation-based rules are derived, in the planning phase, via deterministic (linear and nonlinear programming, dynamic programming, etc.) or via stochastic (generally stochastic dynamic programming) approaches. In operation, the resulting deterministic or stochastic optimised operating rules are then triggered based on inflow predictions. In order to fully benefit from predictions, one must avoid using them as direct inputs to the reservoirs, but rather assess the "predictive knowledge" in terms of a predictive probability density to be operationally used in the decision making process for the estimation of expected benefits and/or expected losses. Using a theoretical and extremely simplified case, it will be shown why directly using model forecasts instead of the full predictive density leads to less robust reservoir management decisions. Moreover, the effectiveness and the tangible benefits for using the entire predictive probability density instead of the model predicted values will be demonstrated on the basis of the Lake Como management system, operational since 1997, as well as on the basis of a case study on the lake of Aswan.

Dynamic Order Algebras as an Axiomatization of Modal and Tense Logics

NASA Astrophysics Data System (ADS)

Chajda, Ivan; Paseka, Jan

2015-12-01

The aim of the paper is to introduce and describe tense operators in every propositional logic which is axiomatized by means of an algebra whose underlying structure is a bounded poset or even a lattice. We introduce the operators G, H, P and F without regard what propositional connectives the logic includes. For this we use the axiomatization of universal quantifiers as a starting point and we modify these axioms for our reasons. At first, we show that the operators can be recognized as modal operators and we study the pairs ( P, G) as the so-called dynamic order pairs. Further, we get constructions of these operators in the corresponding algebra provided a time frame is given. Moreover, we solve the problem of finding a time frame in the case when the tense operators are given. In particular, any tense algebra is representable in its Dedekind-MacNeille completion. Our approach is fully general, we do not relay on the logic under consideration and hence it is applicable in all the up to now known cases.

Laser arytenoidectomy in children with bilateral vocal fold immobility.

PubMed

Worley, G; Bajaj, Y; Cavalli, L; Hartley, B

2007-01-01

Bilateral vocal fold immobility in children is a challenging problem because a balance between good airway and voice quality has to be achieved. Surgery to improve the airway is often postponed or avoided because of fear of losing the voice. In this study our results of laser arytenoidectomy in children are described. This was a retrospective case notes review at a tertiary level paediatric ENT department. The six patients in this case series ranged from nine to 16 years old at the time of laser arytenoidectomy. Post-operative airway and voice quality were assessed. All children in the series had an adequate post-operative airway. Four of these patients had tracheostomies pre-operatively and achieved decannulation. All six patients rated their post-operative voice as better than pre-operatively. This is principally due to increased loudness associated with increased airflow through the larynx, particularly after tracheostomy decannulation. It is recommended that special care should be taken not to disturb the anterior two thirds of the vocal fold during the surgery in order to achieve a good post-operative voice outcome.

Introduction on the operational storm surge forecasting system in Korea Operational Oceanographic System (KOOS)

NASA Astrophysics Data System (ADS)

Kwon, Jae-Il; Park, Kwang-Soon; Choi, Jung-Woon; Lee, Jong-Chan; Heo, Ki-Young; Kim, Sang-Ik

2017-04-01

During last more than 50 years, 258 typhoons passed and affected the Korean peninsula in terms of high winds, storm surges and extreme waves. In this study we explored the performance of the operational storm surge forecasting system in the Korea Operational Oceanographic System (KOOS) with 8 typhoons from 2010 to 2016. The operation storm surge forecasting system for the typhoon in KOOS is based on 2D depth averaged model with tides and CE (U.S. Army Corps of Engineers) wind model. Two key parameters of CE wind model, the locations of typhoon center and its central atmospheric pressure are based from Korea Meteorological administrative (KMA)'s typhoon information provided from 1 day to 3 hour intervals with the approach of typhoon through the KMA's web-site. For 8 typhoons cases, the overall errors, other performances and analysis such as peak time and surge duration are presented in each case. The most important factor in the storm surge errors in the operational forecasting system is the accuracy of typhoon passage prediction.

Operative experience in an orthopaedic surgery residency program: the effect of work-hour restrictions.

PubMed

Baskies, Michael A; Ruchelsman, David E; Capeci, Craig M; Zuckerman, Joseph D; Egol, Kenneth A

2008-04-01

The implementation of Section 405 of the New York State Public Health Code and the adoption of similar policies by the Accreditation Council for Graduate Medical Education in 2002 restricted resident work hours to eighty hours per week. The effect of these policies on operative volume in an orthopaedic surgery residency training program is a topic of concern. The purpose of this study was to evaluate the effect of the work-hour restrictions on the operative experiences of residents in a large university-based orthopaedic surgery residency training program in an urban setting. We analyzed the operative logs of 109 consecutive orthopaedic surgery residents (postgraduate years 2 through 5) from 2000 through 2006, representing a consecutive interval of years before and after the adoption of the work-hour restrictions. Following the implementation of the new work-hour policies, there was no significant difference in the operative volume for postgraduate year-2, 3, or 4 residents. However, the average operative volume for a postgraduate year-5 resident increased from 274.8 to 348.4 cases (p = 0.001). In addition, on analysis of all residents as two cohorts (before 2002 and after 2002), the operative volume for residents increased by an average of 46.6 cases per year (p = 0.02). On the basis of the findings of this study, concerns over the potential adverse effects of the resident work-hour polices on operative volume for orthopaedic surgery residents appear to be unfounded.

[Our experience in portal cavernomatosis in childhood: cross-sectional study and analysis of results].

PubMed

López Saiz, A; Vila Carbó, J J; Fernández, M S; Muro, D; Ibáñez, V; Gutiérrez, C; Roca, A; García-Sala, C

1997-07-01

A retrospective and transversal study of our patients with portal cavernomatosis is developed, with the aim of comparing the evolution and the present status of the patients that have undergone different therapeutical approaches. Between 1975 and 1995, 15 patients with portal cavernomatosis have been treated. Personal history, signs and symptoms at the moment of diagnosis, and treatment were analyzed. Now, the controls have been made by physical examination and ECO-Doppler of the espleno-portal system. In 6 cases the absence of bleeding made surgery unnecessary. In the 9 patients with digestive haemorrhage, it could be controlled pharmacologically, with a later surgical approach. Now, all non-operated and 6 operated patients show splenomegaly, without bleeding. The ECO-Doppler shows colateral flow, the splenomegaly in the non-operated and the surgical shunts and the hepatofugal circulation in the operated patients. Looking at our results, we believe that prophylactic surgery is not indicated. In those cases of digestive bleeding, surgery after the complete resolution of the acute disease shows good results at a short and long term.

Temporo mandibular joint ankylosis.

PubMed

Vasconcelos, Belmiro Cavalcanti do Egito; Porto, Gabriela Granja; Bessa-Nogueira, Ricardo Viana

2008-01-01

Ankylosis may be defined as joint surfaces fusion. The treatment of temporomandibular joint ankylosis poses a significant challenge because of the high recurrence rate. The aim of this study is to report six cases treated by joint reconstruction, evaluate the results of these surgeries and review the literature. The sample in this retrospective study was obtained from the records of the university hospital, patients who had to undergo ankylosis treatment by alloplastic or autogenous graft between March 2001 and October 2005. Pre - and post-operative assessment included a throughout history and physical examination to determine the cause of ankylosis, the Maximum mouth opening (MMO), etiology and type of ankylosis, recurrence rate and presence of facial nerve paralysis. The mean MMO in the pre-operative period was 9.6 mm (0 mm to 17 mm) and in the post-operative period it was of 31.33 mm (14 mm to 41 mm), there was no facial nerve paralysis and there was recurrence in just one case. The joint reconstruction with alloplastic or autogenous grafts for the ankylosis treatment proved to be efficient in relation to the post-operative MMO, recurrence and joint function.

Surgical outcomes of laparoscopic hysterectomy with concomitant endometriosis without bowel or bladder dissection: a cohort analysis to define a case-mix variable.

PubMed

Sandberg, Evelien M; Driessen, Sara R C; Bak, Evelien A T; van Geloven, Nan; Berger, Judith P; Smeets, Mathilde J G H; Rhemrev, Johann P T; Jansen, Frank Willem

2018-01-01

Pelvic endometriosis is often mentioned as one of the variables influencing surgical outcomes of laparoscopic hysterectomy (LH). However, its additional surgical risks have not been well established. The aim of this study was to analyze to what extent concomitant endometriosis influences surgical outcomes of LH and to determine if it should be considered as case-mix variable. A total of 2655 LH's were analyzed, of which 397 (15.0%) with concomitant endometriosis. For blood loss and operative time, no measurable association was found for stages I ( n  = 106) and II ( n  = 103) endometriosis compared to LH without endometriosis. LH with stages III ( n  = 93) and IV ( n  = 95) endometriosis were associated with more intra-operative blood loss ( p  = < .001) and a prolonged operative time ( p  = < .001) compared to LH without endometriosis. No significant association was found between endometriosis (all stages) and complications ( p  = .62). The findings of our study have provided numeric support for the influence of concomitant endometriosis on surgical outcomes of LH, without bowel or bladder dissection. Only stages III and IV were associated with a longer operative time and more blood loss and should thus be considered as case-mix variables in future quality measurement tools.

Weight of the Evidence or Wait for the Evidence? Protecting Underground Miners From Diesel Particulate Matter

PubMed Central

Monforton, Celeste

2006-01-01

A coalition of mine operators has used a variety of tactics to obstruct scientific inquiry and impede public health action designed to protect underground miners from diesel particulate matter. These workers are exposed to the highest level of diesel particulate matter compared with any other occupational group. This case study profiles a decade-long saga of the Methane Awareness Resource Group Diesel Coalition to impede epidemiological studies on diesel exhaust undertaken by the National Institute for Occupational Safety and Health and the National Cancer Institute, and to derail a health standard promulgated by the Mine Safety and Health Administration. The case study highlights the coalition’s mastery of legislative, judicial, and executive branch operations and the reaction of policymakers. PMID:16380560

Organizing Chaos: The Tactical Assault Kit Collaborative Mission Planner

DTIC Science & Technology

2018-12-01

choice. Case studies , such as the 2017 Presidential Inauguration Collective Security Event, Operation Flaming Sword 2017, and the counter-ISIS campaign...rallied around the Tactical Assault Kit (TAK) as their mission command tool of choice. Case studies , such as the 2017 Presidential Inauguration...authorities ADA Air Defense Artillery ADM Army Design Methodology ADAPT Advanced Digital Advisor Partner Technologies ATAK Android Tactical Assault Kit

Dissent by Design: Fostering Student Activism in Higher Education through a Case Study of Student Affairs in a Public University in the Philippines

ERIC Educational Resources Information Center

Bernardo, Maria Aurora Correa; Baranovich, Diana-Lea

2016-01-01

Student activism is a ubiquitous component in most democratic societies. Despite its disconcerting implications to the university's operations, it remains an important agenda to student development in higher education. This study presents the case of a university in the Philippines where student activism is a predominant ethos. The findings expose…

Korean ESL Parents' Perspectives and Maintenance of Mother Tongue: A Case Study of Two Korean Mothers

ERIC Educational Resources Information Center

Yang, Jaeseok

2017-01-01

This case study explores the language attitudes and perceptions of Korean parents, with regard to their children's native language maintenance and ESL education in the US. The primary focuses are on (1) what aspects are held by Korean parents toward the maintenance of the native language in the US, and (2) how these perspectives operate in their…

Making Sense in the City: Dolly Parton, Early Reading and Educational Policy-Making

ERIC Educational Resources Information Center

Hall, Christine; Jones, Susan

2016-01-01

In this paper, we present a case study of a philanthropic literacy initiative, Dolly Parton's Imagination Library, a book-gifting scheme for under 5s, and consider the impact of the scheme on literacy policy in the English city where it was introduced. We bring four lenses to bear on the case study. First, we analyse the operation of the scheme in…

Harvard University: Green Loan Fund. Green Revolving Funds in Action: Case Study Series

ERIC Educational Resources Information Center

Foley, Robert

2011-01-01

The Green Loan Fund at Harvard University has been an active source of capital for energy efficiency and waste reduction projects for almost a decade. This case study examines the revolving fund's history from its inception as a pilot project in the 1990s to its regeneration in the early 2000s to its current operations today. The green revolving…

Systems Engineering Case Studies, Synopsis of the Learning Principles

DTIC Science & Technology

2009-08-24

TBMCS refers to the Theater Battle Management Core System Systems Engineering Case Study Peacekeeper refers to the Peacekeeper Intercontinental...primary mirror defect going to orbit undetected in spite of substantial evidence that could have been used to prevent this occurrence. TBMCS /1...The requirements baseline was volatile up to system acceptance, which took place after TBMCS passed operational test and evaluation. Approved for